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 PRINCIPLES AND PRACTICE 
 
 OF 
 
 SPINAL ADJUSTMENT 
 
 For the Use of Students 
 and Practitioners 
 
 BY 
 
 ARTHUR L. FORSTER, M.D., DC. 
 
 WITH NINETY-XIXE ILLUSTRATIONS 
 
 CHICAGO 
 
 THE NATIONAL SCHOOL OF CHIROPRACTIC 
 
 421-427 SOUTH ASHLAND BOULEVARD 
 
 1915
 
 Copyright, 1915. 
 THE NATIONAL SCHOOL OF CHIROPRACTIC
 
 H 
 
 
 DEDICATED TO 
 
 HtUtam Olljarlffi ^rI|ulHP, MM, 
 
 IN ADMIRATION OF HIS VALUABLE WORK IN 
 
 PHYSIOLOGICAL THERAPEUTICS AND 
 
 AS A TOKEN OF MY SINCERE 
 
 REGARD AND ESTEEM
 
 PREFACE 
 
 This book has been written primarily with a view to pre- 
 senting the subject of Spinal Adjustment along strictly scien- 
 tific lines. While the theory of Spinal Adjustment has been 
 repeatedly propounded, and its value as a remedial agency 
 undeniably proved by the clinical results of those who have 
 preceded me in this field of endeavor, I think that this work 
 will constitute a step forward in placing this subject upon a 
 scientific basis, and prove for all time that it rests upon facts 
 that are irrefutable. 
 
 In common w'ith most advances in the art of healing. Spinal 
 Adjustment was first used in a purely empirical manner, its 
 own advocates being unable to explain satisfactorily the re- 
 sults produced through its use. Careful investigation, how- 
 ever, has revealed the premises and furnished the data which 
 rescue this form of treatment from the empiricism of the past 
 and put it upon a substantial basis. 
 
 The greatest obstacle to the general adoption of Spinal 
 Adjustment has been the inherited belief that vertebral sub- 
 luxations are impossible. This belief has been successfully 
 shattered by a large amount of experimental work, particularly 
 upon the cadaver. In this work I was ably assisted by Dr. 
 Erik Juhl and I hereby make grateful acknowledgement of this 
 gentleman's great help in this connection. 
 
 The first section of this work deals with the principles of 
 Chiropractic. For verification of the different physiological 
 facts enumerated in this part of the book I have referred quite 
 extensively to the American Text Book of Physiology and 
 Kirk's Physiology. 
 
 The anatomy and physiology of the nervous system, and 
 the spinal nerve influence upon the various organs, are an es- 
 sential feature in a work of this nature, and must be thor- 
 oughly understood in order to appreciate the modus operandi 
 of Spinal Adjustment.
 
 Vlll 
 
 PREFACE 
 
 The section on Vertebral Mal-alignment shows the direct 
 causes of subluxation of the vertebrae, and further shows the 
 manner in which they may be produced reflexly. The exact 
 manner of such reflex production of Spinal Lesions is of vital 
 importance to a comprehension of the fact that pre-existing 
 subluxations not only cause disease but may themselves be 
 produced by disease. 
 
 The section on Spinal Analysis presents this important sub- 
 ject in a manner which should make it of practical value to 
 students and practitioners. The classification of the various 
 forms of vertebral subluxations is, we think, logical and 
 therefore easy to remember. 
 
 In the section giving the various holds used in the adjust- 
 ment of subluxations, those which have been found after long 
 usage to be the most practical have been presented. These 
 holds have been given a new and distinctive nomenclature ; 
 they have been described briefly and concisely, and they are 
 accompanied by original illustrations, which have been pre- 
 pared with great care. While these holds are not all original 
 and have become common property, still it is only meet that 
 our indebtedness to the pathfinders in this field of. work, not- 
 ably Dr. John F. A. Howard, and others, should be expressed. 
 Lack of space forbids detailed reference in every instance, and 
 this inadequate way of acknowledging a heavy debt must 
 suffice. 
 
 The section dealing with the Practice of Spinal Adjustment 
 we consider a valuable feature both for the practitioner and 
 for use in schools. 
 
 I am under deep obligation to my friend and colleague, Dr. 
 W. C. Schulze, without whose encouragement and assistance 
 the publication of this book would not have been possible. 
 
 My thanks are also due Miss Amy Schultz for valuable 
 assistance in the preparation of the manuscript of the last 
 section of the book. 
 
 The illustrations are in the main original, and at a sacrifice 
 of artistic finesse for technical accuracy I have executed them 
 myself. For all others credit has been given. 
 
 A. L. F. 
 Chicago, May, 1915.
 
 TABLE OF CONTENTS 
 
 SECTION I 
 
 PRINCIPLES OF CHIROPRACTIC 
 
 CHAPTER PAGF. 
 
 I The Origin of Chiropractic 1-4 
 
 II The Theoretical Basis of Chiropractic 5-14 
 
 III The Anatomical Basis of Chiropractic 15-38 
 
 IV The Physiological Basis of Chiropractic 39-45 
 
 SECTION 2 
 THE SYMPATHETIC NERVOUS SYSTEM 
 
 I The Anatomy of the Sympathetic Nervous 
 
 System 47-60 
 
 II The Connection Between the Sympathetic 
 Nervous System and the Cerebro-Spinal 
 Nervous System 61-66 
 
 III The Connection Between the Sympathetic 
 
 Nervous System and the Cranial Nerves 67-74 
 
 IV The Physiology of the Nervous System 75-^5 
 
 — --V The Physiology of the Nervous System (cont.) 86-92 
 
 — VI The Physiology of the Sympathetic System... 93-1 ro 
 
 ix
 
 X TABLE OF CONTENTS 
 
 SECTION 3 
 INNERVATION 
 
 CHAPTER PAGE 
 
 I The Innervation of the Structures of the 
 
 Cranium, Face and Neck 111-134 
 
 II The Innervation of the Organs of the Thorax 135-142 
 
 III The Innervation of the Organs of the Abdomeni43-i56 
 
 I\' The Innervation of the Organs of the Pelvis. . 157-161 
 
 SECTION 4 
 VERTEBRAL ^lAL-ALIGNMENT 
 
 I The Etiolog}' of Abnormal Nerve Function. . . 163-170 
 II A^ertebral ]\Ial-Alignnient 171-178 
 
 III The External Causes of A'ertebral ]\Ial-Align- 
 
 ment 179-187 
 
 IV The Internal Causes of A'ertebral Mal-Align- 
 
 ment 188-198 
 
 \' The Local Effects of Mal-Alignment of Verte- 
 brae 199-202 
 
 VI The Eft'ect of A'ertebral Subluxations on Nerve 
 
 Function 203-212 
 
 SECTION 5 
 
 SPINAL ANALYSIS 
 
 I Segmentation and Localization 213-238 
 
 II Spinal Symptomatology 239-247
 
 TABLE OF CONTENTS xi 
 
 CHAPTER PAGE 
 
 III Spinal Diagnosis 248-255 
 
 IV Vertebral Subluxation 256-278 
 
 V Spinal Analysis 279-3 14 
 
 SECTION 6 
 SPINAL ADJUSTMENT 
 
 I General Considerations 315-321 
 
 II Adjustment of the Cervical Vertebrae 322-340 
 
 III Adjustment of the Thoracic \'ertebrae 341-364 
 
 IV Adjustment of the Lumbar A^ertebrae 365-377 
 
 V Regional Classification of Holds 378-382 
 
 SECTION 7 
 PRACTICE OF SPINAL ADJUSTMENT 
 
 I Vertebral Subluxations and Disease 383-389 
 
 II Infectious Diseases 390-412 
 
 III Diseases Caused by Animal Parasites 413-416 
 
 IV The Intoxications and Sunstroke 417-420 
 
 V Constitutional Diseases 421-428 
 
 VI Diseases of the Resjiiratory System 429-441 
 
 ATI Diseases of the Circulatory System 442-455 
 
 \TII Diseases of the Digestive System 456-4S4 
 
 IX Diseases of the Nervous System 485-511 
 
 X Diseases of the Blood and Ductless Glands. . . 512-518
 
 xii TABLE OF CONTENTS 
 
 CHAPTER PAGE 
 
 XI Diseases of the Genito-Urinary System 519-530 
 
 XII Diseases of the Eye and Ear 531-53^ 
 
 XIII Gynecological Diseases 537-550 
 
 XIV Diseases and Injuries of the Spine and De- 
 
 formities 551-564 
 
 XV Diseases of the Skin 565-573
 
 LIST OF ILLUSTRATIONS 
 
 FIG. PAGE 
 
 1 Back Showing Subluxations Found on Cadaver 20 
 
 2 Cadaver with First Layer of Muscles Revealed 22 
 
 3 Cadaver with Second Layer of Muscles Revealed 24 
 
 4 Cadaver with Third Layer of Aluscles Revealed 26 
 
 5 Cadaver with Fourth Layer of Muscles Revealed 28 
 
 6 Cadaver with Fifth Layer of Muscles Revealed 30 
 
 7 Left Half of Torso Showing Spine 32 
 
 8 The Spine Showing Narrowed Foramina 34 
 
 9 A Group of Subluxated Vertebrae 36 
 
 10 The Sympathetic Nervous System (Gray) 48 
 
 11 Parts Influenced by the First Cervical Nerve 112 
 
 12 Parts Influenced by the Second Cervical Nerve 114 
 
 13 Parts Influenced by the Third Cervical Nerve 116 
 
 14 Parts Influenced by the Fourth Cervical Nerve 118 
 
 15 Parts Influenced by the Fifth Cervical Nerve 120 
 
 16 Parts Influenced by the Sixth Cervical Nerve 122 
 
 17 Parts Influenced by the Seventh Cervical Nerve 124 
 
 18 Parts Influenced by the Eighth Cervical Nerve 126 
 
 19 Parts Influenced by the First Dorsal Nerve 128 
 
 20 Parts Influenced by the Second Dorsal Nerve 130 
 
 21 Parts Influenced by the Third Dorsal Nerve 132 
 
 xiii
 
 xiv LIST OF ILLUSTRATIONS 
 
 FIG. PAGE 
 
 22 Parts Influenced by the Fourth Dorsal Nerve 134 
 
 23 Parts Influenced by the Fifth Dorsal Nerve 136 
 
 24 Parts Influenced by the Sixth Dorsal Nerve 138 
 
 25 Parts Influenced by the Seventh Dorsal Nerve 140 
 
 26 Parts Influenced by the Eighth Dorsal Nerve 142 
 
 27 Parts Influenced by the Ninth Dorsal Nerve 144 
 
 28 Parts Influenced by the Tenth Dorsal Nerve 146 
 
 29 Parts Influenced by the Eleventh Dorsal Nerve 148 
 
 30 Parts Influenced by the Twelfth Dorsal Nerve 150 
 
 31 Parts Influenced by the First Lumbar Nerve 152 
 
 32 Parts Influenced by the Second Lumbar Nerve 154 
 
 33 Parts Influenced by the Third Lumbar Nerve 156 
 
 34 Parts Influenced by the Fourth Lumbar Nerve 158 
 
 35 Parts Influenced by the Fifth Lumbar Nerve 160 
 
 36 Phantom of the Nervous System 164 
 
 }J The Normal Spine 172 
 
 38 Anterior Aspect of Spine Showing Subluxations 174 
 
 39 Posterior Aspect of Spine Showing Subluxations 176 
 
 40 Lateral Aspect of Spine Showing Subluxations 177 
 
 41 Segmentation Chart 252 
 
 42 Kyphotic Subluxation .... 262 
 
 43 Lordotic Subluxation 264 
 
 44 Scoliotic Subluxation 265 
 
 45 Compression Subluxation 267 
 
 46 Supero-Inferior Subluxation 269 
 
 47 Lateral Subluxation 271
 
 LIST OF ILLUSTRATIONS XV 
 
 FIG. PAGE 
 
 48 Anterior Subluxation 272 
 
 49 Posterior Subluxation 274 
 
 50 Rotary Subluxation ". 275 
 
 51 Palpation of the Transverse Processes 286 
 
 52 The Adams Position 288 
 
 53 The Erect Position 290 
 
 54 Spinal Adjustment Table 292 
 
 55 Spinal Adjustment Table 294 
 
 56 Prone Position — Palpation of the Spinous Processes.. 296 
 
 57 Palpation of the Transverse Processes 298 
 
 58 Palpation of the Cervical \^ertebrae 306 
 
 59 Spinal Analysis Chart 308 
 
 60 Signs Showing A'arious Subluxations 310 
 
 61 Record of Spinal Analysis 312 
 
 62 Contact Points of the Hand 320 
 
 63 Temporo-Transverse Hold 323 
 
 64 Temporo-Transverse Hold 324 
 
 65 Fronto-Tranverse Hold 325 
 
 66 Parieto-Transverse Hold 326 
 
 67 Bilateral Pisiform-Transverse Anterior Hold 327 
 
 68 Alalar-Transverse Hold 330 
 
 69 Malar-Transverse Hold 33 1 
 
 70 Unilateral Pisiform-Transverse Hold 332 
 
 71 Temporo-Centrum Hold 333 
 
 72 Occipito-Mandibular Hold A 336 
 
 73 Occipito-Mandibular Hold B 2,-^^
 
 xvi LIST OF ILLUSTRATIONS 
 
 FIG. PAGE 
 
 74 Occipito-Mandibular Hold C . . 330 
 
 75 Temporo-Occipital Hold 339 
 
 76 Thumb-Transverse Hold 342 
 
 yy Crossed Thumb-Transverse Hold 343 
 
 78 Crossed Bilateral Pisiform-Transverse Hold 344 
 
 79 Pisiform-Spinous Hold 345 
 
 80 Unilateral Pisiform-Transverse Hold 348 
 
 81 Ulno-Spinous Hold 349 
 
 82 Calcaneo-Pisiform-Transverse Hold 350 
 
 83 Bilateral Digito-Transverse Hold 351 
 
 84 T. M. Hold 354 
 
 85 Mandibulo-Spinous Hold 355 
 
 86 Calcaneo-Spinous Hold 356 
 
 87 Sacro-Spinous Hold 357 
 
 88 Thoracic Extension Hold i 360 
 
 89 Thoracic Extension Hold 2 361 
 
 90 The Recoil Hold 362 
 
 91 Bilateral Pisiform-Transverse Hold 366 
 
 92 Ulno-Spinous Hold 367 
 
 93 Ilio-Spinous Hold 368 
 
 94 Supra-Sacral Hold 369 
 
 95 Supra-Iliac Hold 372 
 
 96 Infra-Iliac Hold 373 
 
 97 Genu-Spinous Hold 374 
 
 98 Ilio-Deltoid Hold 375 
 
 99 Genu-Deltoid Hold 376
 
 SECTION ONE 
 
 Principles of Chiropractic 
 
 CHAPTER I 
 The Origin of Chiropractic 
 
 Chiropractic (G. chcir, hand and praktikos, efficient) is 
 the art and science of treating disease by the adjustment of 
 displaced vertebrae, thereby reHeving impingement of the 
 nerves passing through the intervertebral foramina. 
 
 Nothing definite is known as to where or when chiropractic 
 was first used or who was the originator of this method of 
 treating disease. Its value as a curative measure was prob- 
 ably first ascertained when its employment was directed 
 toward the relief merely of sprains and other injuries of the 
 vertebral column. Patients who were being treated for the 
 relief of such vertebral lesions were often suffering from 
 coincident affections of various kinds. In such cases it was 
 found that, many times, diseases other than the spinal injury 
 itself also responded to the manipulation of the vertebrae. 
 Thus its value as a curative agent was first brought to the 
 notice of those using this method. 
 
 Its wide range of usefulness becoming more and more 
 recognized, its use became more and more general, until we 
 find it employed not merely by a few individuals but by the 
 people of an entire nation. Many anecdotes are told regarding 
 its efficiency among especially the inhabitants of Bohemia. 
 By some authorities this latter country is regarded as the 
 birth-place of this science. Others, however, affirm that 
 spinal manipulations for the cure of disease were used by the 
 Germans for many years before it was heard of in Bohemia. 
 Still others state that during a sojourn among the Indians 
 they were told by them that methods similar to the chiroprac- 
 tic treatments of the present day were in common use among 
 their tribes for as long as these aborigines could remember. 
 
 1
 
 2 SPINAL ADJUSTMENT 
 
 Thus we are told of a cruel application of spinal treatment 
 by the Indians. It consisted in the patient being tied to a 
 tree, and his back being then vigorously pounded. Another 
 way in which adjustment was attempted, was the following: 
 The patient would lie upon the floor while another walked 
 on his back, one foot being placed on either side of the spinous 
 processes. 
 
 Coming down to more modern times, we are all more or 
 less familiar with the fact that among athletes forcible strik- 
 ing of the back on each side of the spinous processes is often 
 resorted to for the purpose of restoring to normal the action 
 of the heart and respiration of one of their number who is 
 injured. 
 
 These are all examples of different ways in which the same 
 end was sought, namely the adjustment of subluxated verte- 
 brae. While the methods used do not resemble in the slightest 
 degree the modern chiropractic adjustment of the present 
 day, the results obtained were sufificiently encouraging to 
 perpetuate their employment. 
 
 The Bohemians were probably the first to use a definite 
 "thrust" upon such vertebrae as they found displaced. But 
 they also, although ignorant of the real reason for giving the 
 thrust, applied it because they had come to know that in so 
 many instances its use was followed by a cure of the ailment 
 from which the patient suffered. Not only did they use the 
 thrust for the relief of spinal injuries and diseases but also 
 for its general stimulating effects. 
 
 In the light of our present day methods, these means of 
 accomplishing the desired end, namely the adjustment of 
 subluxated vertebrae, were crude indeed. But it must be 
 remembered that to those who employed the methods de- 
 scribed the underlying cause was unknown. They simply 
 knew that striking the back, walking over the patient's spine, 
 et cetera, produced the desired effect. But why or how it 
 produced such an effect they did not know. 
 
 Nevertheless, these procedures, crude and unscientific 
 though they were, tended to restore the ligaments of each 
 side of the vertebral column to balanced tonicity ; they reduced 
 subluxated vertebrae and thus relieved the impingement upon 
 the nerves passing through the intervertebral foramina. In
 
 ORIGIN OF CHIROPRACTIC 3 
 
 short, the empirical use of chiropractic preceded, by many 
 years, its scientific explanation; a circumstance, by the way, 
 which holds true in the entire history of the healing art. 
 
 Thus chiropractic remained, for many years, in ignorant 
 hands. Nothing was written concerning this new method 
 of treating disease, and the regular system of healing never 
 recognized it. In fact, it was looked upon as a form of quack- 
 ery, and physicians would have nothing to do with it. As a 
 result, what was destined to become a most valuable acquisi- 
 tion to the armamentarium of those engaged in the art of 
 healing, remained unnoticed by those best fitted, in those days, 
 to place it upon a scientific basis. 
 
 There was nothing surprising in this when one stops to 
 consider with what extreme difficulties he is beset who de- 
 sires to receive recognition for some new method of therapy. 
 Many, indeed, are averse to adopting anything new no matter 
 what possibilities it holds forth. And many a well-meaning 
 physician will promptly condemn chiropractic without grant- 
 ing the method an opportunity to demonstrate any possible 
 merit it may possess. 
 
 While the above may seem like a digression from the sub- 
 ject in hand, it is deemed worthy of mention for the reason 
 that it throws a strong light on the cause of the long delay in 
 the recognition of chiropractic. But aside from all this, the 
 empirical beginnings of this method were also largely 
 instrumental in keeping it back. 
 
 Again, when first introduced into this country it was spon- 
 sored by men of little or no education. Furthermore, on seeing 
 some instances of what it accomplished, its advocates at once 
 jumped to the conclusion that spinal adjustment would "cure" 
 all diseases. It was rather natural, therefore, that such ex- 
 travagant claims should have been met by the condemnation 
 which they received at the hands of the medical profession. 
 
 Once more, osteopathy claims that chiropractic is but a 
 branch of that science. A most careful review of osteopathic 
 literature fails to disclose the slightest reference to any mode 
 of treatment resembling the chiropractic thrust. And while 
 it is true that recent books on osteopathy dwell at some length 
 on the application of the chiropractic thrust, it is nevertheless 
 a fact that osteopathy took no notice of it until chiropractors
 
 4 SPINAL ADJUSTMENT 
 
 had popularized spinal adjustment sufficiently to make its use 
 "worth while." 
 
 The art of spinal adjustment was originally introduced to 
 this country by D. D. Palmer, who died in 1912. He had 
 heard of this form of treating disease from a Bohemian, and 
 he conceived the idea of moulding the information thus ob- 
 tained into a system of healing. He classified the various 
 kinds of possible displacements of the vertebrae, and devised 
 thrusts suitable to their reduction. Palmer, however, fell 
 into one serious error. He did as so many before him have 
 done. He became overzealous. He claimed that all disease 
 is due to subluxations of the vertebrae and that all diseases 
 could be eradicated by adjustment of the vertebrae. Naturally, 
 such views could not be subscribed to by anyone with a liberal 
 training in the sciences underlying the art of healing, and espe- 
 cially, one with a knowledge of pathology. This preliminary 
 training Palmer lacked ; and it goes without saying that had he 
 possessed such knowledge, he would not have made the claims 
 which he did. He derided all other forms of therapy, and 
 persisted in his original views to the end. Nevertheless, while 
 the advancement made in chiropractic technique has been very 
 great, and broader views now obtain among the profession 
 as a whole, still to Palmer must be given the credit for fur- 
 nishing the impetus which carried chiropractic to a recognition 
 of its wonderful possibilities. 
 
 It was, however, only natural that of all his disciples there 
 should be some who could not agree with Palmer's views in 
 their entirety. And such a condition of afifairs really did arise. 
 There were some who devised what they considered more 
 accurate methods of spinal analysis to determine the existence 
 of possible subluxations. Others originated different thrusts 
 for the adjustment of the different kinds of subluxations. Still 
 others, in addition to making changes in the manner of pal- 
 pating and the form of thrusts applied, incorporated adjunct 
 methods of physiological therapy, such as attention to diet, 
 hydrotherapy, massage, et cetera. 
 
 At the present time chiropractic is practiced by several 
 thousands of graduates. By the results achieved it has dem- 
 onstrated in an unmistakable manner that of all therapeutic 
 measures cliiropractic accomplishes more than any other single 
 agent.
 
 CHAPTER II 
 
 The Theoretical Basis of Chiropractic 
 
 As stated at the commencement of the preceding chapter, 
 chiropractic is founded on the theory that vertebrae may be- 
 come subliixated, that is to say, that a slight displacement of 
 their opposing articular surfaces may occur. 
 
 As a consequence of this subluxation there is produced an 
 impingement upon the nerves which pass through the inter- 
 vertebral foramen corresponding to the vertebrae involved in 
 the displacement. This impingement is a direct result of 
 the pressure produced by the altered position of the margins 
 of the intervertebral foramen. 
 
 In order to appreciate exactly how such displacement of 
 the vertebrae could produce impingement upon the spinal 
 nerve, a study of the parts of the vertebra which enter into 
 the formation of the intervertebral foramen is necessary. A 
 portion of the circumference of the foramen is forrned by the 
 intervertebral notches which are concavities on the upper 
 and under surfaces of the pedicles. The pedicles are two short, 
 thick processes of bone, which project backward, one on each 
 side, from the upper part of the body of the vertebra, at the 
 line of union of its posterior and lateral surfaces. The inter- 
 vertebral notches are four in number, two on each side, the 
 inferior ones being generally the deeper. When the vertebrae 
 are articulated the notches of each contiguous pair of bones 
 form the upper and lower border of the intervertebral fora- 
 men. The articular processes of the vertebrae are nearly 
 vertical, and project from the upper and lower surfaces of the 
 pedicles. A part of the margin of the articular process thus 
 forms a portion of the margin, namely the posterior portion 
 of the intervertebral foramen. The anterior part of the wall 
 of the intervertebral foramen is formed by the body of the 
 vertebra and the intervertebral disc. 
 
 From the above description it is seen that the intervertebral 
 foramen is bounded above and below by the pedicles, posteri- 
 
 5
 
 6 SPINAL ADJUSTMENT 
 
 orly by the articular process, and anteriorly by the body and 
 intervertebral disc. 
 
 Since the anterior surface of the articular process consti- 
 tutes the posterior wall of the intervertebral foramen, it can 
 be easily understood how the slightest forward displacement 
 of a vertebra would cause the articular process to encroach 
 on the anbero-posterior diameter of the intervertebral foramen, 
 and press upon the spinal nerve at that point. 
 
 In like manner, since the pedicles form the upper and lower 
 walls of the intervertebral foramen, it is at once apparent how 
 an upward or a downward displacement of a vertebra would 
 cause the pedicles to encroach on the vertical diameter of the 
 foramen. In such a case the spinal nerve is pressed upon by 
 the pedicles, either the lower or upper one, as the displacement 
 is either upward or downward. 
 
 Lastly, since the body of the vertebra forms the anterior 
 wall of the intervertebral foramen, it is clear that a backward 
 displacement of a vertebra would result in the posterior sur- 
 face of the body encroaching on the antero-posterior diameter 
 of the foramen, and press upon the spinal nerve. 
 
 It is a well known fact that nature permits of no spaces 
 in the body left unoccupied. Consequently, the intervertebral 
 foramen must not be looked upon as a circular opening with a 
 nerve passing through its center. On the contrary it is en- 
 tirely occupied by the structures which pass through it. 
 Nature wastes no space, and no cavity or foramen in the entire 
 body is larger than is required for the holding of the struc- 
 tures which it contains or transmits. Thus the intervertebral 
 foramen is only of sufficient size to contain the vessels and 
 nerves which it transmits, and a decrease in the size of the 
 foramen results in a diminution of the space required by the 
 nerves for the exercise of their normal function. 
 
 That part of the vertebra which is displaced and encroaches 
 upon the diameter of the foramen presses upon the spinal 
 nerve. It must be borne in mind that the margins of the inter- 
 vertebral foramen are not sharp, but smooth and rounded. 
 Consequently the pressure upon the nerve of the displaced 
 portion of the circumference of the foramen does not sever 
 the continuity of the nerve, but results in an impairment" of 
 its power of conductivity.
 
 THEORETICAL BASIS OF CHIROPRACTIC 7 
 
 Therefore, chiropractic maintains that when, as a result 
 of a displacement of a vertebra, the nerve is impinged, as 
 above described, it is prevented from conveying impulses to 
 those parts which it controls. This opinion is based upon 
 the physiological fact that mechanical applications to a nerve 
 first increase and later lessen and destroy its irritability. Irri- 
 tability is that property of living protoplasm which causes it 
 to undergo characteristic physical and chemical changes when 
 it is subjected to certain influences, called irritants. The 
 term irritants, in speaking of nerves, includes anything which 
 causes the nerve-cell to send an impulse along its branches. 
 Consequently when chiropractic states that pressure upon a 
 nerve interferes with its power to transmit impulses it does 
 so in full accord with the further physiological fact that pres- 
 sure gradually applied to a nerve first increases and later re- 
 duces its power to respond to irritants. If the power of a 
 nerve to respond to irritants is lost, it assuredly is unable to 
 carry impulses, for upon its irritability depends its power 
 to generate impulses or convey them. 
 
 Assuming, then, for the moment, that subluxations really 
 may occur, and that as a result of these subluxations of the 
 vertebrae an impingement upon the spinal nerve is produced, 
 chiropractic maintains that disease results in that particular 
 part or organ controlled by the spinal segment involved in the 
 displacement. 
 
 This must follow because the normal function and the 
 organic integrity of every organ and part of the body is de- 
 pendent upon proper innerv^ation without which health cannot 
 be preserved. The medium through which this state of per- 
 fect equilibrium of the various parts of the body is maintained 
 is the sympathetic nervous system. This portion of the nerv- 
 ous system is the mechanism which governs every unconscious 
 act of the body. It regulates the proper circulation of the 
 blood, secretion, excretion, and metabolism. This is accom- 
 plished by a constant stream of out-going impulses, the ex- 
 istence of which is proven by the fact that under normal 
 conditions both the voluntary and involuntary muscles are in 
 a state of slight contraction or tonus at all times. 
 
 The human organism is regarded generally as a machine 
 made up of various parts. When these parts are functioning
 
 8 SPINAL ADJUSTMENT 
 
 as a harmonious whole, health exists. When, on the contrary 
 a lack of balance is present, there is a perversion of function, 
 and what we know as disease develops. 
 
 We have said that the regulation of all these various func- 
 tions of the body economy depends upon a perfect and un- 
 interrupted flow of impulses along the course of the nerves. 
 Any interference with the free a nd continuous transm ission 
 \,-j ofThese^inpTilsesTa^Tytiring, liTotherwords, which diminishes 
 Vv the pow^r-€rf-cOn duct ivity of the nerves, must be regarded as 
 -^ the true cause of disease. The only place where such inter- 
 lerBllce can logically ^ccur is at the intervertebral foramina, 
 for in no other place along their entire course are the nerves 
 placed in a position where there exists the possibility of 
 pressure upon them of displaced bony structures. 
 
 An isolated organ or viscus will not functionate even 
 though all the functional elements are present and its integrity 
 has not been interfered with in the slightest degree. Of itself 
 it has no power to act, and when separated from the body it 
 becomes an inanimate mass of specialized cells which from 
 that moment forth not only lose their ability to exercise their 
 normal function but their very existence itself, and disintegra- 
 tion rapidly follows. The functional ability of an organ 
 depends upon the vital force inherent in the living organism as 
 a whole, which acts through the medium of the brain. Here the 
 impulses are generated which govern the activity of the body 
 economy, and these impulses are conveyed along the course 
 of the nerves to every cell. Without these impulses the cell 
 would cease to act and cease to be. '=^-\ 
 
 In view of these facts the facto rs commonly considered as 
 the cause of disease are not the real cause, but merely sec- 
 ondaryTacToTS acting^ opel^atmg by^virtue of the presence 
 in the body of conditions which make their activity possible. 
 These conditions are produced primarily by a want of resist- 
 ance to the invasion of the secondary factors, as a result of 
 deficient innervation of the part involved. Thus, for example, 
 in pneumonia which is ordinarily considered as being caused 
 by the pneumococcus of Fraenkel, the pneumococcus is not 
 the primary or direct cause of the disease; were this true 
 nearly every individual would "catch" this disease, since we 
 are constantly brought into contact with this organism. There
 
 THEORETICAL BASIS OF CHIROPRACTIC 9 
 
 must, therefore, be something which prevents certain individ- 
 uals from becoming affected with pneumonia, and which 
 makes it possible for others to contract the disease. This 
 something is the resistance of the former and the want of such 
 resistance in the latter. It may be questioned why do some 
 recover from the disease, while others succumb to it. Once 
 again the answer is simply that in the case of the patient who 
 recovers a sufficient amount of resistance was possessed to 
 overcome the deleterious influences of the micro-organism and 
 its toxins. In the case of the patient who succumbed to the 
 disease this resistance was not present; in other words his 
 bodily state as a whole was such as to make it possible for the 
 secondary factors to obtain a foothold and make their de- 
 structive influences possible. 
 
 ■Xi ack of resistanc e, then, is the primary factor ijijthe pro- 
 (j uction of disease, smce in the face of a perfect resistance the 
 action of the secondary factors become impossible. Resistance 
 thus becomes but another term for perfect metabolism, per- 
 fect functioning of the organs of the body; and a perfectly 
 harmonious whole. This perfect state of the body economy 
 we have seen depends upon a free and uninterrupted flow of 
 nerve impulses. Anything, therefore, which interferes with 
 the conductivity of the nerves must be considered as being the 
 primary cause of disease. The place at which this interference 
 occurs is at the point where the spinal nerve, and the sym- 
 pathetic fibers in the substance of the spinal nerve, pass 
 throug^h the intervertebral foramen. 
 
 In order to appreciate the exact manner in which the sym- 
 pathetic system is influenced by a subluxated vertebra brief 
 consideration of the connection between the cerebro-spinal 
 and sympathetic nervous systems must be included in this 
 chapter. 
 
 The spinal nerve, formed by the union of the anterior and 
 posterior roots which originate in the anterior and posterior 
 horns of the spinal cord respectively, passes through the 
 intervertebral foramen. After its complete emergence from 
 the foramen it bifurcates into the anterior and posterior pri- 
 mary divisions. The anterior root of the spinal nerve is 
 efferent or motor; the posterior is afferent or sensory. Situ- 
 ated on the posterior root is a ganglion called the spinal
 
 10 SPINAL ADJUSTMENT 
 
 ganglion. That portion of the sympathetic system with which 
 we are now engaged consists of (1) a series of ganglia, joined 
 to each other by intervening cords, extending from the base 
 of the skull to the coccyx, one on each side of the middle line 
 of the body, partly in front and partly on each side of the 
 vertebral column ; (2) of numerous nerve-fibres, which are 
 of two kinds : namely, communicating, by means of which 
 the ganglia communicate with each other and the cerebro- 
 spinal nerves, and distributory, which supply the internal 
 viscera and the coats of the blood-vessels. The sympathetic 
 fibres are also both efferent and afferent. The efferent or 
 white branches of communication between the ganglia and 
 the cerebro-spinal nerves arise in the spinal cord; they pass 
 out in the anterior root, and then into the spinal nerve. Here 
 they join the afferent fibres which originate in the spinal 
 ganglion. These united fibres then pass on into the anterior 
 primary division of the spinal nerve. They leave this, and, 
 now being known as the white rami communicantes, they pass 
 to the ganglion of the sympathetic cord of the corresponding 
 situation. The afferent branches of communication between 
 the sympathetic and cerebro-spinal nerves pass from the gang- 
 lion of the sympathetic cord to the spinal nerve and are called 
 the gray rami communicantes. They may extend separately 
 from the white rami, or both kinds of fibres may be contained 
 in a single bundle. The gray rami pass through the anterior 
 primary division of the spinal nerve to the spinal nerve and 
 then accompany it throughout all its divisions. The branches 
 between the ganglia themselves consist of gray and white 
 nerve-fibres, the latter being a continuation of the efferent 
 fibres which pass from the spinal nerves to the ganglia. 
 
 Situated in front of the spine, in the thoracic, abdominal 
 and pelvic regions, are three great gangliated plexuses. They 
 are called the cardiac, solar and hypogastric plexuses, re- 
 spectively. They are made up of nerves and ganglia ; the 
 nerves are derived from the gangliated cords and from the 
 cerebro-spinal nerves. These great gangliated plexuses send 
 branches to the viscera. 
 
 Smaller ganglia are found amidst the nerves in certain 
 viscera, and form additional centres for the origin of 
 nerve-fibres.
 
 THEORETICAL BASIS OF CHIROPRACTIC 11 
 
 The branches of distribution from the gangliated cords, from 
 the great gangHated plexuses, and from the smaller ganglia, 
 supply impulses to the involuntary muscular coats of the blood- 
 vessels, all hollow viscera, and the secreting cells of all glands. 
 
 Thus we see that the two systems are interlocked in the 
 most intimate manner. Branches pass from the spinal nerve 
 to the ganglion, and from the ganglion to the spinal nerve, re- 
 sulting in a double interchange between them. In this way 
 they really constitute one composite system, and impulses 
 from the brain which are arrested at the intervertebral fora- 
 men by a subluxation of a vertebra must of necessity cause 
 disturbances in the parts of the body governed by that segment 
 which is involved in the subluxation. 
 
 The foregoing applies exclusively to the thoracic, abdom- 
 inal and pelvic viscera. How the structures of the head and 
 face are influenced must also be briefly shown. 
 
 Each gangliated cord enters the cranium through the 
 carotid canal by an ascending branch. The two cords are 
 united within the cranium by these ascending branches unit- 
 ing in a small ganglion, called the ganglion of Ribes. The 
 ganglia of the gangliated cords are classed as cervical, dorsal, 
 lumbar, and sacral. We concern ourselves in this connection 
 with only the cervical portion which has three pairs of ganglia. 
 These three pairs of ganglia are classified from their position 
 as the superior, middle, and inferior. 
 
 The superior cervical ganglion which is the largest of the 
 three is situated opposite the second and third cervical verte- 
 brae. It is commonly supposed that it is formed by a coal- 
 escence of the four ganglia corresponding to the four upper 
 cervical vertebrae. It has five branches, namely, superior, 
 inferior, anterior, internal, and external. These branches form 
 plexuses which send filaments to all the cranial nerves. There 
 is thus formed a connection between the cranial nerves and the 
 sympathetic system as intimate as that which we have seen 
 exists between the spinal nerves and the sympathetic system. 
 By reason of this intimate relationship it is possible to directly 
 influence the cranial nerves by adjustment of the cervical 
 vertebrae. And it is a clinical fact that in nearly all affections 
 involving the structures of the head and face, such as the ear, 
 eye, nose, and throat, subluxations exist, and that, moreover
 
 12 SPINAL ADJUSTMENT 
 
 adjustment of subluxated vertebrae is followed by a cure or 
 improvement in the particular disease thus produced. 
 
 The question which now naturally arises, is, does the 
 vertebral subluxation cause enough actual pressure to be 
 brought to bear upon the spinal nerve to inhibit its power 
 of transmitting impulses This question will be answered in 
 detail in a future chapter. One fact will, however, be men- 
 tioned at this time to demonstrate that it is possible for suffi- 
 cient pressure to occur to impede the flow of impulses along 
 the nerve impinged. The intervertebral foramen of the adult 
 human spine is from 1/6 to 1/4 inch in diameter. The spinal 
 nerve measures 1/12 inch in diameter at its narrowest point, 
 and 1/6 inch at its widest point. It is placed in such a posi- 
 tion that it does not come into actual contact with the bony 
 boundary of the foramen -at any point. But it can be demon- 
 strated mathematically that its farthest distance from the wall 
 of the foramen is only 1/8 of an inch, while only 1/32 of an 
 inch intervenes between it and the wall of the foramen at 
 the point where it lies nearest the bone. Now, when we con- 
 sider that in addition to the spinal nerve, the intervertebral 
 foramen also contains blood-vessels, fat cells, and fibrous 
 tissue, it at once becomes apparent that it requires only a very 
 slight movement of the vertebra in any direction to result in 
 sufficient pressure upon the spinal nerve to seriously impair 
 its power of conductivity. 
 
 It has been stated by some that empty spaces exist in the 
 intervertebral foramen. This is, however, incorrect both from 
 an anatomical and a physical point of view. The spaces seen 
 in the foramen when viewed through the microscope do not 
 exist during life as they appear in the section of the foramen 
 prepared for microscopical examination. 
 
 In the first place, as previously stated in this chapter. 
 Nature tolerates no vacant spaces in the body. What, then, 
 do the vacant spaces seen under the microscope contain when 
 the foramen is in situ? Partly distended blood-vessels which, 
 after excision become empty; the remaining portion is occu- 
 pied by lymph. That the nerve is surrounded by these soft 
 structures affords it no protection, for it must be borne in 
 mind that the pressure which occurs in a subluxation is that 
 of hard bone on soft tissues.
 
 THEORETICAL BASIS OF CHIROPRACTIC 13 
 
 Another question that frequently arises is that referring to 
 the absence of pain at the point of the subluxation. It must 
 not be supposed that simply because no pain is present at 
 any point along the spine that no abnormality exists along 
 the course of the spine. To do this would be exactly the 
 same as to maintain that because no pain exists at the hip- 
 joint no lesion exists there. It is a well known fact that 
 pain is very often referred to a point along the course of a 
 nerve at some distance from the seat of the lesion which pro- 
 duces the pain. Thus in many cases of hip-joint disease pain 
 is referred to the knee; and how very often is this fact not 
 overlooked? In like manner, the pain which is really pro- 
 duced at the place where the nerve is impinged is interpreted 
 by the patient at the terminals of the nerve which is impinged, 
 and not at the seat of its production, namely, the intervertebral 
 foramen. 
 
 That subluxations in certain segments of the spine produce 
 certain diseases is attested to by the fact that upon an accurate 
 determination of a subluxation in a certain section of the 
 vertebral column an exact knowledge is gained as to what 
 particular system or organ of the body is diseased. Naturally 
 the exact nature of the disease cannot be determined in this 
 way. Thus, for example, when the liver is afifected — it may 
 be accurately determined that there is an abnormal condition 
 of that organ, but whether this abnormality is cancer or con- 
 gestion of the liver requires a direct examination of the organ 
 itself. 
 
 In conclusion, chiropractic maintains that by a careful and 
 painstaking examination of the vertebral column as a whole, 
 and by a palpation of the vertebrae individually, the exact 
 nature of a subluxation can be determined. Possibly the 
 most convincing evidences that displacements really exist are 
 these: upon adjustment of a subluxated vertebra it is noted 
 that the same condition which was felt before the vertebra 
 was adjusted, is no longer present. To illustrate: a vertebra 
 is found to be displaced laterally ; the proper chiropractic 
 thrust is applied for the reduction of this lateral displacement ; 
 the vertebra is then palpated again, and is found to be in 
 perfect alignment. 
 
 Another evidence that subluxations exist and produce the
 
 14 SPINAL ADJUSTMENT 
 
 effects ascribed to them is the clinical fact that, conditions 
 which existed before an adjustment of the vertebrae, disappear 
 and a return to normal results. 
 
 The nature of the subluxation being determined, the proper 
 thrust is applied, using the spinous or transverse processes 
 as levers. This thrust, by virtue of its spontaneity, replaces 
 the vertebra in its proper position. Thus the size and form 
 of the intervertebral foramen is again made normal. Tlie 
 mechanical pressure at the foramen is removed and a free and 
 uninterrupted flow of impulses along the nerve is made 
 possible. 
 
 William Jay Dana, B. S., says : "A spine can stand a ten- 
 sion of 750 pounds. Such being true, it can easily be shown 
 mathematically that it would only take a blow with a velocity 
 of five feet a second, given by a man who could put ten 
 pounds of his weight behind his adjustment, in order to move 
 a vertebra one-sixteenth of an inch. This kind of a blow is 
 obviously within the capacity of any average man." 
 
 From all the foregoing it is evident that chiropractic does 
 not deal with the effects of a disease process. It does not 
 guess, surmise, or theorize. It recognizes the true and pri- 
 mary cause of many diseases and relieves that cause. It is 
 founded on anatomical and physiological facts. Its action 
 is specific, scientific, and unfailing.
 
 CHAPTER III 
 
 The Anatomical Basis of Chiropractic 
 
 Probably the chief reason why so many have thus far 
 decHned to accept vertebral subluxations as a possible factor 
 in the production of disease is because of the opinions of the 
 anatomists of a centuryago, and of many who have followed 
 in their wake. These anatomists have continually taught 
 that while a certain amount of motion between individual 
 vertebrae is possible, a displacement of a vertebra is impossible. 
 
 There are three chief reasons for this opinion having been 
 formed and adhered to: (1) The main reason why displace- 
 ments of the vertebrae have thus far been considered as being 
 impossible is the fact that they are surrounded and held in 
 position by numerous ligaments, the natural tendency of 
 which is to bind the individual vertebrae so firmly in place 
 that any movement beyond that necessary for normal move- 
 ments of the spine should be impossible without fracture. 
 (2) It has been considered impossible for vertebral subluxa- 
 tions to exist on account of the configuration of the surfaces 
 of the articular processes in relation to each other. (3) Fail- 
 ure to discriminate between a subluxation and a dislocation 
 has been an important factor in the want of recognition of 
 the possibility of subluxation of the vertebrae. 
 
 We will now consider each of these points, and show 
 wherein they fail to disprove the possibility of subluxation 
 of the vertebrae. 
 
 Some works on anatomy make the statement that if a team 
 of oxen were placed at one end of a spinal column, and an- 
 other team at the other end, both pulling in the opposite direc- 
 tion, separation of the vertebrae would not occur. This may 
 be perfectly true but it would not prove that displacement 
 of the vertebrae could not be produced by forces applied in 
 other directions than tension. The spine "can withstand tre- 
 mendous stresses perfectly." Considering the spine in tension, 
 we know that a child can be lifted by the head and suffer no 
 
 15
 
 16 SPINAL ADJUSTMENT 
 
 injury; the spines of aerial acrobats are constantly in tension 
 and they have perfect co-ordinative control, are constantly 
 swinging by the hands, feet, knees, or teeth, and supporting 
 one or two of their fellows. Stretching machines have shown 
 that 750 pounds can be maintained with benefit (Dana). 
 But tension, and compression, which is the opposite to ten- 
 sion, are two very different things. Tension tends to increase 
 the calibre of the intervertebral foramina, in fact actually does 
 so, for it can be demonstrated that following tension of the 
 spine it is longer than before. Compression, on the contrary, 
 diminishes the calibre of the intervertebral foramina by lessen- 
 ing the length of the spine as a whole. Whether the vertebrae 
 can be moved apart or not makes very little difference, there- 
 fore, from a clinical standpoint. And, further, as will be 
 shown later on, experiments on the dead spine are no criterion 
 by which to draw conclusions regarding the living spine. 
 The conclusion drawn from the fact that tension of the spine 
 does not produce displacement of the vertebrae are erroneous, 
 for the reason that simply because a vertebra cannot be dis- 
 placed by that means, it does not follow that displacements 
 may not occur in other directions, or be produced by other 
 means. 
 
 The great strength of the ligaments surrounding the verte- 
 brae is adduced as a reason for the impossibility of subluxa- 
 tions taking place. Superficially considered, this view seems 
 plausible, for we know that the vertebrae really are surrounded 
 by many powerful ligaments, which, all conditions being equal, 
 should prevent any displacement of the vertebrae. But just 
 here this theory disproves itself, for conditions are not always 
 equal. Were the ligaments unyielding, inanimate bands, 
 never changing, and always of the same degree of contraction 
 on each side of the vertebral column, any displacement of the 
 vertebrae sufficient to produce serious consequences would be 
 impossible. But these ligaments are vital structures, con- 
 stantly changing, now contracted and again relaxed. At times 
 the ligaments on one side are more contracted than those of 
 the opposite side, as a result of external or reflex irritation. 
 As examples of the production of contraction of muscles by 
 irritation the following may be cited : Cold air striking the 
 surface of the body causes the tiny muscles surrounding the
 
 ANATOMICAL BASIS OF CHIROPRAC TIC 17 
 
 pores of the skin to contract. Striking the biceps muscle a 
 quick blow and noting the local contraction at the exact spot 
 struck also illustrates the production of muscular contraction 
 by irritation. These are both examples of external irritation. 
 As an example of reflex irritation acting to produce muscular 
 contraction, the spasmodic contraction of the musculature of 
 the intestine produced by the presence of gas may be noted. 
 
 These same principles may be applied to the muscles and 
 ligaments of the spine, and will be fully discussed in the 
 section dealing with vertebral malalignment. 
 
 It was stated above that the ligaments of one side of the 
 spine may at times be more contracted than those of the 
 other side. This would naturally tend to draw the vertebra 
 with which these ligaments are connected toward the side on 
 which the contracted condition of the ligaments exists. Were 
 the ligaments of each side equally contracted, there would be 
 a perfectly balanced condition and displacements of the verte- 
 brae would be impossible. It is because of this lack of bal- 
 ance that subluxations may be produced, and it is this 
 contingency which anatomists have failed to take into 
 consideration. 
 
 The musculature of each segment of the spinal column is 
 supplied by outgoing nerve-fibres in the posterior division of 
 the corresponding spinal nerve. In a reflex act the outgoing 
 impulse passes to this branch of the spinal nerve. \\'hen the 
 stimulus at the periphery which excites the reflex act is applied 
 on one side of the median plane, the responses first appear in 
 the muscles of the same side ; and if the stimulus is slight, 
 they may appear on that side only. The incoming impulses 
 are therefore first and most eft'ectively distributed to the 
 efferent cells located on the same side of the cord as that 
 on which these impulses enter. In the peripheral system the 
 nerve-impulse, when once started within a fibre or axone, is 
 confined to that track and does not diffuse to other fibres 
 running parallel with it, but if does extend to all the branches 
 of that axone, zvhate^t'er their distribution. As a result of 
 this physiological fact, the first response to the outgoing im- 
 pulse of a reflex act will be a contraction of the muscles and 
 ligaments of the spine on the side at wdiich the ingoing im- 
 pulse entered the cord, since these muscles and ligaments
 
 18 SPINAL ADJUSTMENT 
 
 are supplied by the efferent fibres in the posterior division of 
 the spinal nerve, which is the first branch given off from the 
 spinal nerve. 
 
 Physiologically, a muscle that is repeatedly stimulated by 
 nerve-impulses finally reaches a state of tetanic contraction, 
 that is to say, if the impulses are continuous, the muscle 
 finally remains in a permanently contracted condition. We 
 know that the act of defecation is reflexly produced as a re- 
 sult of efferent nerve-impulses to the muscles of the bowel. 
 These efferent impulses are first excited in the cord in re- 
 sponse to afferent impulses from the bowel, produced by 
 stimulation of the nerve-endings in its walls by the presence 
 of feces. Since the efferent impulses extend to all the branches 
 of the efferent nerve, each such outgoing impulse also pro- 
 duces a slight contraction of the muscle in that segment of 
 the spine, and on the same side on which the ingoing impulses 
 entered. 
 
 If instead of the mild normal afferent impulses there should 
 be continuous strong impulses, as a result, for example, of an 
 inflammatory condition of the intestine, there will be a con- 
 tinuous flow of efferent impulses and the mild contractions 
 of the muscles and ligaments of the spine will be replaced by 
 continuous contractions. 
 
 In like manner there are numerous ways in which different 
 spinal segments are affected, depending on the origin of the 
 afferent impulses. We thus see that reflex action is constantly 
 going on, and that, therefore, the musculature of different 
 spinal segments is seldom if ever in a state of balanced con- 
 traction on each side. If this contraction on the one side is 
 continuous, the corresponding vertebra must inevitably be 
 drawn toward that side. We find, therefore, that although 
 the ligaments of the spine are strong enough to hold the verte- 
 brae in proper position, if the potential strength of one side be 
 increased by contraction of the ligaments the vertebra will be 
 drawn to that side. 
 
 As to the second of the reasons adduced for the impossi- 
 bility of subluxation of the vertebrae, namely, the configura- 
 tion of the articular processes, this opinion is based on com- 
 parison with animals and a study of the surfaces of the 
 articular processes in the human spine.
 
 ANATOMICAL BASIS OF CHIROPRACTIC 19 
 
 Studied from a purely mechanical viewpoint, the error 
 in these conclusions becomes at once apparent. First of all, 
 not only are the articular processes of quadrupeds constructed 
 differently from those in man, they are also placed in a differ- 
 ent plane ; that is to say, they are placed in a horizontal 
 position in animals, while in man they are in a vertical 
 position. 
 
 Let us take for example the dorsal vertebrae. By study- 
 ing a group of these vertebrae, it may be seen at a glance how 
 comparatively impossible it would be for a subluxation to 
 occur there while the body is in the horizontal position, and 
 how easily possible it is for the subluxation to occur with the 
 body in the vertical position. 
 
 The human spine has been compared with that of a cat 
 to show that subluxations are impossible owing to the shape 
 and placement of the articular processes. The human spine 
 and that of the cat are, however, very different. In the cat, 
 the articulations between the vertebrae permit of the greatest 
 flexibility, there is great freedom of movement, not alone of 
 the spine as a whole, but also of the individual vertebrae with 
 each other. In man, on the contrary, while the spine as a 
 whole is comparatively flexible, movement between any two 
 vertebrae is very much restricted. As a result of this differ- 
 ence in the mobility of one vertebra upon the other, it is evi- 
 dent that, when a slight displacement of one vertebra upon 
 another is brought about in a cat, it is at once rectified, while 
 in man it tends to persist. 
 
 Many diseases and conditions peculiar to the human be- 
 ing have been proven beyond doubt to be dependent upon 
 the vertical position assumed during his waking hours. These 
 conditions are analogous to those which occur, for the same 
 reason, in the spine. Thus we may consider, for example, 
 hemorrhoids ; it is well known that the hemorrhoidal veins 
 in the lower rectum have no valves, as have the veins of the 
 extremities ; it was simply because these veins were originally 
 designed by nature with a horizontal position in view. Natu- 
 rally, in this position the return flow of the blood to the heart 
 would readily occur, which is not true of the veins in the 
 vertical position, and consequently no valves would be re- 
 quired there. Owing to the fact, however, that during so
 
 20 
 
 SPINAL ADJUSTMENT 
 
 Fig. 1.
 
 ANATOMICAL BASIS OF CHIROPRACTIC 21 
 
 many of our waking hours we are in a vertical position, the 
 blood tends to gravitate toward the most dependent portions, 
 with the result that the hemorrhoidal veins become pouched 
 and dilated, which condition is known as hemorrhoids. 
 
 Another illustration of the anatomical basis of abnormal 
 conditions which is a counterpart of the anatomical basis of 
 the production of vertebral subluxations are uterine disorders, 
 especially malpositions. A study of the arrangement and 
 points of attachment of the uterine ligaments, which exist for 
 the purpose of holding the uterus in position, shows that these 
 ligaments subserve their purpose best when the body is in 
 the horizontal position. In proof of this fact, note how quickly 
 retroversion of the uterus is rectified by having the patient 
 assume the knee-chest position for a half-hour each day. It 
 is because the uterine ligaments hold the uterus in the vertical 
 position for which they are not designed that anteflexion is so 
 common in girls. It is also on account of the likelihood of 
 weakening of the ligaments during pregnancy that retrover- 
 sion follows childbirth. Lastly it is for this reason that opera- 
 tions upon the uterine ligaments for the correction of uterine 
 displacements are so uniformly unsuccessful. 
 
 If the above hypothesis, namely that the vertical posi- 
 tion is responsible, on account of the anatomical construction 
 of those parts, for the production of hemorrhoids and uterine 
 malpositions is true, it can be with equal reason applied to 
 the vertebral column, since a study of its construction from 
 a mechanical viewpoint shows clearly that it is originally de- 
 signed for a horizontal position and not for the vertical. 
 Consequently, when the vertebral column is placed in the ver- 
 tical position — when a "beam" becomes a "column" — slight 
 separation of its component parts is likely to occur. 
 
 It may be questioned by some : If the spine is constructed 
 for the horizontal position, what is the need of the interverte- 
 bral cartilaginous discs, which are considered to exist for the 
 purpose of preventing jars to the vertebral column? Further- 
 more if they were formed since the spine has assumed an up- 
 right position, why have not the articular processes also had 
 time to change to meet the changed requirements put upon 
 them? This can be answered very readily, by calling atten- 
 tion to the fact that the discs are far from being merely for the
 
 22 
 
 SPINAL ADJUSTMENT 
 
 Fig. 2.
 
 ANATOMICAL BASIS OF CHIROPRACTIC 23 
 
 purpose of preventing jarring of the spinal column. Their 
 important function is this : Were there no cartilage interposed 
 between the bodies of the vertebrae, the slight movement be- 
 tween the bare bone would soon cause the bones to wear 
 away. It has its counterpart in all joints (and the vertebral 
 articulations are joints) which are lined with cartilage. 
 
 In this connection, let us quote a few extracts from an 
 article on this subject by an engineer, William Jay Dana, B. S. 
 "The spine is used as a column, while it is designed to serve 
 as a beam. As a column it is far from ideally efficient, is 
 made up of twenty-four vertebrae held together by ligaments, 
 muscles, etc., and separated by cartilaginous pads, which are 
 easily compressed. When a spinal column is suspended hori- 
 zontally all the vertebrae lock with one another, the zygapo- 
 physes being in perfect articulation. When held vertically the 
 vertebrae tend to collapse and to form imperfect articulations, 
 as there are no osseous checks — nor ligaments strong enough 
 to keep the spine in perfect alignment when vertical ; moreover 
 the loading on the column is eccentric, the center of gravity 
 of head and thorax is outside the center line of the column ; 
 this means the vertical column always has a load on it tending 
 to pull it downward ; to overcome this there are powerful 
 muscles along the back. The result is the column becomes 
 curved at two points to compensate for the eccentric load it 
 has to support. These curves due to deflection are parabolic. 
 Loads carried upon the head produce peculiar types of back, 
 resulting in curvatures, cretinism, thyroidism, and similar dis- 
 eases which previously had not a satisfactory etiology. The 
 cervicals, being the weakest, give way first ; hence we see the 
 thyroid type in European mountainous districts, where drink- 
 ing water has been erroneously accused of causing cretinism, 
 etc. The lower cervical vertebrae become subluxated, so that 
 adjustments here relieve thyroid troubles. Any muscular con- 
 tractions approximate the vertebrae or pull them out of line 
 if daily persisted in ; hence, occupational diseases. Every mo- 
 tion causes a pose or attitude ; a persistence of attitude causes 
 a subluxation or a tendency thereto. 
 
 "Besides tension and compression there are two other 
 forces acting through the spine, namely shearing (slipping) 
 and torsion (turning). The whole argument rests upon
 
 24 
 
 SPINAL ADJUSTMENT 
 
 Fig. 3.
 
 ANATO.MICAL BASIS OF CHIROPRACTIC 25 
 
 whether the vertebrae can slip or sHde in respect to one an- 
 other. We know that in turning the head and trunk with 
 respect to the hips, that the vertebrae twist slightly in respect 
 to their fellows. Question : Can a condition occur in which 
 twisting is so great as to cause pressure on the spinal nerves 
 which pass through the lateral openings? Dissection of spinal 
 vertebrae shows such pressure does take place with conse- 
 quent atrophy or degeneration." 
 
 The next question that naturally arises is : Assuming that 
 vertebral subluxations may occur, does enough displacement 
 occur to produce pressure upon the structures passing through 
 the intervertebral foramina ? This question has been answered 
 at length in the preceding chapter, and leaves little to be said. 
 It must be remembered that it requires very little pressure 
 upon a nerve to destroy its power of conductivity, and that is 
 all that is required to disturb the function of the parts which 
 that ner^e supplies. 
 
 That nature recognizes the tremendous importance of 
 maintaining the normal calibre of the intervertebral foramina 
 she demonstrates in numerous ways. For example, examina- 
 tion of spines in osteological collections of the National School 
 of Chiropractic shows how the exostoses, where present, are 
 so arranged that they protect the intervertebral foramen from 
 becoming completely occluded, as the vertebrae collapse. 
 Again, in old age, when settling of the spine occurs, and there 
 comes the danger of complete closure of the intervertebral 
 foramina, nature recognizes this danger, and the spine be- 
 comes bent forward, and the back parts of the vertebrae are 
 thrown apart to prevent this contingency. 
 
 Comparison of the eftect of pressure of the margins of the 
 intervertebral foramen upon a nerve has been made to the 
 shutting ofif of -the flow of water through a hose, to the stop- 
 ping of the current of electricity in a wire, and to many other 
 similar examples. Such examples are misleading, and prove 
 nothing because the exact nature of the conduction process is 
 not understood and bears no similarity to the examples noted. 
 All that is positively known is that pressure upon a nerve will 
 prevent conduction of impulses by it, and that sufificient pres- 
 sure to produce this effect may be exercised by the margins of 
 the intervertebral foramina when a vertebra is subluxated.
 
 26 
 
 SPINAL ADJUSTMENT 
 
 Fig. 4,
 
 ANATOMICAL BASIS OF CHIROPRACTIC 27 
 
 It is a strange fact that medical students are required to 
 make a minute dissection of the peripheral nervous system to 
 the minutest branches of the nerves, but a dissection of the 
 spine is not required. Probably if such had been required, 
 much that at the present time seems to the average medical 
 man as mysterious would long ago have been made clear. It 
 has remained for the students of spinal adjustment to do this, 
 and the spinal findings, post mortem, reveal the truth of the 
 existence of displacements of the vertebrae. The figures 
 shown on the following pages are reproductions of photo- 
 graphs taken of a cadaver in process of dissection in the an- 
 atomical laboratory of the National School of Chiropractic of 
 Chicago, by the author, with the assistance of Dr. Erik Juhl. 
 These illustrations show several important things : first, that 
 subluxations really exist; second, that sufificient displacement 
 of the vertebrae is present to occasion pressure upon the struc- 
 tures passing through the intervertebral foramina ; and, third, 
 that these subluxations may be detected by palpation of the 
 surface of the back. 
 
 In reading articles in medical journals dealing with the 
 etiology of various diseases and conditions one is often struck 
 with the fact that statements made imply that a spinal lesion 
 must be the basis, yet the simple statement to that efifect is 
 never made. Numerous quotations might be given in which 
 it could be shown that the etiological factors given by the 
 authors of those articles are but another name for subluxation 
 of the vertebrae. These writers realize that improper innerva- 
 tion is the basis for many conditions, yet fail to find the key 
 to the mode of production of the faulty innervation, namely 
 pressure upon the spinal nerves by the displaced margins of 
 the lateral foramina through which they pass. 
 
 A careful study of these illustrations reveals the interest- 
 ing fact that the subluxated vertebrae as indicated on the 
 integument in Fig. 1 are shown with the various layers of the 
 muscles of the back removed. In succeeding reproductions 
 the abnormal position of the spinous processes becomes gradu- 
 ally more and more distinct. Finally the narrowed interver- 
 tebral foramina are seen corresponding to the seat of some of 
 the spinal lesions. 
 
 These figures prove beyond any successful denial that dis-
 
 28 
 
 SPINAL ADJUSTMENT 
 
 Fig. 5.
 
 ANATOMICAL BASIS OF CHIROPRACTIC 29 
 
 placements of the vertebrae, without fracture, are not only 
 possible but actually do exist. These photographic repro- 
 ductions, while showing the actual narrowing of the interver- 
 tebral foramina, cannot show the compression of the vessels 
 and nerves as witnessed directly on the cadaver. Another in- 
 teresting fact brought out in the cadaver was the ease with 
 which the handle of the scalpel could be introduced into the 
 foramina corresponding to vertebrae which were not sub- 
 luxated, and the impossibility of introducing it into those 
 foramina whose component vertebrae were displaced. 
 
 It might be stated that there were present at the dissection 
 of the cadaver which revealed these findings some who had 
 more or less misgivings relative to the actual existence of 
 vertebral subluxations. No one, however, could deny the 
 truth of what his eyes witnessed. 
 
 The accompanying illustrations, being reproductions of 
 photographs of the spinal column, are as convincing as the 
 direct dissection of the cadaver was, and prove once more 
 that subluxation of the vertebrae is no longer a theory but 
 a fact. 
 
 By palpation of the vertebral column of the cadaver the 
 ■ following subluxations were noted : 
 
 The first cervical vertebra was displaced laterally to the 
 right. 
 
 The fourth cervical vertebra was displaced laterally to the 
 right. 
 
 The sixth cervical vertebra was displaced laterally to the 
 right. 
 
 The third thoracic vertebra rotated upon its axis toward 
 the left. 
 
 The eighth thoracic vertebra was rotated on its axis toward 
 the left. 
 
 The ninth thoracic vertebra was rotated on its axis toward 
 the right. 
 
 The tenth thoracic vertebra was displaced posteriorly. 
 The first luml)ar vertebra was rotated on its axis toward 
 the right. 
 
 The fourth lumbar vertebra was displaced posteriorly.
 
 30 
 
 SPINAL ADJUSTMENT 
 
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 Fifl. 6.
 
 ANATOMICAL BASIS OF CHIROPRACTIC 31 
 
 The following are the designations of the subluxations of 
 the vertebrae as outlined above : 
 
 IC R. L. 9D L. R. 
 
 4C R. L. lOD P. 
 
 6C R. L. IL L. R. 
 
 3D R. R. 4L P. 
 
 8D R. R. 
 
 Fig. 1 shows these various subluxations marked opposite 
 the vertebrae above enumerated. The marks correspond to 
 the position of the spinous processes of the vertebrae which 
 Avere subluxated. Several other spinous processes were also 
 found out of alignment, but palpation of the corresponding 
 transverse processes revealed nothing abnormal as to the 
 position of the vertebrae in question. This was later verified 
 upon directly viewing the vertebrae, when it was noted that 
 the spinous processes merely deviated from their normal di- 
 rection of projection from the body of the vertebrae. 
 
 Fig. 2 shows the back with the skin and superficial fascia 
 removed, and the first layer of muscles of the back revealed. 
 In this illustration the position of the spinous processes is 
 somewhat evident on inspection, and they were readily palpable. 
 
 Fig. 3 shows the back with the first layer of muscles re- 
 moved and the second layer revealed. The spinous processes 
 in this figure are readily seen, and deviations from their 
 normal position can be noted. 
 
 Fig. 4 shows the back with the second layer of muscles 
 removed, and the third layer revealed. In this illustration the 
 transverse processes are also seen in some segments, while 
 the spinous processes are very evident. 
 
 Fig. 5 shows the back with the fourth layer of muscles re- 
 moved and the fifth layer exposed. The spinous and trans- 
 verse processes can be readily seen. 
 
 Fig. 6 shows the back with the fourth layer of muscles 
 removed and the fifth layer exposed. The spinous processes 
 in this illustration are entirely uncovered by muscles and liga- 
 ments and stand out very prominently. 
 
 Fig. 7 shows the left half of the back, the right half hav- 
 ing been entirely removed by disarticulating the ribs from the 
 vertebrae, for the purpose of showing the intervertebral
 
 32 
 
 SPINAL ADJUSTMENT 
 
 Fig. 7.
 
 ANATOMICAL BASIS OF CHIROPRACTIC 33 
 
 foramina seen in the following figure. This illustrates a pos- 
 terior view of the back, with all muscles and ligaments re- 
 moved, and showing the vertebrae. The lower ribs have been 
 disarticulated, and the pleura is visible. This figure shows 
 very clearly the displacement of the eighth thoracic vertebra ; 
 note the prominence of the transverse process on the right side, 
 which shows that the vertebra is rotated toward the left; the 
 right side of the intervertebral cartilage was also compressed; 
 and the vertebra displaced upward, as shown by the fact 
 that the transverse processes of the eighth and ninth vertebrae 
 are close to each other. The upward displacement is well 
 shown in the following figure. 
 
 Fig. 8 shows two intervertebral foramina which are much 
 diminished in size, as will be readily noted by comparing them 
 with the other foramina shown. These foramina whose lumen 
 is diminished correspond to the eighth, ninth and tenth tho- 
 racic segments. The eighth thoracic vertebra is distinctly 
 shown displaced toward the right side, which was the side 
 of the spine photographed. Note how the articular process 
 encroaches upon the lumen of the intervertebral foramen. This 
 figure shows the actual narrowing of an intervertebral fora- 
 men, by the displacement of a vertebra, and positively dispels 
 any doubt as to the possibility of vertebral subluxations with- 
 out fracture, and a consequent narrowing of the corresponding 
 intervertebral foramen. This narrowing is amply sufficient 
 to produce enough pressure upon the vessels transmitted 
 through the foramen, and of the nerves to destroy their power 
 of conductivity. 
 
 The following extracts from Dr. Alfred Walton's writings 
 along this subject apply in this connection as bearing on the 
 anatomical basis of chiropractic : "Every normal spine has 
 certain architectural defects. The third and fourth cervical 
 vertebrae are exceedingly delicate in structure, and permit of 
 much lateral motion, whereby the head is greatly tilted to 
 one side, as is seen in children with hydrocephalus. The 
 sixth, seventh and eighth dorsal vertebrae are relatively weak, 
 and are frequently subluxated, which accounts for the 
 prevalence of dyspepsia, and also for the whole train of dis- 
 orders incident to pressure upon the spinal nerves concerned 
 with digestion.
 
 34 
 
 SPINAL ADJUSTMENT 
 
 Fig. 8.
 
 ANATOMICAL BASIS OF CHIROPRACTIC 35 
 
 "The American people are said to be a nation of dyspeptics. 
 The cause is frequently referred to as due to improperly cooked 
 foods and hurried eating; these are not the principal factors, 
 however, for dyspepsia is exceedingly common with those 
 who are confirmed invalids, who eat slowly, and confine them- 
 selves to a carefully selected diet. The fact is, that as soon 
 as pressure is removed from the middle dorsal nerves, the 
 dyspeptic begins to take on flesh, and has a digestion strong 
 enough to eat anything placed before him. 
 
 "The tenth dorsal vertebra because of not being supported 
 by the ribs, permits of the rotation of the body, a beautiful 
 example of which is demonstrated when the golf player tops 
 a ball. If his drive has been of sufficient force, it will be 
 noticed that the body has described nearly three-fourths of a 
 circle ; hence the frequency with which the tenth dorsal 
 vertebra is found out of alignment. Its position is an im- 
 portant factor in the functioning of the kidneys; an adjust- 
 ment of the tenth dorsal is followed by the disappearance of 
 a great variety of diseases, not only diseases of the kidneys, 
 but those of a totally dissimilar character, but dependent 
 upon uric acid conditions as, for example, rheumatism, 
 neuralgia, eye troubles, and many forms of skin disease." 
 
 The third reason that subluxations are not considered pos- 
 sible by some investigators is, that they have, in the first 
 place, not looked into this subject thoroughly enough, and, 
 secondly, that they have failed to discriminate between the 
 terms subluxation and dislocation, which are entirely dissimilar. 
 
 It is true that major lesions of the spine have received 
 proper attention. But the possibility of the existence of minor 
 injuries of the spine has never been thoroughly investigated 
 until the results achieved by spinal adjustment have made 
 it plain that minor spinal lesions are exceedingly common, 
 and are followed by the most serious consequences in many 
 instances. It will be shown further on in this work that upon 
 a proper functioning of the nervous system depends the 
 harmonious relationship of all parts of the body, as well as 
 their functional activity and organic integrity. This being 
 true, the vertebral column becomes the most important di- 
 vision of the body. Yet it has received less study than any 
 other portion, at least from a mechanical viewpoint, and the
 
 36 
 
 SPINAL ADJUSTMENT 
 
 Fig. 9. 
 
 (A) Compression of the anterior portion of the disc, causing the superior 
 vertebra to approach the inferior, the articular process of which encroaches on 
 the lateral foramen between them. 
 
 (B) Posterior displacement of the vertebra and thinning of the disc, causing 
 the articular process of the vertebra below to encroach on the intervertebral 
 foramen. 
 
 (C) Compression of the disc in its entirety, resulting in a diminution of 
 the vertical diameter of the intervertebral foramen.
 
 ANATOMICAL BASIS OF CHIROPRACTIC 37 
 
 body should be studied from that viewpoint, since it is in 
 reality a piece of mechanism. The location at which inter- 
 ference with nerve function is most likely to occur is naturally 
 there where the nerves are most subject to injury. Such a 
 location the intervertebral foramina admirably furnish, for 
 here the nerves pass between movable bones which may be- 
 come displaced and subject the nerves to pressure. 
 
 Ordinarily when the word subluxation is mentioned the 
 reader at once pictures to himself a disarticulation of the 
 vertebrae, and since it really is impossible for a complete 
 disarticulation of a vertebra to occur without fracture, he 
 discredits the possibility of a subluxation. This is, however, 
 the wrong construction of the term since a subluxation is not 
 a complete disarticulation of a vertebra from the vertebra 
 above and below it. It is simply a slight change in the 
 relative position of a vertebra with the contiguous vertebrae 
 above and below it. That is to say, instead of the entire sur- 
 face area of a vertebra being approximated, with die-like pre- 
 cision and accuracy, to its fellows above and below it, it is 
 slightly moved from this position. There is not an absolute 
 and entire separation of the articular processes of two ver- 
 tebrae ; on the contrary, the greater portion of their surface 
 area still oppose each other; there has simply been a slight 
 shifting of one upon the other. This movement takes place 
 in various directions depending upon the configuration of the 
 articular processes. 
 
 As was shown in the preceding chapter this movement 
 of a vertebra need be very slight to produce sufficient pres- 
 sure upon the structures passing through the intervertebral 
 foramen to destroy their irritability and power of conductivity. 
 
 The accompanying illustrations show clearly that sub- 
 luxations, or displacements of vertebrae may exist without 
 fracture of the vertebrae taking place. Were the vertebrae 
 absolutely locked in position, even the slightest movement 
 would be impossible, including the normal movements. But 
 the fact that some movement between individual vertebrae is 
 possible is evidence that varying degrees of movement may 
 take place, depending upon the force applied. Anything that 
 is capable of some movement is capable of greater or less 
 movement, and we know that the vertebrae must move upon
 
 38 SPINAL ADJUSTMENT 
 
 each other, or there could be no movement of the spine as a 
 whole. When this movement exceeds certain definite limits, 
 there is present the danger of inability of the vertebra to 
 return to its normal position. In speaking of movement in 
 this regard very slight movement is implied, since as men- 
 tioned above, a movement of one-eighth of an inch will occa- 
 sion pressure upon the structures passing through the inter- 
 vertebral foramen sufficient to prevent the conduction of im- 
 pulses to the parts for which they are destined, with derange- 
 ment in the parts supplied by the involved nerves.
 
 CHAPTER IV 
 
 The Physiological Basis of Chiropractic 
 
 In the preceding chapter it was shown that subluxations 
 of the vertebrae can and do occur, and that as a result of this 
 displacement sufficient pressure is brought to bear upon the 
 nerves passing through the intervertebral foramina, by the 
 displaced margins of the foramina, to seriously impair their 
 function. In this chapter we will consider the manner in 
 which this disturbance of the functional activity is brought 
 about. 
 
 The Function of the Nervous System. — By virtue of its 
 continuity the nervous system puts into connection all the 
 other systems of the body. Its branches form pathways over 
 which nerve-impulses pass from the brain to every part of the 
 body, and from the periphery to the brain. All incoming im- 
 pulses must react in the central nervous system. It is a fact 
 of the utmost importance that until the incoming impulses 
 have reached the brain and spinal cord, they do not give rise 
 to the outgoing impulses. It must be remembered that nearly 
 all outgoing impulses are generated as a result of stimulation 
 of the cerebral or spinal centres by an incoming impulse. 
 For example, the sight of food excites an afferent impulse to 
 the brain which in turn excites an efferent impulse in the 
 cerebral centres which send nerve-fibres to the salivary glands, 
 and a flow of saliva results. In like manner every action per- 
 formed by any part of the body is produced as a result of an 
 outgoing impulse which was generated in the brain or spinal 
 cord in response to an impulse from the periphery. 
 
 By means of the central nervous system reactions are 
 established in parts of the body not directly affected by the 
 changing external conditions. In this way harmony between 
 the activities of the various systems of the body is maintained. 
 Also the body as a whole, in relation to all things outside it 
 and forming its environment, is under the guidance of the 
 nervous system. 
 
 39
 
 40 SPINAL ADJUSTMENT 
 
 The Conduction Process. — In order to appreciate properly 
 the effects of pressure upon the nerve we must first look into 
 the nature of the transmission of impulses along the nerves, 
 namely the conduction process. Many views have been ad- 
 vanced as to the nature of the conduction process among 
 which are, that the whole nerve moves like a bell-rope; that 
 the nerve is a tube and a biting acid flows through it; that 
 the nerve contains a fluid which moves in waves ; that it con- 
 ducts an electric current like a wire; that it is composed of 
 definitely arranged electro-motor molecules which exert an 
 electro-dynamic influence on each other ; that it is made up of 
 chemical particles each of which excites its neighbor; lastly, 
 that the molecules of the nerve-substance undergo a form of 
 vibration like that of light. 
 
 None of these theories has been proven as the only cor- 
 rect one, and it is likely that the conduction process is simply 
 a property of the living substance of the cell. It is a state of 
 activity which spreads like a wave in all directions through 
 the living substance. It is markedly changed by chemical 
 and physical influences. Protoplasmic continuity is absolutely 
 essential to conduction. Hence, as will be shown further on, 
 any pressure upon the nerve which breaks this protoplasmic 
 continuity impedes the transmission of impulses along that 
 nerve. 
 
 The Nerve-impulse. — The neurones form pathways along 
 which nerve-impulses travel. It is through the power of con- 
 ductivity possessed by the neurones that the impulses travel 
 along the nerves. The impulses which arrive at the cell- 
 body produce there chemical changes. These changes, when 
 they reach a given volume, cause a nerve-impulse which 
 leaves the cell-body by way of the axone. 
 
 As will be pointed out, the impulses travel either toward 
 the central system, or from it. The former class of impulses 
 are called afferent, and by means of them the proper relation- 
 ship of all parts of the body, individually and collectively, to 
 their environment is maintained. The latter class of impulses 
 are known as efferent, and it is through them that the func- 
 tional activity and organic integrity of every part of the body 
 are governed and maintained. 
 
 The amount of nerve influence generated by the brain
 
 PHYSIOLOGICAL BASIS OF CHIROPRACTIC 41 
 
 must always be commensurate with the amount of work re- 
 quired of the parts supplied by the nerves. This is excellently 
 illustrated by the following: We have the power of de- 
 termining beforehand the amount of nervous influence neces- 
 sary for the production of a certain degree of movement. Thus 
 when we lift a vessel, the force which we employ in lifting it 
 depends upon the idea which we have formed of its contents, 
 when we are not certain what it contains. If it should, there- 
 fore, contain something much lighter than we had estimated, 
 useless force would be expended, and it would be lifted with 
 exceptional ease ; but if it contain something much heavier 
 than we had anticipated, we would very likely drop it, because 
 insufificient force was expended to accomplish the end de- 
 sired. 
 
 Just as the response of muscles is proportionate to the 
 amount of nerve-force received by them, so also are the 
 functional activities of all parts of the body dependent on the 
 amount or strength of the nerve-impulses received by them. 
 If, therefore, anything interferes with the power of conduc- 
 tion of the nerve, the impulses which it normally conveys to 
 the parts which it supplies are not forthcoming, and these 
 parts will suffer. There will be either functional derange- 
 ment, or changes in its structure. 
 
 Irritability of Nerves. — Irritability is that property of liv- 
 ing protoplasm which causes it to undergo characteristic 
 physical and chemical changes when it is subjected to cer- 
 tain influences, called irritants. The term irritants, when 
 speaking of nerves includes anything which causes the nerve- 
 cell to send an impulse along its branches. The irritability 
 of cell-protoplasm is very dependent upon its physical and 
 chemical constitution, and even slight alterations of this con- 
 stitution, such as may be induced by mechanical conditions, 
 may modify the finely-adjusted molecular structure upon 
 which the normal response to irritants depends. 
 
 Without going into this subject in detail, the fact must be 
 stated that, when a nerve is experimentally subjected to slight 
 pressure, it is found that it will not conduct impulses ; when 
 the pressure is removed, it again conducts the impulses. A 
 frog in which the sciatic nerve and gastrocnemius muscle 
 are dissected and prepared, and then connected with an elec-
 
 42 SPINAL ADJUSTMENT 
 
 trie current, will show this. When the nerve is stimulated 
 by the current, contractions of the muscle occur; when pres- 
 sure is brought to bear upon the nerve, the muscular con- 
 tractions cease ; when the pressure is removed and the nerve 
 again electrically excited, the contractions of the muscle again 
 occur. This proves conclusively that the pressure which was 
 applied prevented the conduction of the impulses, for it is 
 the nervous impulses that caused the muscle to contract. It 
 also shows and demonstrates another important fact, namely, 
 that sufficient pressure may be applied to a nerve to prevent 
 it from conducting impulses without destroying the nerve 
 itself, because, in the experiments mentioned, as soon as the 
 pressure was removed, the muscular contractions again oc- 
 curred. 
 
 The Effect of Pressure upon a Nerve. — In a future chapter 
 the effects of vertebral subluxations are given in detail, but 
 the physiological efTect of pressure on nerves in general must 
 be considered at this time. 
 
 The effect of pressure to lessen the conduction power of 
 nerves is one which everyone may demonstrate upon himself. 
 For example, if pressure be brought to bear on the ulnar 
 nerve where it crosses the elbow, the region supplied by the 
 nerve becomes numb, "goes to sleep," as it were. 
 
 In like manner, mechanical applications to nerves first 
 increase and later destroy their irritability. Thus pressure 
 gradually applied first increases and later reduces the power 
 to respond to irritants. 
 
 As stated above, sufficient pressure may be applied to a 
 nerve to destroy its irritability and conductivity without in- 
 juring the nerve itself structurally. Such pressure is exer- 
 cised upon the nerves passing through the intervertebral for- 
 amina by the displaced margins of the foramen when a ver- 
 tebra is subluxated. The pressure does not crush or otherwise 
 injure the nerve, but it is sufficient to block the impulses 
 which pass along that nerve. As a result, the organs which 
 are deprived of these impulses undergo functional or organic 
 aberrations, and disease results in the part supplied. The 
 nature of the disease depends upon other contributory factors 
 which may be present at the time of the subluxation, or may 
 appear later. In any event the subluxation, by promoting
 
 PHYSIOLOGICAL BASIS OF CHIROPRACTIC 43 
 
 conditions in the organ which make disease possible in that 
 organ, are the primary cause of that disease. 
 
 For example, a subluxation is produced in the lower dorsal 
 or upper lumbar region of the vertebral column ; no untoward 
 effects may follow at once. But years later, perhaps, the in- 
 dividual develops typhoid fever. The reason that this occurs 
 is simply that the intestines which are the atrium of the in- 
 fection in this disease are in such a state of diminished re- 
 sistance that they form a favorable culture-medium for the 
 multiplication of the typhoid bacilli and the elaboration of 
 their toxins. It is for this reason that the fever subsides so 
 rapidly when these subluxations are corrected — because the 
 elaboration of the toxins, which are the cause of the fever, 
 is arrested, favorable conditions for the activity of the bacilli 
 having been eliminated. 
 
 The Effect of Blood-supply on Nerves. — In addition to the 
 direct effect of pressure upon the nerves, owing to a subluxa- 
 tion, there is also an indirect effect, as a result of the occlusion 
 of the blood-vessels which pass through the intervertebral 
 foramen. 
 
 The nerve-fibre requires a constant supply of blood for 
 the maintenance of its irritability. The irritability of the 
 nerve cannot long continue without oxygen, and a nerve which 
 has been removed from the body is found to remain irritable 
 longer in oxygen than in air, and in air than in an atmosphere 
 which contains no oxygen. 
 
 It will be learned further on that one of the effects of 
 a subluxation is pressure upon the arteries and veins. These 
 arteries supply the structures of the corresponding segment 
 of the spine with nourishment, and the veins carry away the 
 waste materials. When the circulation of the blood is im- 
 peded, there will consequently be an impoverishment of the 
 nerves, and an accumulation of waste materials, both of which 
 have a deleterious effect on the nerves. 
 
 Another function of the blood in respect to the nerves 
 is that it distributes heat. A nerve which is deprived of this 
 heat loses its power of irritability and conductivity. This 
 can be demonstrated by dipping the elbow in ice-water, and 
 allowing it to remain there until the cold has had time to 
 penetrate ; at first there will be pain, but as the effect of the
 
 44 SPINAL ADJUSTMENT 
 
 cold becomes greater, the pain is replaced by numbness, 
 both the irritability and power of conduction of the nerve 
 being reduced. 
 
 In like manner obstruction of the arteries passing through 
 the intervertebral foramina, by pressure upon them of the 
 displaced margins of the foramen, diminish the blood-supply 
 to the nerves, and hence the heat which the blood normally 
 conveys to them. Impulses to be transmitted by that nerve 
 will accordingly be impeded, or fail to reach their destination, 
 and disorders in the parts thus deprived of their necessary 
 nerve-control will follow. 
 
 Further, the blood has the power to neutralize the acids 
 which are produced by the cells during action, and so main- 
 tain the alkalinity essential to the life and activity of the 
 cell; also, by virtue of the salts which it contains it secures 
 the osmotic relations which are necessary to the preserva- 
 tion of the normal chemical constitution of the protoplasm 
 of the nerve. 
 
 The irritability of nerve protoplasm is markedly influenced 
 by even slight changes in its constitution. If, experimentally, 
 a nerve be allowed to lie in a liquid of a different composition 
 from its own fluid, and especially if such a liquid be injected 
 into its blood-vessels, an interchange of materials takes place 
 which results in an alteration of the tissue and a change of its 
 irritability. 
 
 If, therefore, the venous flow is obstructed, the acid waste 
 materials of the activities of nerves remain within them, and 
 a change in the constitution of their protoplasm impairs their 
 irritability and conductivity. This effect the pressure of the 
 displaced margins of an intervertebral foramen produces by 
 obstructing the circulation of the blood in the veins which 
 it transmits. 
 
 The Effects of Lymphatics on Nerves. — The last of the 
 physiological effects resulting from a subluxation of a verte- 
 bra with consequent narrowing of the corresponding inter- 
 vertebral foramen is the influence which it exercises upon 
 the lymphatics, and their effect on the nerves which they 
 supply. 
 
 The lymphatics which pass through the intervertebral 
 foramina have much to do with the metabolism of each seg-
 
 PHYSIOLOGICAL BASIS OF CHIROPRACTIC 45 
 
 ment of the spinal cord. If the nutrition of a certain segment 
 is faulty as a result of an insufficient supply of lymph, the 
 reflex excitability of that segment will be diminished. Con- 
 sequently any incoming impulses to that segment will not 
 result in a reflex action with the production of an outgoing 
 impulse, and the tissues thus deprived of these necessary 
 impulses will fail to function properly. 
 
 Such a condition of hypo-excitability is always produced 
 by a vertebral subluxation. In such an event the lymphatic 
 flow is obstructed, and the corresponding segment of the 
 spinal cord and the spinal nerves emerging through the nar- 
 rowed intervertebral foramen is improperly nourished, and 
 diminution of its irritability and power of conductivity results. 
 
 From the foregoing it is apparent that the efYects on nerve 
 function attributed to vertebral subluxaions are in perfect 
 accord with accepted physiological facts and must therefore 
 be considered as scientifically correct. To recapitulate: Nerve 
 impulses travel along a nerve and all its branches and control 
 the functional activity and organic integrity of the parts in 
 which they end. Pressure upon these nerves will prevent the 
 conduction of these impulses to the parts for which they are 
 destined, without necessarily injuring the nerve itself. Ver- 
 tebral subluxations are capable of producing such a pressure 
 on the nerves emerging through the intervertebral foramina. 
 Removal of this pressure by correcting the subluxation will 
 again permit the nerve to conduct impulses to the parts for 
 which they are intended, and thus restore them to their 
 normal condition.
 
 SECTION TWO 
 
 The Sympathetic Nervous System 
 
 CHAPTER I 
 The Anatomy of the Sympathetic Nervous System 
 
 A thorough knowledge of the sympathetic nervous system 
 is necessary to an understanding of chiropractic theory and 
 technique. This knowledge is also essential to understand 
 how results are obtained by the application of the "thrust" for 
 the adjustment of subluxated vertebrae. A comprehensive 
 study of chiropractic must include the anatomy of this por- 
 tion of the nervous system in all its ramifications, from the 
 gangliated cords to the finest filaments which supply each 
 cell of the body. It must embrace the exact relationship of 
 the sympathetic system with the cerebro-spinal system and 
 the cranial nerves. With such knowledge the clinical results 
 of chiropractic will be readily appreciated. Fig. 10. 
 
 The sympathetic nervous system consists of (1) a double 
 chain of ganglia extending along the front and sides of the 
 spinal column, from the base of the skull to the coccyx, and 
 connected with each other by intervening cords. Each gang- 
 lion is reinforced by motor and sensory filaments derived from 
 the cerebro-spinal system, and thus the organs under its 
 influence are brought indirectly into communication with ex- 
 ternal objects and phenomena. (2) Of three great gangliated 
 plexuses or collections of nerves and ganglia, located in front 
 of the spine in the thoracic, lumbar, and pelvic cavities. (3) 
 Of smaller ganglia situated in close relation to the viscera. 
 (4) Of a large number of nerve-fibres which are of two kinds : 
 communicating, by which the ganglia communicate with each 
 other and with the cerebro-spinal nerves; and distributory 
 which supply the internal organs and the coats of the 
 blood-vessels (Gray). 
 
 47
 
 48 
 
 SPINAL ADJUSTMENT 
 
 yngcal hranches. 
 brandies. 
 
 plans. 
 
 I cai-diac.j)!exus, 
 
 Solar plexus. 
 
 ~~L. Aortic plexus. 
 
 Hypogastric plexus. 
 
 Sacral ganglia. 
 
 Ganglion impat 
 
 Fig. 10. 
 
 Tbe Sympathetic Nervous 
 System (Gray).
 
 SYMPATHETIC NERVOUS SYSTEM 49 
 
 The nerves of the sympathetic system are distributed to 
 organs over which the consciousness and the will have no 
 direct control, as the intestines, kidneys, liver, heart, etc. The 
 entire sympathetic series is in this way composed of numer- 
 ous small ganglia which are connected throughout, first, with 
 each other; second, with the cerebro-spinal system; and third, 
 with the internal viscera of the body. 
 
 The upper end of each gangliated cord enters the cranial 
 cavity through the carotid canal by means of an ascending 
 branch. These ascending branches unite in a small ganglion, 
 known as the ganglion of Ribes, situated upon the anterior 
 communicating artery. 
 
 The lower end of each gangliated cord passes into the 
 pelvis. Here the two cords converge and unite in a single 
 ganglion, called the ganglion impar, situated in front of the 
 coccyx. 
 
 The ganglia of these cords are classified according to the 
 region in which they are situated, as cervical, dorsal, lumbar 
 and sacral. They correspond in number to the vertebrae 
 against which they lie, except in the cervical region. Thus 
 they are arranged into the following classes : The cervical 
 portion of the gangliated cord has three pair of ganglia; the 
 dorsal portion has twelve pairs ; the lumbar portion has four ; 
 and the sacral portion has four or five. 
 
 In the neck the ganglia are situated in front of the trans- 
 verse processes of the vertebrae ; in the thoracic region, in 
 front of the heads of the ribs; in the lumbar region, on the 
 sides of the bodies of the vertebrae ; and in the sacral region, 
 in front of the sacrum. 
 
 By many, the ganglia on the posterior roots of the spinal 
 nerves, on the glosso-pharyngeal and vagus, and on the sensory 
 root of the fifth cranial nerve (Gasserian ganglion) are also 
 included as sympathetic-nerve structures. (Kirks.) 
 
 Each portion of the gangliated cord will now be considered 
 in turn. 
 
 The cervical portion of the gangliated cord consists of 
 three ganglia on each side, which are called, from their 
 position, the superior, middle, and inferior. 
 
 The superior cervical ganglion is the largest of the three. 
 It is located opposite the second and third cervical vertebrae,
 
 50 SPINAL ADJUSTMENT 
 
 and is supposed to be formed by a coalescence of the four 
 ganglia which correspond to the four upper cervical vertebrae. 
 It has five branches, namely, superior, inferior, anterior, in- 
 ternal, and external. The superior branch is a direct upward 
 extension of the ganglion. It ascends along the internal 
 carotid artery and, on reaching the carotid canal in the tem- 
 poral bone, enters the cranial cavity, and divides into two 
 branches, an outer and an inner. The outer branch distributes 
 filaments to the internal carotid artery, and forms the carotid 
 plexus; the inner branch also sends filaments to the internal 
 carotid, and, passing onward, forms the cavernous plexus. 
 Filaments are sent from the carotid and cavernous plexuses 
 to cranial nerves. Their terminal filaments extend along the 
 course of the internal carotid artery, forming plexuses which 
 wind about the cerebral and ophthalmic arteries ; they can 
 be traced along the former vessel to the pia mater; along the 
 latter vessel they pass into the interior of the eye-ball. As 
 previously stated, the tilaments which pass on to the anterior 
 communicating artery form a small ganglion, the ganglion of 
 Ribes, which connects the sympathetic cords of the right and 
 left sides. 
 
 The inferior branch of the superior cervical ganglion 
 passes downward, and communicates with the middle cervical 
 ganglion. 
 
 The external branches of the superior cervical ganglion 
 are numerous. They communicate with the cranial nerves 
 and with the four upper spinal nerves. 
 
 The internal branches are three in number, namely, the 
 pharyngeal, laryngeal, and superior cardiac nerve. The 
 pharyngeal branches pass inward to the side of the pharynx 
 where they join with branches from some of the cranial nerves. 
 The superior cardiac nerve is formed by two or more branches 
 from the superior cervical ganglion, and also sometimes re- 
 ceives a filament from the communicating cord between the 
 upper and middle cervical ganglia. It runs down the neck 
 behind the common carotid artery, and at the root of the neck 
 divides into the right and the left superior cardiac nerves. 
 The right superior cardiac nerve passes along the innominate 
 artery to the back part of the arch of the aorta, at which point 
 it joins the deep cardiac plexus. It receives filaments from
 
 SYMPATHETIC NERVOUS SYSTEM 51 
 
 cranial nerves, and sends filaments of communication with 
 the thyroid branches from the middle cervical ganglion. The 
 left superior cardiac nerve passes along the common carotid 
 artery to the front of the arch of the aorta, where it 
 communicates with the superficial cardiac plexus. 
 
 The anterior branches of the superior cervical ganglion 
 wind about the external carotid artery and its branches, on 
 many of which plexuses are formed. Many of these plexuses 
 send important twigs of communication with other nerves. 
 
 The middle cervical ganglion is formed by the two ganglia 
 corresponding to the fifth and sixth cervical vertebrae. It is 
 often spoken of as the thyroid ganglion on account of its 
 relation to the thyroid artery. It has four branches, superior, 
 inferior, internal, and external. 
 
 The superior branches ascend to unite with the superior 
 cervical ganglion. 
 
 The inferior branches descend to communicate with the 
 inferior cervical ganglion. 
 
 The external branches pass outward and communicate with 
 the fifth and sixth spinal nerves. 
 
 The internal branches are known as the thyroid and the 
 middle cardiac nerve. 
 
 The thyroid nerve has small filaments which accompany 
 the inferior thyroid artery to the thyroid gland. They also 
 communicate with important nerves. 
 
 The middle cardiac nerve arises from the middle cervical 
 ganglion or from the cord which connects the middle and 
 inferior cervical ganglia. It passes down the neck behind 
 the common carotid artery, on the right side ; then it accom- 
 panies the trachea, gives off filaments to other nerves, and 
 finally joins the right side of the deep cardiac plexus. The 
 middle cardiac nerve of the left side joins the left side of 
 the deep cardiac plexus. 
 
 The inferior cervical ganglion is formed by the union of 
 the two ganglia which correspond to the last two cervical 
 nerves. It is located between the base of the transverse proc- 
 ess of the seventh cervical vertebra and the neck of the first 
 rib, on the inner side of the superior intercostal artery. It 
 has four branches, namely, superior, inferior, internal, and 
 external.
 
 52 SPINAL ADJUSTMENT 
 
 The superior branches ascend to communicate with the 
 middle cervical ganglion. 
 
 Its inferior branches descend to commupjcate with the first 
 thoracic ganglion. 
 
 The external branches are made up of some filaments 
 which communicate with spinal nerves. Other filaments ac- 
 company the vertebral artery in its upward course along the 
 vertebral canal; they form plexuses along its course, which 
 in turn give off filaments which are continued upward along 
 the vertebral and basilar to the cerebral arteries. 
 
 The internal branch is known as the inferior cardiac nerve. 
 This nerve passes downward along the trachea to join the 
 deep cardiac plexus. It also communicates with the recurrent 
 laryngeal and middle cardiac nerves. 
 
 The thoracic portion of the gangliated cord is made up 
 of twelve ganglia, corresponding to the twelve thoracic verte- 
 brae, and named in the order of their position as first, second, 
 third, etc. They are connected by cords which are an exten- 
 sion of their substance. All except the last two are situated 
 in front of the heads of the ribs, on each side of the vertebral 
 column. The last two ganglia are placed on the side of the 
 bodies of the eleventh and twelfth thoracic vertebrae. The 
 thoracic ganglia have external and internal branches. 
 
 The external branches of the ganglia are two in number, 
 and communicate with the corresponding spinal nerves. 
 
 The internal branches from the five or six upper thoracic 
 ganglia send filaments to the thoracic aorta and its branches; 
 also branches to the bodies of the vertebrae and their liga- 
 ments. Branches from the third and fourth, and sometimes 
 also from the first and second ganglia form a portion of the 
 posterior pulmonary plexus. 
 
 The internal branches from the six or seven lower ganglia 
 send filaments to the aorta, and unite to form the three 
 splanchnic nerves, namely the great, the lesser, and the 
 smallest splanchnics. 
 
 The great splanchnic nerve is formed by branches from 
 the thoracic ganglia between the fifth or sixth and the ninth 
 or tenth ganglia. The fibres from the roots in the fifth or 
 sixth ganglionic branches can be traced upward in the gangli- 
 ated cords as far as the first or second thoracic ganglia. The
 
 SYMPATHETIC NERVOUS SYSTEM 53 
 
 nerve descends obliquely inward in front of the bodies of the 
 vertebrae, passes through the diaphragm, and ends in the 
 semilunar ganglion of the solar plexus, sending filaments to 
 the renal and suprarenal plexuses. 
 
 The lesser splanchnic nerve is formed by branches from 
 the tenth and eleventh thoracic ganglia and also from the cord 
 between them. It passes through the diaphragm with the 
 great splanchnic, and communicates with the solar plexus. It 
 communicates in the thorax with the great splanchnic, and 
 also occasionally sends filaments to the renal plexus. 
 
 The smallest, also called the renal splanchnic nerve, arises 
 from the twelfth thoracic ganglion. It pierces the diaphragm, 
 and terminates in the renal plexus and the lower portion of 
 the solar plexus. 
 
 The lumbar portion of the gangliated cord is placed in 
 front of the spinal column, along the inner border of the 
 psoas muscle, much nearer the median line than the thoracic 
 ganglia. This portion of the gangliated cord usually consists 
 of four ganglia united by intervening cords. Each ganglion 
 has four branches, namely, superior, inferior, external, and 
 internal. 
 
 The superior branches of the lumbar ganglia act as the 
 branches of communication between the ganglia. 
 
 The inferior branches act in the same manner as the 
 superior in joining the ganglia with each other. 
 
 The external branches communicate with the spinal nerves 
 of this region. There are other filaments which accompany 
 the lumbar arteries passing around the sides of the bodies 
 of the vertebrae. 
 
 The internal branches in part pass inward in front of the 
 aorta, helping to form the aortic plexus. Others descend in 
 front of the common iliac arteries and then unite in front of 
 the promontory of the sacrum, assisting to form the hypo- 
 gastric plexus. Many small filaments are distributed to the 
 bodies of the vertebrae and their ligaments. 
 
 The pelvic portion of the gangliated cord is located in 
 front of the sacrum along the inner side of the anterior sacral 
 foramina. It is made up of four or five ganglia, united by 
 intervening cords. Below, these cords approach each other 
 and then unite on the anterior aspect of the coccyx in a gang-
 
 54 SPINAL ADJUSTMENT 
 
 lion called the ganglion impar. The sacral ganglia have the 
 same branches as the preceding, namely, superior, inferior, 
 external, and internal. 
 
 The superior and inferior branches constitute the cords 
 connecting the ganglia above and below. 
 
 The external branches communicate with the sacral nerves. 
 There are two from each ganglion. The coccygeal nerve com- 
 municates either with the last sacral or with the ganglion 
 impar. 
 
 The internal branches communicate with those of the 
 other side, on the front of the sacrum. Some pass onward 
 to join the pelvic plexus, while others form a plexus about 
 the sacra media artery, and send filaments to Luschka's gland. 
 
 The gangliated cords and their branches of communication 
 and distribution to the plexuses having been described, we 
 will now direct our attention to the consideration of the great 
 gangliated plexuses, which constitute the second of the four 
 divisions of the sympathetic system, as outlined above. 
 
 The three great gangliated plexuses are the large aggrega- 
 tions of ganglia and nerves, situated in the thoracic, abdom- 
 inal, and pelvic cavities. They are called the cardiac, the solar 
 or epigastric, and the hypogastric plexus, respectively. The 
 nerves which enter into their composition are derived from 
 the gangliated cords and from the cerebro-spinal nerves. 
 From these plexuses branches are distributed to the stomach, 
 small and large intestine, liver, spleen, pancreas, kidneys, 
 supra-renal capsules, and the internal generative organs, 
 bladder, heart and lungs, thyroid gland, pharynx, larynx, 
 trachea, and esophagus. 
 
 The cardiac plexus is situated at the base of the heart. 
 It is divided into a superficial part which lies in the concavity 
 of the arch of the aorta, and a deep part which lies between 
 the aorta and the trachea. These two plexuses are very closely 
 connected. 
 
 The deep cardiac plexus is situated in front of the bifur- 
 cation of the trachea, above the point of division of the pul- 
 monary artery, and behind the arch of the aorta. It is formed 
 by the cardiac nerves which are derived from the cervical 
 ganglia of the sympathetic, and from the cardiac branches 
 of the pneumogastric and recurrent laryngeal nerves. The
 
 SYMPATHETIC NERVOUS SYSTEiM 55 
 
 only cardiac nerves which do not enter into the formation of 
 the deep cardiac plexus are the left superior cardiac nerve 
 and the inferior cervical cardiac branch from the left vagus. 
 
 Some of the branches from the right side of this plexus 
 pass in front of the right pulmonary artery, while others pass 
 behind it. The former send a few filaments to the anterior 
 pulmonary plexus, and then proceed onward to form a part of 
 the anterior coronary plexus. 
 
 The branches from the left side of the deep cardiac plexus 
 send filaments to the superficial cardiac plexus, to the left 
 auricle of the heart, and to the anterior pulmonary plexus, 
 and then continue onward to form the greater part of the 
 posterior coronary plexus. 
 
 The superficial cardiac plexus lies under the arch of the 
 aorta, in front of the right pulmonary artery. It is formed 
 by the left superior cardiac nerve, by the inferior cervical 
 cardiac branch from the left vagus, and lastly by filaments 
 from the deep cardiac plexus. A small ganglion, the gang- 
 lion of Wrisberg, is sometimes connected with these nerves, 
 and, when present, is located just beneath the arch of the 
 aorta. The superficial cardiac plexus together with the deep, 
 as mentioned above, forms the anterior coronary plexus, the 
 former entering principally into its formation. Several fila- 
 ments also pass along the pulmonary artery to the left anterior 
 pulmonary plexus. 
 
 The posterior coronary plexus surrounds the branches of 
 the coronary artery at the back of the heart, and filaments 
 from it are distributed to the muscles of the ventricles. 
 
 The anterior coronary plexus passes forward between the 
 aorta and the pulmonary artery, and accompanies the coronary 
 artery on the front of the heart. 
 
 Some anatomists have found nervous filaments ramifying 
 beneath the endocardium (Valentin). In some mammalia 
 numerous small ganglia exist on the cardiac nerves both on 
 the surface of the heart and in its muscular substance 
 (Remak). 
 
 The epigastric or solar plexus consists of a great network 
 of nerves and ganglia, situated behind the stomach, and in 
 front of the aorta and the crura of the diaphragm. It sup- 
 plies all the viscera of the abdominal cavity. It surrounds
 
 56 SPINAL ADJUSTMENT 
 
 the celiac axis and the root of the superior mesenteric artery, 
 and extends down as far as the pancreas and outward as far 
 as the suprarenal capsules. The solar plexus and the ganglia 
 connected with it receive the great and small splanchnic nerves 
 of both sides and some filaments from the right vagus. 
 
 Of the ganglia which partly compose the solar plexus the 
 principal are the two semilunar ganglia, which are located 
 one on each side of the plexus, and are the largest ganglia 
 in the body, being sometimes referred to as the "Abdominal 
 Brain." They are large, irregular gangliform masses, formed 
 by a collection of smaller ganglia. They are situated in front 
 of the crura of the diaphragm, near the suprarenal capsules. 
 The upper part of each ganglion is in communication with 
 the great splanchnic nerve, and to the inner side of each the 
 branches of the solar plexus are connected. From the semi- 
 lunar ganglia a multitude of radiating and intertwining 
 branches are sent out, which, from their diverging course 
 and their common origin from a central mass are termed the 
 solar plexus. From the solar plexus other diverging plexuses 
 originate, which accompany the abdominal aorta and its 
 branches and are distributed to the stomach, large and small 
 intestine, liver, spleen, pancreas, kidney, suprarenal capsules, 
 and the internal organs of reproduction. These plexuses are 
 the following: 
 
 Phrenic or Diaphragmatic plexus. 
 Suprarenal plexus. 
 Renal plexus. 
 Spermatic plexus. 
 Superior mesenteric plexus. 
 Aortic plexus. 
 
 'Gastric plexus. 
 
 Celiac plexus 
 
 Splenic plexus. 
 Hepatic plexus. 
 
 The phrenic plexus arises from the upper part of the semi- 
 lunar ganglion. It receives one or two branches from the 
 phrenic nerve. It is larger on the right side than the left. 
 It accompanies the phrenic artery to the diaphragm which it 
 supplies, and then sends some filaments to the suprarenal cap- 
 sule. At its junction with the phrenic nerve, on the right
 
 SYMPATHETIC NERVOUS SYSTEM 57 
 
 side is a small ganglion named the ganglion diaphragmaticum, 
 which is situated on the under surface of the diaphragm near 
 the suprarenal capsule. The branches of this ganglion are 
 distributed to the inferior vena cava, suprarenal capsule, and 
 the hepatic plexus. There is no ganglion on the left side. 
 
 The suprarenal plexus is formed by branches from the 
 solar plexus, semi-lunar plexus, splanchnic and phrenic nerves, 
 a ganglion being located at the junction with the former 
 nerve. It supplies the suprarenal capsule. The large size of 
 the branches of this plexus in comparison with the small organ 
 which they supply is of much clinical significance. 
 
 The renal plexus is formed by branches from the solar 
 plexus, the outer part of the semilunar ganglion, and the 
 aortic plexus. Filaments from the lesser and smallest 
 splanchnic nerves also join it. There are about fifteen or 
 twenty nerves from these sources, and they have numerous 
 ganglia upon them. They accompany the branches of the 
 renal artery into the kidney, some filaments being distributed 
 to the spermatic plexus on both sides, and to the vena cava 
 inferior on the right side. 
 
 The spermatic plexus is derived from the renal plexus, and 
 also receives some filaments from the aortic plexus. It ac- 
 companies the spermatic vessels to the testes. In the female 
 the ovarian plexus corresponds to the spermatic of the male, 
 and is distributed to the ovaries and the fundus of the uterus. 
 
 The celiac plexus is a direct continuation of the solar 
 plexus, and is of large size. It surrounds the celiac axis, and 
 subdivides into the gastric, hepatic, and splenic plexuses. It 
 receives branches from the splanchnic nerves, and, on the left 
 side, a filament from the vagus. 
 
 The gastric or coronary plexus accompanies the gastric 
 artery along the lesser curvature of the stomach, and unites 
 with branches from the left vagus nerve. It supplies the 
 stomach. 
 
 The hepatic plexus is the largest of the divisions of the 
 celiac plexus. It receives branches from the left vagus and 
 the right phrenic nerves. It enters the substance of the liver 
 in company with the hepatic artery and the portal vein, and 
 passes through the organ ramifying upon all their branches. 
 In this manner the pyloric plexus is formed, which accom-
 
 58 SPINAL ADJUSTMENT 
 
 panics the pyloric branch of the hepatic artery and joins with 
 the gastric plexus and the vagus nerves. There is also the 
 gastro-duodenal plexus which further subdivides into two 
 plexuses, namely the pancreatico-duodenal and the gastro- 
 epiploic. The pancreatico-duodenal plexus accompanies the 
 pancreatico-duodenal artery to supply the pancreas and duo- 
 denum, and joins with branches from the mesenteric plexus. 
 The gastro-epiploic plexus accompanies the right gastro- 
 epiploic artery along the greater curvature of the stomach and 
 anastomoses with the branches from the splenic plexus. The 
 cystic plexus also arises from the hepatic plexus near the 
 liver and supplies the gall bladder. 
 
 The splenic plexus is formed by branches from the celiac 
 plexus, the left semilunar ganglia, and the right vagus nerve. 
 It accompanies the splenic artery and its branches to the sub- 
 stance of the spleen, and, in its course, gives off filaments to 
 the pancreas, forming the pancreatic plexus, and the left gas- 
 tro-epiploic plexus which accompanies the left gastro-epiploic 
 artery along- the convex border of the stomach. 
 
 The superior mesenteric plexus is a continuation of the 
 lower part of the solar plexus, and receives a branch from the 
 union of the right pneumogastric nerve with the celiac plexus. 
 It ramifies about the superior mesenteric artery and accom- 
 panies it into the mesentery, where it divides into several 
 secondary plexuses. These plexuses are distributed to the 
 corresponding parts supplied by the artery, namely, pancre- 
 atic plexus to the pancreas ; intestinal branches which supply 
 the entire small intestine ; and ileo-colic, right colic, and mid- 
 dle colic which supply corresponding parts of the "large in- 
 testines. There are situated upon these nerves at their origin 
 numerous ganglia. 
 
 The aortic plexus is formed by branches which are de- 
 rived on each side from the solar plexus and semilunar gang- 
 lia, and also receives filaments from some of the lumbar 
 ganglia. The aortic plexus is situated upon the front and 
 sides of the aorta, between the superior and inferior mesenteric 
 arteries. This plexus gives oft' the spermatic, inferior mes- 
 enteric, and hypogastric plexuses. It also distributes filaments 
 to the inferior vena cava. The inferior mesenteric plexus 
 which arises principally from the left side of the aortic plexus,
 
 SYMPATHETIC NERVOUS SYSTEM 59 
 
 surrounds the inferior mesenteric artery. It gives off a num- 
 ber of secondary plexuses which are distributed to all the 
 parts which are supplied by that artery, namely, the left 
 colic and sigmoidal plexuses which supply the descending 
 colon and sigmoid flexure ; and the hemorrhoidal plexus which 
 supplies the upper part of the rectum, and joins with the pelvic 
 plexus in the pelvis. 
 
 The hypogastric plexus supplies the viscera of the pelvic 
 cavity. It is formed by the union of many filaments, which 
 descend on each side from the aortic plexus and the lumbar 
 ganglia. It is situated in front of the promontory of the 
 sacrum, between the common iliac arteries. No ganglia are 
 demonstrable in this plexus. It divides below into two portions, 
 which descend on each side to form the pelvic plexuses. 
 
 The pelvic plexus is situated at the side of the rectum in 
 the male, and at the side of the rectum and the vagina in the 
 female. It supplies the viscera of the pelvic cavity. It is 
 formed, as stated above, by the downward continuation of the 
 hypogastric plexus ; also by branches from the second, third, 
 and fourth sacral nerves, and by a few filaments from the 
 first two sacral ganglia. At the points where these fibres 
 join there are situated a few ganglia. The branches from 
 this plexus are very numerous, accompany the branches of 
 the internal iliac artery, and are distributed to all the organs 
 of the pelvis. 
 
 The inferior hemorrhoidal plexus arises from- the back 
 part of the pelvic plexus. It supplies the rectum, and unites 
 with branches from the superior hemorrhoidal plexus. 
 
 The vesical plexus arises from the front part of the pelvic 
 plexus. The nerves which make up this plexus are very 
 numerous, and a large number of spinal nerves are contained 
 among them. They accompany the vesical arteries, and are 
 distributed to the base and sides of the bladder. Many fila- 
 ments also pass to the seminal vesicles, and the vas deferens. 
 Those fibres which accompany the vas deferens unite with 
 branches from the spermatic plexus on the spermatic cord. 
 
 The prostatic plexus is a prolongation of the lower part 
 of the pelvic plexus, and the nerves composing it are of large 
 size. They are distributed to the prostate gland, seminal 
 vesicles, and the erectile tissue of the penis. The nerves
 
 60 SPINAL ADJUSTMENT 
 
 which supply the erectile structure of the penis are in two 
 sets, the large and the small cavernous nerves. They are 
 slender filaments, and after uniting with branches from the 
 internal pudic nerve, pass forward below the pubic arch. 
 The large cavernous nerve passes along the dorsum of the 
 penis, unites with the dorsal branch of the pudic nerve, and 
 supplies the corpus cavernosum and spongiosum. The small 
 cavernous nerves pass through the fibrous covering of the 
 penis near its roots. 
 
 The vaginal plexus arises from the lower part of the pelvic 
 plexus, and is distributed to the walls of the vagina. The 
 nerves which make up this plexus are similar to those of 
 the vesical plexus in that they contain a large number of 
 spinal nerves. 
 
 The uterine plexus arises from the upper part of the pelvic 
 plexus, above the part where the sacral nerves unite with this 
 plexus. Its branches accompany the uterine arteries, passing 
 along between the folds of the broad ligaments, to the sides 
 of the uterus. They pass to the lower part of the body of 
 the uterus and to the cervix. Separate filaments pass to the 
 body of the uterus and the broad ligaments. Branches which 
 pass into the substance of the organ have upon them numerous 
 ganglia.
 
 CHAPTER II 
 
 The Connection Between the Sympathetic Nervous System 
 and the Cerebro-Spinal Nervous System 
 
 In the preceding chapter there were considered the 
 chain of ganglia and the nerves of communication between 
 the gangHa, forming, together, the gangliated cords ; also the 
 three great gangliated plexuses whose nerves are derived from 
 the gangliated cords and the cerebro-spinal nerves; lastly 
 the smaller ganglia which are situated in relation with the 
 viscera and serving as additional centres for the origin of nerve 
 fibres which penetrate the substance of the organs of the 
 body. 
 
 From the description which was given, it can be readily 
 appreciated what a tremendous influence the sympathetic 
 nervous system must have upon the life processes of these 
 organs. Not only do these nerves regulate the proper func- 
 tioning of the viscera, but the cellular integrity, even, of the 
 organs, depends upon the unimpeded and unhampered action 
 of this portion of the nervous system. 
 
 This is true for the reason that the sympathetic and the 
 cerebro-spinal nervous systems are not two distinct and sepa- 
 rate systems, but are on the contrary united with each other 
 in the most intimate manner. Thus they constitute in reality 
 one system, which is continuous from the centres in the 
 brain to the minute fibrils that guide the destinies of each 
 individual cell. 
 
 The exact manner in which these two systems are con- 
 nected with each other will be shown in this chapter. Previ- 
 ous to taking up the consideration of the branches of com- 
 munication between the cerebro-spinal and sympathetic 
 systems, however, a brief review of the cerebro-spinal system 
 must be given. 
 
 It must be constantly borne in mind that when the nerv- 
 ous system is described as being formed of a central and a 
 
 61
 
 62 SPINAL ADJUSTMENT 
 
 peripheral portion, and the peripheral portion is further sub- 
 divided into a spinal and a sympathetic portion, that such 
 subdivisions are only for the purpose of facilitating topo- 
 graphical descriptions. The nervous system is show^n by 
 dissection to be continuous throughout its entire extent, and 
 by virtue of this continuity it puts into connection with each 
 other all the other systems of the body. 
 
 The cerebro-spinal system consists of the following 
 divisions : 
 
 1. The brain; (a) cerebrum; (b) cerebellum; (c) pons 
 varolii; (d) medulla oblongata. 
 
 2. The spinal cord. 
 
 3. The cranial nerves. 
 
 4. The spinal nerves. 
 
 5. Branches of communication, 
 
 6. Branches of distribution. 
 
 The brain is the central organ of the nervous system. It 
 is the seat of origin of all impulses which pass to all parts 
 of the body; and it receives the incoming impulses, with the 
 exception of those which are classed as reflex acts. The brain 
 generates the impulses which govern the vital processes of 
 the body economy, and which impulses are transmitted along 
 the course of the nerves, finally reaching every cell in the 
 body. 
 
 The spinal cord is the prolongation of the brain, in the 
 vertebral canal. It is an elongated, cylindrical bundle of 
 nerve tracts which convey the impulses to the brain from 
 the various parts of the body, and from the brain to the 
 different parts of the body. At regular points along its course 
 it gives ofif the roots of the spinal nerves. 
 
 The cranial nerves are the twelve pairs of nerves given 
 off by the brain, which pass out of the cranial cavity through 
 foramina in the skull; they then pass directly to the organ 
 which they supply. 
 
 The spinal nerves are so named because they originate 
 from the spinal cord, and are transmitted through the interr 
 vertebral foramina. There are thirty-one pairs of spinal 
 nerves, which are classified according to the region of the 
 spine through which they pass, as follows:
 
 CEREBRO-SPINAL NERVOUS SYS'lEM 63 
 
 Cervical 8 pairs Sacral 5 pairs 
 
 Dorsal 12 pairs Coccygeal 1 pair 
 
 Lumbar 5 pairs 
 
 It will be noticed that the number of spinal nerves corre- 
 sponds to that of the vertebrae of the corresponding region 
 except in the cervical and coccygeal regions. 
 
 Each spinal nerve is formed by two roots^ an anterior or 
 motor root, and a posterior or sensory root. The anterior 
 root is efferent, the posterior is afferent. The latter is dis- 
 tinguished by the presence upon it of a ganglion, called the 
 spinal ganglion. 
 
 The Anterior Root. — The superficial origin is from the 
 antero-lateral columns of the cord, each root being composed 
 of from four to eight filaments. The real origin is in the 
 anterior horns of the spinal cord. The anterior roots are 
 smaller than the posterior, have no ganglion, and their fibrils 
 are collected into two bundles near the intervertebral foramen. 
 
 The Posterior Root. — The superficial origin is from the 
 postero-lateral fissure of the cord. The real origin is from 
 the nerve-cells in the ganglion on the posterior root, from 
 which they can be traced into the cord in two main bundles. 
 The posterior roots are larger than the anterior because there 
 are more sensory nerves than motor in the body, but the 
 individual fibrils composing the root are finer than those of 
 the anterior root. The fibrils which compose the posterior 
 roots pass outward, and merge into two bundles which enter 
 the ganglion on each root. This ganglion is situated on the 
 posterior root at a point just internal to the place of junction 
 of the posterior root with the anterior in the vertebral canal, 
 and is located within the intervertebral foramen, external to 
 the point where the nerves perforate the dura mater. Three 
 exceptions to this location of the spinal ganglion exist; the 
 ganglion upon the first and second cervical nerves is placed 
 on the arches of the vertebrae over which the nerves pass ; 
 the ganglia of the sacral nerves are located within the spinal 
 canal ; that of the coccygeal nerve is also in the spinal canal, 
 at some distance from the origin of the posterior root. 
 
 Distribution of the Spinal Nerves. — The two roots unite 
 just beyond the ganglion, their fibres become blended, and the
 
 64 SPINAL ADJUSTMENT 
 
 trunk thus formed constitutes the spinal nerve. The spinal 
 nerve passes through and then out of the intervertebral 
 foramen, and divides into an anterior division for the supply 
 of the anterior part of the body, and a posterior division for 
 the supply of the posterior part of the body. Each of these 
 divisions contains fibres from both roots. 
 
 The anterior divisions of the spinal nerves are larger than 
 the posterior divisions. In the dorsal region the anterior 
 divisions of the spinal nerves are separate from each other, 
 and are of uniform distribution ; but in the cervical, lum- 
 bar, and sacral regions they form plexuses prior to their 
 distribution. They supply the muscles and skin in front of 
 the spine. 
 
 The posterior divisions of the spinal nerves are usually 
 smaller than the anterior. All except the first cervical, fourth 
 and fifth sacral, and the coccygeal divide into internal 
 branches. These branches are distributed to the skin and 
 muscles behind the spine. 
 
 The Sympathetics. — The only portion of the sympathetic 
 system not yet considered are the branches of communication 
 between the cerebro-spinal nerves and the ganglia of the 
 gangliated cords of the sympathetic nervous system. 
 It is this important phase of the subject which we will now 
 consider. 
 
 The sympathetic fibres are like the spinal, both efterent 
 and aflferent, and it is by means of these fibres that the two 
 systems are united. 
 
 The efferent or white branches of communication between 
 the ganglia of the sympathetic system and the cerebro-spinal 
 nerves arise in the spinal cord ; they pass out in the anterior 
 root, and then into the spinal nerve. Here they join the 
 afferent fibres which originate in the spinal ganglion. The 
 united fibres then pass on into the anterior primary division 
 of the spinal nerve. They leave this, and, now known as the 
 white rami communicantes, they pass to the ganglion of the 
 sympathetic cord of the corresponding situation. 
 
 The afferent or gray branches of communication between 
 the sympathetic ganglia and the spinal nerves pass from the 
 ganglion of the sympathetic cord to the spinal nerve, and are 
 called the gray rami communicantes. They may extend sepa-
 
 CEREBRO-SPINAL NERVOUS SYSTEM 
 
 65 
 
 rately from the white rami, or both kinds of fibres may be 
 contained in a single bundle. The gray rami pass through 
 the anterior primary division of the spinal nerve to the spinal 
 nerve proper, and then accompany it throughout all its 
 divisions. 
 
 The sympathetic fibres that pass through the intervertebral 
 foramen are contained in the substance of the spinal nerve. 
 
 From the above the exceedingly intimate connection and 
 interdependence of the sympathetic system and the spinal 
 nerves is readily seen. Branches pass from the spinal nerve 
 to the sympathetic ganglion, and from the ganglion to the 
 spinal nerve, resulting in a double interchange taking place 
 between the two systems. 
 
 The branches between the sympathetic ganglia themselves 
 consist of both gray and white nerve-fibres, the latter being a 
 continuation of the efferent fibres which pass from the spinal 
 nerves to the ganglia. 
 
 The following table shows the portion of the gangliated 
 cord that connects with each of the spinal nerves : 
 
 Spinal Nerve 
 
 Sympathetic System 
 
 Cervieal 1 External branch from the superior cervical ganglion 
 
 " 2 External branch from the superior cervical ganglion 
 
 " 3 External branch from the superior cervieal ganglion 
 
 " 4 External branch from the superior cervical ganglion 
 
 sometimes also from the cord connecting the supe- 
 rior and middle cervical ganglia 
 
 " 5 External branch from the middle cervical ganglion 
 
 " 6 External branch from the middle cervieal ganglion 
 
 " 7 External branch from the inferior cervieal ganglion 
 
 " 8 External branch from the inferior cervical ganglion 
 
 Dorsal 
 
 1.. 
 
 . . Two 
 
 external branches from the first 
 
 2.. 
 
 ( ( 
 
 
 ' " " second 
 
 3.. 
 
 ( < 
 
 
 " third 
 
 4.. 
 
 I i 
 
 
 " fourth 
 
 5.. 
 
 . . " 
 
 
 " " fifth 
 
 6.. 
 
 ( I 
 
 
 ' " " sixth 
 
 7. . 
 
 . . " 
 
 
 ' " " seventh 
 
 8.. 
 
 . . " 
 
 
 ' " " eighth 
 
 9.. 
 
 < < 
 
 
 ' " " ninth 
 
 10.. 
 
 . . " 
 
 
 ' " " tenth 
 
 11.. 
 
 < ( 
 
 
 ' " " eleventh 
 
 12.. 
 
 < < 
 
 
 " " " twelfth 
 
 thoracic ganglion
 
 66 
 
 SPINAL ADJUSTMENT 
 
 Spinal Nerve Sympathetic System 
 
 Lumbar 1 . . . . Two external branches from the first 
 
 Sacral 
 
 lumbar ganglion 
 
 2.... " 
 
 " " " second 
 
 < ( It 
 
 3 " " 
 
 " third 
 
 i I 11 
 
 4 " " 
 
 " fourth 
 
 1 i ( t 
 
 5 " " 
 
 " fifth 
 
 it 11 
 
 1 " 
 
 " " " first 
 
 ^.^cral " 
 
 2 " 
 
 " " " second 
 
 " 
 
 3 " " 
 
 " third 
 
 ( ( I i 
 
 4 " 
 
 " " " fourth 
 
 " 
 
 5 " 
 
 " " fifth 
 
 1 ( ( ( 
 
 Coccygeal Either with the last sacral or the coccygeal ganglion
 
 CHAPTER III 
 
 The Connection Between the Sympathetic Nervous System 
 and the Cranial Nerves 
 
 The Cranial Nerves. — Prior to a consideration of the con- 
 nection of the sympathetic nervous system with the cranial 
 nerves, a brief review of the cranial nerves themselves will 
 be given so as to make the connection more clearly defined. 
 
 The cranial nerves arise from certain parts of the brain, 
 and are transmitted through foramina in the base of the 
 cranium. They are named numerically according to the order 
 in which they pass through the dura mater lining the base of 
 the skull. Other names are also given to them, according 
 to their function or the particular system, organ, or part 
 of the body which they supply. 
 
 Taken in their order, from before backward, they are as 
 follows : 
 
 1st — Olfactory. 7th — Facial. 
 
 2nd — Optic. 8th — Auditory. 
 
 3rd — Motor oculi. 9th — Glosso-Pharyngeal. 
 
 4th — Trochlear (Pathetic). 10th — Pneumogastric (Vagus). 
 
 5th — Trifacial (Trigeminus). 11th — Spinal accessory. 
 
 6th — Abducens. 12th — Hypoglossal. 
 
 All the cranial nerves have two points of origin, a super- 
 ficial or apparent, and a deep or real origin. The superficial 
 origin is from some part on the surface of the brain. The 
 deep origin is from a special centre of gray matter, called 
 a nucleus, deeply situated in the substance of the brain. The 
 nerves, after emerging from the brain at their apparent 
 origin, pass through openings in the dura mater, leave the 
 skull through various foramina, and then pass on to their 
 final distribution. 
 
 The Sympathetics and the Cranial Nerves. — Reference to 
 any standard work on anatomy will inform the reader of the 
 
 67
 
 68 SPINAL ADJUSTMENT 
 
 fact that the superior cervical ganglion communicates with all 
 the cranial nerves. That this relation is an exceedingly inti- 
 mate and intricate one will be shown by the following descrip- 
 tion of the branches of communication between these two 
 portions of the nervous system. 
 
 We have seen that the superior cervical ganglion is situ- 
 ated in front of the transverse processes of the second and 
 third cervical vertebrae; also that it is formed by the coal- 
 escence of the four ganglia corresponding to the upper four 
 cervical vertebrae. The communicating branches which con- 
 nect the ganglion with the spinal nerves are what make the 
 ganglion continuous with the cerebro-spinal system, and per- 
 mit of the passage of impulses from the brain to the gang- 
 lion, and from it to its various branches of distribution. The 
 branches of communication are four in number, and con- 
 nect with the four upper cervical spinal nerves. We saw that 
 the sympathetic fibres pass through the intervertebral foramen 
 in the substance of the spinal nerve; therefore, a subluxation 
 of one of the four upper cervical vertebrae will produce a 
 direct pressure upon these branches in the intervertebral 
 foramen, and prevent the transmission of impulses from the 
 brain, through the communicating branch to the ganglion. 
 The absence of these impulses to the superior cervical gang- 
 lion will inevitably cause abnormalities in the parts supplied 
 by its branches of distribution, because we know that upon 
 the proper innervation through the sympathetic system 
 depends the health of any part of the body. 
 
 The superior cervical ganglion is the first ganglion of the 
 gangliated cord of the sympathetic nervous system, and has 
 the following five branches : superior, inferior, internal, 
 external, and anterior. 
 
 The superior branch is a direct upward prolongation of the 
 ganglion. It ascends by the side of the internal carotid 
 artery, and, entering the carotid canal in the temporal bone, 
 divides into two branches, an outer, which forms the carotid 
 plexus, and an inner, which forms the cavernous plexus. 
 
 The carotid plexus communicates with the Gasserian gang- 
 lion of the fifth cranial nerve from which are derived the oph- 
 thalmic, superior maxillary, and inferior maxillary nerves, 
 with the sixth nerve, the spheno-palatine ganglion which gives
 
 CRANIAL NERVES 69 
 
 off branches to the nose, palate and orbit, and with the tym- 
 panic branch of the glosso-pharyngeal nerve which supplies 
 the mucous membrane of the tympanum, the Eustachian tube, 
 and the mastoid cells. The communicating branches with the 
 sixth netve consist of one or two filaments which join that 
 nerve at the point where it lies on the outer side of the 
 internal carotid. The communication with the spheno-pala- 
 tine ganglion is through the vidian nerve which is formed 
 by the large deep petrosal nerve, a branch of the carotid 
 plexus, uniting with the great superficial petrosal. The 
 branches of communication with the tympanic nerve are the 
 small deep petrosal nerve and the carotico-tympanitic. The 
 Gasserian ganglion is united with the carotid plexus by a few 
 filaments from the latter. 
 
 The cavernous plexus communicates with the third, the 
 fourth, the ophthalmic division of the fifth, and the sixth 
 cranial nerves, and with the ophthalmic ganglion. The branch 
 of communication with the third nerve is at the point where 
 the latter divides; the branch of communication with the 
 fourth nerve unites with it as it lies on the outer wall of 
 the cavernous sinus; other filaments are connected with the 
 under surface of the ophthalmic nerve ; and a second filament 
 of communication unites with the sixth nerve ; the filament of 
 communication with the ophthalmic ganglion arises from the 
 anterior part of the cavernous plexus. 
 
 The external branches of the superior cervical ganglion are 
 numerous, and send ofif branches of communication with the 
 ganglion of the trunk of the pneumogastric nerve, and the 
 hypoglossal nerve. Another filament from the cervical gang- 
 lion subdivides and joins the petrosal ganglion of the glosso- 
 pharyngeal nerve and the ganglion of the root of the 
 pneumogastric nerve in the jugular foramen. 
 
 The internal branches are three in number : the pharyngeal, 
 which pass inward to the side of the pharynx, where they 
 join with branches from the glosso-pharyngeal, pneumogas- 
 tric, and external laryngeal nerves ; the laryngeal, which unite 
 with the superior laryngeal nerve and its branches; the supe- 
 rior cardiac, the right division of which receives filaments 
 from the external laryngeal nerve at about the middle of the 
 neck; lower down, one or two twigs from the pneumogastric;
 
 70 SPINAL ADJUSTMENT 
 
 and as it enters the thorax it is joined by a branch from the 
 recurrent laryngeal ; the left superior cardiac nerve ends in 
 the cardiac plexus. 
 
 The anterior branches of the superior cervical ganglion 
 ramify upon the external carotid artery and its branches, 
 forming delicate plexuses about them on the nerves compos- 
 ing which small ganglia are sometimes found. The plexus 
 that surrounds the external carotid communicates with a 
 branch of the facial nerve ; the plexus that surrounds the 
 facial artery sends one or two filaments to the submaxillary 
 ganglion, the sensory root of which is derived from the lingual 
 nerve, and the motor root from the chorda tympani, both 
 branches of the fifth cranial nerve ; the plexus that accom- 
 panies the middle meningeal artery sends off branches that 
 pass to the otic ganglion of the fifth cranial nerve, and the 
 geniculate ganglion of the seventh cranial nerve. 
 
 We have seen that the branches of communication between 
 the spinal nerves and cranial nerves are efferent or white, 
 and afferent or gray. The white rami communicantes of all 
 the thoracic spinal nerves and the first two lumbar spinal 
 nerves connect directly with the corresponding ganglia of the 
 gangliated cord. The first thoracic spinal nerve, however, 
 sometimes fails to connect in this manner. Above the first 
 or second thoracic pair of nerves, therefore, and below the 
 second lumbar pair, however, there is a different distribution 
 of the white rami communicantes. 
 
 The white rami that are given off by the cervical spinal 
 nerves and the cranial nerves do not unite with the ganglia 
 of the gangliated cords, but pass directly to the terminal 
 ganglia of the sympathetic nervous system. The white rami 
 of the lumbar spinal nerves, below the second lumbar pair, 
 also pass directly to the terminal ganglia. The sacral spinal 
 nerves, also, send their white rami to the terminal ganglia, 
 instead of first joining with the ganglia of the gangliated 
 cord. 
 
 Some of the branches of communication between the 
 ganglia of the gangliated cord corresponding to the upper 
 six thoracic vertebrae continue upward to unite with the 
 superior cervical ganglion. It is by means of these fibres 
 that the upper portions of the gangliated cords are supplied
 
 CRANIAL NERVES 71 
 
 from the spinal system. It will be remembered that the 
 white rami that connect the ganglia of the gangliated cords are 
 a direct continuation of the white fibres in the anterior divi- 
 sions of the spinal nerves. Since there is no direct connection 
 with the ganglia and the cervical spinal and cranial nerves by 
 such fibres, an indirect connection is produced by the white 
 fibres which pass uninterruptedly upward from the upper 
 six thoracic segments to the superior cervical ganglion. 
 
 It is through the existence of these fibres of white rami 
 communicantes in the gangliated cord that the cranial nerves 
 are influenced by any interference with the normal flow of 
 nerve impulses as a result of subluxations of any of the 
 upper six dorsal vertebrae. It is for this reason that adjust- 
 ments in the upper dorsal region influence the ear, eye, nose, 
 throat, and any other parts or organs of the body supplied 
 by the cranial nerves. 
 
 In like manner, some of the fibres of the white rami of 
 the gangliated cord below the level of the sixth thoracic gang- 
 lion and down to the second lumbar, which have a direct 
 communication with the spinal nerves of the corresponding 
 region, pass downward, and in that manner supply the lower 
 portions of the gangliated cords of the sympathetic nervous 
 system. 
 
 The gray rami communicantes from the superior cervical 
 ganglion communicate with all the cranial nerves. Some 
 of the fibres of the gray rami pass to the origin of the cranial 
 nerves in the brain, while others accompany the nerves 
 throughout all their distribution. The connection between 
 the superior cervical ganglion and the upper thoracic ganglia 
 of the gangliated cord, therefore, makes it possible to correct 
 any functional derangement of all the cranial nerves. Exam- 
 ples of a clinical nature to show that this is being done by 
 means of chiropractic are exceedingly numerous. 
 
 The cranial nerves all connect through communicating 
 fibres with the first four cervical spinal nerves. These spinal 
 nerves also are connected with the superior cervical gang- 
 lion of the sympathetic system by means of the gray rami. 
 The superior branch of the superior cervical ganglion com- 
 municates with the ganglion on the root, and the ganglion of 
 the trunk of the pneumogastric nerve. There is thus estab-
 
 72 SPINAL ADJUSTMENT 
 
 lished a connection between the cranial nerves and the vagus 
 by means of the sympathetic fibres. This connection is well 
 illustrated by the following example : An individual wit- 
 nesses an accident; the optic nerve conveys the impression 
 to the visual centers in the brain ; the sight of the accident 
 produces nausea; the nausea is simply a sympathetic dis- 
 turbance produced as a result of the connection between the 
 optic nerve and the vagus. The relation between gastric and 
 ocular disturbances may also be reversed ; thus the visual 
 disorders accompanying gastric disturbances are readily ex- 
 plained when the connection between the nervous mechanism 
 controlling each part is understood. 
 
 The following table shows the connection between the 
 cranial nerves and the sympathetic and spinal nervous system : 
 
 1st — Olfactory. — The olfactory nerve receives fibres from 
 the first to fourth cervical spinal nerves which receive gray 
 rami from the superior cervical ganglion of the gangliated 
 cord. It also connects with the sympathetic system through 
 the vagus, which receives fibres from the superior cervical 
 ganglion, which in turn communicates with the first four 
 cervical spinal nerves. Communication with the upper thoracic 
 ganglia also exists through the ascending fibres of white rami 
 connecting with the superior cervical ganglion. 
 
 2nd — Optic. — The optic nerve is connected with the first 
 and fourth spinal nerves which receive gray rami from the 
 superior cervical ganglion. The optic also is connected with 
 the ganglion on the trunk of the vagus which receives fila- 
 ments from the external branches of the superior cervical 
 ganglion. Terminal filaments from the carotid and cavernous 
 plexuses extend along the internal carotid artery, forming 
 plexuses which entwine around the cerebral and ophthalmic 
 arteries; the latter plexus passes into the orbit, and there 
 forms another plexus which accompanies the arteria centralis 
 retina ; the arteria centralis retina supplies the optic nerve, 
 and the nutrition of this nerve is thus controlled by the 
 superior cervical ganglion. 
 
 3rd — Motor Oculi.— The motor oculi nerve receives a 
 branch from the cavernous plexus. 
 
 4th — Trochlear. — The trochlear nerve receives a branch 
 from the cavernous plexus.
 
 CRANIAL NERVES 71 
 
 5th — Trigeminus. — The Gasserian ganghon receives 
 branches from the carotid plexus ; the otic ganglion receives 
 branches from the plexus surrounding the middle meningeal 
 artery; the spheno-palatine ganglion connects with the supe- 
 rior cervical ganglion through the large deep petrosal nerve 
 from the carotid plexus ; the ophthalmic ganglion receives 
 a branch from the anterior part of the cavernous plexus, and 
 then accompanies the nasal nerve ; the submaxillary ganglion 
 receives branches from the plexus surrounding the facial 
 artery. 
 
 6th — Abducens. — The abducens nerve receives branches 
 from the carotid and cavernous plexuses. 
 
 7th — Facial. — The geniculate ganglion communicates with 
 the sympathetic plexus on the middle meningeal artery 
 through the external superficial petrosal nerve, with Meckel's 
 ganglion through the large superficial petrosal nerve, and 
 with the otic ganglion through the small superficial petrosal 
 nerve; the facial nerve also communicates with the auditory 
 nerve in the internal auditory meatus ; with the auricular 
 branch of the pneumogastric in the Fallopian aqueduct ; with 
 the glosso-pharyngeal, the pneumogastric, the auricularis 
 magnus, and the auriculo-temporal at its exit from the stylo- 
 mastoid foramen ; with the small occipital behind the ear ; 
 with the three divisions of the fifth on the face ; and lastly 
 with the superficial cervical in the neck. 
 
 8th — Auditory. — The auditory nerve receives a branch 
 from the geniculate ganglion, which connects with the su- 
 perior cervical ganglion through the external petrosal nerve; 
 it also connects with the upper thoracic ganglia of the gangli- 
 ated cord through the connection of the ascending fibres of 
 the white rami with the superior cervical ganglion. 
 
 9th — Glosso-pharyngeal. — The petrous ganglion receives 
 a branch from the superior cervical ganglion of the sym- 
 pathetic; Jacobson's nerve receives a branch from the carotid 
 plexus of the superior cervical ganglion ; there is also a branch 
 of communication with the pneumogastric. namely one to its 
 auricular branch and one to the ganglion of the root of the 
 vagus ; lastly, it communicates with the facial nerve. 
 
 10th — Pneumogastric. — The pneumogastric nerve com- 
 municates in the thorax with the pharyngeal, laryngeal, car-
 
 74 SPINAL ADJUSTMENT 
 
 diac, pulmonary, and esophageal plexuses ; in the abdomen 
 with the solar, celiac, gastric, hepatic, and splenic plexuses ; 
 the ganglion of the root of the pneumogastric communicates 
 with the sympathetic by means of the external branch of the 
 superior cervical ganglion ; the ganglion of the trunk also 
 unites with external branches from the superior cervical 
 ganglion ; the recurrent laryngeal branch unites with the right 
 superior cardiac nerve, which is one of the internal branches 
 of the superior cervical ganglion; the external laryngeal and 
 one or two other twigs from the pneumogastric also unite with 
 the right superior cardiac nerve ; the recurrent laryngeal and 
 external laryngeal nerves also communicate with thyroid 
 branches from the middle cervical ganglion ; the vagus also 
 sends branches of communication with the first and second 
 cervical spinal nerves. 
 
 11th — Spinal accessory.^ — The spinal accessory is connected 
 with the ganglion of the root of the vagus by a few fibres ; it 
 also communicates with the cervical spinal nerves ; it is con- 
 tinuous with the vagus to the pharyngeal and laryngeal 
 branches of the latter ; some few filaments are continued into 
 the trunk of the vagus and distributed with the recurrent 
 laryngeal and the cardiac nerves. 
 
 12th — Hypoglossal. — The hypoglossal nerve unites with 
 external branches from the superior cervical ganglion ; it also 
 has a branch from the first and second cervical spinal nerve ; 
 it gives ofT a branch to the ganglion of the trunk of the vagus ; 
 it also communicates with the lingual nerve. 
 
 Since all the cranial nerves connect with the superior cer- 
 vical ganglion, it is easily comprehended how they are influ- 
 enced by subluxations in the cervical or upper thoracic regions. 
 The connection between the cranial nerves and the sympa- 
 thetic nervous system is as intimate as that between the spinal 
 nerves and the sympathetics. Therefore, any interference 
 with the conduction of impulses from one system to the other 
 or anything which prevents a harmonious action, will produce 
 disturbances in the portions of the body supplied by the part 
 of the sympathetic system involved in a subluxation of a 
 vertebra.
 
 CHAPTER IV 
 
 The Physiology of the Nervous System 
 
 Having established the connection between the cerebro- 
 spinal system and the sympathetic nervous system, it now 
 becomes necessary to consider the physiology of the nervous 
 system. The physiology of every portion of this, the govern- 
 ing mechanism of the body, must be thoroughly understood, 
 for upon such a knowledge depends a proper conception of 
 disturbed functions or organic changes in any organ, part, or 
 system of the body. In considering this subject the function 
 of each topographical division of the nervous system will be 
 taken up separately. It must be constantly borne in mind, 
 as previously pointed out, that from a physiological viewpoint 
 no such divisions exist, but that the cerebro-spinal and sym- 
 pathetic systems constitute an entity, both anatomically and 
 physiologically. The separation of one from the other is 
 purely for convenience of description. In the present chapter, 
 therefore, the function of the cerebro-spinal system will be 
 considered. 
 
 The Origin of Nerve Impulses. — The basic principle un- 
 derlying the study of the physiology of the nervous system is 
 this : that in the brain and spinal cord, being the central axis 
 of the nervous system, all impulses either originate or are 
 received. That is to say, all efferent or out-going impulses 
 are generated in the brain ; and all afferent or incoming im- 
 pulses terminate in the brain. 
 
 The functional activity and the organic integrity of every 
 part of the body are governed and maintained by the efferent 
 impulses, which originate in the brain, and are transmitted 
 along the course of the nerve-fibres to their proper destination. 
 The proper relationship of all parts of the body, individually 
 and collectively, to their environment, is maintained by the 
 flow of afferent impulses from the periphery to the brain. 
 
 The Function of the Nerve-Fibres. — The office of nerve- 
 fibres is to convey impulses. This is made possible by reason 
 of their inherent property of irritability and conductivity. The 
 
 75
 
 76 SPINAL ADJUSTMENT 
 
 impulse conveyed by the nerve is the resultant of a stimulus 
 applied to the end organ of the nerve in the brain or periphery. 
 The effect of this stimulus is produced at the termination of 
 the nerve which carries the impulse created by the stimulus. 
 The effect of the stimulus, therefore, depends upon the nature 
 of the end organ of the nerve. 
 
 A nerve-fibre is either afferent or centripetal, or efferent or 
 centrifugal. The same fibre cannot be used for the one pur- 
 pose at one time, and for the other at another. For example, 
 if a cerebro-spinal nerve-fibre is irritated by electrifying it, 
 there is but one of two effects — either pain is produced, or 
 there is twitching of a certain muscle or muscles governed by 
 fibres from this nerve. Therefore, when a nerve is thus irri- 
 tated, there is either an impulse conducted by it to the brain, 
 when there is pain ; or there is an impulse conveyed to the 
 muscle, when there is movement. 
 
 As a result of the unvarying effects of such stimulation, 
 nerves have been classed as sensory and motor. However, 
 such a classification of nerve function is not broad enough, 
 since the nerves have other functions. The electrification of 
 nerves is an artificial stimulus, and while the results of such a 
 stimulus are either pain or movement, the natural stimuli on 
 centripetal nerves do not always produce pain, nor is move- 
 ment always produced when stimuli are applied to a centrif- 
 ugal nerve. But the effects vary, and, as stated above, de- 
 pend upon the nature of the end-bulb or plate of the nerve 
 stimulated. 
 
 The effects of excitation of an afferent or centripetal nerve 
 may be classed as follows: 
 
 (a) Pain or other form of sensation. 
 
 (b) Touch. 
 
 (c) Taste. 
 
 (d) Smell. 
 
 (e) Hearing. 
 
 (f) Sight. 
 
 (g) Temperature, 
 (h) Muscular sense. 
 
 (i) Reflex action of some kind, 
 (j) Inhibition, restraint of action.
 
 PHYSIOLOGY OF NERVOUS SYSTEM 77 
 
 The effects of stimulation of an efferent or centrifugal 
 nerve arc the following: 
 
 (a) Contraction of muscle (motor nerve). 
 
 (b) Influence on nutrition (trophic nerve). 
 
 (c) Influence on secretion (secretory nerve). 
 
 (d) Inhibit, augment, or stop another efferent action. 
 
 Sensations. — Sensations are the result of the stimulation of 
 certain centres in the brain, by irritations conveyed to them 
 by aft'erent nerves. By means of these sensations the mind 
 obtains a knowledge of the existence both of the various parts 
 of the body, and of the external world. For the production of 
 these sensations, three structures are necessary : first, a pe- 
 ripheral organ for the reception of the impression ; second, a 
 nerve for conducting it; third, a nerve-centre for feeling or 
 perceiving it. 
 
 These sensations are classed as, (a) Common and (b) 
 Special. 
 
 What principally distinguishes them is that by the common 
 sensations the individual is made aware of certain conditions 
 of various parts of his body ; while from the special sensations 
 he gains a knowledge of the external world also. This dif- 
 ference can be illustrated by comparing the sensations of 
 pain and touch, the former being a common, while the latter 
 is a special sensation. If we touch the skin with the point 
 of a pin, we feel the point by means of our sense of touch ; 
 we perceive a sensation, and think of the object which caused 
 it. But if we puncture the skin with the point of the pin, a 
 pain is felt, a feeling which is felt within ourselves, and by 
 this sensation we are not able to determine what the object was 
 that caused this sensation, because a sensation of pain does 
 not refer to the pin, but simply to the fact that there is a 
 changed condition of the body. 
 
 It must be remembered that the seat of sensation is in the 
 sensorium in the brain, and not in the particular end-organ 
 which receives the impression. Thus we say that we see with 
 our eyes and hear with our ears ; but these organs merely re- 
 ceive the impressions, which being transmitted to the optic 
 and auditory centres in the brain are there perceived as sen- 
 sations and interpreted.
 
 78 SPINAL ADJUSTMENT 
 
 If, for example, the free flow of impulses through the 
 optic nerve is interrupted, sight is lost, because, although 
 the retina receives the impressions, the connection between it 
 and the sensorium is broken. A subluxation in the upper 
 cervical region of the vertebral column, by causing an inter- 
 ference with the gray rami connection between the cervical 
 spinal nerves and the superior cervical ganglion of the 
 sympathetic system, will cause the impressions made upon the 
 retina to be imperfectly conveyed to the sensorium and de- 
 fective vision results. It is for this reason that spinal adjust- 
 ment in the upper cervical region so often relieves impaired 
 vision. 
 
 The cause of excitation of some part of the brain may be 
 some object of the external world, which is termed an objective 
 sensation. Or, the cause of the excitation may be due to some 
 excitement in the brain itself, when it is called subjective. We 
 habitually refer all sensations received to the external causes, 
 even when they are in reality subjective. In this way illusions 
 are produced, such as hearing musical sounds when the 
 auditory nerve is irritated, or seeing various unreal objects 
 during delirium. External influences may also produce illu- 
 sions of sensation ; for example, a blow causes the seeing of 
 "stars" by the eye, a sense of ringing of the ears, a salty taste 
 on the tongue, and a shock over the entire body. 
 
 Common Sensations. — These include sensations which can- 
 not be referred to any special part of the body, and are classed 
 as follows : 
 
 (a) Discomfort (including a sensation referred to the 
 fauces and stomach). 
 
 (b) Fatigue. 
 
 (c) Faintness. 
 
 (d) Hunger. 
 
 (e) Thirst. 
 
 (f) Satiety. 
 
 (g) Irritations of the bronchial mucous membrane, pro- 
 ducing coughing. 
 
 (h) Sensations from various viscera which indicate a 
 necessity to expel their contents, as, defecation, urination, 
 labor in the female.
 
 PHYSIOLOGY OF NERVOUS SYS'IEAI 79 
 
 (i) Itching, creeping, tingling, burning, tickling, aching, 
 (some of which come under the head of pain). 
 
 (j) Muscular sense. 
 
 (k) Touch is the connecting link between the common 
 and special sensations. 
 
 Special Sensations. — These are the following: 
 
 (a) 
 
 Touch. 
 
 (b) 
 
 Taste. 
 
 (c) 
 
 Smell. 
 
 (d) 
 
 Hearing. 
 
 (e) 
 
 Sight. 
 
 Touch. — The sense of touch renders us conscious of the 
 presence of a stimulus, from the mildest to the most severe 
 form, by that something which we term feeling, or common 
 sensation. The end-organs of all sensory nerves are in reality 
 also organs of touch, and upon their irritability depends the 
 acuteness of this sense. All parts of the body are therefore 
 susceptibe to touch, especially the skin, tongue, and lips. 
 
 The three varieties of touch are: (1) Touch proper, tactile 
 sensibility or pressure ; (2) Temperature ; (3) Pain. 
 
 Many of the varieties of common sensation mentioned 
 above come under the head of touch, as hunger, thirst, satiety, 
 irritations, weight, and itching, creeping, tingling, etc., when 
 not amounting to actual pain. 
 
 All these varieties of touch sensibility are dependent on 
 normal irritability and conductivity of the afferent nerves 
 from the periphery to the sensorium. Pressure upon the 
 nerves transmitted by the intervertebral foramen will conse- 
 quently cause disturbances of the sense of touch, the clinical 
 significance of which will be explained further on. 
 
 Temperature. — The entire surface of the body is more or 
 less sensitive to differences of temperature. The power of 
 discriminating temperatures may remain when the sense of 
 touch is temporarily lost; this shows that there are special 
 nerves and nerve-endings for temperature. 
 
 The nerves of temperature convey the sensation that a 
 given object is cooler or warmer than the skin. The tem- 
 perature of the skin is thus the standard. This varies from
 
 80 SPINAL ADJUSTMENT 
 
 hour to hour according to the activity of the cutaneous cir- 
 culation. The vaso-motor nerves of the sympathetic system 
 govern the circulation, and when their function is in abeyance, 
 vaso-dilation with increased surface temperature results. 
 This physiological fact is the basis of the "Heat Test," used 
 in spinal analysis, for when a nerve is compressed by a cer- 
 tain vertebra, the skin of the segment of the back correspond- 
 ing thereto is found to be warmer, and it is a fact that at such 
 segments subluxations can be invariably found. 
 
 Subjective Sensations. — These, which are dependent upon 
 internal causes, are very frequent in the sense of touch. All 
 sensations of heat and cold, pleasure and pain, lightness and 
 weight, fatigue, etc., may be produced by internal causes. 
 Examples of subjective sensations are, sensations of chilliness, 
 creeping of ants (formication) etc. The mind has a wonder- 
 ful faculty of exciting sensations in the nerves of common 
 sensibility. Thus the thought of something nauseating pro- 
 duces the feeling of nausea ; and the idea of pain will give rise 
 to pain in a part predisposed to it. 
 
 Pain. — There are various views concerning which nerves 
 and nerve-endings convey this sensation. That there is a 
 special pain sense with special nerves and end-organs is not 
 likely. The sensation of pain is most probably due to an over- 
 stimulation of a nerve of special sensation or its end-organ. 
 
 Muscular Sense. — It is by means of this sense that w'e are 
 made aware of the condition of the muscles, and thus obtain 
 the information required for adjusting them to various pur- 
 poses — standing, walking, grasping, etc. This muscular sen- 
 sibility is shown by our power to estimate the difference be- 
 tween weights by the different muscular efforts required to 
 raise them. This sense must be distinguished from the sense 
 of contact and of pressure, for the skin is the organ of these. 
 
 We have the power of determining beforehand the amount 
 of nervous influence necessary for the production of a certain 
 degree of movement. Thus when we lift a vessel the force 
 which we employ in lifting it depends upon the idea which 
 we have formed of its contents, when we are not certain what 
 it contains. If it should, therefore, contain something much 
 lighter than we had estimated, useless force would be ex- 
 pended, and it would be lifted with exceptional ease ; but if it
 
 PHYSIOLOGY OF NERVOUS SYSTEiM 81 
 
 contain something much heavier than we had anticipated, we 
 would very likely drop it, because insufficient force was ex- 
 pended to accomplish the end desired. This proves that the 
 amount of nerve influence generated by the brain must always 
 be commensurate with the amount of work required of the 
 parts supplied by the nerves. Just as the response of muscles 
 is proportionate to the amount of nerve force received by 
 them, so also are the functional activities of all other parts of 
 the body dependent on this influence. Anything, therefore, 
 which interferes with the conduction of the requisite amount 
 of nerve force for the performance of its function by any organ, 
 necessarily must be considered the primary factor in the pro- 
 duction of disease of that organ. 
 
 Taste. — There are three conditions necessary for the per- 
 ception of taste : First, the presence of a specially endowed 
 nerve-centre and a nerve to conduct the stimulus produced ; 
 this stimulus is the result of the production of a change in 
 the condition of the gustatory nerves, and this stimulus being 
 conducted to the nerve-centre produces the sense of taste. 
 Second, the matters to be tasted must either be in a state of 
 solution or be readily dissolved by the moisture of the tongue ; 
 for this reason dry powders are usually tasteless, and merely 
 produce a sensation of touch on the tongue. Third, the sur- 
 face with which these matters come in contact must also be 
 moist, and the temperature be of about 100° F. ; therefore, 
 when the tongue or fauces are dry, substances are tasted with 
 difficulty, even though they be moist. 
 
 Taste, like any other sensation is perceived in the sensorium 
 in the brain, and is usually referred to the tongue ; but the soft 
 palate, uvula, tonsils, and throat are also endowed with taste. 
 These parts derive their sense of taste from the glosso- 
 pharyngeal nerve, branches of which supply them. Besides 
 the sense of taste, the tongue also is endowed with the sense 
 of touch; it may lose either of these senses and retain the 
 other. This shows that the nervous conductors for these two 
 different sensations are distinct, and since the glosso-pharyn- 
 geal nerve also contains fibres of common sensation, as well 
 as the fifth nerve which supplies the tip of the tongue with 
 taste, the same nerve trunk may contain fibres having en- 
 tirely different properties.
 
 82 SPINAL ADJUSTMENT 
 
 Smell. — The conditions necessary to the sense of smell are 
 the following: First, a special set of nerves and nerve-end- 
 ings, the changes in whose condition produce stimulation of a 
 special nerve-centre which perceives the sensation of odor. 
 The same substance which excites the sense of smell in the 
 olfactory centre may also cause another sensation through the 
 nerves of taste, and produce a burning sensation on the nerves 
 of touch. Second, the matters which stimulate the nerve- 
 endings which are either finely divided particles floating in 
 the air or are in the form of gaseous vapors, must first be 
 brought into solution, for which purpose the mucous lining 
 of the nose must be moist. When the Schneiderian membrane 
 is dry, the perception of odors is lost, and thus in the first 
 stage of nasal catarrh, when the mucous secretion in the 
 nostrils is diminished, the sense of smell is imperfect or lost. 
 Third, it is also essential that the odorous matter be trans- 
 mitted through the nostrils in a current. This is accomplished 
 by breathing through the nose with the mouth closed ; we 
 are thus able to control the sense of smell, for by interrupting 
 the respirations we can prevent the perception of odors ; in 
 like manner the perception of odors is increased by rapid 
 inspiration, as snififing. 
 
 The sense of smell is derived from the olfactory nerves. 
 These nerves connect with the superior cervical ganglion of 
 the sympathetic system, as do all the cranial nerves, and spinal 
 adjustment in the cervical and upper dorsal regions restore 
 the sense of smell as well as of taste in a great many instances, 
 where no actual destruction of the nerve centres has occurred. 
 
 Hearing. — The essential part of the organ of hearing is the 
 internal ear. The other two portions, namely the external and 
 middle ear, are merely accessory. The sense of hearing is 
 produced by the exposure of the filaments of the auditory 
 nerve to sonorous vibrations. The auditory nerve filaments 
 are distributed within the labyrinth of the inner ear, which 
 consists of a set of cavities in the petrous portion of the 
 temporal bone. The labyrinth contains peculiar cells, called 
 rod-cells, which vibrate in unison with certain tones and thus 
 strike a particular note, the sensation of which is carried to 
 the brain by those filaments of the auditory nerve with which 
 the auditory apparatus is connected.
 
 PHYSIOLOGY OF NERVOUS SYSTEM 83 
 
 Subjective sounds are produced by any irritation of the 
 auditory nerve or other portions of the auditory apparatus. 
 Thus are explained the buzzing and ringing sounds heard by 
 those individuals suffering from nervousness, cerebral disease, 
 vascular congestion of the head and ear, and irritation of the 
 auditory nerve. 
 
 The auditory nerve, being connected with the superior 
 cervical ganglion of the gangliated cord of the sympathetic 
 system, may be influenced by adjustment of subluxated ver- 
 tebrae in the upper cervical and upper thoracic regions. Some 
 cases, however, do not respond, and when this is so, it is due 
 to pathological changes in the internal ear as a result of long- 
 continued catarrh. 
 
 Sight. — The sense of sight is produced by the following 
 process: A ray of light reflected from any object causes vi- 
 brations of the luminiferous ether which are transmitted 
 through the iris of the eye; these rays then pass through the 
 refractive media of the eye-ball and finally impinge upon the 
 retina ; the endings of the nerves of sight in the retina, namely 
 the rods and cones, convey the impulse thus produced to the 
 optic nerve, which transmits the sensation to the visual 
 centres of the sensorium in the brain; here the size, form, etc., 
 of the object are correctly interpreted or estimated. 
 
 Numerous instances are on record pointing to the marked 
 influence exerted by the sympathetic system upon the optic 
 nerves, as shown by the clinical results achieved by adjust- 
 ment of subluxated vertebrae in the cervical and upper dorsal 
 regions. 
 
 Reflex Action. — This is an action depending upon the 
 power possessed by nerve-cells of sending out to the periphery 
 impulses along efferent nerves in response to impulses reach- 
 ing them from afferent nerves. It is supposed that when an 
 impulse reaches a ner\'e-cell, a change in its metabolism occurs, 
 resulting in a discharge of energy. This discharge is con- 
 ducted out along the course of an efferent nerve as a stimulus, 
 which differs in the action which it produces according to 
 the nature of the terminals of the nerve; the action which is 
 produced may be secretory, motor, nutritive, etc. Such reflex 
 act may be limited in its effect, or it may be extensive. Those 
 reflex movements which occur independently of sensation are
 
 84 SPINAL ADJUSTMENT 
 
 generally called excito-motor ; those which are guided or ac- 
 companied by sensation, but not constituting an intellectual 
 process, are called sensori-motor. 
 
 The following things are necessary for the development 
 of every reflex action : (a) One or more perfect afferent fibres 
 to conduct an impression received at the periphery; (b) A 
 nerve centre for receiving the impression, and by which it 
 may be reflected ; (c) One or more efferent fibres along which 
 the impression is conducted outward ; (d) The tissue by which 
 the effect of the action is manifested. For the production of 
 a reflex act there must therefore be two perfect, unimpinged 
 neurons, a sensory or afferent, and a motor or efferent one. 
 
 Essentially all reflex actions are involuntary, although most 
 of them are capable of being modified, controlled, or prevented 
 by a voluntary effort of the will. 
 
 Reflex actions which are performed in health have a dis- 
 tinct purpose, and are adapted to producing some end w^hich 
 is desirable and necessary for the well-being of the body; in 
 disease, however, many of them are irregular and purposeless. 
 
 In the simplest form of reflex action it may be supposed 
 that a single efferent and afferent neuron are concerned. But 
 in the majority of actual reflex actions many neurons are very 
 likely engaged. The impulse is carried by collaterals up and 
 down to different levels of the cord, and thus a number of 
 groups of cells are affected. 
 
 The reflex effect produced by the stimulation of a sensory 
 surface, depends not alone on the strength of the stimulus, but 
 also upon the condition of the nerve-centre, and upon the un- 
 impeded conductivity of the nerves involved in the action. 
 
 The result of stimulation of a reflex centre may be not 
 only an outgoing impulse which stimulates the parts con- 
 trolled by its peripheral endings to activity. It may also 
 prevent or stop an action already going on, or it may aug- 
 ment, make more powerful or extensive, or increase in a cer- 
 tain direction an action already going on. 
 
 Automatism. — This is an automatic action which is not 
 dependent for its discharge upon any afferent stimuli, but is 
 produced by the nerve-centre which of itself sends out efferent 
 impulses of various kinds. The nerve-centre is supposed to 
 do this by the nature of its own metabolism — the building up
 
 PHYSIOLOGY OF NERVOUS SYSTEM 85 
 
 of the explosive substance being anabolic, while the discharge 
 of this force is catabolic. This is the kind of impulses which 
 are constantly going out and keep the muscles in a state of 
 continuous contraction or tone. 
 
 Inhibition and Augmentation. — Not only may the move- 
 ments of muscles, the discharge of secretions from glands, and 
 other actions be the result of afferent impulses stimulating the 
 nerve-centres, but inhibition of such action which is already 
 going on may be produced. This is well illustrated by the 
 inhibitory action of the vagus upon the contractions of the 
 heart. The vagi convey to the heart impulses from the cardio- 
 inhibitory centre which have a restraining action upon the 
 activity of the heart ; thus it is that appropriate afiferent 
 stimuli, as, for example, when applied to the abdominal 
 sympathetic, may increase the action of the centre to such an 
 extent as to altogether stop the heart during diastole. The 
 action of almost any other centre may be inhibited in like 
 manner by impulses reaching it ; or conversely, if appropriate 
 stimuli fail to reach it, its action is disturbed, and the in- 
 hibitory action is destroyed, so that the heart, for example, 
 beats very rapidly when all the afiferent impulses are pre- 
 vented from reaching the cardio-inhibitory centre as a result 
 of a vertebral displacement in the upper cervical or upper 
 dorsal regions of the spinal column.
 
 CHAPTER V 
 
 The Physiology of the Nervous System — (Continued) 
 
 In the preceding chapter the afferent function of the nerves 
 was considered; in this chapter we will study their efferent 
 function. 
 
 A thorough knowledge of the efferent function of the nerv- 
 ous system is as essential as that of the afferent nerves, for 
 upon such a knowledge depends a proper appreciation of the 
 results of any interference with their action. Such interfer- 
 ence, produced by pressure upon the nerves at the interver- 
 tebral foramina, prevents their conduction of impulses, and 
 we have seen that upon these impulses depends the action 
 which takes place at the terminations of the nerves. Derange- 
 ment of the function of the different parts of the body is a 
 result of such impeded nerve action. 
 
 Efferent Action of Nerves. — The eft'ects of stimulation of 
 an efferent or centrifugal nerve are the following: (a) Con- 
 traction of muscle (motor nerve), (b) Influence on nutrition 
 (trophic nerve), (c) Influence on secretion (secretory nerve), 
 (d) Inhibit, augment, or stop another efferent action. We 
 will now consider the various kinds of action under each of 
 these heads. 
 
 The Motor Functions.— Every movement made by any 
 part of the body depends upon the contraction of a muscle as 
 a result of an efferent impulse to it from the nerve which 
 controls it. Thus, every conscious and unconscious act per- 
 formed by the human organism is accomplished through the 
 medium of a muscle or group of muscles. It is through muscu- 
 lar action, dependent upon nerve impulses, that we stand erect, 
 have the power of locomotion, that the face has expression, 
 that the heart forces the blood onward, that respiratory move- 
 ments occur, that the viscera, as the stomach and intestines, 
 move and perform their functions, that the secretions of the 
 glands are produced, and so on. There must necessarily be 
 some controlling influence which guides the definite and 
 proper action of the muscles, and it is the brain which acts 
 in this capacity, by the generating of impulses which are 
 
 86
 
 PHYSIOLOGY OF NERVOUS SYSTEM 87 
 
 transmitted along the nerves. All the movements outlined 
 above are governed by a separate and distinct centre in the 
 brain, and depend for their performance upon an impulse sent 
 from this centre along the course of a special nerve, to the 
 muscle which produces it. Anything which prevents the 
 uninterrupted conduction of this impulse prevents action tak- 
 ing place in that part of the body for which the particular 
 impulse was destined. 
 
 Not only are movements of the muscles dependent upon 
 impulses originating in the brain, namely elTerent impulses, 
 but they are also produced as a result of those external in- 
 fluences upon the periphery which cause a reflex action. The 
 afferent impulse being changed to an efferent one, as occurs 
 in a reflex action, produces a contraction of a certain muscle, 
 depending upon the spinal segment involved. 
 
 The two forms of motion possessed by all muscles are 
 contraction and relaxation. While the muscle is contracted, 
 it is rigid ; while it is relaxed, it is lax. When the nervous 
 system is perfectly intact, there is a continuous flow of effer- 
 ent impulses which maintain the muscles in a state of constant 
 contraction. This produces an exactly balanced state of con- 
 traction on corresponding portions of each lateral half of the 
 body. If there is a disturbance of the centre in the brain, or 
 if there is an interference with the flow of these impulses, or 
 if there are reflex disturbances, this harmonious balance is 
 disturbed, and is followed by a greater contraction of the 
 muscles of one side of the body than of those of the other 
 side. This is very clearly shown in facial paralysis where the 
 muscles of one side of the face are relaxed and are conse- 
 quently drawn to the other side by the action of the muscles 
 of the unaffected side, by the constant contraction present in 
 the latter. 
 
 As an example of interference with the conduction of the 
 impulses controlling this state of muscular contraction, we 
 may consider a subluxation of a vertebra. This subluxation 
 causes pressure upon the nerves passing through the cor- 
 responding intervertebral foramen ; these nerves send branches 
 to the ligaments and muscles of the spinal column ; as a result 
 of the impingement upon the nerves, the impulses which are 
 necessary to maintain the muscles of that segment of the
 
 gg SPINAL ADJUSTMENT 
 
 spine do not reach the muscle, and it becomes relaxed ; the 
 opposite side, not being affected, draws the bones, namely 
 the vertebrae, toward that side, and takes the vertebra out 
 of its proper alignment. We see in this fact the basis for the 
 permanence of a subluxation until corrected by mechanical 
 means. 
 
 We are daily exposed to various forms of irritation which 
 produce stimuli upon the peripheral endings of afferent 
 nerves. The impulses thus generated are transferred to an 
 efferent nerve-fibre and produce contraction of the muscle 
 controlled by the segment affected. For example, the irritant 
 may be a draught of cold air striking the surface ; this stimu- 
 lus to the afferent nerves reflexly produces a contraction of 
 the muscles of one side of the neck, making them rigid. This 
 contraction of one side may produce a subluxation of a cer- 
 vical vertebra; this may be so slight that it will be spon- 
 taneously relaxed during sleep ; but if sufficient impingement 
 of the nerves is produced, the displacement may be permanent, 
 and lead to various disorders of function of the parts supplied 
 by that particular segment of the vertebral column. 
 
 The Trophic Function. — The second efferent action of 
 nerves enumerated is their influence on nutrition. Nutrition 
 or assimilation is probably the most universal of the five 
 properties of all living matter. By this term we designate the 
 series of changes through which dead matter is received into 
 the structure of living substance. In its broadest sense it 
 includes the subsidiary processes of digestion, respiration, 
 absorption, secretion, excretion, anabolism, and catabolisjn. 
 
 Assimilation and disassimilation, or anabolism and cata- 
 bolism, go hand in hand, and together constitute an ever-re- 
 curring cycle of activity that persists as long as life lasts. It 
 is designated under the name metabolism. In most forms of 
 living matter metabolism is in some way self-limited, so that 
 it gradually becomes less perfect, then old age comes on, and 
 finally death follows. 
 
 The Secretory Function. — The function of gland cells is 
 to produce certain substances called secretions. These ma- 
 terials are of two kinds, namely, those which are designed to 
 perform a certain function in the economy, and those which 
 are discharged from the body as useless or injurious. In the
 
 PHYSIOLOGY OF NERVOUS SYSTEM 89 
 
 former case the materials formed are termed true secretions, 
 in the latter they are termed excretions. 
 
 The secretions do not exist in the same form in the blood, 
 but require a special process and special cells for their pro- 
 duction, for example, the glands of the stomach for the forma- 
 tion of gastric juice, the mammary gland-cells for the forma- 
 tion of milk, and so on. The excretions, however, consist of 
 substances which exist ready-formed in the blood, and are 
 merely abstracted from it. 
 
 Every secreting apparatus possesses three essential parts ; 
 a basement membrane, certain cells, and blood-vessels. These 
 three structural elements are arranged in various ways, but all 
 the varieties come under two classes, namely, membranes and 
 glands. 
 
 The principal secreting organs are the following: 1, the 
 serous and synovial membranes ; 2, the mucous membranes 
 with their special glands, as the buccal, gastric, and intestinal 
 glands ; 3, the salivary glands ; 4, the pancreas ; 5, the mammary 
 glands ; 6, the liver ; 7, the lachrymal glands ; 8, the skin ; 9, the 
 kidneys; 10, the testes; 11, the ovaries; 12, the thyroid gland; 
 13, the adrenals; 14, the petuitary body; 15, the spleen. 
 
 The process of secretion is greatly influenced by the nerv- 
 ous system. It has this influence by virtue of its power of in- 
 creasing or diminishing the blood-supply of secreting organs ; 
 also it exercises a direct influence upon the gland-cells them- 
 selves, which may be called a trophic influence. Its influence 
 on secretion may be excited by causes acting directly upon 
 the nerve-centres, upon the nerves going to the secreting or- 
 gan, or upon the nerves of other parts. In the last-named case 
 the action produced is reflex ; thus the contact of food with 
 the mucous membrane reflexly excites a free flow of saliva. 
 Various conditions of the brain also may stimulate the nerves 
 of secretion, such as the mere thought of food exciting a flow 
 of gastric juice, the tears excited by sorrow or excessive joy, 
 the discharge of urine in hysterical paroxysms, etc. Further 
 facts regarding the nervous mechanism of secretion will be 
 given in the chapter on the function of the sympathetic sys- 
 tem. 
 
 Inhibition and Augmentation. — These functions of efferent 
 nerves have been considered in the previous chapter, since
 
 90 SPINAL ADJUSTMENT 
 
 they depend for their production upon the excitation of a 
 nerve-centre by a stimulus carried to it by an afferent nerve. 
 The impulse which produces various forms of inhibition or 
 augmentation at the terminals of the nerves is a centrifugal 
 one. Thus the vagi convey to the heart from the cardio- 
 inhibitory centres impulses which restrain its contractions. 
 
 The Cranial Nerve Functions. — The physiology of the 
 First, Second, and Eighth cranial nerves has been considered 
 under the special senses. We will now briefly consider the 
 function of the others. 
 
 According to their several functions the cranial nerves may 
 be classed as follows : 
 
 (a) Nerves of special sense — Olfactory, Optic, Auditory, 
 part of the Trigeminal, and part of the Glosso-pharyngeal. 
 
 (b) Nerves of common sensation — The greater part of the 
 Trigeminal. 
 
 (c) Nerves of motion — Motor Oculi, Trochlear, lesser 
 division of the Trigeminal, Abducens, Facial, and Hypoglossal. 
 
 (d) Mixed nerves — Glosso-pharyngeal, Pneumogastric, 
 and Spinal accessory. 
 
 The 1st Nerve, or Optic, is the nerve of sight. 
 
 The 2nd Nerve, or Olfactory, is the nerve of the sense of 
 smell. 
 
 The 3rd Nerve, or Motor Oculi, supplies the levator palpe- 
 brae superioris muscle, and all the muscles of the eye-ball 
 except the superior oblique and external rectus ; also the iris 
 and ciliary muscle. The functions of the eye derived from 
 the impulses through this nerve are, accommodation, contrac- 
 tion of the pupil, and movement of the eye-ball. 
 
 The 4th Nerve, or Trochlear, has only a motor function, 
 supplying the superior oblique muscle of the eye-ball. 
 
 The 5th Nerve, or Trigeminal, is a nerve of special and 
 common sensation, and motion. The first and second di- 
 visions are purely sensory ; the third, or non-gangliated di- 
 vision is both motor and sensory. Its motor portion supplies 
 the muscles of mastication. Its sensory portion supplies all 
 the anterior and antero-lateral parts of the face and head ex- 
 cept the skin of the parotid region. It also confers common 
 sensibility to the organs of special sense. It also provides
 
 PHYSIOLOGY OF NERVOUS SYSTEM 91 
 
 the muscles with that sensibility without which the mind, 
 being unconscious of their position and state, cannot exercise 
 them. The fifth nerve, further, has a trophic influence over 
 the organs of special sense. 
 
 The 6th Nerve, or Abducens, is exclusively motor and 
 supplies the external rectus muscle of the eye. 
 
 The 7th Nerve, or Facial, is the motor nerve of all the 
 muscles of expression, including the platysma, and those 
 muscles of mastication not supplied by the fifth nerve ; also the 
 parotid gland, and some of the muscles of the soft palate. 
 By its tympanic branches it supplies the stapedius and laxator 
 tympani ; and through the optic ganglion, the tensor tympani ; 
 through the chorda tympani it sends branches to the sub- 
 maxillary gland and to the lingualis and some other muscular 
 fibres of the tongue, and to the mucous membrane of its an- 
 terior two-thirds ; and by branches given off before it reaches 
 the face it supplies the muscles of the external ear, the pos- 
 terior part of the digastric and the stylohyoid. The facial 
 nerve is also a secretory nerve, as it sends fibres to the sub- 
 maxillary and parotid glands. 
 
 The 8th Nerve, or Auditory, is the nerve of hearing through 
 its cochlear branch, and of equilibrium through its vestibular 
 branch. 
 
 The 9th Nerve, or Glosso-Pharyngeal, contains some motor 
 fibres together with those of common sensation and the sense 
 of taste. The motor fibres are distributed to the palato- 
 pharyngeus, stylo-pharyngeus, palato-glossus, and constric- 
 tors of the pharynx. Sensory fibres influence the parts 
 which it supplies, and an afferent nerve conveys im- 
 pressions inward to be reflected to the adjacent muscles. 
 The 9th nerve, together with the chorda tympani and the 
 gustatory, are the nerves of taste, not of themselves, but 
 through their connection with the Fifth nerve. Numerous 
 experiments have shown that when nerve impulses are pre- 
 vented from passing through the fifth nerve, the sense of 
 taste is lost ; this is instantaneous when the nerve is severed, 
 and consequently cannot be attributed to defective nutrition 
 of the parts ; but it is due to this fact when the nerve is com- 
 pressed or prevented from transmitting the necessary im- 
 pulses as a result of a vertebral subluxation.
 
 92 SPINAL ADJUSTMENT 
 
 The 10th Nerve, or Vagus, has the most varied distribu- 
 tion and functions of all the nerves. By its branches it sup- 
 plies the following parts : Its pharyngeal branches, which 
 enter the pharyngeal plexus, supply the mucous membrane and 
 muscles of the pharynx. By the superior laryngeal nerve it 
 supplies the mucous membrane of the under surface of the 
 epiglottis, the glottis, the greater part of the larynx, and the 
 crico-thyroid muscle. Through the inferior laryngeal nerve 
 are supplied the mucous membrane and muscles of the 
 trachea, the lower part of the pharynx and larynx, and all 
 the muscles of the larynx except the crico-thyroid. By its 
 esophageal branches are supplied the mucous membrane and 
 muscular coat of the esophagus. Through the cardiac nerves 
 the vagus supplies a large portion of the heart and great ves- 
 sels. By the anterior and the posterior pulmonary plexuses 
 the lungs are supplied. Its gastric branches supply the 
 stomach. Through its hepatic and splenic branches the liver 
 and spleen are partly supplied. Its terminal branches supply 
 the intestines and kidneys. 
 
 The vagus nerve contains both sensory and motor nerve- 
 fibres throughout its whole course. Its many functions, 
 briefly considered, are as follows: (a) motor, to the larynx 
 trachea, bronchi, and lungs, the pharynx and esophagus, and 
 the stomach and intestines ; (b) sensory and (c) partly vaso- 
 motor, to the same regions ; (d) inhibitory influence to the 
 heart; (e) inhibitory afferent impulses to the vaso-motor 
 centre ; (f ) excito-secretory to the salivary glands ; (g) excito- 
 motor in coughing, vomiting, etc. 
 
 The 11th Nerve, or Spinal Accessory, supplies the vagus 
 with its motor fibres by its internal branch, while its external 
 branch supplies the sternomastoid and trapezius muscles. 
 
 The 12th Nerve, or Hypoglossal, is purely a motor nerve, 
 and supplies the muscles connected to the hyoid bone, in- 
 cluding those of the tongue. These muscles are the sterno- 
 hyoid, sterno-thyroid, and the omo-hyoid through its descend- 
 ing branch ; the thyro-hyoid through a special branch ; and 
 the genio-hyoid, stylo-glossus, hyo-glossus, genio-hyo-glos- 
 sus, and linguales through its lingual branches. When the 
 hypoglossal nerve is irritated, these muscles twitch, and 
 when its power is lost entirely, they are paralyzed.
 
 CHAPTER VI 
 
 The Physiology of the Sympathetic System 
 
 In studying tlie functions of the sympathetic nervous 
 system it must be constantly borne in mind that it is con- 
 tinuous, anatomically, with the cerebro-spinal system. Each 
 ganglion of the sympathetic system is reinforced by motor 
 and sensory filaments from the cerebro-spinal system, and 
 thus the organs under its influence are brought directly into 
 communication with external objects and phenomena. The 
 nerves of the sympathetic system are distributed to parts over 
 which the consciousness and the will have no control. 
 
 The properties and functions of the sympathetic system 
 have received less attention than those of the cerebro-spinal 
 system, by physiologists, on account of the difiiculties attend- 
 ing experiments upon this system. Many facts have, how- 
 ever, been brought forth tending to prove that the functions 
 of this portion of the nervous system are of the greatest im- 
 portance to the general well-being of the body economy. 
 
 The vital processes in those structures supplied by the 
 gray rami of the sympathetic ganglia end as soon as the con- 
 nection between the sympathetic and cerebro-spinal systems 
 is abolished. But the fact that the sympathetic ganglia do 
 for a time maintain their functional power, under favorable 
 conditions, when isolated from the cerebro-spinal system, 
 shows that its action is independent of the mind. In other 
 words, its functional activity is automatic. 
 
 When, however, the connection between the two systems 
 is interrupted for a prolonged period, the action of the sym- 
 pathetic system ceases, and disorders of various kinds become 
 evident in those parts supplied by the portion which is thus 
 cut off. It has been shown that a misplaced vertebra will, by 
 exercising pressure upon the spinal nerve, break the con- 
 tinuity between the sympathetic and cerebro-spinal systems, 
 so that impulses passing from the spinal cord will be inter- 
 
 93
 
 94 SPINAL ADJUSTMENT 
 
 rupted at this point from going onward to their destination 
 along the sympathetic nerves. 
 
 The Functions of the Sympathetic Nervous System, — The 
 sympathetic system possesses the following functions : 
 
 (a) Influence on Movement and Sensibility. 
 
 (b) Influence on Nutrition. 
 
 (c) Influence on Heat Production. 
 
 (d) Influence on Metabolism. 
 
 (e) Influence on Circulation. 
 
 (f) Influence on Secretion. 
 
 (g) Influence on Excretion. 
 
 (h) Influence on other existing Action, 
 
 (i) Influence on the Special Senses, 
 
 (j) Influence on Reflex Actions, 
 
 (k) Influence on the Organs. 
 
 Influence on Movement and Sensibility. — The sympathetic 
 system is endowed with the power of conveying impulses of 
 sensibility and of exciting motion. These properties are, how- 
 ever exercised differently and more slowly than by the cere- 
 bro-spinal system. If, for example, we irritate a sensory 
 nerve in the arm, the evidences of pain or reflex action are in- 
 stantaneous ; on the other hand irritation of the sympathetic 
 nerves and ganglia, while they give evidence of sensibility 
 being manifested here also, do so only after a longer interval 
 of time, and after prolonged application of the irritant. These 
 results correspond very closely with what we know of the 
 internal organs which are supplied almost exclusively by the 
 sympathetic system, as in the liver, lungs and kidneys. These 
 organs, as is well known, are poorly endowed with nerves of 
 common sensation ; we are not conscious of the changes and 
 operations going on in them. Nor are they very sensitive to 
 pain. But they are capable of causing the perception of sen- 
 sations after prolonged or unusual irritation, and become very 
 painful when inflamed for some time. Since, as stated above, 
 these organs are supplied nearly entirely by nerve fibres from 
 the sympathetic system, these facts show that the power of 
 sensibility is possessed by this portion of the nervous system. 
 
 There is the same peculiarity of action of the sympathetic 
 system in its motor function. If, for example, the facial nerve
 
 PHYSIOLOGY OF SYMPATHETIC SYSTEM 95 
 
 is irritated, the spasms of the muscles which it controls are 
 instantaneous, violent, and of short duration. If, however, 
 the semilunar ganglion be irritated, it is only after a few 
 seconds that a slow, peristaltic contraction of the intestine 
 takes place, which continues for some time after the exciting 
 cause has been removed. 
 
 Morbid changes taking place in the organs supplied by the 
 sympathetic system thus present a similar peculiarity in the 
 mode of their production. If the body, for example, be ex- 
 posed to cold and dampness, congestion of the kidneys, per- 
 haps, shows itself on the following day. Inflammation of the 
 internal organs, as is well known, is very rarely produced 
 within twelve or twenty-four hours after the application of 
 the exciting cause. 
 
 Influence on Nutrition. — It is essential that all parts of 
 the body be nourished if they are to functionate normally and 
 maintain their organic integrity. The nerves themselves must 
 be nourished in order to retain their power of conveying im- 
 pulses ; in fact mal-nutrition is one of the causes of disturbed 
 nerve-action. The nutrition of every cell in the body depends 
 upon the trophic influence of the nerve-fibres of the sym- 
 pathetic system. 
 
 The exact manner in which the nerves influence nutritive 
 processes is not as yet well understood. But since nutrition 
 is simply the building up of parts of the body, and since nu- 
 tritive materials must first be digested, before they can be 
 absorbed, conveyed to the cells, and assimilated, it is readily 
 apparent what a great number of individual processes enter 
 into the accomplishment of that single end, which we term 
 nutrition. Since all these processes which make the ultimate 
 nutrition of the cells possible are governed by nerve-impulses, 
 it cannot be questioned that the nerves control nutrition 
 primarily. Whether or not there are special nerves which 
 govern the nutritive process within the cell itself has been 
 much debated, and evidence seems to support the theory that 
 there are such nerves. 
 
 These nerves have been termed katabolic and anabolic 
 nerves. It is supposed that every tissue is supplied with two 
 sets of nerves, the anabolic, which subserve constructive 
 metabolism, and the katabolic nerve which stimulates de-
 
 96 SPINAL ADJUSTMENT 
 
 structive metabolism. The augmentor nerves are the kata- 
 bolic nerves; the inhibitory nerves are the anabolic nerves. 
 Stimulation of a katabolic nerve produces increased activity, 
 increased metabolism, and is followed by exhaustion, and a 
 breaking dow^n of tissue. Such a nerve is illustrated by the 
 sympathetic augmentor nerve of the heart, on stimulation of 
 which increased activity of the heart takes place, followed by 
 exhaustion. Stimulation of the anabolic nerve, however, pro- 
 duces diminished activity, repair of tissue and building up. 
 The cardiac vagus is an illustration of such a nerve, stimula- 
 tion of which produces inhibition. 
 
 No nerve-impulses are generated without some form of 
 stimulus acting upon the nerve-centre, and it is therefore not 
 sufficient, to dispose of the subject of trophic nerve-action by 
 saying that there exist nerves which send out impulses which 
 regulate this function, without giving some explanation as 
 to where these impulses originate. It is not only necessary 
 that sufficient nutritive materials be ingested by the body so 
 that the balance between repair and waste may be preserved, 
 but the use of these materials must be regulated also. The 
 digestive, secretory, and absorptive apparati can accomplish 
 only a certain amount of work, that is to say, can prepare 
 for assimilation by the body only a certain amount of nutritive 
 material for its constructive metabolism. Assuming, there- 
 fore, that a certain amount of this latent energy is available, 
 the activities of the body must be proportioned to this energy. 
 The nerves that govern the activity of a part must therefore 
 regulate this activity in such a way that the output of energy 
 will never exceed the income. If, for example, the augmentor 
 nerve of a certain organ and the inhibitory nerve of the same 
 organ are not acting harmoniously, the waste processes on 
 account of excessive action may become excessive, and the 
 nutrition of the organ will suffer because of the failure of the 
 inhibitory nerve to suspend or retard its activity for a time, 
 and permit the necessary reparative processes to take place 
 during the interval of rest. Thus the nerves assume trophic 
 functions as a result of afferent impulses reaching their centre. 
 These impulses are generated as a result of the stimulus 
 created at the terminals of the nerves in the organs. These 
 stimuli are excited by the state of exhaustion in the cells, and
 
 PHYSIOLOGY OF SYMPATHETIC SYSTEM 97 
 
 it is well known that exhaustion is one of the common sensa- 
 tions also of the cerebro-spinal nerves. In the organs ex- 
 haustion is not perceived as such by the sensonum in the 
 brain, but efferent impulses are sent out retarding the activ- 
 ity of the organ until sufficient rest can be secured to permit 
 the building up processes to occur. In this way is the nutri- 
 tion of all parts maintained, namely by regulating the activ- 
 ity of a part, through the balanced action of the augmentor 
 or katabolic and the inhibitory or anabolic nerves. 
 
 Influence on Heat Production. — One of the most import- 
 ant results of the metabolism of the tissues is the production 
 of the heat of the body. It is by this means that the tempera- 
 ture of the body is raised to such a point as to make life pos- 
 sible. The chief part of the metabolic changes in the tissues 
 is of the nature of oxidation, since the oxygen taken into 
 the system is ultimately combined with carbon and hydrogen 
 and discharged as carbonic acid and water. Any changes 
 which occur in the protoplasm of the tissues resulting in a 
 manifestation of their functions, are attended by the evolution 
 of heat and the production of carbonic acid and water. The 
 more active the tissue, the greater will be the amount of 
 heat produced, and the amount of carbonic acid and water 
 formed. But in order that the protoplasm may perform its 
 function the waste of its own tissue must be repaired by a 
 due supply of good material to be changed into its own 
 substance. 
 
 The heat-producing tissues are the following: (a) The 
 muscles, which form such a large part of the body, and in 
 which metabolism is particularly active, supply the principal 
 part of the heat produced in the body, (b) The secreting 
 glands, and especially the liver, since it is the largest, come 
 next to the muscles as heat-producing tissue. It has been 
 found by experiments that the blood which leaves the glands 
 is much warmer than that which enters them. The metabolism 
 in the glands is very active, and as we have seen, the more 
 active the metabolism, the greater the heat produced, (c) 
 The brain ranks next as a heat producing tissue, (d) It must 
 be remembered that although the above organs are the chief 
 sources of heat in the body, that all parts contribute their 
 share, in proportion to their activity. The blood itself is
 
 98 SPINAL ADJUSTMENT 
 
 the seat of metabolism, and therefore also contributes some- 
 thing to the heat of the body, although a very small amount. 
 Two other minor means of heat-production are, friction of 
 parts of the body, as the circulation of the blood, movement, 
 of the muscles, etc. ; and the ingestion of warm food and 
 drink. 
 
 The normal temperature of the body is maintained under 
 the varying conditions to which the body is exposed by 
 mechanisms which permit (1) variation in the loss of heat, 
 and (2) variations in the production of heat. Thus in normal 
 warm-blooded animals the loss and gain of heat are so well 
 balanced that a uniform temperature is maintained. 
 
 The loss of heat from the body is through the following 
 avenues : (a) By radiation and conduction from its surface ; 
 
 (b) By continuous evaporation of water from the same part; 
 
 (c) By the respiration of air some loss of heat occurs ; (d) All 
 food and drink which enters the body at a lower temperature 
 also abstracts some of the heat of the body ; (e) The urine and 
 feces leaving the body also occasion the loss of a small amount 
 of heat. 
 
 We have the power of heat production as well as heat 
 dissipation. Each individual has his own coefficient of heat 
 production. Since, as has been said, the amount of heat 
 varies with the metabolism of the tissues of the body, every- 
 thing which increases that metabolism will increase the heat 
 production. The ingestion of food increases the metabolism 
 of the tissues, and accordingly the rate of heat production in 
 the dog is found to be increased after a meal, and reaches its 
 height six to nine hours after the meal. The kind of food 
 eaten also has an effect upon the amount of heat produced, 
 and thus when sugar is added to the meal given the dog in 
 the experiment proving these facts, it was found that still 
 more heat was produced. Fat is also used to increase the 
 production of heat, as is evidenced by the large amounts of 
 fat eaten by those who live in a cold climate to produce the 
 requisite amount of heat. Exercise is an important measure 
 for the production of heat, as through it the metabolism of 
 the muscles is increased. 
 
 The influence of the nervous system in the production of 
 heat is very marked for upon the nervous influence depends
 
 PHYSIOLOGY OF SYMPATHETIC SYSTEM 99 
 
 the metabolism of the tissues. The facts which best prove 
 this are these : First, when the nerve supply to a part is cut 
 off, the temperature of that part soon falls below its usual 
 degree ; second, when death is caused by a serious injury of 
 the nerve-centres, the temperature of the body rapidly falls, 
 even though the circulation be maintained, artificial respira- 
 tion performed, and all the chemical processes of the body 
 are in operation ; third, if the nerves of a limb are severed or 
 compressed, it becomes cold ; fourth, by its power of controll- 
 ing the calibre of the bloodvessels the nervous system also 
 governs the temperature of the body. 
 
 In addition to this regulation of temperature by the vaso- 
 motor influence of the nervous system, there is a separate 
 nervous apparatus, by means of which heat production and 
 heat loss are regulated as circumstances demand. This ap- 
 paratus consists of centres which may be reflexly stimulated 
 by afferent impulses from the skin, and which act through 
 special efferent nerves supplying the various tissues. Any 
 disturbance of this reflex arc will produce a temperature higher 
 than normal. For example, a patient suffering from fever, 
 has a body temperature several degrees higher than normal. 
 While this increase of temperature is no doubt due to dimin- 
 ished loss of heat from the skin, this is far from being the 
 only cause of the fever. The amount of oxygen taken in and 
 the amount of carbon dioxide given out are both increased, 
 and with this there must be increased metabolism of the 
 tissues, and especially of the muscular tissue, because in 
 these cases the amount of urea excreted by the urine is always 
 increased. We are all familiar with the rapid wasting which 
 accompanies high fevers ; this means that the metabolism is 
 not only too rapid, but also that insufficient time is had for 
 the tissues to build up. In fever, then, there must be some 
 interference in the ordinary channel by which the skin is 
 able to communicate to the nervous system the necessity of 
 an increased or a diminished production of heat in the mucles 
 and other tissues. The only logical place at which such an 
 interference could occur is at the intervertebral foramina, 
 where the nerves pass between movable bones. As a result of 
 this, and in spite of the condition of heat of the surface of 
 the body, the production of heat goes on at an abnormal rate,
 
 100 SPINAL ADJUSTMENT 
 
 constituting what we term fever. It might by appropriately 
 mentioned in this connection that upon this physiological 
 fact depend the remarkable results obtained by spinal ad- 
 justment in reducing a fever. 
 
 Influence on Metabolism. — Something has already been 
 said of the influence of the sympathetic system on metabolism, 
 in connection with its influence on nutrition. As a matter of 
 fact, the influence of this system on metabolism is so closely 
 interwoven with all its other functions that this action is not 
 an isolated one, but is the prime action about which revolve 
 all the activities of the body economy, as influenced by the 
 nervous system. 
 
 The processes of constructive and destructive metabolism 
 are under the control of special nerve-fibres of the sympathetic 
 system. In the case of the submaxillary gland, for example, 
 if the chorda tympani is stimulated, there is a thin, watery 
 secretion obtained, which contains only 1 or 2 per cent of 
 solids ; if the sympathetic is stimulated in the cervical region, 
 a thick, turbid secretion is obtained, which contains as much 
 as 6 per cent of solids. In the former case, there is vaso-dila- 
 tion, an increased flow of blood through the gland occurs, and 
 it has a ruddy color. In the latter case, there is vaso-con- 
 striction, a diminished flow of blood occurs, and the gland is 
 pale. Experiments have disproved the old theory that the 
 amount of secretion depends upon the vaso-motor effect. 
 What it does show is that the sympathetic system stimulates 
 the metabolism, as shown by the much greater richness of 
 the secretion obtained by stimulation of the sympathetic, 
 as compared with that obtained when the chorda tympani 
 is stimulated. This increased richness is a result of 
 greater protoplasmic activity, which is synonymous with 
 metabolism. 
 
 Another evidence of the effect of the sympathetic system 
 on metabolism is shown by the following experiment : When 
 the cerebral fibres controlling the parotid gland of a dog 
 were stimulated, an abundant, thin, and watery saliva was 
 obtained. Stimulation of the sympathetic fibres alone, with 
 the tympanic nerve cut, and the cerebral fibres not previously 
 stimulated, produced no secretion at all. But by this stimu- 
 lation of the sympathetic a marked effect was produced on
 
 PHYSIOLOGY OF SYMPATHETIC SYSTEM 101 
 
 the gland ; this was shown by the fact that subsequent or 
 simultaneous stimulation of the cerebral fibres gave a secre- 
 tion of saHva very different from that obtained on stimulating 
 the cerebral fibres alone, in that it was very rich in organic 
 constituents. When the sympathetic nerve is stimulated 
 previous to stimulating the cerebral fibres, the saliva may be 
 ten times as rich as when only the cerebral fibres are stimu- 
 lated. This shows that by stimulation of the sympathetic 
 the metabolism was so stimulated to activity that when the 
 cerebral fibres were stimulated, the products of this increased 
 metabolism were obtained in the saliva. 
 
 Influence on Circulation. — Perhaps the most important 
 fact concerning the sympathetic system is its influence over 
 the vascularity and nutrition of the parts supplied by it. First 
 of all, the division of the sympathetic nerves immediately pro- 
 duces a vascular congestion in the corresponding parts. If 
 the sympathetic be divided in the neck, in the rabbit, a vascu- 
 lar congestion of all parts of the head, on the corresponding 
 side immediately follows. This congestion is most evident in 
 the thin and transparent ears, which on the affected side 
 become very red, due to the turgid condition of the blood- 
 vessels. This condition lasts for a considerable time, and 
 even for a longer time when the cervical ganglion is ex- 
 tirpated, or a portion of the nerve cut out, than when its fila- 
 ments have been simply divided. It finally disappears when 
 the separated filaments have been re-united and their func- 
 tional activity restored. 
 
 The vascular congestion thus produced by the division of 
 the sympathetic nerve is accompanied by three important 
 phenomena, all intimately connected with each othec. 
 
 First, the amount of blood in a part is fncreased, and the 
 rapidity of its movement is accelerated. The congestion is 
 not due to venous obstruction, but all the vessels are dilated, 
 an increased amount of blood passes through the capillaries, 
 and returns by the veins in greater abundance than before. 
 
 Second, there is a marked elevation in the temperature of 
 the affected part. This increase of temperature may be felt 
 by touching the ear of the rabbit, and even the skin of the 
 corresponding side of the head. Measured by the thermom- 
 eter, it has been found by Bernard to reach, in some cases.
 
 102 SPINAL ADJUSTMENT 
 
 go or 9° F. It is due to the increased quantity of blood, 
 which carries added heat to the parts. 
 
 Third, the color of the venous blood in the affected part 
 becomes brighter and more ruddy. This effect is also due to 
 the increased rapidity of the circulation. As the arterial 
 blood is deprived of its oxygen and darkened in color by the 
 changes of nutrition which usually take place in the tissues, 
 if the rapidity of the circulation be suddenly increased, a cer- 
 tain part of the blood escapes deoxidation, and the change in 
 color, from arterial to venous, is incomplete. Summed up, 
 therefore, the blood returns by the veins of the affected part 
 in greater abundance, at a higher temperature, and of a more 
 ruddy color, than that on the unaffected side. 
 
 Now it is found that, if that portion of the divided nerve 
 which is in connection with the affected tissue is irritated by 
 electricity, all the above effects rapidly disappear; the blood- 
 vessels of the ear and side of the head contract to their 
 previous size, the quantity of blood circulating through the 
 tissues is diminished, the temperature of the parts is reduced 
 to a corresponding degree, and the blood in the veins returns 
 to its ordinary dark color. 
 
 The variations in the rapidity of the circulation dependent 
 on the sympathetic were shown by Bernard in the following 
 experiment. The upper part of a rabbit's ear is cut off so 
 that the blood may escape in jets. The force and height of • 
 the jets having been observed, the sympathetic nerve is then 
 divided, and at once the blood escapes from the ear in greater 
 abundance ; if then the galvanic current is applied to the 
 proximal end of the cut nerve, the escape of blood gradually 
 ceases ; as soon as the galvanic current is removed, the flow 
 of blood again increases. A similar influence is exerted by 
 the sympathetic nerve upon the circulation in the limbs. If 
 the lumbar nerves of one side be divided, in a dog, within the 
 spinal canal, paralysis and anaesthesia of the corresponding 
 limb follow, but there is no change in its temperature or 
 vascularity. But if the lumbar portion of the sympathetic be 
 divided, without disturbing the spinal nerves, increased cir- 
 culation and temperature are at once evident, without any 
 loss of motion or sensibility. Exsection of the first thoracic 
 ganglion produces similar effects in the upper extremity; and
 
 PHYSIOLOGY OF SYMPATHETIC SYSTEM 103 
 
 these effects disappear when the galvanic current is applied 
 to the upper end of the divided nerve. 
 
 The vascularity of all parts, therefore, as w^ell as their 
 functional activity depends upon the action of the nervous 
 system. The sympathetic nerves accompany the blood-ves- 
 sels to their minutest ramifications. These sympathetic fibres 
 act by causing a contraction of the muscular coat of the blood- 
 vessels and thus regulate the passage of blood through them. 
 These nerves are termed, accordingly, vaso-motor nerves, and 
 they do not differ from the pilo-motor and secretory nerves 
 except in the nature of the structure in which they terminate. 
 They are of two kinds, according to their function, namely : 
 vaso-constrictor and vaso-dilator. 
 
 Influence on Secretion. — Numerous experiments which 
 have been made tend to prove that special secretory nerves 
 exist. These nerves govern the activity of the secretory 
 structures of the body, assisted by trophic nerves. A detailed 
 account of them is scarcely appropriate in this place, since 
 a thorough understanding of them can be obtained by refer- 
 ence to any work on physiology. 
 
 The various secretory organs contain special secreting 
 cells, which form the secretion peculiar to that special organ. 
 The products of secretion are not derived from the blood 
 through osmosis as was formerly supposed, because the 
 secreted material contains ingredients which are never found 
 in the bood. Thus the saliva contains ptyalin, the gastric 
 juice contains pepsin, etc. These characteristic ingredients 
 of the various glands are formed by the catalytic transforma- 
 tion of their organic constituents; these new substances 
 formed by the gland cells, together with the saline and watery 
 constituents derived from the blood constitute the secreted 
 fluid. A true secretion, therefore, is produced only in its own 
 particular gland, and cannot be formed elsewhere, since the 
 glandular cells of that organ are the only ones capable of 
 producing its most characteristic ingredient. 
 
 The process of secretion depends upon the peculiar 
 anatomical and chemical constitution of the glandular tissue 
 and its secreting cells. These cells have the property of 
 taking from the blood certain inorganic and saline substances, 
 and of producing by chemical metamorphosis certain peculiar
 
 104 SPINAL ADJUSTMENT 
 
 animal matters from their own tissue. These substances are 
 then mingled together, dissolved in the watery fluids of the 
 secretion, and discharged simultaneously by the excretory 
 duct. 
 
 This process is controlled by the sympathetic and cerebro- 
 spinal systems, and is entirely involuntary. It depends for 
 its occurance upon the excitation of the secretory centre, by 
 afferent impulses, which reflexly affect the fibres which control 
 the secretory cells of a particular gland. For example, the 
 smell of food reflexly causes a free flow of saliva ; the ingestion 
 of food then produces the secretion of gastric juice. A con- 
 stant flow of efferent impulses, such as that which maintains 
 the muscles in a state of continuous contraction, may also 
 govern the secretory activities of certain glands, as those 
 having an internal secretion, namely the thyroid, spleen, etc. 
 
 Any interference with the conductivity of the sympathetic 
 nerves changes the character of the secretion and interferes 
 with the functional activity of the organ which depends for 
 its action upon the materials which it secretes. The sym- 
 pathetic nerves influence secretion by their vaso-dilatory 
 action upon the blood, and also by their trophic action. Thus, 
 when the sympathetic fibres are stimulated, previous to stimu- 
 lation of the cerebral fibres controlling the parotid gland of 
 a dog, a rich salivary secretion is obtained, while stimulation 
 of the cerebral fibres alone gives an abundant thin and watery 
 secretion. The sympathetic system alone does not govern 
 secretion, but the part which it takes in this function is ex- 
 ceedingly important, as demonstrated by clinical results ob- 
 tained in the various conditions dependent upon faulty secre- 
 tion. 
 
 Influence on Excretion. — In order to understand the nature 
 of this process we must bear in mind that all the component 
 parts of a living organism are in a state of constant change. 
 Every animal absorbs constantly substances which it con- 
 verts into the natural ingredients of the organized tissues. At 
 the same time there goes on in the same tissues an incessant 
 process of waste and decomposition. The products of this de- 
 structive process are destined to be discharged from the body 
 and are known as excrementitious substances. These sub- 
 stances are conveyed by the blood to certain excretory organs,
 
 PHYSIOLOGY OF SYMPATHETIC SYSTEM 103 
 
 which discharge them from the body. This entire process 
 is known as excretion. 
 
 The importance of this process to the maintenance of life 
 is readily shown by the injurious effects which follow upon 
 its disturbance. If the discharge of the excrementitious sub- 
 stances be in any way impeded or stopped, they accumulate 
 in the blood and tissues. In consequence of this retention 
 and accumulation, they become poisonous, and rapidly pro- 
 duce a disturbance of the vital functions. Their influence is 
 particularly exerted upon the nervous system, producing vari- 
 ous forms of irritability, disturbance of the special senses, 
 deliriums, insensibility, coma, and even death. 
 
 The most important avenues for the discharge from the 
 body of these poisonous substances are the bowels, kidneys, 
 skin, and lungs. The nerve supply, both cerebro-spinal and 
 sympathetic, of these organs will be given in detail farther 
 on. Suffice it to say at this point that derangement of the 
 nerve-supply to these eliminative organs is followed by a 
 train of diseased conditions, the number and seriousness of 
 which is stupendous. These conditions have as their basis 
 that very common condition known as autointoxication, and 
 it is scarcely necessary to go into detail regarding the vast 
 number of affections of diverse kinds which may be traced to 
 a perverted function of the excretory organs. What a variety 
 of conditions result from constipation, for example, is well 
 known ; again, the great number of diseases resulting from 
 faulty action of the kidneys needs no explanation; then, the 
 train of diseases following depleted excretory activity of the 
 skin are very well understood ; lastly, deficient oxygenation 
 of the blood as produced by respiratory incapacity, is also 
 well known to be the cause of many and varied disorders. 
 
 The importance of proper excretory action of the parts to 
 which this function is peculiar assumes tremendous propor- 
 tions. These functions are intimately dependent upon a free 
 and untrammeled action of the nervous system. Any obstruc- 
 tion to the passage of the efferent impulses along the cerebro- 
 spinal and sympathetic nerve-fibres at once produces deficient 
 excretion from the organs which are deprived of these nerve- 
 impulses. The profuse perspiration following stimulation of 
 the cervical sympathetic ganglia illustrates the marked influ-
 
 106 SPINAL ADJUSTMENT 
 
 ence it has upon the action of the excretory apparatus of the 
 skin. Like results follow adjustment to their proper posi- 
 tion of displaced vertebrae when the other excretory organs 
 are affected. 
 
 Influence on Other Existing Action. — All the active tissues 
 of the body may be influenced by their nerves in two opposite 
 ways. That is, stimulation may increase or decrease their 
 activity. Thus the functional activity of the glands, nerve- 
 centres and muscles can be so varied. The nerves which cause 
 increased action are known as augmentor, while those that 
 produce decreased action are called inhibitory nerves. They 
 are distinct from each other anatomically, except in the 
 central nervous system. 
 
 It is questionable whether there exists a special class of 
 inhibitory nerves but there must certainly be a different 
 dendritic pathway for the impulses causing inhibition. What- 
 ever nerves do subserve this function, their importance is 
 manifest ; for they control the balanced activity of all parts. 
 Since their action is involuntary, it may be safely assumed 
 that it is the peculiar office of the sympathetic system to 
 influence existing action, in connection with the cerebro-spinal 
 nerves to the part involved. 
 
 The general bearing of these facts is of the greatest im- 
 portance. As has been pointed out by Hughlings-Jackson, 
 damage of any sort to a portion of the nervous system may, 
 in the simplest case, decrease the activity of the group of 
 neurons controlled by the damaged part by cutting off the 
 stimulating impulses from them. On the other hand, a fact 
 which is often overlooked, it may cause them to become 
 abnormally active, by the stoppage of some impulses which 
 exert an inhibitory effect. 
 
 Influence on the Special Senses. — In the cranium, the sym- 
 pathetic system has a very close and important connection 
 with the exercise of the special senses. This is especially well 
 illustrated in the case of the eye, by its influence on the 
 expansion and contraction of the pupil. 
 
 The ophthalmic ganglion sends off a number of ciliary 
 nerves, which are distributed to the iris. As we have seen, 
 it is connected with the remaining sympathetic ganglia in the 
 head, and receives, beside, a sensory root from the ophthalmic
 
 PHYSIOLOGY OF SYMPATHETIC SYSTEM 107 
 
 branch of the fifth cranial nerve, and a motor root from the 
 third cranial nerve. The reflex action by which the pupil 
 contracts when a strong light falls upon the retina, and ex- 
 pands when the amount of light is diminished, takes place, 
 accordingly, through this ganglion. The impression on the 
 retina is conveyed by the optic nerve to the tubercula quad- 
 rigemina, and then reflected outward by the motor oculi. The 
 efferent impulse is not transmitted directly to the iris by the 
 last-named nerve, but passes first to the ophthalmic ganglion, 
 and thence to its destination, by the ciliary nerves. 
 
 The reflex movements of the iris are somewhat sluggish, 
 which indicates the intervention of the sympathetic. The 
 changes in the size of the pupil do not occur immediately with 
 the varying amounts of light, but require an appreciable 
 interval of time. For example, if we pass from a dark apart- 
 ment into the brilliant sunshine, we are at once conscious 
 of a painful sensation in the eyes, which lasts for a consider- 
 able time; this results from the inability of the pupil to con- 
 tract with sufficient rapidity to shut out the excessive amount 
 of light. 
 
 The reflex movements of the iris derive their original 
 stimulus from the motor oculi nerve. This nerve, however, 
 will not act without the assistance of the sympathetic. Any 
 break in the connection of the sympathetic with the motor 
 oculi, therefore, prevents the latter from functionating. Thus 
 if the sympathetic in the neck, in a cat, be divided, the pupil 
 of the corresponding eye becomes strongly and permanently 
 contracted. In addition to this, the upper and lower eyelids 
 and the nictitating membrane are also drawn partially over 
 the cornea, and assist in excluding the light. Secondly, divi- 
 sion of the motor oculi, alone, in the cat, does not cause dila- 
 tation of the pupil. The fact that the motor oculi and the 
 facial nerves control the external muscles of the eye, ear, and 
 nose, but that contraction of those muscles follows division 
 of the sympathetic, shows the intimate dependence of these 
 cranial nerves upon the integrity of the sympathetic. 
 
 Similarly, in spasms of the eyelids, no actual lesion of the 
 motor oculi can be found, but irritation of the superior cervical 
 ganglion of the gangliated cord is present, and is responsible 
 for this condition. It is for this reason that adjustment of a
 
 108 SPINAL ADJUSTMENT 
 
 displaced cervical vertebra, especially the fourth, or one of 
 the upper dorsal region, at once stops such spasms. 
 
 In the olfactory apparatus, the external muscles, namely 
 the compressors and elevators of the alae nasi, are supplied 
 by filaments from the facial nerve. Their action serves to per- 
 mit the entrance of odoriferous particles when desirable, and 
 to exclude those which are not desired. The deep muscles, 
 namely the levators and depressors of the velum palati, and 
 the azygos uvulae, are supplied by the spheno-palatine gang- 
 lion, and accomplish a similar purpose with the external 
 muscles; they tend to close the posterior nares, and their 
 action is involuntary. 
 
 The auditory apparatus has two similar sets of muscles, 
 similarly supplied. The external muscles are supplied by 
 branches from the facial nerve, and their action is voluntary, 
 namely movement of the external ear. The deep-seated set 
 are the muscles of the middle ear. It must be remembered 
 that sounds are transmitted from the external to the middle 
 ear through the tympanic membrane, which vibrates, like the 
 head of a drum, on receiving sonorous impulses from without. 
 Accordingly the ear-drum may be made more or less sensi- 
 tive to sonorous impressions by varying its degree of tension 
 or relaxation. This condition, as we well know, is regulated 
 by the action of the two muscles of the middle ear, viz., the 
 tensor tympani and the stapedius. The tensor tympani is sup- 
 plied by filaments from the otic ganglion of the sympathetic. 
 By its contraction the membrane is rendered tense, and on 
 the relaxation of this muscle, the mem"brane returns to its 
 former condition. This action is involuntary. But the 
 stapedius is supplied by a minute filament from the facial 
 nerve, and it is probable that this arrangement enables us 
 to a degree of voluntary action, as in listening intently to 
 distant or faint sounds. 
 
 In all the above instances, the reflex action of the drum 
 which takes place originates from a sensation which is con- 
 veyed inward to the cerebro-spinal centres, and is then trans- 
 mitted outward to its destination through the medium of one 
 of the sympathetic ganglia. 
 
 Influence on Reflex Action. — The influence of the sympa- 
 thetic system on reflex actions is exceedingly important.
 
 PHYSIOLOGY OF SYMPATHETIC SYSTEM 109 
 
 There are three kinds of reflex action, taking place wholly 
 or partly through the sympathetic system, which may be 
 observed to occur in the living body. 
 
 First, reflex actions taking place from the internal organs, 
 through the sympathetic and cerebro-spinal systems, to the 
 voluntary muscles and the sensory surfaces. Thus, the con- 
 vulsions of young children are often due to the presence of 
 undigested food in the intestinal canal. Attacks of indiges- 
 tion often produce temporary amaurosis, double vision, strabis- 
 mus, and even hemiplegia. Nausea and vomiting are promi- 
 nent symptoms of the second and third months of pregnancy, 
 induced reflexly by the peculiar condition of the uterine 
 mucous membrane. 
 
 Secondly, reflex actions taking place from the sensory 
 surfaces, through the sympathetic and cerebro-spinal systems, 
 to the involuntary muscles and secreting glands. Thus ex- 
 posure to cold and wet will often cause diarrhea. Mental and 
 moral impressions, conveyed through the special senses, will 
 afifect the action of the heart, and disturb the processes of 
 digestion and secretion. Terror, or intense interest in some- 
 thing, will cause the pupil to become dilated. Disagreeable 
 sights or odors may bring on or stop menstruation, or induce 
 premature labor. 
 
 Thirdly, reflex actions taking place through the sympa- 
 thetic system, from one part of the internal organs to another. 
 Thus, the contact of food with the mucous membrane of the 
 small intestines excites a peristaltic movement of their muscu- 
 lar walls. The mutual action of the digestive, urinary, and 
 internal generative organs upon each other takes place 
 through the medium of the sympathetic ganglia and their 
 nerves. The variations of the capillary circulation in the 
 abdominal viscera, corresponding with their state of activity 
 or rest, are produced by the same mechanism. 
 
 These phenomena are not accompanied by any conscious- 
 ness on the part of the individual, nor by any apparent inter- 
 vention of the cerebro-spinal system. 
 
 Influence on the Organs. — The sympathetic system has an 
 action entirely separate from any connection with the cerebro- 
 spinal system in those organs in which terminal ganglia are 
 located. For example, the influence of the cardiac sympa-
 
 no SPINAL ADJUSTMENT 
 
 thetic nerves on the heart, and of the splanchnics on the 
 stomach. Other instances of this influence also exist, and will 
 be considered at proper length in the section dealing with 
 the nerve-supply of the various organs of the body.
 
 SECTION THREE 
 Innervation 
 
 CHAPTER I 
 
 The Innervation of the Structures of the Cranium, Face and 
 
 Neck 
 
 A ready familiarity with the nerve-supply of every sys- 
 tem, organ, and part of the body is essential to a thorough 
 understanding of the underlying principles of spinal adjust- 
 ment. It is also necessary from the view-point of diagnosis 
 and treatment of diseased conditions by these methods. 
 
 The connection between the spinal nerves and those of the 
 sympathetic system has already been explained, as well as 
 their connection with the cranial nerves. What remains to be 
 considered, therefore, is the connection between the nerves 
 of each spinal segment and the respective organs which they 
 supply. 
 
 Since the nervous system is continuous throughout its 
 entire course, it follows that each system, organ, and part of 
 the body derives its nerve-supply through the medium of the 
 spinal cord and the spinal nerves which, given ofif from it, 
 emerge through the intervertebral foramina. It is at this 
 point that the reflex arc is situated by which the body is kept 
 in harmony with the external influences which afifect it. Any 
 interference with the proper action of this arc will cause 
 disharmony and disease. 
 
 As has been previously shown, vertebral subluxations will, 
 by destroying the conductivity of the nerves at this point, 
 deprive the corresponding parts of the body of the nerve- 
 impulses necessary to their functional activity and organic 
 integrity. It is for this reason that we will consider in this 
 connection the parts of the body supplied by the nerve from 
 each segment of the spine, and all its ramifications, 
 
 111
 
 112 
 
 SPINAL ADJUSTMENT 
 
 fikin ofF<»,ce a,/ttl HecK 
 
 Fig. 11. 
 
 Parts Influenced by the First 
 Cervical Nerve.
 
 CRANIUM, FACE AND NECK 113 
 
 The Innervation of the Scalp. — The innervation of the 
 scalp is derived from the following nerves : 
 
 1. The posterior auricular, which is a branch of the facial 
 which communicates with the sympathetic on the middle 
 meningeal artery by the external superficial petrosal nerve ; 
 this in turn communicates with the superior cervical ganglion. 
 
 2. The great auricular nerves, the branches of origin of 
 which communicate with the second and third pairs of cervical 
 nerves, and send branches to the region of the scalp about 
 the ears. 
 
 3. The suboccipital nerves, which are the first pair of 
 spinal nerves and emerge from the vertebral canal through 
 the posterior condyloid notches between the occipital bone 
 and the posterior arch of the atlas on each side. These nerves 
 supply a greater portion of the scalp than any others, sending 
 branches to the occipital region, the vertex and the forehead. 
 
 4. The occipitalis major nerve, which is the internal branch 
 of the posterior division of the second cervical nerve. In its 
 upward course it is joined by a filament from the posterior 
 division of the third cervical nerve, and on the back part 
 of the head divides into two branches which supply the 
 integument of the scalp as far forward as the vertex. 
 
 5. The occipitalis minor, which arises from the second 
 cervical nerve, and sometimes also the third. It extends up- 
 ward along the side of the back of the head, and supplies the 
 integument behind the ear. Here it communicates with the 
 occipitalis major, the great auricular, and the posterior auri- 
 cular branch of the facial. It gives off an auricular branch 
 which supplies the integument of the upper and back part 
 of the auricle. 
 
 6. The third occipital nerve, which arises from the internal 
 or cutaneous branch of the posterior division of the third 
 cervical nerve, and which supplies the skin on the lower and 
 back part of the head. 
 
 7. The fourth pair of cervical nerves also influence the 
 scalp, by reason of their control of the circulation. They 
 form the greater part of the phrenic nerve which innervates 
 the diaphragm and lungs, and governs their movements. In 
 this manner, the middle cervical nerves by affecting the cir- 
 culation of the thorax, influence indirectly the circulation of
 
 114 
 
 SPINAL ADJUSTMENT 
 
 Fig. 12. 
 
 Parts Influenced by the Second 
 Cervical Nerve.
 
 CRANIUM, FACE AND NECK 115 
 
 the head. Failure of proper action of the diaphragm and 
 lungs, by diminishing the blood in those parts, will result in 
 an excess of blood in the brain. On the contrary, a free 
 action of the diaphragm and lungs will relieve congestion of 
 the brain. 
 
 8. The scalp is also indirectly affected by the spinal seg- 
 ments down to the tenth segment. This is due to the influ- 
 ence of these nerves upon the glands of the skin. All the 
 nerves, and especially the tenth dorsal, affect the skin of the 
 corresponding region of the body. 
 
 The Innervation of the Face and Neck. — The innervation 
 of the integument of the face and neck is derived principally 
 from the cervical plexus and the cranial nerves. The dorsal 
 nerves also indirectly influence these parts by their con- 
 trol of the circulation. Specifically the face and neck are 
 innervated by the following nerves : 
 
 1. The trigeminal nerves, through the ophthalmic, supe- 
 rior maxillary, and inferior maxillary nerves supply the integ- 
 ument of the face and the deeper structures. The Gasserian 
 ganglion from which the three branches of this nerve are 
 derived communicates with the carotid plexus of the sympa- 
 thetic. The ophthalmic nerve communicates with the cavern- 
 ous plexus of the sympathetic, the third and sixth nerves and 
 occasionally with the fourth nerve. By means of this con- 
 nection with the superior cervical ganglion of the sympathetic 
 the structures supplied by the trigeminal nerve may be 
 influenced by adjustment of the upper four cervical vertebrae. 
 
 2. The facial nerves, which supply the remaining portions 
 of the skin of the face and the muscles of expression. This 
 nerve communicates, through the geniculate ganglion, with 
 the sympathetic on the middle meningeal artery by the ex- 
 ternal superficial petrosal nerve. The structures which it 
 supplies are thus also influenced by adjustment of the upper 
 four cervical vertebrae. 
 
 3. The first, second, third, and fourth cervical nerves, 
 which give off branches to form the cervical plexus which is 
 distributed to the integument and muscles of the face and 
 neck. 
 
 4. The first six thoracic nerves send white rami communi- 
 cantes to the superior cervical ganglion of the sympathetic,
 
 116 
 
 SPINAL ADJUSTMENT 
 
 Fig. 13. 
 
 Tarts Influenced by the Third 
 Cervical Nerve.
 
 CRANIUM, FACE AND NECK 117 
 
 which through its various communications influences the 
 integument of the face and neck. 
 
 5. The tenth thoracic nerves by reason of their influence 
 upon the function of the skin, affect the integument of the 
 face and neck. These nerves also have a decided influence 
 upon the action of the kidneys, and by increasing the elimina- 
 tion of fluids through this channel, will diminish the 
 elimination through the skin. 
 
 The Innervation of the Brain. — Various nerves are dis- 
 tributed to the substance of the brain and its meninges, and 
 govern its function, metabolism and the circulation of the 
 blood through it. ■ The brain is accordingly innervated by 
 the following nerves : 
 
 1. The dura mater is supplied by filaments from the Gas- 
 serian ganglion, from the ophthalmic, superior maxillary, 
 inferior maxillary, vagus, and hypoglossal nerves, and from 
 the sympathetic. 
 
 The arachnoid is supplied by a rich plexus derived from 
 the motor division of the fifth, the facial, and the spinal 
 accessory nerves. 
 
 The pia mater is supplied by branches from the sympa- 
 thetic, and from the third, fifth, sixth, seventh, ninth, tenth, 
 and eleventh cranial nerves. 
 
 Since the above nerves all communicate with the superior 
 cervical ganglion of the gangliated cord, and this in turn 
 with the upper four spinal nerves, subluxations of the upper 
 four cervical vertebrae will affect the meninges of the brain. 
 
 2. The fourth cervical nerves by their influence upon the 
 circulation of the blood in the thorax indirectly influence the 
 cerebral blood-supply, and are therefore considered as having 
 an influence upon the brain. 
 
 3. The suboccipital nerves affect the meninges by giving 
 off branches which assist in the formation of the recurrent 
 nerve to the tentorium. 
 
 4. The lower cervical nerves, by their influence upon the 
 respiratory movements, indirectly influence the circulation in 
 the brain. The expansion of the thorax in inspiration in- 
 creases the blood-supply to this region, and thus decreases the 
 blood-supply to the cranium. Deficient respiratory move-
 
 118 
 
 SPINAL ADJUSTMENT 
 
 g. 14. 
 
 I'aits Influenced by the Fourth 
 Cervical Nerve.
 
 CRANIUM, FACE AND NECK 119 
 
 meats diminish the blood-supply to the thorax, and therefore 
 cause a congestion in the brain. 
 
 5. The upper thoracic nerves, by sending white rami 
 communicantes to the superior cervical ganglion which com- 
 municates with all the cranial nerves, have an influence upon 
 the functional activity of the brain. From the superior cervi- 
 cal ganglion impulses are transmitted by the gray rami to 
 the cranial nerves, the rami then accompanying the cranial 
 nerves from their origin outward to their entire distribution. 
 
 6. The lower thoracic nerves, by reason of their communi- 
 cation with the phrenic nerves, have an indirect, but decided, 
 influence upon the circulation of the brain. 
 
 The Innervation of the Eye. — The innervation of the eye 
 both direct and indirect, is of the greatest importance, since 
 clinical experience bears out the fact that, although, anatom- 
 ically the connection between certain spinal nerves with the 
 optic nerve cannot be exactly demonstrated, yet their influ- 
 ence on the functional activity of the structures of the orbit 
 cannot be denied. The eyes are innervated by the following 
 nerves : 
 
 1. The optic nerves, which pass directly from the cortical 
 surface of the occipital lobe of the cerebrum to the retina of 
 the eye, have a direct and decided influence upon the eye. 
 These nerves, from their mode of development and their 
 structure, must be considered as direct prolongations of the 
 brain substance, rather than as an ordinary cerebrospinal 
 nerve. As the optic nerves pass from the brain they receive 
 sheaths from the three cerebral membranes — a perineural 
 sheath from the pia mater, an intermediate sheath from the 
 arachnoid, and an outer sheath from the dura mater, which 
 is also connected with the periosteum as it passes through 
 the optic foramen. 
 
 2. The suboccipital nerves, by communicating with, and 
 assisting in the formation of the recurrent nerve to the tento- 
 rium, influence the nutrition of the cortical surfaces of the 
 occipital lobes, and consequently of the optic nerves. 
 
 3. The fourth cervical nerves have the most marked influ- 
 ence upon the function of the optic nerves, and also influence 
 the contraction and dilatation of the pupil. Subluxations 
 affecting these nerves have been known to result in loss of
 
 120 
 
 SPINAL ADJUSTMENT 
 
 Fig. 15. 
 
 I'arts lufliicncod by the Fifth 
 Cervical Nerve.
 
 CRANIUM, FACE AND NECK 121 
 
 vision, and cases are on record where their adjustment has 
 restored vision. 
 
 4. The first, second and third dorsal nerves have an influ- 
 ence on the action of the ciHary muscles of the eye, by reason 
 of their communication with the ciliary nerves. Their im- 
 pingement may result in failure of the power of accommo- 
 dation of the eye, and thus cause disturbances of vision. 
 Spasms of the eye-lids may be relieved instantly by adjust- 
 ment of the upper thoracic vertebrae. 
 
 5. The fifth pair of dorsal spinal nerves influence the eye- 
 balls by reason of their communication with the superior 
 cervical ganglion, which communicates with the cranial 
 nerves. This connection is established by the communication 
 of the carotid plexus with the Gasserian ganglion, and with 
 the sixth nerve; and of the cavernous plexus with the third, 
 the fourth, the ophthalmic division of the fifth, the sixth, 
 and the ophthalmic ganglion. In this manner there is a direct 
 communication of the fifth dorsal spinal nerves with the • 
 nerves to the eye-ball, and adjustment of the fifth dorsal 
 vertebra relieves many abnormal conditions of the eye. 
 
 6. The tenth pair of dorsal spinal nerves have an influence 
 upon the eyes. This has been rather obscure anatomically, 
 but clinical evidence bears out the connection. We know 
 that the tenth dorsal nerves markedly influence the kidneys, 
 and clinically we very often meet with visual troubles in 
 various diseases of the kidneys. The only connection that 
 exists between the tenth pair of thoracic nerves with the 
 optic nerves is through the communication of the former 
 with the terminal fibres of the phrenic, which in turn is derived 
 partly from the fourth cervical nerve, which we have seen 
 has so powerful an influence upon vision. 
 
 7. The first and second lumbar nerves also have a some- 
 what obscure yet decided influence upon the eyes. The 
 reader must constantly bear in mind that clinical phenomena 
 are very often met with for which there is no positive ex- 
 planation, yet which are sufficient to prove that a connection 
 exists between certain nerves, even though they cannot be 
 traced anatomically. 
 
 The Innervation of the Ear. — The innervation of the ear is 
 derived from the following ner^^es :
 
 122 
 
 SPINAL ADJUSTMENT 
 
 Parts Influenced by the Sixth 
 Cervical Nerve.
 
 CRANIUM, FACE AND NECK 123 
 
 1. The auditory nerves, which receives a branch from the 
 geniculate ganglion, which communicates with the superior 
 cervical ganglion through the external petrosal nerve. It 
 also connects with the upper thoracic spinal nerves through 
 the connection of the continuous ascending fibres of white 
 rami communicantes with the superior cervical ganglion. 
 Hence it is that the upper cervical and upper dorsal segments 
 influence to such a marked degree the ear. 
 
 2. The first four cervical spinal nerves unite with and 
 influence the ganglia which supply the auditory apparatus. 
 Through the medium of the recurrent nerve to the tentorium 
 they also afifect the circulation of the brain, and consequently 
 influence also the auditory centers in the cerebrum. 
 
 3. The upper five pairs of dorsal spinal nerves influence 
 the ear by reason of their connection with the superior cervi- 
 cal ganglion. The superior cervical ganglion communicates 
 with the eighth cranial nerve, and for this reason subluxations 
 in the upper cervical or upper dorsal region produce disturb- 
 ances in reference to the ear. The test for determining 
 whether deafness is due to a lesion of the auditory nerve 
 itself or to a lesion of the auditory apparatus is to place a 
 vibrating tuning fork on the head ; in cases where the auditory 
 apparatus is at fault the vibrations will be heard, but not 
 when there is a lesion of the auditory nerve. A serious lesion 
 of the auditory nerve proper necessarily produces permanent 
 deafness, but functional disturbances due to subluxations in 
 the upper cervical or upper dorsal regions, as well as disturb- 
 ances of the auditory apparatus respond very readily to spinal 
 adjustment. 
 
 The Innervation of the Nose. — The innervation of the nasal 
 chambers is derived from the following nerves : 
 
 1. The olfactory nerve, the special nerve of the sense of 
 smell, is distributed to the olfactory region of the nasal 
 cavities. This nerve communicates with the superior cervical 
 ganglion of the sympathetic, and is therefore influenced by 
 lesions in the upper cervical region. 
 
 2. The nasal nerve, a branch of the ophthalmic division of 
 the fifth cranial ner\'e. distributes filaments to the fore part 
 of the septum and the outer wall of the nasal fossae. This 
 nerve is also influenced by lesions of the upper four cervical
 
 124 
 
 SPINAL ADJUSTMENT 
 
 Fig. 17. 
 
 Tarts luHueiiced by the iSeveuth 
 Cervical Nerve.
 
 CRANIUM, FACE AND NECK 125 
 
 vertebrae since the Gasserian ganglion communicates with 
 the carotid plexus of the superior cervical ganglion, while 
 the ophthalmic division of the fifth cranial nerve communicates 
 with the cavernous plexus. 
 
 3. The vidian nerve, which supplies the upper and back 
 part of the septum and the superior spongy bone, communi- 
 cates through the superior cervical ganglion with the upper 
 four spinal nerves. 
 
 4. The naso-palatine nerve, a branch of the superior divi- 
 sion of the fifth cranial nerve, communicates with the superior 
 cervical ganglion through the connection of the Gasserian 
 ganglion with the carotid plexus. 
 
 5. The third cervical spinal nerve, by its connection with 
 the superior cervical ganglion, communicates with the fifth 
 cranial nerve, and thus becomes the most direct source of 
 innervation to the nose. 
 
 6. The fourth cervical spinal nerve, for the same reason 
 that the third spinal nerve afifects the nose, also influences the 
 nasal cavities directly. 
 
 7. The fourth and fifth dorsal spinal nerves, by their con- 
 nection wnth the superior cervical ganglion of the sympathetic, 
 have an indirect influence upon the nasal cavities. 
 
 8. The tenth pair of thoracic spinal nerves have a very 
 great influence on the action of the skin. A subluxation caus- 
 ing interference wath these nerves will, therefore, markedly 
 aflfect the Schneiderian membrane of the nose. 
 
 The Innervation of the Pharynx. — The innervation of the 
 pharynx is derived from the following nerves : 
 
 1. The first and second cervical spinal nerves, by reason 
 of their connection with the vagus, have a direct influence 
 upon the pharynx. 
 
 2. The fifth, sixth and seventh cervical spinal nerves have 
 a direct influence on the pharynx. 
 
 3. The upper dorsal spinal nerves have an indirect influ- 
 ence upon the pharynx, through their connection with the 
 superior cervical ganglion. 
 
 4. The pharyngeal nerves, which are one of the internal 
 branches of the superior cervical ganglion of the sympathetic, 
 pass to the side of the pharynx, where they join with branches 
 from the glosso-pharyngeal, vagus, and external laryngeal
 
 126 
 
 SPINAL ADJUSTMENT 
 
 Fig. 18. 
 
 Parts Influenced by the Eighth 
 Cervical Nerve.
 
 CRANIUM, FACE AND NECK 127 
 
 nerves to form the pharyngeal plexus. The superior cervical 
 ganglion communicating with the upper four spinal nerves, 
 any impingement of these nerves will interfere with the 
 proper innervation of the larynx, which is very quickly 
 corrected by adjustment of the displaced vertebrae. 
 
 5. The pharyngeal branch from Meckel's ganglion, which 
 communicates with the superior cervical ganglion of the 
 sympathetic, also influences the pharynx. 
 
 6. The pharyngeal branches of the glosso-pharyngeal 
 nerve unite with the pharyngeal branches of the vagus and 
 sympathetic nerves to form the pharyngeal plexus, branches 
 from which perforate the muscular coat of the pharynx to 
 supply the muscles and mucous membrane. 
 
 7. The pharyngeal branch of the vagus, the principal 
 motor nerve of the pharynx, arises from the inferior ganglion 
 of the vagus. 
 
 8. The lower dorsal spinal nerves supply the pharynx by 
 reason of their connection with the phrenic and vagus. 
 
 The Innervation of the Tonsils. — The innervation of the 
 tonsils is derived from the following nerves : 
 
 1. The upper cervical spinal nerves, especially the first 
 and second, influence the tonsils through their connection 
 with the superior cervical ganglion of the sympathetic which 
 communicates with the vagus, the tonsillar branch of the 
 glosso-pharyngeal, the pharyngeal plexus, Meckel's ganglion 
 which gives oiY the middle or external palatine nerve to the 
 tonsil, and the posterior palatine nerve which joins with the 
 middle palatine to form the plexus around the tonsil. 
 
 2. The fifth, sixth, and seventh cervical spinal nerves have 
 a decided influence upon the tonsils, as shown by clinical 
 results obtained by adjustment of vertebrae which impinge 
 these nerves. 
 
 3. The fifth thoracic spinal nerves, by their connection with 
 the superior cervical ganglion indirectly influence the tonsils. 
 
 The Innervation of the Larynx. — The innervation of the 
 larynx is derived from the following nerves : 
 
 1. The first cervical spinal nerve, through its connection 
 with the vagus and its communication with the superior cervi- 
 cal ganglion of the sympathetic. The vagus in turn gives 
 off the following branches: The superior laryngeal, which
 
 128 
 
 SPINAL ADJUSTMENT 
 
 Fig. 19. 
 
 Parts Influenced by the First 
 Dorsal Nerve.
 
 CRANIUM, FACE AND NECK 129 
 
 is the sensory nerve of the larynx, and which arises from the 
 inferior ganglion of the vagus; it consists principally of fila- 
 ments from the spinal accessory, and divides into two 
 branches, the internal and external laryngeal. The inferior or 
 recurrent laryngeal nerve, also a branch of the vagus, is the 
 motor nerve of the larynx, and unites with the cardiac branch 
 from the vagus and the sympathetic. 
 
 The sympathetic laryngeal nerve is one of the internal 
 branches of the superior cer\ical ganglion, and communicates 
 with the superior laryngeal nerve and its branches. 
 
 2. The second pair of cervical spinal nerves also influence 
 the larynx by reason of their communication with the superior 
 cervical ganglion of the sympathetic, and by sending fila- 
 ments to the terminal ganglia by which these structures are 
 innervated. 
 
 3. The fourth pair of cervical nerves also communicate 
 with the terminal ganglia of this region, and with the superior 
 cervical ganglion of the sympathetic. 
 
 4. The fifth pair of dorsal spinal nerves, through their 
 connection with the superior cervical ganglion have a marked 
 influence upon the larynx and the throat as clinical results 
 frequently demonstrate. 
 
 The Innervation of the Tongue. — The innervation of the 
 tongue is derived from the following nerves : 
 
 1. The hypoglossal and glosso-pharnygeal nerves are the 
 two cranial nerves which directly supply the tongue. 
 
 2. The first and second cervical spinal nerves influence 
 the tongue by reason of the fibres which they send to the 
 hypoglossal and glosso-pharyngeal nerves. Also by reason 
 of their communication with the superior cervical ganglion 
 of the sympathetic, which in turn communicates wath the 
 hypoglossal nerve by external branches, and with the glosso- 
 pharyngeal by a separate filament w^hich joins the petrosal 
 ganglion of that nerve. 
 
 3. The upper four cervical spinal nerves influence the 
 tongue, by reason of their connection with the superior cervi- 
 cal ganglion of the sympathetic which in turn communicates 
 with the cranial nerves, as follows : The lingual branch of the 
 fifth, which supplies ordinary sensibility to the anterior two- 
 thirds of the tongue; the chorda tympani. in the sheath of
 
 130 
 
 SPINAL ADJUSTMENT 
 
 Fig. 20. 
 
 Parts Influenced by the Second 
 Dorsal Nerve.
 
 CRANIUM, FACE AND NECK 131 
 
 the lingual, which confers the sense of taste on the anterior 
 two-thirds of the tongue; the lingual branch of the glosso- 
 pharyngeal, which supplies sensation and the sense of taste 
 to the base and sides of the tongue ; the superior laryngeal 
 branches of the tenth, which distribute fine branches to the 
 root of the tongue near the epiglottis. 
 
 Sympathetic fibres pass to the tongue from the nervi 
 molles on the lingual and other arteries supplying the tongue. 
 
 4. The fifth, sixth, and seventh cervical nerves supply the 
 tongue through their connection with the sympathetic 
 branches to the facial nerve. 
 
 5. The fifth thoracic spinal nerve has a marked effect upon 
 the tongue, by reason of its connection with the superior 
 cervical ganglion. This in turn communicates with the 
 terminal ganglia of the tongue. 
 
 The Innervation of the Teeth and Oral Cavity. — The in- 
 nervation of the teeth and oral cavity is derived from the 
 following nerves: 
 
 1. The upper four cervical nerves, by reason of their com- 
 munication with the superior cervical ganglion, which unites 
 with the trifacial nerve. The third and fourth cervical spinal 
 nerves especially communicate with the three divisions of the 
 fifth cranial nerve, and adjustment of the vertebrae causing 
 impingement of these nerves has a marked effect upon the 
 teeth and mouth. 
 
 3. The fifth thoracic spinal nerves afifect the teeth and 
 gums, as well as the other structures of the head and neck, 
 by reason of their communication with the superior cervical 
 ganglion. 
 
 The Innervation of the Thyroid Gland.^ — The innervation 
 of the thyroid gland is derived from the following nerves : 
 
 1. The upper four cervical spinal nerves influence the 
 thyroid gland through their connection with the superior 
 cervical ganglion which sends a branch of communication to 
 the vagus, branches of which form the pharyngeal plexus 
 which supplies the thyroid gland. 
 
 2. The fifth and sixth cervical nerves influence the thyroid 
 gland by reason of their communication with the middle 
 cervical ganglion of the sympathetic. The thyroid branches 
 of this ganglion directly supply the thyroid gland; they ac-
 
 132 
 
 SPINAL ADJUSTMENT 
 
 Fig. 21. 
 
 Parts Influenced by the Third 
 Dorsal Nerve.
 
 CRANIUM, FACE AND NECK 133 
 
 company the inferior thyroid artery to the thyroid gland. 
 They communicate on the artery with the cardiac nerves, and 
 in the gland with the recurrent and external laryngeal nerves. 
 3. The seventh and eighth cervical nerves also influence 
 the thyroid, since they join the inferior cervical ganglion 
 which sends fibres to the middle cervical ganglion, and with 
 the cardiac and recurrent laryngeal nerves.
 
 134 
 
 SPINAL ADJUSTMENT 
 
 Fig. 22. 
 
 Parts Influenced by the Fourth 
 Dorsal Nerve.
 
 CHAPTER II 
 
 The Innervation of the Organs of the Thorax 
 
 The Innervation of the Mammary Gland. — The innervation 
 of the mammary gland is derived from the following nerves : 
 
 1. The second, third, fourth, fifth, and sixth dorsal spinal 
 nerves through their anterior branches, named the upper or 
 pectoral intercostal nerves. These nerves give off the lateral 
 cutaneous, the anterior branches of which supply the 
 mammary gland. 
 
 2. The upper thoracic nerves further influence the 
 mammary gland through the medium of the gray rami 
 communicantes which join the intercostal nerves. 
 
 3. The lower cervical nerves as well as the upper dorsal 
 also influence the mammary gland through the internal and 
 external intercostal branches of the brachial plexus. 
 
 The Innervation of the Heart. — The innervation of the 
 heart is derived from the following nerves : 
 
 1. The first, second, third and fourth cervical spinal 
 nerves influence the heart as a result of their following con- 
 nections : They communicate with the superior cervical 
 ganglion which sends a branch to the vagus ; the branches of 
 the vagus which supply the heart are the cervical cardiac 
 branches which arise from it at the upper and lower part 
 of the neck; the superior branch connects with the cardiac 
 branches of the sympathetic ; the inferior branch communi- 
 cates with the superficial cardiac plexus. The thoracic cardiac 
 branches arise from the trunk of the vagus and end in the 
 deep cardiac plexus. 
 
 The superior cardiac is one of the internal branches of the 
 superior cervical ganglion of the sympathetic; it receives a 
 filament from the cord of communication between the upper 
 and middle cervical ganglia. 
 
 The deep cardiac plexus is formed by the cardiac nerves 
 derived from the cervical ganglia of the sympathetic and the 
 cardiac branches of the recurrent laryngeal and vagus. 
 
 135
 
 136 
 
 SPINAL ADJUSTMENT 
 
 Fig. 23. 
 
 I'arts Influenced by the Fifth 
 Dorsal Nerve.
 
 ORGANS OF THE THORAX 137 
 
 The superficial cardiac plexus is formed by the left supe- 
 rior cardiac nerve, the left (and occasionally the right) infe- 
 rior cervical cardiac branches of the vagus, and filaments 
 from the deep cardiac plexus. A small ganglion, the cardiac 
 ganglion of Wrisberg, is sometimes found connected with 
 these nerves at their point of junction. These plexuses supply 
 the surface and substance of the heart. 
 
 The superior cardiac nerve, above referred to, divides 
 into two branches : the right superior cardiac nerve at about 
 the middle of the neck receives filaments from the external 
 laryngeal nerve; lower down, one or two twigs from the 
 vagus ; and as it enters the thorax it is joined by a filament 
 from the recurrent laryngeal. Filaments from this nerve 
 communicate with the thyroid branches from the middle 
 cervical ganglion. 
 
 The left superior cardiac nerve, in the chest, runs by the 
 side of the left common carotid artery and in front of the 
 arch of the aorta to the superficial cardiac plexus, but occa- 
 sionally it passes behind the aorta and ends in the deep 
 cardiac plexus. 
 
 2. The fifth and sixth cervical spinal nerves influence 
 the heart by their connection with the middle cervical gang- 
 lion of the sympathetic. This ganglion gives oflf the middle 
 cardiac nerve, which divides into two branches. The one 
 on the right side receives a few branches from the recurrent 
 laryngeal nerve, and joins the right side of the deep cardiac 
 plexus ; in the neck it communicates with the superior 
 cardiac and recurrent laryngeal nerves. On the left side the 
 middle cardiac nerve joins the left side of the deep cardiac 
 plexus. 
 
 3. The seventh and eighth cervical spinal nerves influence 
 the heart by their connection with the inferior cervical gang- 
 lion of the sympathetic, which gives oflf the inferior cardiac 
 nerve. This nerve communicates freely with the recurrent 
 laryngeal nerve and the middle cardiac nerve. 
 
 4. The third, fourth and fifth cervical spinal nerves, in 
 addition to the above mentioned connections with cardiac 
 nerves, also give off the phrenic nerves which supply the 
 pericardium, and which assist in the formation of the cardiac 
 plexus.
 
 138 
 
 SPINAL ADJUSTMENT 
 
 Parts Influenced by the Sixth 
 Dorsal Nerve.
 
 ORGANS OF THE THORAX 139 
 
 5. The upper dorsal, spinal nerves, especially the second, 
 have a powerful influence upon the action of the heart. 
 
 6. The fourth thoracic spinal nerves have a vaso-motor 
 and inhibitory influence upon the heart. The action of the 
 heart may be restored to normal by removing pressure upon 
 this nerve, as well as by percussion over the spinous processes 
 of the first and second thoracic vertebrae. This influence of 
 the fourth thoracic nerve upon the action of the heart may be 
 readily demonstrated by using the above described methods 
 when it will be found that the number of heart-beats may 
 be reduced from ninety per minute to seventy in a few 
 minutes. 
 
 7. The lower thoracic spinal nerves, through their com- 
 munication with the terminal fibres of the phrenic nerves, 
 exert an indirect influence on the heart action. 
 
 The Innervation of the Lungs. — The innervation of the 
 lungs is derived from the following nerves : 
 
 1. The first cervical spinal nerves influence the lungs by 
 sending a branch to the vagus, which supplies the lungs 
 through the anterior and posterior pulmonary nerves. 
 
 2. The upper four cervical nerves influence the lungs 
 through their connection with the superior cervical ganglion 
 of the sympathetic, which communicates with the vagus. 
 The anterior pulmonary branches of the vagus are distributed 
 to the anterior aspect of the root of the lungs. They join 
 with the filaments from the sympathetic to form the anterior 
 pulmonary plexus. The posterior pulmonary branches are 
 distributed on the posterior aspect of the root of the lungs. 
 Branches from both these plexuses accompany the bronchial 
 tubes, and have small ganglia along their course. 
 
 3. The fourth cervical spinal nerves have an especial in- 
 fluence upon the lungs. These nerves give origin to the 
 phrenic nerves, which have a direct effect on the lungs by 
 reason of their distribution to the pleurae, pericardium and 
 diaphragm. As previously explained, these nerves, by gov- 
 erning the movements of the thoracic viscera, influence to a 
 marked degree the cerebral circulation. 
 
 4. The first to fourth thoracic spinal nerves affect the 
 lungs by their connection with the first four thoracic gangha 
 of the gangliated cord, which communicate with the posterior
 
 140 
 
 SPINAL ADJUSTMENT 
 
 Fig. 25. 
 
 I'arts Influenced by the Seventh 
 Dorsal Nerve.
 
 ORGANS OF THE THORAX 141 
 
 pulmonary branch of the vagus to form the pulmonary plexus. 
 The third and fourth ganglia especially, and the first and 
 second more rarely have this connection. 
 
 5. The third thoracic nerves, however, have the most 
 marked influence upon the lungs. They supply the entire 
 extent of the pleurae and the upper lobe of both lungs. 
 
 6. Various other spinal nerves indirectly influence the 
 lungs by their connection with nerves influencing other or- 
 gans, the proper function of which has much to do with the 
 condition of the lungs or their restoration to a normal state 
 when they are diseased.
 
 142 
 
 SPINAL ADJUSTMENT 
 
 Fig. 26. 
 
 Parts Influenced by tbe Eighth 
 Dorsal Nerve.
 
 CHAPTER III 
 
 The Innervation of the Organs of the Abdomen 
 
 The Innervation of the Peritoneum. — The innervation of 
 the peritoneum is derived from practically the same nerves 
 that supply the large and small intestines (q. v.). Its upper 
 portions are supplied by the vagus and phrenic nerves, while 
 in the lower portions of the abdomen it receives its innerva- 
 tion from the splanchnic nerves and white rami from the 
 lower dorsal and upper lumbar nerves. 
 
 The Innervation of the Diaphragm. — The innervation of 
 the diaphragm is derived from the following nerves : 
 
 1. The first to fourth cervical spinal nerves influence the 
 diaphragm by reason of their communication with the vagus 
 nerve, which assists in the formation of the phrenic or 
 diaphragmatic plexus, and also sends fibres directly to the 
 diaphragm. 
 
 2. The third, fourth and fifth cervical nerves by entering 
 into the formation of the phrenic nerves have an important 
 effect upon the diaphragm. 
 
 3. The middle thoracic nerves influence the diaphragm 
 by their communication with the fifth to tenth thoracic 
 ganglia of the sympathetic, branches from which form the 
 great splanchnic nerves which terminate in the semilunar 
 plexus, of which the phrenic or diaphragmatic plexus is a 
 prolongation. 
 
 4. The seventh to eleventh thoracic nerves whose anterior 
 divisions, namely the lower or abdominal intercostal nerves, 
 also supply the diaphragm, have a direct influence on this 
 structure. 
 
 5. The tenth and eleventh thoracic nerves further influence 
 the diaphragm by reason of their connection with the corre- 
 sponding ganglia which give off the lower splanchnic nerve 
 which joins the solar plexus, and, in the chest, communicates 
 with the great splanchnic nerve. 
 
 143
 
 144 
 
 SPINAL ADJUSTMENT 
 
 Fig. 27. 
 
 I'arts Influenced by the Ninth 
 Dorsal Nerve.
 
 ORGANS OF THE ABDOMEN 145 
 
 The Innervation of the Liver. — The innervation of the 
 liver is very similar to that of the stomach. The various 
 segments of the spinal column affect the liver in practically 
 the same manner that they do the stomach. The innervation 
 of the liver is accordingly derived from the following nerves : 
 
 1. The upper cervical nerves influence the liver by their 
 connection with the vagus nerve which sends a filament of 
 communication to the hepatic plexus. 
 
 2. The third, fourth and fifth cervical nerves also influ- 
 ence the liver by reason of their formation of the phrenic 
 nerves which send a filament to the hepatic plexus. 
 
 3. The middle thoracic nerves influence the liver in the 
 same manner and for the same reason that they influence 
 the stomach. From this region emanate the splanchnic 
 nerves, which are derived from the fifth or sixth to the ninth 
 or tenth thoracic ganglia, and which have a direct influence 
 upon the liver. 
 
 The Innervation of the Spleen. — The innervation of the 
 spleen is derived from the following nerves : 
 
 1. The upper four cervical nerves influence the spleen 
 through their connection with the vagus nerve, in the same 
 manner that these nerves influence the liver and stomach. 
 
 2. The third, fourth and fifth cervical nerves also influence 
 the spleen by reason of their entering into the formation of 
 the phrenic nerves. 
 
 3. The middk thoracic spinal nerves influence the spleen 
 through their connection with the corresponding thoracic 
 ganglia of the gangliated cord, which latter communicate with 
 the splanchnic nerves to the semilunar ganglion of the solar 
 plexus. The left semilunar ganglia, together with branches 
 from the celiac plexus and the right vagus nerve, form the 
 splenic plexus, which accompanies the splenic artery to the 
 substance of the spleen. 
 
 The sixth dorsal spinal nerve has the most marked 
 influence upon the spleen. 
 
 The Innervation of the Pancreas. — The innervation of the 
 pancreas is derived from the following nerves : 
 
 1. The upper four cervical spinal nerves through their 
 connection with the vagus nerve have an indirect influence on 
 the pancreas.
 
 146 
 
 SPINAL ADJUSTMENT 
 
 Fig, 28. 
 
 Parts Influenced by the Tenth 
 Dorsal Nerve.
 
 ORGANS OF THE ABDOMEN 147 
 
 2. The middle cervical nerves, especially the fourth, by 
 forming the phrenics also influence the pancreas. 
 
 3. The middle thoracic spinal nerves through their con- 
 nection with the semilunar ganglia and solar plexus have the 
 greatest effect on the pancreas and adrenals. The eighth 
 dorsal spinal nerves have the most marked influence on the 
 pancreas. Filaments from the splenic plexus form the pan- 
 creatic plexus and it is the eighth thoracic nerve which enters 
 most largely into the formation of this portion of the splenic 
 plexus. 
 
 The Innervation of the Stomach. — The innervation of the 
 stomach is derived from the following nerves : 
 
 1. The vagus by its terminal branches supplies the stom- 
 ach; the one on the right being distributed to the back part, 
 and the left to the front part of the organ. Its communication 
 with spinal nerves through the rami communicantes in vari- 
 ous segments of the spine makes possible the influence of the 
 function of the stomach by adjustment of the vertebrae in 
 various regions of the vertebral column. 
 
 The splanchnic nerves also influence the stomach, through 
 their termination in the solar plexus. Since these nerves com- 
 municate with the thoracic ganglia, and these in turn with the 
 thoracic spinal nerves, the stomach may be affected more 
 or less directly and markedly by subluxations in this region 
 of the spine. 
 
 A great number of branches from the sympathetic also in- 
 fluence the stomach, and their connection with the spinal 
 nerves make impingement of such spinal nerves an important 
 factor in the production of various gastric disorders. 
 
 2. The upper cervical spinal nerves influence the stomach 
 and other organs of the abdomen by their communication 
 with the vagus. Any impingement of these nerves will, there- 
 fore, interfere with the action of those parts supplied by the 
 vagus. 
 
 3. The fourth cervical spinal nerves, by forming in con- 
 nection with the third and fifth cervicals the phrenic 
 nerves, influence the stomach. The phrenics enter into the 
 formation of the solar plexus. 
 
 4. The fifth, sixth and seventh pairs of thoracic spinal 
 nerves have the most marked influence on the stomach. These
 
 148 
 
 SPINAL ADJUSTMENT 
 
 Fig. 29. 
 
 Parts Influenced by the Eleventh 
 Dorsal Nerve.
 
 ORGANS OF THE ABDOMEN 149 
 
 nerves form the great splanchnic nerves, which terminate 
 in the semilunar ganglion, a portion of the solai plexus. 
 
 5. The tenth and eleventh thoracic spinal nerves have an 
 influence on the stomach. These nerves communicate with 
 the corresponding ganglia of the gangliated cord, which in 
 turn form the lesser splanchnic nerves which, together with 
 a filament from the right vagus nerve, communicate with the 
 celiac plexus. This plexus is a direct continuation of the 
 solar plexus, and gives off the gastric plexus which accom- 
 panies the gastric artery along the lesser curvature of the 
 stomach and joins with branches from the left vagus nerve. 
 
 6. The first and second lumbar nerves, by communicat- 
 ing with the terminal fibres of the vagus nerve, directly influ- 
 ence the stomach. It is for this reason that we find nausea 
 and vomiting in pelvic disorders and especially in pregnancy. 
 
 The Innervation of the Large Intestine. — The nerves that 
 supply the large intestine are derived from the plexuses of the 
 sympathetic nerve around the branches of the superior and 
 inferior mesenteric arteries that are distributed to the large 
 intestine. They are distributed in a similar way to those in 
 the small intestine. 
 
 The innervation of the large intestines is derived from the 
 following nerves : 
 
 1. The vagus nerve influences the large intestine by its 
 communication with the celiac and splenic plexuses. The 
 celiac plexus is a continuation of the solar plexus, while the 
 superior mesenteric and aortic plexuses which supply the 
 large intestines are also derived from the solar plexus. 
 
 2. The lower thoracic nerves influence the large intes- 
 tine through the splanchnic nerves, and through the descend- 
 ing fibres of white rami communicantes. These nerves further 
 influence the large intestine in the following manner: The 
 splanchnic nerves terminate in the solar plexus and semilunar 
 ganglia which give rise to the aortic plexus, from which is 
 derived the inferior mesenteric plexus. This plexus surrounds 
 the inferior mesenteric artery, and subdivides into a number 
 of secondary plexuses, which are distributed to all the parts 
 supplied by the artery, namely the left colic and sigmoid 
 plexuses which supply the descending and sigmoid flexure of 
 the colon ; and the superior hemorrhoidal plexus, which sup-
 
 150 
 
 SPINAL ADJUSTMENT 
 
 Fig. 30. 
 
 Parts Supplied by tjie Twelfth 
 Dorsal Nerve.
 
 ORGANS OF THE ABDOMEN 151 
 
 plies the upper part of the rectum. The ileo-colic, right 
 colic, and middle colic branches of the superior mesenteric 
 plexus supply the corresponding parts of the large intestine. 
 
 3. The upper lumbar nerves, especially the second, influ- 
 ence the large intestines through their connection with the 
 ganglia which communicate with the aortic plexus. 
 
 4. The innervation of the appendix is practically identical 
 to that of the large intestine, of which it is a part. Thus 
 we find that adjustment of the second lumbar vertebra will 
 in the great majority of instances relieve appendicitis. 
 
 5. In addition to the innervation of the upper part of the 
 rectum mentioned above, the lower portion is supplied by 
 the inferior hemorrhoidal plexus which arises from the pelvic 
 plexus. This plexus communicates with the superior 
 hemorrhoidal plexus. 
 
 The fourth, and especially the fifth lumbar spinal nerves 
 indirectly influence the rectum through their connection with 
 the pelvic plexus which supplies the rectum. 
 
 The Innervation of the Small Intestine. — The nerves of the 
 small intestine are derived from the plexuses of sympathetic 
 nerves around the superior mesenteric artery. From this 
 source they run to a plexus of nerves and ganglia situated 
 between the circular and longitudinal muscular fibres, named 
 Auerbach's plexus, from which the nervous branches are dis- 
 tributed to the muscular coats of the intestine. From this 
 plexus a secondary plexus is derived, named the plexus of 
 Meissner, which is formed by branches which have per- 
 forated the circular muscular fibres. This plexus lies between 
 the muscular and mucous coats of the intestine. It is also 
 gangliated, and from it the terminal fibres pass to the 
 muscularis mucosae and to the mucous membrane and villi. 
 
 The following are the spinal segments which influence the 
 innervation of the intestine : 
 
 1. Since the vagus nerve supplies the small intestines the 
 upper cervical spinal nerves which communicate with this 
 nerve through the medium of the sympathetic have an 
 influence on the intestines. 
 
 2. The phrenic nerves also supply the small intestines, and 
 being formed by the third, fourth and fifth cervical spinal 
 nerves, these nerves influence the small intestines.
 
 152 
 
 SPINAL ADJUSTMENT 
 
 Fig. 31. 
 
 Parts Influenced by the First 
 Lumbar Nerve.
 
 ORGANS OF THE ABDOMEN 153 
 
 3. The three splanchnic nerves supply the small intestine, 
 and since they communicate with the thoracic spinal nerves 
 through the sympathetic ganglia and rami communicantes 
 these spinal nerves have a decided influence upon the small 
 intestine. 
 
 The great splanchnic nerve is formed by branches from 
 the thoracic ganglia between the fifth and sixth and the ninth 
 or tenth, but the fibres in the upper roots may be traced 
 upward in the gangliated cord as high as the first or second 
 thoracic ganglia. It terminates in the semilunar ganglion of 
 the solar plexus. 
 
 The lesser splanchnic nerve is formed by filaments from 
 the tenth and eleventh ganglia, and from the cord between 
 them. It joins the solar plexus, and communicates in the 
 chest with the great splanchnic nerve. 
 
 The smallest splanchnic nerve arises from the twelfth 
 thoracic ganglion and terminates in the solar and renal 
 plexuses. It sometimes communicates with the lesser 
 splanchnic nerve. 
 
 4. The lumbar nerves have some influence upon the small 
 intestines. 
 
 The Innervation of the Kidneys. — The nerves of the kid- 
 ney, although small, are about fifteen in number. They have 
 small ganglia developed upon them. They are derived from 
 the renal plexus, which is formed by branches from the solar 
 plexus, the lower and outer part of the semilunar ganglion, 
 the aortic plexus, and from the lesser and smallest splanchnic 
 nerves. They communicate with the spermatic plexus, and 
 this fact probably explains the occurrence of pain in the 
 testicle in affections of the kidney. 
 
 The following are the spinal nerves which influence the 
 kidneys : 
 
 1. The first and second cervical spinal nerves influence 
 the kidneys by reason of their communication with the vagus 
 nerve which supplies the kidneys indirectly. 
 
 2. The lower thoracic spinal nerves influence the kidneys 
 by reason of their connection with the lesser and smallest 
 splanchnics, which communicate with the renal plexus. The 
 tenth dorsal is the one which has the greatest influence on 
 the kidney.
 
 154 
 
 SPINAL ADJUSTMENT 
 
 Fig. 32. 
 
 Parts Influenced by tlio Second 
 Lumbar Nerve.
 
 ORGANS OF THE ABDOMEN 155 
 
 The Innervation of the Suprarenal Capsule. — The ninth 
 thoracic nerves have the greatest influence on the suprarenal 
 capsule. The suprarenal plexus, which supplies the adrenal 
 bodies is formed by branches from the solar plexus, the outer 
 part of the semilunar ganglion, and from the phrenic and 
 great splanchnic nerves, a ganglion being formed at the point 
 of junction of the latter nerve. The branches of this plexus 
 are remarkable for their large size in comparison with the 
 size of the organ which they supply.
 
 156 
 
 SPINAL ADJUSTMENT 
 
 Fig. 33. • 
 
 rarts Influenced by the Third 
 Lumbar Nerve.
 
 CHAPTER IV 
 
 The Innervation of the Organs of the Pelvis 
 
 The Innervation of the Bladder. — The nerves of the blad- 
 der are derived from the pelvic plexus of the sympathetic and 
 from the second, third and fourth sacral nerves; the former 
 supply the upper part of the organ, while the latter supply 
 its base and neck. The sympathetic fibres have ganglia con- 
 nected with them, which send branches to the vessels and 
 muscular coat. The pelvic plexus is formed by a continua- 
 tion of the hypogastric plexus, by branches from the second, 
 third, and fourth sacral nerves, and by a few filaments from 
 the first two sacral ganglia. From this plexus numerous 
 branches, which accompany the branches of the internal iliac 
 artery, are distributed to all the viscera of the pelvis. 
 
 The specific plexus which supplies the bladder is the 
 vesical plexus, which arises from the fore part of the pelvic 
 plexus. The nerves composing it are numerous, and contain 
 a large proportion of spinal nerve-fibres. They accompany 
 the vesical arteries, and are distributed at the side and base 
 of the bladder. Numerous filaments also pass to the seminal 
 vesicles and vas deferens ; those supplying the vas deferens 
 unite with branches of the spermatic plexus on the spermatic 
 cord. 
 
 The spinal nerves which have the greatest influence on the 
 bladder are the eleventh thoracic and the first lumbar. These 
 nerves communicate with the vesical plexus by connecting 
 with the corresponding ganglia of the sympathetic, which send 
 internal branches that communicate with the hypogastric 
 plexus. 
 
 The most marked efifect upon the bladder is obtained by 
 adjustment of the first and fifth lumbar vertebrae. 
 
 The Innervation of the Uterus. — The nerves to the uterus 
 are derived from the inferior hypogastric and ovarian plexuses, 
 and from the third and fourth sacral nerves. The uterine 
 plexus which specifically supplies the uterus arises from the 
 
 157
 
 158 
 
 SPINAL ADJUSTMENT 
 
 Parts Influenced by the Fourth 
 Lumbar Nerve.
 
 ORGANS OF THE PELVIS 159 
 
 upper part of the pelvic plexus above the point where the 
 branches from the sacral nerves unite with that plexus. Its 
 branches accompany the uterine arteries to the side of the 
 organ between the folds of the broad ligament, and are dis- 
 tributed to the substance of the lower part of the body of 
 the uterus and to the cervix. Branches from the uterine 
 plexus also accompany the uterine arteries into the substance 
 of the organ, and have numerous ganglia developed upon 
 them. Other filaments pass separately to the fundus and the 
 Fallopian tubes. 
 
 The following spinal nerves influence the uterus : 
 
 1. The lower thoracic nerves, through their communica- 
 tion with the pelvic plexus have an influence on the uterus. 
 
 2. The lumbar nerves also influence the uterus by reason 
 of their communication directly with the hypogastric and 
 uterine plexuses. The fourth lumbar especially controls the 
 uterus, and adjustment of this vertebra is indicated in various 
 uterine disorders. 
 
 The Innervation of the Prostate Gland. — The nerves which 
 supply the prostate gland are derived from the pelvic plexus, 
 through the medium of the prostatic plexus. The nerves com- 
 posing this plexus are of large size. They are distributed to 
 the prostate gland, seminal vesicles, and erectile tissue of the 
 penis. 
 
 The spinal nerves which have an influence on the prostate 
 gland are the following: 
 
 1. The lower thoracic spinal nerves, by their connection 
 with the pelvic plexus have some influence upon the prostate 
 gland. 
 
 2. The lumbar nerves, however, have the most marked in- 
 fluence upon this organ, and the nerves which most directly 
 influence it are the first and fifth lumbar. 
 
 The Innervation of the Ovaries. — The nerves which sup- 
 ply the ovary are derived from the pelvic plexus and from 
 the ovarian plexus. The pelvic plexus has been previously 
 described. The ovarian plexus is derived from the renal 
 plexus, and is distributed to the ovaries and the fundus of the 
 uterus. 
 
 The spinal nerves that influence the ovaries are the 
 following :
 
 160 
 
 SPINAL ADJUSTMENT 
 
 Fig. 35. 
 
 Parts Influenced by the Fifth 
 Lumbar Nerve.
 
 ORGANS OF THE PELVIS 161 
 
 1. The tenth, eleventh, and twelfth thoracic nerves form 
 the lesser and smallest splanchnics, which assist in the forma- 
 tion of the renal plexus from which the ovarian plexus is 
 derived. 
 
 2. The lumbar nerves, by their connection with the lum- 
 bar ganglia which assist in the formation of the hypogastric 
 plexus from which the pelvic and finally the ovarian plexus 
 are derived, also influence the ovaries. The third lumbar 
 nerve, especially, influences the ovaries. 
 
 The Innervation of the Testicles. — The nerve-supply of 
 the testicles is analogous to that of the ovaries. It is de- 
 rived from the spermatic plexus which, like the ovarian plexus, 
 is a branch of the renal plexus. It accompanies the spermatic 
 vessels to the testes. 
 
 The spinal nerves which influence the testes are the same 
 as those which influence the ovary. 
 
 The Innervation of the Vagina. — The nerve-supply of the 
 vagina is derived from the vaginal plexus, which arises from 
 the lower part of the pelvic plexus. It is lost on the walls of 
 the vagina, being distributed to the erectile tissue on its ante- 
 rior part and to the mucous membrane. The nerves compris- 
 ing this plexus contain, like those of the vesical, a large 
 number of spinal nerve-fibres. 
 
 The spinal nerves which influence the vagina are identical 
 with those which afifect the uterus. 
 
 The Innervation of the Penis. — The nerves which supply 
 the penis are comprised of two sets, namely, the large and 
 small cavernous nerves. These are slender filaments which 
 arise from the front part of the prostatic plexus, and, after 
 uniting with branches from the internal pudic nerve, pass 
 forward beneath the pubis. 
 
 The second and fourth lumbar nerves are the spinal nerves 
 which have the most decided influence upon this organ, by 
 reason of their connection with the hypogastric plexus through 
 the corresponding lumbar ganglia.
 
 SECTION FOUR 
 Vertebral Mal-Alignment 
 
 CHAPTER I 
 The Etiology of Abnormal Nerve Function 
 
 We have seen in the previous section that the nervous 
 system penetrates every part and parcel of the body. So 
 much so, that were all the other portions of the body removed 
 and the nervous system left intact, the human figure could 
 still be recognized. Fig. 36. 
 
 It was also shown how every part of the body is dependent 
 upon the nervous system for its organic integrity and its 
 functional activity. 
 
 As a result, were the human organism deprived of this 
 dynamic influence, the harmony normally existing between 
 its component parts would be destroyed, and functional and 
 organic disorders would rapidly supervene. 
 
 Even though the brain itself, which is the producing and 
 receiving centre of all impulses, be organically and function- 
 ally perfect, it would be useless, were the irritability and 
 conductivity of the nerves impaired. This is true because 
 the brain is as dependent on the nerves for transmitting im- 
 pulses to and from it as are the nerves on the brain for the 
 receiving of impulses. 
 
 So long, therefore, as the nerve irritability and conduc* 
 tivity are intact, there will be a normal flow of impulses and 
 a condition of health. When, however, the nerves are pre- 
 vented from conducting a continuous flow of impulses, the 
 vital processes are impaired, and the body then becomes sus- 
 ceptible to the secondary and contributing factors in the 
 production of disease. An acute disease may follow. If the 
 interference with the nerve impulses persists, it becomes the 
 cause of the continuance of a chronic disorder. 
 
 163
 
 164 
 
 SPINAL ADJUSTMENT 
 
 Fig. 36. 
 
 Phantom of Nervous System.
 
 ABNORMAL NERVE FUNCTION 165 
 
 The Causes of Disturbed Nerve Function. — A thorough 
 knowledge of the various w^ays in which disturbed nerve 
 function may be produced is naturally very important, for 
 upon the principal cause of this disturbed function, namely 
 vertebral subluxations, depends the science of spinal adjust- 
 ment. A detailed discussion of the causes of disturbed nerve 
 function other than vertebral lesions is scarcely necessary in 
 a work of this nature, and they will be referred to only briefly. 
 
 The causes of disturbed nerve function embrace those 
 factors which operate to alter the strength of the conduction 
 process, for upon its conductivity depends its functional 
 activity, namely the conveying of impulses to and from the 
 central nervous system. These causes may, accordingly be 
 classed as follows : 
 
 (a) Fatigue. 
 
 (b) Malnutrition. 
 
 (c) Traumatism. 
 
 (d) Extremes of Temperature. 
 
 (e) Chemicals and Drugs. 
 
 (f) Mechanical Conditions. 
 
 Fatigue of Nerves.^ — Almost every form of protoplasm, 
 when stimulated to prolonged action, deteriorates and finally 
 fails to act. Such cannot be said of nerve-fibres, however, 
 for they have been experimentally excited numerous times 
 per second, for many hours, and still, at the end of that time, 
 were capable of developing an impulse at the stimulated point. 
 Why this is so is still not known. If, as is generally sup- 
 posed, the nerve-impulse is a form of energy which passes 
 along the length of the nerve, and since the liberation of 
 energy implies the breaking down of chemical combinations, 
 it seems strange on a superficial view that fatigue apparently 
 does not result. The nerve-cells, however, appear to tire 
 after frequent excitation. This fact appears to make the lack 
 of fatigue of the nerve-fibres still more perplexing, since the 
 latter are direct processes of the nerve-cell. 
 
 Fatigue of nerves must therefore be looked upon as fatigue 
 not of the conduction apparatus, but of the centre which gen- 
 erates the impulse. That the conduction of nerve-impulses 
 does not exhaust the nerve-fibre shows that the process of
 
 166 SPINAL ADJUSTMENT 
 
 conduction does not involve any change in the substance of 
 the nerve-fibre. Generation of the impulses does involve 
 chemical changes in the nerve-centre, and therefore the nerve- 
 cell may become exhausted ; conduction of the impulse does 
 not involve any chemical change, and hence the nerve-fibre 
 does not become fatigued by conducting the impulses, no mat- 
 ter how often repeated. 
 
 Consequently, when the nerve-fibre is experimentally ex- 
 cited, it does not become fatigued because it has generated 
 nothing, at the expense of its own structure, the impulse which 
 it conveyed having been generated by the electric apparatus 
 which excited the nerve to action, and acted in the same ca- 
 pacity that the nerve-cell does in the living body. 
 
 Fatigue of a nerve-centre is well illustrated by the in- 
 ability to detect the odor of a perfume of a certain kind, after 
 having previously smelled various other kinds. The repeated 
 stimulation of the olfactory centre tires it until finally it no 
 longer correctly interprets the impulse received and is unable 
 to send an impulse to the olfactory portion of the Schneiderian 
 membrane of the nose to which the sense of smell is referred. 
 
 Malnutrition of Nerves. — The nerve-fibre, in order to pre- 
 serve its irritability, must receive a constant supply of blood. 
 Even though the nerve-fibre depends for its nourishment upon 
 the cell-body from which it is derived, it must be plentifully 
 supplied with blood and also oxygen. For example, it is seen, 
 experimentally, that a nerve retains its irritability much 
 longer in oxygen than in air, and longer in air which con- 
 tains oxygen than that which does not. 
 
 Malnutrition, therefore, is always productive of disturbed 
 nerve function. When, for example, the abdominal aorta of 
 a rabbit was ligated, complete paralysis of the lower limbs, 
 both motor and sensory, followed very soon. This paralysis 
 was due, in the first place, to loss of function of the nerve- 
 cells in the spinal cord, and later to loss of irritability of the 
 nerves of the limbs. 
 
 This shows that nerves deprived of their nourishment lose 
 their function. Such deprivation of the nerves of blood and 
 oxygen occurs in the living body when an improper quality 
 or a deficient quantity of food is ingested. It is also a result 
 of faulty digestion and assimilation.
 
 ABNORMAL NERVE FUNCTION 167 
 
 The nerve-cells in the spinal cord derive their blood-supply 
 from the vessels in the sheath of the spinal nerve. If a dis- 
 placement of a vertebra, sufficiently marked to produce pres- 
 sure upon these vessels by the margins of the intervertebral 
 foramen, occurs, the nourishment of the corresponding seg- 
 ment of the cord suffers. As a. result of this the nerve-cells 
 in that segment are affected, and we find disturbed function 
 in those parts of the body supplied by the nerve-cells which 
 are involved. 
 
 Traumatism of Nerves. — The point at which a nerve is 
 most liable to injury is at the intervertebral foramina. The 
 place of injury to a nerve where the greatest measure of ill 
 effects ensue is also at the intervertebral foramina. They are 
 most liable to injury at this point because in this location 
 along their course they pass between movable bones which 
 are subject to more or less marked displacement. 
 
 The nerves naturally may be injured at any point along 
 their course, but such an injury is usually local in its effects, 
 and regeneration soon occurs, with reestablishment of the 
 function of those parts supplied by it. But when the injury 
 is produced by a subluxated vertebra, it persists until 
 mechanically corrected. Since the primary divisions of the 
 nerves in such cases are affected, the effects are marked in 
 their distribution and severity. 
 
 That pressure upon a nerve disturbs its power of con- 
 ductivity every one has had occasion to demonstrate on him- 
 self. For example, if pressure is brought to bear upon the 
 ulnar nerve where it crosses the elbow, the region supplied by 
 the nerve becomes numb. 
 
 The most common ways in which nerves are injured are 
 by tearing, blows, cuts, pinching, twitching, stretching, and 
 pressure. 
 
 The most important of these is pressure at the interver- 
 tebral foramina, for the reason that the producing cause re- 
 mains in operation until the vertebral displacement is cor- 
 rected by "adjustment" of the vertebra. The effects of such 
 pressure vary from those of slight, to those of the greatest 
 seriousness. 
 
 The Effect of Extremes of Temperature on Nerves. — 
 Changes in temperature, if sudden and extreme, irritate
 
 168 SPINAL ADJUSTMENT 
 
 nerves. If, for example, the elbow be dipped into ice-water, 
 the ulnar nerve is excited, and in addition to the sensations 
 from the skin, the subject feels pain in all parts supplied by 
 the nerve. As the effect of the cold becomes more marked, the 
 pain is replaced by numbness, which shows that both the 
 irritability and the power of conduction of the nerve have 
 been reduced. As to increased temperature, it may be said 
 that, raising the temperature above the usual temperature 
 of the body increases, while cooling decreases the irritability 
 of the nerves. 
 
 The same applies to the conductivity of the nerves. Thus, 
 both the sympathetic and the vagus nerve-fibres have their 
 influence on the heart-beat increased by heat, and decreased 
 by cold, in experiments on a frog. 
 
 It has been observed that if cold be applied locally to a 
 nerve, the part afifected cannot conduct an impulse, and acts 
 as a block to the passage of any impulses along that nerve. 
 On the other hand, the impulse is increased in strength 
 if it passes through a part which has been previously 
 warmed. 
 
 The proper temperature of the body is maintained and 
 equalized by the blood. In this way, in addition to other 
 acts which it performs, it exerts a marked influence upon the 
 irritability of the nerves, and their conductivity. Thus, when 
 the artery passing through an intervertebral foramen in the 
 sheath of the spinal nerve is compressed as a result of a sub- 
 luxation of a vertebra, the heat which it conveys to the parts 
 through the medium of the blood is withdrawn. This diminu- 
 tion of the amount of heat, in addition to the defective nutri- 
 tion which also results, causes the power of conductivity of 
 the nerve to become enfeebled. 
 
 The Effect of Chemicals and Drugs on Nerves. — The ir- 
 ritability of ner\^es is greatly influenced by even slight changes 
 in the constitution of their protoplasm. Thus, if a nerve be 
 allowed to lie in a liquid of a different nature than its own 
 normal fluid medium, and especially if such a liquid enters the 
 blood vessels which supply the nerve, its irritability is soon 
 destroyed. 
 
 For this reason a certain chemical constitution of the 
 nerve protoplasm must be maintained, because even slight
 
 ABNORMAL NERVE FUNCTION 169 
 
 variations from this will alter or destroy the irritability of 
 the nerve. 
 
 The first result of chemicals is to increase the irritability 
 of the nerves, but this effect is only transient, and, as stated 
 above, is soon followed by a diminished irritability. Various 
 drugs used to stimulate nerve-action accomplish the desired 
 result, but the eiTects are not lasting, and finally are wanting 
 altogether. For example, different drugs are given in con- 
 stipation to promote evacuation of the bowels. At first these 
 drugs sufficiently arouse the irritability of the nerves con- 
 trolling the bowels to produce the efifect desired namely, 
 evacuation of their contents. Finally, however, one after 
 another, these drugs fail to act, the irritability of the nerves 
 having been so diminished that impulses are no longer gen- 
 erated and conveyed to the parts supplied. It is for this rea- 
 son that drugs are so uniformly useless in the treatment of 
 chronic constipation. 
 
 Other drugs are used for their depressing efifect, namely 
 to retard nerve function. This is also accomplished by rapidly 
 diminishing the irritability of the nerves, and by directly be- 
 numbing the nerve-centres, or by overstimulating the nerves 
 until a state of exhaustion rapidly supervenes. 
 
 The Effect of Mechanical Conditions on Nerves. — This, the 
 most common of all the causes of disturbed nerve function, 
 has had less attention than any of the other causes enumerated. 
 
 A sudden blow, pinch, twist, or cut excites a nerve. We 
 have all experienced this efifect on a sensory nerve, by acci- 
 dental blows on the ulnar nerve at the point where it passes 
 over the elbow, "the funny bone." 
 
 Mechanical applications to nerves first increase and later 
 lessen and destroy their irritability. Thus pressure, gradu- 
 ally applied, first increases and later diminishes the power to 
 respond to irritants. 
 
 The most common form of continuous pressure upon a 
 nerve is that produced by the margins of the intervertebral 
 foramen when a vertebra is subluxated. A slight amount of 
 pressure of this kind upon a ner\-e will increase its irritability. 
 Its action will then be increased. Continuous pressure of a 
 more marked degree will finally destroy all sensibility of the 
 nerve, and cause its action to be abolished.
 
 170 SPINAL ADJUSTMENT 
 
 The power of conductivity of nerves is similarly aflfected 
 by pressure upon them. The efifect of pressure to lessen the 
 conductivity of nerves is one which every one has had occa- 
 sion to demonstrate on himself. For example, if pressure be 
 brought to bear on the ulnar nerve where it crosses the elbow, 
 the region supplied by the nerve becomes numb. 
 
 The great majority of all the functions of the various 
 systems of the body are produced as a result of the mechanical 
 stimulation of the afferent nerves from such organs. Thus the 
 presence of food in the mouth reflexly excites the secretory 
 activity of the salivary glands. This is accomplished by the 
 sending of an afferent impulse from the nerve-endings in 
 the mouth, which reflexly produces a stimulus through the 
 efferent nerves to the salivary glands, with the result that 
 saliva is produced. 
 
 From the foregoing it is apparent that although there are 
 other causes than vertebral subluxations which operate to 
 produce abnormal nerve function, still such displacements are 
 really the underlying cause in most cases. Whether the cause 
 ascribed be malnutrition, or some other cause, such a cause 
 is usually secondary to a pre-existing vertebral displacement, 
 and these, therefore, become the most important single factor 
 in the production of disturbed nerve function.
 
 CHAPTER II 
 
 Vertebral Mal-Alignment 
 
 The human body is generally regarded as a most wonder- 
 ful and intricate piece of mechanism. The central pivot, upon 
 which hangs every unit of this mechanism, is the vertebral 
 column. The spine thus becomes the most important part of 
 the body. 
 
 It is strange, therefore, that so very little time has been 
 devoted to the study of this part of the body. Every other 
 portion has received careful consideration by the students of 
 anatomy, but the spine has received very slight attention. So 
 also, clinicians have investigated everything having the slight- 
 est bearing on the production of disease, but the possibility 
 of minor lesions in the spine as a factor in producing disease 
 has been entirely overlooked. 
 
 If, as previously pointed out, proper function and organic 
 integrity of every part of the body depend upon normal nerve 
 function, then the vertebral column is the most important 
 part of the body, from a clinical viewpoint. This is true for 
 the reason that the location at which interference with nerve 
 function is most likely to occur is at the point where soft 
 nerves pass between hard, movable bones, namely through the 
 intervertebral foramina, and where they are constantly in 
 danger of being impinged upon. This impingement, as we 
 have already seen, will so impair the conductivity of the 
 nerves as to check the flow of impulses to the parts for which 
 they are destined. 
 
 It is true that major lesions of the spine have received 
 proper attention. But the possibility of the existence of 
 minor injuries has never been investigated until the clinical 
 results obtained through spinal adjustment made it plain that 
 vertebral lesions of a minor character are the greatest single 
 factor in the production of disease. 
 
 Probably another reason why vertebral subluxations have 
 received so little credit in the etiology of disease is that, while 
 
 171
 
 172 
 
 SPINAL ADJUSTMENT 
 
 Fig. 37. 
 
 TiiK Normal Spine. 
 
 This illustrates the normal spine. Compare it with figure 40, which shows 
 
 certain vertebrae subluxated, as described under that figure.
 
 VERTEBRAL MAL-ALIGNMENT 173 
 
 the body has always been regarded as a piece of mechanism, 
 its mechanical possibilities have never been studied. 
 
 The Nature of Subluxations. — An exact knowledge of pre- 
 cisely what is meant when the term "subluxation" is used, has 
 been the chief cause of the failure of many to investigate 
 spinal adjustment. 
 
 The general opinion has been that by the term subluxation 
 a dislocation is understood to be implied. Such is, however, 
 the wrong construction of the term, and a complete disloca- 
 tion in the general acceptance of that word, is not what the 
 term implies. A dislocation of a vertebra without fracture 
 is practically impossible. A subluxation is not a disarticula- 
 tion of a vertebra from the adjacent vertebrae above and be- 
 low it. It is simply a slight change in the relative position of 
 a vertebra with the contiguous surfaces of the vertebrae above 
 and below it. That is to say, instead of the entire surface 
 area of a vertebra being approximated, with die-like precision, 
 to its fellows above and below it, it is slightly moved from 
 this position. There is not an absolute and entire separation 
 of the articular processes of two vertebrae ; the greater part 
 of their surface area still oppose each other ; there has simply 
 been a shifting of the position of one upon the other. This 
 movement is in various directions depending on the configura- 
 tion of the articular processes and the manner of application 
 of the forces which produce the displacement. These various 
 forms of subluxations will be considered in detail in a future 
 chapter. 
 
 When displacement of a vertebra occurs, the lumen of 
 the intervertebral foramen must of necessity be encroached 
 upon by the displaced portions, and its opening narrowed. 
 This fact rests upon the physical axiom that, any movement 
 toward the centre of an opening of the parts bounding it, 
 diminishes its area. Further, whatever is contained in a 
 space so diminished in area is either compressed or displaced. 
 If it is softer than the parts pressing upon it, compression will 
 occur. This is what occurs in vertebral subluxations, where 
 hard bone presses on soft nerves, blood-vessels, and lym- 
 phatics. 
 
 This, then, is what is meant by vertebral subluxation, 
 namely, a displacement of a vertebra, resulting in an impinge-
 
 174 
 
 SPINAL ADJUSTMENT 
 
 Fig. 38. 
 
 Anterior Aspect of Spine. 
 
 (A and B) Compression of the right side of the discs between the first, sec- 
 ond, and third dorsal vertebrae with approximation of these vertebrae on that 
 side and narrowing of the intervertebral dorsal foramina. 
 
 (C) Lateral displacement of the fifth dorsal vertebra to the left. 
 
 (D, E, and F) Compression of the anterior portion of the discs between the 
 ninth, tenth, eleventh, and twelfth dorsal vertebrae. 
 
 (G) Rotary displacement of the second lumbar vertebra to the right side. 
 
 (II) Compression of the right side of the disc between the fourth and fifth 
 liunbnr vertebrae.
 
 VERTEBRAL MAL-ALIGNMENT 175 
 
 nient of the structures in the intervertebral foramen by the 
 displaced mari^ins of the foramen. 
 
 General Results of Mal-Alignment of the Vertebrae. — 
 Minor vertebral lesions, as has been repeatedly mentioned, 
 produce certain diseases. It is not intended to convey the im- 
 pression that all diseases are due to lesions of the spine. There 
 are some disorders which are so evidently the result of other 
 factors, that it would be irrational to presume that a vertebral 
 subluxation was responsible for the abnormality in question. 
 But it is a fact which cannot be successfully denied that not 
 one other single thing is productive of so many abnormal 
 conditions as are subluxations of the vertebrae. This state- 
 ment is not only vouched for by a thorough study of the 
 "mechanics" of the vertebral column, but is also proven by 
 the clinical results achieved by adjustment of the vertebrae 
 wherever subluxations are the basis of abnormal conditions. 
 
 Spontaneous Adjustment.- — A great majority of the sub- 
 luxations which are sustained during the day are corrected 
 during sleep. Nature, in every case, makes an effort to correct 
 spontaneously all the slight displacements of the vertebrae in- 
 curred during the previous day. When we are relaxed in 
 sleep, those vertebral subluxations which are not too severe 
 are adjusted in this way. When, however, a vertebra is so 
 far out of alignment that the equalizing of muscular and 
 ligamentous laxity and rigidity on both sides will not permit 
 it to spontaneously resume its proper position, then mechanical 
 means are required. 
 
 Sleep is the great restorative of vital energy because it 
 produces a state wherein the generation of nerve-impulses is 
 temporarily diminished or suspended. It is because the con- 
 tinuous flow of impulses ceases during this time, that the 
 state of constant contraction of the muscles is absent, and 
 relaxation of muscles and ligaments takes place. In like man- 
 ner, most organs, during deep sleep, cease to function be- 
 cause the nerve impulses necessary to their functional activity 
 are not being generated. Were the nerve impulses still flow- 
 ing along the nerves as during our waking hours, there would 
 be no relaxation during sleep, and the organs would never 
 rest. 
 
 Fatigue, which is present at the end of the day, is simply,
 
 176 
 
 SPINAL ADJUSTMENT 
 
 Fig. 39. 
 
 PosTEUioR Aspect of Spine. 
 
 (A) Lateral displacement of the second dorsal vertebra to the left. 
 
 (B) Lateral displacement of the eighth dorsal vertebra to the right. 
 
 (C) Compression of the left side of the disc between the twelfth dorsal and 
 first lumbar vertebrae resulting in a tilting of the twelfth dorsal. 
 
 (D) Inferior displacement of the third lumbar vertebra due to tliinninj; of 
 the posterior portion of the disc between it and the fourth lumbar vertebra.
 
 VERTEBRAL MAL-ALTGNMENT 
 
 177 
 
 Fig. 40. 
 
 Lateual Aspect of Spine. 
 
 (A and B) The anterior portion of the lntervertel>ral disc is thinned, and as a 
 result of the approximation of the vertebrae the intervertebral foramina are 
 encroached upon by the displaced articular processes. 
 
 (C, D, and E) The discs between these vertebrae are thinned and, owing to 
 the approximation of the vertebrae, the vertical diameter of the corresponding 
 intervertebral foramina is diminished. 
 
 (P) The fourth lumbar vertebra is displaced posteriorly and encroaches on 
 the antero-posterior diameter of the intervertel)ral foramen below.
 
 178 SPINAL ADJUSTMENT 
 
 therefore, the result of exhaustion of the nerve centres. We 
 retire at night, exhausted, and awaken in the morning, re- 
 freshed. The various minor vertebral lesions produced dur- 
 ing the previous day, by the numerous external and reflex in- 
 fluences with which we were brought into contact, were spon- 
 taneously adjusted. A normal flow of impulses along the 
 nerves is the result, and the effect of these impulses is perfect 
 function, balanced metabolism, an equalized circulation of 
 the blood, and perfect muscular tonicity. Were these bodily 
 activities at all times in the state of balanced perfection that 
 they are in the morning, we would never become exhausted, 
 since the anabolic processes would compensate for the cata- 
 bolic effects. 
 
 But we are not yet adapted to our present mode of living, 
 and cannot successfully cope with the disadvantages which it 
 entails. The air we breathe, the positions which our occupa- 
 tion makes necessary, the food which we eat, and all the 
 deleterious influences of our more or less artificial life act 
 as reflex causes of minor vertebral lesions, by disturbing the 
 balance of muscular laxity and rigidity. 
 
 As a result of these influences, various subluxations occur. 
 Metabolism is disturbed, organs do not functionate harmoni- 
 ously, the poisonous products of muscular activity begin to 
 accumulate, the activity of the skin is diminished, and gen- 
 eral exhaustion ensues. 
 
 Sleep then comes, and while the body is completely re- 
 laxed during this period of rest, the subluxations are spon- 
 taneously adjusted, and normal conditions are restored. 
 
 It was stated above that certain subluxations may be so 
 severe that it is not possible for nature to correct them spon- 
 taneously. These more marked subluxations, which are the 
 result of traumatisms, as a rule, then become a cause of 
 disease. It is with these innumerable minor vertebral injuries 
 that we have to deal.
 
 CHAPTER III 
 
 The External Causes of Vertebral Mal-Alignment 
 
 The etiological factors in the production of vertebral sub- 
 luxations are generally very imperfectly understood. That 
 they exist is freely conceded by those who have investigated 
 the subject. A simple palpation of the vertebral column by 
 one trained for the work will reveal the existence of subluxa- 
 tions in most sick people. Further, the fact that after a proper 
 adjustment the same conditions no longer obtain, proves 
 rather conclusively that subluxations of the vertebrae are not 
 "myths." 
 
 A fact, however, which is little understood, even by prac- 
 titioners of spinal adjustment, and a question concerning 
 which arises in the minds of practitioners in other branches of 
 the healing art, is: How are these displacements produced ?- 
 Certainly, a force of some kind must be brought to bear upon 
 the vertebrae or their supporting structures, the muscles and 
 ligaments, to bring about the subluxation. 
 
 That we are constantly beset by circumstances which may 
 produce subluxations of vertebrae was shown in the previous 
 chapter. When, however, an unusual or a continuous force 
 is brought to bear upon a certain region of the spine, a perma- 
 nent subluxation is produced. 
 
 From a mechanical standpoint, every force, and by that 
 term is included everything connected with our environment, 
 has its influence upon the spine which is the central axis, or, 
 as it has been termed, the "line-shaft" of the body. Every 
 jar, fall, twist, jolt, etc., to which the body is subjected, if it 
 is excessive, and overcomes the elasticity of the intervertebral 
 discs and the tonicity of the ligaments, will result in a sub- 
 luxation. 
 
 The External Causes of Subluxations. — The chief external 
 factors in the production of vertebral subluxations may be 
 classified as follows: 
 
 179
 
 180 SPINAL ADJUSTMENT 
 
 1. Occupation. 
 
 2. Habits. 
 
 3. Injuries. 
 
 4. Age. 
 
 5. Exhaustion. 
 
 Vertebral Subluxations Produced by Occupation. — That 
 
 certain forms of occupation predispose to various lesions of 
 the vertebral column cannot be doubted. The slightest knowl- 
 edge of mechanics will make this fact plain. It is physically 
 impossible to assume a constant position, day after day, with- 
 out some permatient change in the conformity of the parts 
 which are thus changed, taking place. 
 
 This factor in the production of vertebral subluxations 
 coincides with undeniable certainty with the occupational 
 diseases as generally recognized. For example : the upper 
 thoracic segments of the vertebral column control the heart 
 and lungs ; accountants, book-keepers, clerks, compositors, 
 printers, bench-workers, dressmakers, tailors, and milliners, 
 by the position which they assume at their work, produce a 
 spinal curvature in the upper thoracic region of the spine ; 
 and it is well known that in these persons asthma, tuberculosis, 
 and cardiac diseases are most prevalent. It is therefore be- 
 cause of the subluxations incident to their occupation that 
 these diseases prevail in individuals following these occupa- 
 tions. 
 
 Those who follow sedentary occupations, having very 
 little exercise, and working in situations where the air is 
 vitiated, are susceptible to gastro-intestinal diseases, diseases 
 of the respiratory system, and numerous nervous disorders. 
 Owing to the deficient amount of exercise which these per- 
 sons take, the tonicity of the muscular system becomes im- 
 paired, and subluxations are easily induced. Sedentary po- 
 sitions cause especially compression subluxations of the ver- 
 tebrae in the lower dorsal and upper lumbar region, resulting 
 in a deficient amount of nerve-impulses to the intestinal tract ; 
 as a result constipation, hemorrhoids (through sluggish cir- 
 culation), etc., develop. Coincident with this, there is a stoop- 
 ing forward, tending to a backward displacement of the cer- 
 vical and upper dorsal vertebrae, which may inaugurate many
 
 CAUSES OF VERTEBRAL MAL-ALIGNMENT 181 
 
 disorders, depending upon the segment of the spine which is 
 involved. 
 
 In those who follow occupations to which violent exercise 
 is incident, subluxations of vertebrae are often directly pro- 
 duced, as for example, in those obliged to carry heavy weights, 
 wrestlers and athletes in general, etc. 
 
 The above few generalizations serve to show the impor- 
 tance of occupation in the production of vertebral subluxations. 
 It would be manifestly impossible to give in detail each occu- 
 pation, with a list of the diseases incident to such occupation, 
 and the manner in which the subluxations are produced, and 
 bear a definite relationship to the diseases present. In every 
 case, however, it should be ascertained whether the occupa- 
 tion is active or sedentary, or if the patient is subjected by his 
 occupation to deleterious influences of any kind. Reflex sub- 
 luxations, which will be considered in the following chapter, 
 are frequently produced as a result of some factor in connec- 
 tion with the occupation. For example, the handling or 
 breathing of toxic or irritating substances will reflexly pro- 
 duce subluxations. Thus engravers, potters, painters, dyers, 
 etc., by inhaling dust-particles and gases, induce an irritative 
 condition of the bronchial mucous membrane ; this irritation 
 excites the nerve-endings in this region, and the reflex action 
 produced at the corresponding spinal segment is expressed 
 on the musculature of that segment ; the resultant contraction 
 of these muscles ultimately produces a displacement of the 
 vertebrae. 
 
 Vertebral Subluxations Produced by Habits. — Habits, 
 especially those referring to the assuming of incorrect atti- 
 tudes, are a prolific source of subluxations. The most com- 
 mon example of this that could be cited is the posture assumed 
 by school-children, in whom almost every form of spinal dis- 
 placement is thus produced, resulting in disorders of every 
 description, depending upon the segment of the spine which 
 is especially involved. 
 
 Vertebral Subluxations Produced by Injuries, — The ver- 
 tebral column being the axis of the body, a force applied from 
 any direction will be transmitted to the spine, and cause a 
 more or less serious displacement of a vertebra. This may 
 be corrected immediately, and no harmful results follow the
 
 182 SPINAL ADJUSTMENT 
 
 momentary impingement of the nerve passing through the 
 narrowed intervertebral foramen of the affected spinal seg- 
 ment. Or the subluxation may remain until the individual is 
 relaxed in sleep, and be then spontaneously adjusted. How- 
 ever, if the displacement is marked, and a pronounced rigidity 
 of the vertebral ligaments is present, the impinged nerve, 
 whose branches supply the vertebral ligaments in that area, is 
 prevented from sending to these ligaments the impulses neces- 
 sary to the preservation of the balanced tonicity of the corre- 
 sponding sides of the vertebral column. As a result of this 
 condition, the subluxation is neither corrected at once, nor 
 during the period of complete relaxation of the individual in 
 sleep, but persists. As a consequence of the interference with 
 the sympathetic fibres, vasomotor disturbances arise; the ves- 
 sels are dilated, and a reaction of inflammation ensues. A 
 greater or less organization of the products of inflammation 
 now follows, forming adhesions, and the subluxation remains 
 in a fixed position. Only mechanical means, properly directed, 
 will now suffice to adjust the displaced vertebra to its proper 
 position. 
 
 It may now be asked, granted that mal-alignment of the 
 vertebrae may be brought about in the manner above de- 
 scribed, do these causes occur as frequently as they necessarily 
 must to coincide with the claim that most diseases are directly 
 or indirectly produced by this factor? 
 
 If, as maintained by advocates of spinal adjustment, most 
 diseases are due to subluxations of the vertebrae, producing 
 impingement of nerves, and preventing their proper conduc- 
 tion of impulses, then the personal history of nearly all pa- 
 tients should cite the occurrence of some injury. Now, 
 although the author shows that direct injury is only ane 
 etiological factor in the production of subluxations, if the 
 personal history of all patients examined is carefully and 
 studiously investigated, it is surprising what a great number 
 show that some form of injury has been received at some 
 time. The truth of this assertion was proven by looking over 
 the case records of the clinical department of the National 
 School of Chiropractic, in which it was found that 78% of- all 
 examined showed mention of a recent injury. 
 
 Very often, these injuries left no immediate after-effects
 
 CAUSES OF VERTEBRAL M AL-ALIGNMENT 183 
 
 sufficient to fix a lasting impression on the patient's mind. 
 Many patients, also, do not associate the previous injury with 
 their present complaint, and thus fail to mention it when in- 
 quiry is made. 
 
 Works on diagnosis all mention the fact that in taking the 
 patient's history full information regarding previous injuries 
 should be elicited. Practitioners in general, however, do not 
 seem to have regarded previous injuries as a very important 
 factor in the production of disease, and very little attention 
 has been paid to this etiological factor. 
 
 On the other hand, the patient's mind is so engrossed with 
 his present symptoms, that he has no thought of any previous 
 injury, which may, as a matter of fact, date back ten or twenty 
 years. 
 
 When we remember, in addition to this, that jars, falls, 
 blows, strains, twisting, and other similar forms of traumatism 
 may be so slight as to receive no consideration by the patient, 
 and yet produce subluxation of a vertebra, we see how easily 
 the connection may be lost sight of. Therefore, when after 
 careful questioning of the patient, no history of a previous 
 injury can be obtained, the possibility still remains that one 
 may nevertheless have been suffered. However, if the patient 
 be persistently questioned on this point, he will often finally 
 recall a previous injury of some kind. We can readily 
 demonstrate this on ourselves by trying to recall ofif-hand 
 all the injuries which we have sustained during our own 
 lifetime. 
 
 Jars produce subluxations by causing a thinning of the 
 intervertebral cartilaginous discs ; thus railroad men are af- 
 fected by certain diseases incident to a settling of the spine 
 in the lumbar region, popularly known as "railroad spine." 
 This same term is also used to describe a neurasthenic condi- 
 tion following and persisting after injuries or shake-ups, like 
 railway accidents. 
 
 Falls, sometimes of the slightest severity, may injure the 
 muscles and ligaments of the vertebral column, resulting in a 
 contraction of the muscles and ligaments of the region af- 
 fected. Thus numerous cases can be traced back directly to a 
 fall received years previously. 
 
 Blows which cau^^e an injury of the ligaments and muscles
 
 184 SPINAL ADJUSTMENT 
 
 of the spine, will cause contraction of these muscles and liga- 
 ments, for the reason that traumatism of such structures 
 causes them to become contracted. This can be easily demon- 
 strated by striking the biceps with the ulnar surface of the 
 hand ; the local contraction of the muscle which follows is 
 identical with that which occurs in vertebral subluxations ex- 
 cept that in the latter case the contractured condition is more 
 apt to be permanent. The lack of balance thus induced draws 
 the vertebra toward the side of the contraction, and the lesion 
 persists until relieved by mechanical means. Reflex sub- 
 luxations may also be caused by blows which irritate or in any 
 way excite peripheral nerve-endings. 
 
 Strains of moderate severity, which cause a tearing of 
 some of the muscular and ligamentous fibres which hold the 
 vertebrae in proper position, will also produce subluxation 
 thereof. Should the strain be of even slight severity, the irri- 
 tation of the muscles and ligaments will of itself be sufificient 
 to cause a subluxation as a result of the contractured condi- 
 tion produced by the injury. Strains are produced in a great 
 variety of ways, and depending upon the region of the spine 
 afifected will be the disturbances resulting from the impinge- 
 ment of the structures passing through the intervertebral 
 foramen which is involved. The simplicity with which such 
 strains may sometimes be received are out of all proportion 
 to the severity of the disorders which result, and these injuries 
 should never be overlooked. Many cases are known in which 
 a strain so slight at the time of its occurrence as to receive 
 scarcely any attention, resulted in disorders of the greatest 
 gravity, which were relieved entirely within a short time after 
 adjustment of the vertebra which was displaced. 
 
 Twisting of the spine, other than that which would come 
 under the head of sprains, are a prolific source of vertebral 
 subluxations. These have already been referred to under 
 the head of habits, occupations, etc. Abnormal posi- 
 tions of the spine, if maintained for a sufficient length of time, 
 will ultimately produce changes in the bones and ligaments 
 composing it. The intervertebral discs will become thinner 
 on one side and remain thicker on the other; the ligaments 
 will become shorter on one side and longer on the other. 
 Finally the vertebrae are permanently out of their proper
 
 CAUSES OF VERTEBRAL MAL-ALIGNMENT 185 
 
 alignment, and the impingement of the nerves which follows 
 leads to numerous and varied disorders. 
 
 Vertebral Subluxations Produced by Age. — As the declin- 
 ing years of life come on, the vertebral column gradually be- 
 comes shortened, settled, and less straight. This diminution 
 in the length of the spinal column is principally at the ex- 
 pense of the intervertebral discs. Each day, as a result of 
 muscular exhaustion, there is a certain loss in height. It 
 has been shown that the average individual is from one-half 
 to one inch shorter in the evening than he was in the morning 
 of the same day. During youth, when rest and relaxation 
 are perfect, and the elasticity of the tissues is marked, the 
 settling of the spine which occurred during the day is en- 
 tirely corrected during sleep. As age comes on, however, 
 and rest and relaxation are imperfect, and the tissues are 
 becoming less elastic, there is an incomplete return to the 
 normal length of the spine, and gradually the shortening 
 incident to old age comes on. Necessarily the deficiency in 
 the amount of expansion which occurs during the night to 
 compensate for the settling that occurs during the day, is 
 exceedingly slight. But with the advancing years these 
 differences becomes more and more apparent. As the inter- 
 vertebral cartilaginous discs become more and more thinned, 
 the intervertebral foramina become narrowed, and the struc- 
 tures which they transmit become impinged to an increasingly 
 greater degree. Finally the lumen of the intervertebral fora- 
 men is narrowed to one-half its normal size, and the nerves 
 are prevented from conducting the impulses necessary to the 
 proper function of the parts which they supply. Functional 
 and organic disorders of various organs then develop. Secre- 
 tion is deficient, metabolism is disturbed, and the muscular 
 structures lose their tone. Nature endeavors to compensate 
 for this settling of the spine in the aged by causing it to bend 
 forward. This is shown by examination of the spine of an 
 aged person, when it wall be seen that the intervertebral 
 discs are thinned anteriorly, and to a less degree posteriorly. 
 This compensatory curve tends in a rneasure to prevent com- 
 plete occlusion of the intervertebral foramina, though not 
 wholly so. Were the settling of the spine which accompanies 
 old age to be prevented from occurring, and it can be pre-
 
 186 SPINAL ADJUSTMENT 
 
 vented to a great extent, how many of the disorders peculiar 
 to this period of Hfe might not be eliminated? 
 
 Vertebral Subluxations Produced by Exhaustion. — Fatigue 
 as a result of the muscular exhaustion incident to the exercise 
 taken during the day produces numerous vertebral subluxa- 
 tions. As already mentioned these subluxations are usually 
 spontaneously adjusted during the period of sleep when com- 
 plete relaxation of the ligaments and muscles is present. The 
 settling of the vertebral column which occurs during the day 
 causes a narrowing of the intervertebral foramina, producing 
 slight impingement of the nerves and blood-vessels passing 
 through them. This interference with the conductivity of 
 these nerves and with the nutrition of the involved segments 
 of the spinal cord produces a general depression of nervous 
 tonicity, which is expressed as fatigue. Spinal adjustment, 
 by restoring the normal size of these foramina, will relieve 
 the exhaustion at once. It w-as this fact which w^as the under- 
 lying reason why the Bohemians who first practiced spinal 
 adjustment obtained the results they did by their crude meth- 
 ods, although the reason why such results w^ere obtained were 
 not understood by them. 
 
 The more excessive the muscular exhaustion of the day 
 is the greater will be the degree of settling of the vertebral 
 column. Occasionally, a vertebra may become so seriously 
 displaced as a result of this loss of muscular tonicity that 
 spontaneous adjustment w^ill not take place. In such an event 
 a permanent subluxation of the vertebra remains. It is very 
 often subluxations induced in this manner, as a result of 
 excessive work, that produce various disorders. 
 
 The feeling or sensation of exhaustion, like every other 
 sensation perceived by a living organism, is perceived in the 
 sensorium of the brain, and not in the end organs of the 
 nerves. It is by means of the common sensations, of wdiich 
 fatigue is an example, that the individual is made aware of 
 certain conditions in various parts of his body. The sensa- 
 tion of fatigue, further, is a subjective sensation, that is to 
 say,^ one which is dependent upon internal causes. Fatigue, 
 therefore, must be looked upon as the sensation which tells 
 us that exhaustion of the body, either wholly or in part, is 
 present. The sensation of exhaustion is perceived when the
 
 CAUSES OF VERTEBRAL MAL-ALIGNMENT 187 
 
 nerve-endings are irritated by the poisonous by-products of 
 muscular activity. As a result of the settling of the spine 
 consequent on the lack of muscular tonicity and the thinning 
 of the intervertebral discs, the venous flow from each spinal 
 segment is obstructed, and these poisonous by-products have 
 a toxic influence upon the corresponding segments of the 
 spinal cord. The reflex centres are affected, and a want of 
 harmonious action between the cerebro-spinal and sympa- 
 thetic divisions of the nervous systems results. If one por- 
 tion of the body is especially exhausted the reflex excitation of 
 its reflex centre is expressed upon the musculature of that 
 spinal segment and a subluxation results. In this manner 
 a subluxation may be produced not alone by direct failure 
 of the exhausted muscles to hold the vertebra in its proper 
 position, but also by a reflex motor impulse produced by 
 the toxic excitation of the reflex centre of the cord.
 
 CHAPTER IV 
 
 The Internal Causes of Vertebral Mal-Alignment 
 
 It is freely admitted that not all diseases are produced by 
 lesions in the vertebral column. By some students of Spinal 
 Adjustment the assertion has been made that all disease is 
 due to subluxations of the vertebrae, and that all disease is 
 curable by adjustment of displaced vertebrae. Such a view 
 is erroneous. 
 
 The main reason why this opinion was formed is perhaps 
 due to the fact that whenever an abnormal condition obtains 
 in any part of the body, a vertebral subluxation may be found 
 at the point of emergence of the nerves which control that 
 part. Not only that, but it is true that in most instances the 
 abnormality may be removed by the adjustment of such a 
 subluxation. 
 
 In view of these facts, some practitioners of Spinal Ad- 
 justment fail to recognize the further fact that not only may 
 such subluxations produce disease, but a pre-existing disease 
 may produce a displacement of a vertebra. 
 
 Some investigators of Spinal Adjustment have taught that 
 diseased organs may reflexly produce subluxation of vertebrae, 
 but scientific explanations of this phenomenon have been 
 wanting, or, where attempted, have been too involved and 
 complicated to be satisfactory. 
 
 The exact manner in which pathological conditions, as 
 well as other deleterious influences, produce subluxations is 
 reflexly. The exact manner in which this occurs will be 
 shown in this chapter. 
 
 The Reflex Cycle. — The first essential to an understanding 
 of the reflex production of subluxations of the vertebrae is a 
 thorough knowledge of the reflex cycle. This includes the 
 reflex arc of nerves and the reflex act. 
 
 For the performance of a reflex act the following anatom- 
 ical structures must exist : A receptive peripheral nerve- 
 ending ; an afferent path leading to the cord ; cells in the cord 
 
 188
 
 CAUSES OF VERTEBRAL MAL-ALIGNMENT 189 
 
 by which the incoming impulses shall be there distributed ; 
 and a set of efferent nerves to carry the outgoing impulses 
 to the terminal organ which gives the response. The afferent 
 and efferent paths over which the impulses in a reflex act 
 travel are (1) the sensory and motor fibres of the spinal 
 nerves, associated in the gray matter of the cord; (2) the 
 sensory and motor fibres of the cranial nerves, which are 
 connected in the brain ; (3) the afferent spinal fibres, the pos- 
 terior longitudinal bundle, chiefly, and eff'erent cranial fibres ; 
 (4) the afferent cranial and efferent spinal nerve fibres, the 
 two being associated by the anterior longitudinal bundle, the 
 spinal root of the fifth nerve, the vestibulo-olivary and 
 vestibulo-spinal tracts, the solitary bundle, etc. 
 
 Preceding a discussion of the exact manner in which verte- 
 bral subluxations are produced reflexly, consideration of each 
 of the above forms of reflexes will be taken up. 
 
 Spinal Reflexes. — In the most simple spinal reflexes the 
 afferent fibres of the reflex arc arborize about the cell-bodies 
 whose branches constitute the efferent fibres. Among them 
 are the skin and muscle reflexes, such as the patellar, the 
 gluteal, and the plantar reflexes, the involuntary withdrawal 
 of a part from a source of irritation, etc. 
 
 Among the more complex spinal reflexes are the cardio- 
 accellerator reflexes, vaso-motor reflexes, micturition, parturi- 
 tion, and defecation. As an example, let us trace a defecation 
 reflex: the rectum is supplied by the third and fourth sacral 
 nerves and by branches from the inferior mesenteric and 
 hypogastric plexuses. Irritation of the nerve-endings in the 
 mucous membrane of the rectum is caused, normally, by the 
 presence of fecal matter. The impulses caused thereby run 
 to the special defecation center in the lumbar enlargement of 
 the spinal cord, either by way of the sacral nerves or through 
 the sympathetic plexuses, the gangliated cord, and the rami 
 communicantes to the lumbar nerves, through the posterior 
 roots of which they reach the defecation center in the cord. 
 
 From the defecation center the outgoing impulses follow 
 two courses : first, they descend through the third and fourth 
 sacral nerves and cause inhibition in the circular fibres of 
 the rectum and contraction of the longitudinal muscle. Sec- 
 ondly, the above action is immediately followed by impulses
 
 190 SPINAL ADJUSTMENT 
 
 which pursue the sympathetic course, through the anterior 
 roots of the lumbar nerves, the rami communicantes, the 
 gangliated cord, and the inferior mesenteric and hypogastric 
 plexuses, to the rectum. They cause, in succession from above 
 downward, contraction of the circular muscle of the rectum. 
 The two series of impulses thus open a way for the passage 
 of the fecal matter, and then force it through the opening, 
 unless prevented from doing so by the voluntary contraction 
 of the external sphincter of the anus. 
 
 Cranial Reflexes. — The simplest type of this class of re- 
 flexes are such as spasm of the muscles of mastication as a 
 result of a bad tooth, in which both limbs of the reflex arc are 
 formed by the trifacial nerve. Another example is the facial 
 expression of pain also due to the same cause, and in which 
 case the reflex arc is formed in addition by the facial nerve ; 
 that is, the impulses traverse the trifacial nerve and by the 
 collaterals of its root-fibres reach the nucleus of the facial 
 nerve, through which nerve they cause contraction of certain 
 muscles of expression. 
 
 Examples of the more complicated cranial reflexes are : 
 the salivary reflexes in which the sight or smell of food 
 causes the flow of saliva ; coughing, vomiting, sneezing, and 
 deglutition reflexes are further examples. All of these re- 
 flexes can be readily traced if a knowledge of the nerve-supply 
 of the parts is had. 
 
 Spinal and Cranial Reflexes. — Impulses received by the 
 spinal cord through the aft'erent fibres of its nerves are 
 transmitted by the posterior longitudinal bundle to the nuclei 
 of motor cranial nerves. Thus are brought about movements 
 of the eyes toward the source of the impulse, a change of 
 facial expression to agree with the painful or pleasing 
 character of the impulses, etc. 
 
 Cranial and Spinal Reflexes. — There is a great number of 
 this class of reflexes, of which we will note three examples: 
 First, in the respiratory reflex, any obstruction or irritation 
 of the larynx or trachea sends an impulse through the pneu- 
 mogastric nerve to its sensory nucleus ambiguous and nucleus 
 of the phrenic nerve in the cervical cord, causing increased 
 respiratory effort, coughing, spasm of the muscles closing 
 the glottis, etc. Second, the auditory reflex is illustrated
 
 CAUSES OF VERTEBRAL MAL-ALIGNMENT 191 
 
 by the turnin<^ of the head upon hearing a sudden sound ; also 
 the sudden starting caused by hearing a very loud sound. 
 The path for the latter is probably as follows: The auditory 
 nerve, the vestibulo-olivary and vestibulo-spinal tracts, antero- 
 lateral ground bundle, and efferent fibres of spinal nerves. 
 Third, pupillary reflexes belong to the cranial and cranio- 
 spinal group of reflexes. The cilio-spinal centres are in the 
 cervical enlargement of the spinal cord, the pupillo-dilator 
 centre being in the upper part, and the pupillo-constrictor 
 centre in the middle part of that enlargement. They receive 
 optic impulses through the anterior longitudinal bundle from 
 the superior quadrigeminal bodies. The superior quad- 
 rigeminal bodies receive those impulses by two routes : First, 
 directly, through the fibres of the external root of the optic 
 tract, and, second, indirectly, through centrifugal fibres in 
 the optic radiations, and the superior brachium. By the lat- 
 ter route, the optic impulses which have reached the visual 
 area of the occipital lobe, by way of the intrinsic retinal 
 neurones and the optic nerves, tracts and radiations are re- 
 turned to the optic thalamus and external geniculate body 
 and then carried back to the superior quadrigeminal bodies. 
 From there, reaching the cilio-spinal centres through the 
 anterior longitudinal bundle, the impulses take one of two 
 possible courses : (a) They leave the spinal cord through 
 the anterior roots of the upper thoracic nerves and run, in 
 succession, through the rami communicantes, the cervical 
 cord of the sympathetic, the cavernous plexus, the ciliary 
 ganglion, and the short ciliary nerves to the radiating fibres 
 of the iris, producing dilation of the pupil, (b) From the 
 pupillo-constrictor centre the impulses are carried upward by 
 the posterior longitudinal bundle to the nuclei of the motor 
 oculi nerve, where they are reinforced by optic impulses 
 received directly through the superior quadrigeminal body 
 and posterior commissure. The impulses reach the ciliary 
 muscle and the circular muscle of the iris through the motor 
 oculi nerve, ciliary ganglion and short ciliary nerves. The 
 result is a contraction of the pupil and accommodation for 
 distance. 
 
 The Reflex Act. — The nervous mechanism concerned in the 
 reflex act has the following arrangement: Afferent fibres
 
 192 SPINAL ADJUSTMENT 
 
 running from the periphery, and entering the cord by way of 
 the posterior nerve-roots; the central mass of the spinal cord 
 itself in which these roots end, each root marking the middle 
 of a segment; within the cord and stretching its entire length 
 are the central cells, interpolated more or less numerously 
 between the terminals of the afferent neurones and the cell- 
 bodies of the efiferent neurones. From each segment of the 
 cord go to pass the anterior root-fibres, going in part to the 
 muscles and in part to the ganglia of the sympathetic 
 system. 
 
 In a reflex act, the response is not accompanied by con- 
 sciousness. When an impulse enters the central system by 
 way of the posterior root, it is found to follow the course of 
 the afferent axones within the central system, and thus must 
 be distributed ahnost simultaneously to a length of cord coex- 
 tensive with that of the branches of the afferent axones. The 
 parts which respond to the efferent impulse of the reflex act, 
 however, are those innervated from the same segments of 
 the cord which receive the sensory nerves that have been 
 stimulated. Thus stimulation of the skin of the breast causes 
 movements of the arms. Still, wdiile sensory impulses com- 
 ing into any segment tend to rouse exclusively the muscles 
 innervated by that segment, these incoming impulses are dis- 
 tributed in the cord unevenly and in such a way as to easily 
 involve segments controlling other parts of the body.. 
 
 When the stimulus is applied on one side of the median 
 plane, the responses first appear in the muscles of the same 
 side; and if the stimulus is slight, they may appear on that 
 side only. The incoming impulses are therefore first and 
 most effectively distributed to the efferent cells located on 
 the same side of the cord as that on which these impulses 
 enter. 
 
 In a reflex response the strength of the stimulus is coex- 
 tensive with the extent to which the muscles are contracted, 
 the number of muscles taking part in the contraction, and the 
 length of time during which the contraction continues. A 
 single stimulus very rarely, if ever, calls forth a reaction, if 
 the time during which it acts is very short, and hence it is 
 supposed that there is an accumulation of stimuli, implying 
 that at some part of the reflex pathway there is a piling up
 
 CAUSES OF VERTEBRAL MAL-ALIGNMENT 193 
 
 of the effects of the separately inefficient stimuli to a point 
 at which they ultimately become effective. 
 
 The foregoing paragraphs have been concerned mainly 
 with the changes occurring in the afferent portions of the 
 pathway. Next to be considered is the efferent pathway, 
 and we find that the conditions for diff'usion of the outgoing 
 impulses are dependent on the arrangement of several cells 
 in series. When a group of eff'erent cells discharges, we know 
 from the arrangement of the anterior roots that the impulses 
 leave the cord mainly along the fibres which comprise these 
 roots ; but where the white rami of the sympathetic system 
 pass from the spinal nerves to the ganglia these outgoing im- 
 pulses also pass over them, as well as over the few efferent 
 fibres found in the posterior root. These axones carrying the 
 outgoing impulses have two destinations : (a) The voluntary 
 or striped muscle-fibres ; (b) the sympathetic nerve-cells in 
 the ganglia of the gangliated cord. 
 
 Normally there pass from the central system along some 
 of the nerve-fibres impulses which tend to keep the muscles 
 in a state of slight contraction. Though the intensity of these 
 outgoing impulses is normally always small, still it is subject 
 to significant variations. The difference between the tone 
 of the muscles of an athlete in prime condition and those of 
 a patient recovering from a prolonged and exhausting illness 
 is easily recognized, and this difference is in a large measure 
 due to the diff"erence in the intensity of the impulses passing 
 out of the cord. Among the insane, too, the variations in 
 this tonic condition follow in a marked way the nutritive 
 changes in the central system, and both facial and bodily 
 expression have a value as an index of the strength and varia- 
 bility of those impulses on which the tone of the skeletal mus- 
 cles depends. This continuous outflow of impulses from the 
 central system is indicated also by the continuous changes 
 within the glands, and the variations in these metabolic 
 processes according to the activities of the central system. 
 
 Since the strength of the reflex responses depends upon 
 the strength and number of stimuli of the afferent nerve-end- 
 ings, it is apparent that anything which causes the excitation 
 of these nerve-endings by irritating them, and thus pro- 
 ducing stimuli which are carried to the reflex centres in the
 
 194 SPINAL ADJUSTMENT 
 
 cord, must be considered as the prime causative factor in 
 the production of whatever response, or action, follows. 
 
 Take, for example, inflammatory conditions with ulcera- 
 tion, as seen in typhoid fever. Here we would have, instead 
 of the normal condition of the bowel cited above under the 
 head of spinal reflexes, the following change in the reflex 
 act : Instead of a mild contraction of the muscles of the 
 intestinal wall there will be a marked contraction of these 
 muscles, amounting to an actual spasm, known as tenesmus 
 in the anus, and colic in the intestinal tract. This is simply 
 due to the fact that now, instead of mild and few stimuli to 
 the afferent nerve-endings, as produced by the presence of 
 feces in the bowel, there are violent and numerous stimuli, as 
 a result of the great irritation of the mucous membrane. 
 
 But a still more important and far-reaching effect is 
 produced. 
 
 The Diffusion of the Outgoing Impulses. — In the periph- 
 eral, system the nerve-impulse, when once started within 
 a fibre or axone, is confined to that track and does not diffuse 
 to other fibres running parallel with it, but it does extend to 
 all the branches of that axone, zvhatez'er their distribution. In 
 this physiological fact lies the key to the mode of production 
 of reflex vertebral mal-alignments. 
 
 We have seen that the outgoing impulses pass over the 
 anterior root of the spinal nerve, over the white ramus com- 
 municans, and over the efferent fibres in the posterior division 
 of the spinal nerve. Since, as stated above, a nerve-impulse 
 extends to all the branches of the axone in which it originates, 
 it follows that in a reflex action the outgoing impulse will 
 extend to every branch of the anterior root of the spinal nerve, 
 of the ramus communicans, and of the efferent fibres in the 
 posterior division of the spinal nerve. 
 
 The posterior division of the spinal nerve is the first di- 
 vision given off from it, and the efferent fibres in this root 
 supply the musculature of the corresponding segment of the 
 vertebral column. Consequently the first response to the out- 
 going impulse of a reflex act will be a contraction of the mus- 
 cles of that spinal segment, for we have seen that the muscles 
 that respond to the eft"erent impulse of a reflex act are those 
 which are innervated from the same segment of the cord which
 
 CAUSES OF VERTEBRAL MAL-ALIGNMENT 195 
 
 receives the sensory nerves that have been stimulated. Fur- 
 ther, the contraction of the muscles will be on one side only, 
 for we have seen that all incoming impulses are distributed 
 first and most effectively to the efferent cells on the same side 
 of the cord as that on which these impulses enter. 
 
 The action produced by efferent impulses depends upon 
 the character of the tissues in which the nerve-fibre which 
 conducts such an impulse ends. If it ends in a gland, there 
 will be secretion ; if in a muscle, there will be contraction of 
 that muscle. In cases, therefore, where the posterior division 
 of the spinal nerve carries an outgoing impulse, since it ends 
 in the muscles of the spine, there will be contraction of the 
 muscles of the spine. This contraction will be on the same 
 side as the sensory nerves irritated, and will affect that same 
 spinal segment. 
 
 The Reflex Production of Vertebral Subluxations. — 
 Physiologically, a muscle that is repeatedly stimulated by 
 nerve-impulses finally reaches a condition of tetanic contrac- 
 tion. That is to say, if the impulses are continuous, the mus- 
 cle finally remains in a permanently contracted condition. 
 This naturally holds true also of the muscles of the spine. 
 If a continuous flow of violent- outgoing impulses, as a result 
 of repeated reflex acts, enter the muscles of a certain spinal 
 segment, those muscles will become permanently contracted 
 on the side affected. The muscles of the other side remain 
 unaffected, or are affected in a much less degree. 
 
 The inevitable result of this contraction of the muscles of 
 this side will be to draw the vertebra toward that side. The 
 degree of the displacement of the vertebra thus produced will 
 depend upon the severity of the irritation which excites the 
 afferent nerves concerned in the reflex act that causes contrac- 
 tion of the muscles of the involved segment. Since the per- 
 manent contraction of the muscles necessary to the production 
 of a vertebral displacement depends upon repeated or marked 
 stimulation, it follows that the exciting cause must be present 
 for some time. 
 
 Returning to the example already cited, namely, the re- 
 flex contraction of the muscles of the intestines by irritation 
 of their mucous lining in typhoid fever, we note the following: 
 From what was said above, we know that the efferent im-
 
 196 SPINAL ADJUSTMENT 
 
 pulses produced by the reflex act induced in this way will 
 not only affect the muscles of the intestines but all other 
 muscles supplied by the spinal nerve of the same segment at 
 which the sensory nerve which was stimulated ends. There- 
 fore, the muscles of the lower dorsal and upper lumbar seg- 
 ments of the spine will be contracted whenever the intes- 
 tines are affected. As a result of this muscular contraction, 
 there will be a subluxation of a vertebra in these regions. 
 This is true because the sensory nerves of the intestiiies end 
 in these segments of the spine. 
 
 Any disease which produces sufficient irritation at the 
 periphery to stimulate the nerve-endings and produce a reflex 
 act will, in the manner described, produce a subluxation in 
 the same segment of the vertebral column whose muscles 
 are innervated by efferent nerves from the corresponding 
 segment of the spinal cord which receives the sensory nerves 
 that have been stimulated. 
 
 That adjustment of these subluxated vertebrae favorably 
 influences the condition which produced them, clinical evi- 
 dence bears out. It is necessary to explain the exact manner 
 in which this is brought about. 
 
 In the chapter dealing with the theoretical basis of chiro- 
 practic the statement was made, that the primary cause of a 
 large number of diseases is subluxations of vertebrae. This 
 is so by reason of the fact that as a result of these subluxations 
 the flow of those impulses essential to the normal functional 
 activity and organic integrity of the various parts of the body 
 supplied by the impinged nerves is prevented. The with- 
 drawal of these necessary impulses creates in the parts thus 
 deprived a condition which permits the development of 
 pathological processes in them. That condition of the body, 
 or any part of it, in which perfect innervation, and conse- 
 quently perfect function and organic integrity obtains, is 
 known as "resistance." It is by virtue of this resistance that 
 the development of disease processes is prevented. A lack 
 of such resistance constitutes a condition permitting the 
 development of disease processes. 
 
 It was stated that vertebral subluxations thus become in 
 practically all cases the primary and predisposing cause of 
 disease by producing the conditions which permit the devel-
 
 CAUSES OF VERTEBRAL MAL-ALIGNMENT 197 
 
 opment or continuance of a disease process. They are not, 
 however, the direct cause of a disease, in all cases, and here 
 we must differentiate carefully between the terms primary 
 and direct, and the terms secondary and indirect. To do this, 
 let us take as an example, typhoid fever. 
 
 The first question that naturally arises is : What is the 
 primary cause of this disease, and what is the direct cause? 
 The direct cause, in this case, is that factor which directly 
 produces the disease, namely the typhoid bacillus. This 
 bacillus is not, however, the primary cause ; for by this cause 
 must be understood that state or condition of certain parts 
 which makes the action of the typhoid bacillus possible. 
 This primary cause is subluxation of vertebrae, which by 
 producing a disturbed nerve-supply, and thereby diminish- 
 ing the resistance of those parts for which the typhoid bacil- 
 lus has a selective action, make possible their activity in 
 those parts. Therefore the subluxations are the primary 
 and predisposing cause of typhoid fever, and the typhoid 
 bacillus is the direct cause. And, conversely, the subluxations 
 are the indirect cause, and the typhoid bacillus is the secondary 
 cause. 
 
 This statement is equivalent to saying that without a 
 spinal lesion typhoid fever is impossible, and that is exactly 
 what is meant. Why is it that of several people, all of whom 
 are living under the same circumstances, exposed to the iden- 
 tical conditions, eating and drinking the same food, etc., 
 some will contract typhoid fever, and others go free? Evi- 
 dently it must be because of differences in their susceptibility 
 to the disease. We have seen that these differences in sus- 
 ceptibility depend upon the nature of the nerve-supply. And 
 a normal nerve-supply depends upon a free and uninterrupted 
 flow of impulses to those parts of the body at which the 
 typhoid bacillus gains entrance to the body. 
 
 If, therefore, the innervation of the intestines, which are 
 the atrium of infection in typhoid fever, is abnormal, the 
 disease will develop. Thus we see frequently that one indi- 
 vidual who is apparently in perfect health develops typhoid, 
 while another, whose general health is not nearly as perfect, 
 goes free. This depends simply upon the fact that in the 
 former the atrium of infection, namely the intestine, was in
 
 198 SPINAL ADJUSTMENT 
 
 a condition favorable to the entrance of the bacilli, while in 
 the latter such conditions did not obtain. 
 
 This is true of all infectious and contagious diseases. 
 What protects an individual against the development and 
 continuance of a disease is not so much his general state of 
 health, as the condition of the special area of predilection of 
 the specific infection. Resistance as maintained by perfect 
 innervation, therefore, prevents disease, and, conversely, lack 
 of resistance induced by mal-alignment of the vertebrae 
 permits disease. 
 
 To recapitulate : Vertebral subluxations are the primary 
 predisposing and indirect factor in the production of many 
 diseases, in which case they have pre-existed, and have been 
 themselves previously produced by some external influence. 
 They are, secondly, the cause of the continuance of a dis- 
 ease, having been reflexly fostered by the disease itself. 
 Vertebral subluxations, therefore, are the cause of the 
 production and continuance of disease. 
 
 Spinal adjustment, by correcting these displacements of 
 the vertebrae, accomplishes two things : (a) It removes the 
 factor which makes it possible for a disease to gain an en- 
 trance or foothold in the body ; (b) It restores normal nerve- 
 impulses to parts deprived of them, and thus prevents the 
 continuance of the disease.
 
 CHAPTER V 
 
 The Local Effects of Mal-Alignment of Vertebrae 
 
 It now remains to be shown what the immediate and re- 
 mote effects of subkixations of vertebrae are. By the immedi- 
 ate effects are meant the influence upon the structures passing 
 through the intervertebral foramen. By the remote effects 
 are meant those which occur in the parts of the body suppHed 
 by the structures so influenced. 
 
 That subluxations sufficient to produce pressure upon the 
 nerves and vessels passing through the intervertebral foramen 
 may occur, and frequently do occur, has been demonstrated. 
 That this pressure will prevent the conduction of the nerve- 
 impulses which control the functional activity and the 
 organic integrity of all parts of the body, has also been shown. 
 
 From the above, it can be readily deducted what the ef- 
 fects in any given case will be, once the subject of localiza- 
 tion of segmental lesions is understood. Such special effects 
 will be considered in detail further on. In this chapter we 
 will confine ourselves to a discussion of the general effects 
 of vertebral subluxations. 
 
 The Local Effects of Vertebral Subluxations. — When a 
 vertebra becomes shifted from its normal position, its relative 
 position to the vertebra above and below it is altered in all its 
 parts. A change in the position of the margins of the inter- 
 vertebral foramen occurs, and the displaced wall presses on 
 the following structures which pass through the foramen : 
 
 Afferent and Efferent Spinal Nerves. 
 
 White and Gray Rami Communicantes of the Sympa- 
 thetic. 
 
 Arteries and Veins. 
 
 Lymphatics. 
 
 Necessarily every structure that passes through the fora- 
 men is impinged upon, and we will now consider the general 
 effects of pressure upon each of these structures. 
 
 199
 
 200 SPINAL ADJUSTMENT 
 
 Effect of Pressure on the Afferent Spinal Nerve. — The 
 
 afferent fibres of the spinal nerve pass in the sheath of the 
 spinal nerve to the cord. Here a reflex arc is established 
 and impulses from the periphery are transferred to an out- 
 going fibre, and efferent impulses pass to the periphery. A 
 vertebral subluxation will prevent the passage of the ingoing 
 impulses to the cord, along the afferent nerves, and will there- 
 fore prevent the reflex act which occurs in the involved seg' 
 ment, under normal conditions, from taking place. As a result, 
 the efferent impulses to the tissues supplied by that segment 
 are not generated. As an example of this effect, we may 
 consider the patellar reflex : If the afferent nerve is impinged 
 at the intervertebral foramen, in the second lumbar segment, 
 the knee-jerk will be absent. 
 
 Effect of Pressure on the Efferent Spinal Nerve. — An im- 
 pingement on the efferent fibres of the spinal nerve will pre- 
 vent the conduction of all outgoing impulses to the tissues 
 supplied by the affected nerve. If, for example, the fourth 
 cervical nerve is impinged, a poor quality of saliva is secreted 
 and indigestion finally develops. 
 
 Effect of Pressure on the White Rami Communicantes. — 
 It will be recalled that the white rami of the sympathetic 
 system pass through the intervertebral foramen in the sheath 
 of the spinal nerve to the ganglia of the gangliated cord. 
 They therefore are also impinged by subluxation of a vertebra. 
 Their function, which is the conduction of efferent impulses 
 from the brain and spinal cord to the ganglia, and thence to 
 the various tissues, is interfered with. The action of the 
 sympathetic system is thus disturbed, and a lack of balance 
 in the harmonious action of the various systems of the body 
 ensues. These disturbances vary according to the segment 
 of the spinal column which is involved, and will be considered 
 later. 
 
 As an example of the results of pressure on the white rami 
 we may assume that a subluxation exists at the fourth dorsal 
 vertebra. This, by producing pressure on the spinal nerve, 
 results in torpidity of the liver. The function of the liver 
 is controlled especially by the sympathetic system, and 
 interference with the conduction of impulses to this organ 
 invariably results in a disturbance of its function.
 
 MAL-ALIGNMENT OF VERTEBRAE 201 
 
 Effect of Pressure on the Gray Rami Communicantes. — 
 
 The gray rami of the sympathetic system pass to the spinal 
 cord from the ganglia, in the sheath of the spinal nerve. 
 Hence they also are subject to impingement in the event a 
 vertebra becomes subluxated. These filaments govern the 
 nutrition of each corresponding segment of the spinal cord, 
 and complete the reflex arc through which the necessary 
 efferent impulses are generated. 
 
 If, for example, the lower dorsal or upper lumbar vertebrae 
 are subluxated, the afferent impulses are intercepted at this 
 point. The intestinal tract is influenced by the white and 
 gray rami in this region. Any change in the nature or amount 
 of the intestinal contents excites an afferent impulse in the 
 endings of the afferent nerves in the intestinal walls. When 
 the reflex arc is intact, an efferent or motor impulse is gen- 
 erated, which is transmitted to the muscular coat of the in- 
 testines, causing them to evacuate their contents. If this re- 
 flex arc is not intact, in other words, if an impingement of the 
 gray rami communicantes is present, the necessary efferent 
 impulses which move the bowels to action is wanting. It is 
 this fact which operates in the production of constipa- 
 tion. It is for this reason that adjustment of the lower 
 dorsal and upper lumbar vertebrae invariably relieves chronic 
 constipation. 
 
 Effect of Pressure on the Arteries. — As previously shown, 
 faulty nutrition of the nerve-centres, through deficient blood- 
 supply, rapidly reduces their irritability. The arteries which 
 pass through the intervertebral foramen in the sheath of the 
 spinal nerve assist in supplying nourishment to the corre- 
 sponding spinal segments. Impingement of these arteries 
 reduces the blood-supply of this segment of the spinal cord. 
 The effect of this is a diminution or total absence of irrita- 
 bility of that segment, and a consequent break in the reflex 
 arc. As a result the nerve-supply of the parts controlled 
 by this segment is not forthcoming and various disorders 
 ensue. 
 
 As an example of the manner in which such a condition 
 brings about abnormalities, the following may be cited: 
 When the continuous flow of nerve-impulses is impeded, as 
 it is in a case of this kind where the irritability of a spinal
 
 202 SPINAL ADJUSTMENT 
 
 segment is diminished, muscular tonicity will become abnor- 
 mal. For example, a subluxation in the lumbar region, by- 
 producing an anemia of the spinal segment of the region 
 involved, may cause the muscles and ligaments of the arch 
 of the foot to become so relaxed that, with other factors 
 entering, flat-foot may result. 
 
 Effect of Pressure on the Veins. — The veins which pass 
 out through the intervertebral foramen, in the sheath of the 
 spinal nerve, may also be occluded when a subluxation exists. 
 Since these veins convey the venous blood from each corre- 
 sponding segment of the spinal cord, obstruction of the 
 venous flow, by pressure upon the vein, will result in 
 congestion of that segment. 
 
 EfTect of Pressure on the Lymphatics. — The lymphatics 
 which pass through the intervertebral foramina have much 
 to do with the metabolism of each segment of the spinal 
 cord. Any interference with this function, as a result of a 
 subluxation obstructing the lymphatic channels, will alter 
 the excitability of that segment, and the conduction of 
 impulses, both afiferent and eflferent, is impaired.
 
 CHAPTER VI 
 
 The Effect of Vertebral Subluxations on Nerve Function 
 
 The effects of vertebral subluxations on the function of 
 nerves necessarily depend upon the location of the lesion to 
 a large extent. These will be taken up in the chapter deal- 
 ing with segmentation and localization. In this chapter the 
 effects of vertebral mal-alignment on nerve functions in gen- 
 eral will be considered, and examples illustrating each form 
 of abnormal nerve action will be given. The reader is re- 
 ferred in this connection to the chapters dealing with the 
 function of the nervous system, a thorough knowledge of 
 which will make what follows clearer. 
 
 Effect of Vertebral Subluxations on Resistance. — We have 
 fully explained how vertebral subluxations must be con- 
 sidered as being the primary and indirect cause of infectious 
 and contagious diseases. Since normal innervation implies 
 a perfect state of resistance, it follows that mal-alignments 
 of vertebrae, by obstructing the flow of impulses to a part, 
 diminish this resistance. 
 
 It has recently been conclusively shown that rheumatic 
 fever is the result of the entrance of the infective organism 
 through the tonsils. Diseased tonsils are an ideal culture 
 medium for the growth and multiplication of these germs, and 
 the elaboration of their toxins, which enter the body from 
 this point. If, therefore, this atrium of infection is in such 
 a state that it will not harbor these micro-organisms, but 
 destroys them, rheumatic fever becomes impossible of devel- 
 opment. A subluxation in the fifth and sixth cervical seg- 
 ments, however, markedly alters the normal condition of 
 the tonsils, and they then become a favorable medium for 
 the entrance of this specific infection. This same principle 
 applies to all infectious and contagious diseases. 
 
 Effect of Vertebral Subluxations on Movement and Sensi- 
 bility. — The influence of the nerves upon movement and sen- 
 sibility is well known. There is a constant flow of nerve- 
 
 203
 
 204 SPINAL ADJUSTMENT 
 
 impulses which maintains the muscles of the entire body in a 
 state of slight continuous contraction. Every conscious and 
 unconscious movement of any part of the body depends upon 
 the contraction of a muscle, and this contraction depends upon 
 an efferent impulse to the muscle. 
 
 As examples of interference with the motor function of 
 nerves by mal-alignment of vertebrae may be cited the action 
 of the heart, respiratory movements, the movements of the 
 stomach and intestines, the production of secretion by the 
 glands, etc. All these movements are controlled by certain 
 nerves, and a subluxation, by interrupting the efferent im- 
 pulses governing any of these motor actions, will result in 
 abnormal function of the part involved. Thus a subluxation 
 in the upper cervical and upper dorsal regions will interfere 
 with the action of the heart. A subluxation in the fifth, sixth 
 and seventh dorsal segments will interfere with the motility 
 of the stomach, and result in indigestion. A subluxation in 
 the lower dorsal and upper lumbar region of the vertebral col- 
 umn leads to insufficient intestinal peristalsis, and eventually 
 produces constipation. A subluxation involving the fourth 
 dorsal vertebrae will result in various disorders of the liver. 
 The etiological reason for this lies in the fact that from these 
 segments of the cord rise the nerves which supply these 
 various organs. A diagnosis of cardiac disturbances, gastric 
 disorders, etc., can be made and confirmed by examining the 
 spine and locating these subluxations. Naturally, it is im- 
 possible to determine from the spinal diagnosis the exact 
 nature of the disorder, but that the disorder can be referred to 
 a special organ, system or part of the body from the spinal 
 analysis alone, can be demonstrated. The reason that treat- 
 ment of these conditions by spinal adjustment produces the 
 desired results is simply because it restores to the affected 
 parts the nerve-supply necessary to their motility upon which 
 their normal functioning depends. Many of the internal 
 viscera are supplied almost exclusively by the sympathetic 
 system, as is shown by the peculiarity in the mode of pro- 
 duction of morbid conditions in them. If the body, for ex- 
 ample, is exposed to cold and dampness, congestion of the 
 kidneys, perhaps, is produced on the following day. Why not, 
 until the next day, do these renal symptoms manifest them-
 
 VERTEBRAL SUBLUXATIONS ON NERVE FUNCTION 205 
 
 selves? Because as a result of the irritation of the peripheral 
 nerve-endings a reflex vertebral subluxation was produced in 
 this particular individual in the tenth dorsal segment; this 
 segment, governing the kidneys through the sympathetic 
 system, is no longer able to transmit impulses to the kidneys 
 and disturbed circulation results. The reason that the symp- 
 toms do not follow until the day after exposure to the cause, 
 is because the motor properties of the sympathetic system 
 are exercised slowly, as compared with those of the cerebro- 
 spinal, in which the effect of irritation of a motor nerve is 
 instantaneous. 
 
 Effect of Vertebral Subluxations on Nutrition. — The effect 
 of subluxations on the trophic function of nerves is very in- 
 volved, since this term in its broadest sense includes the 
 processes of digestion, respiration, absorption, secretion, 
 excretion, anabolism, and catabolism. It is thus apparent 
 that a great number of individual processes enters into the 
 accomplishment of that single end, which we term nutrition. 
 Since all these processes, which make the ultimate nutrition 
 of the cells possible, are controlled by the nerves, mal-align- 
 ment of the vertebrae, by interfering with their normal exer- 
 cise, causes disturbed nutrition. By some authorities it is 
 claimed that there exist in all nerve bundles certain fibres 
 which govern the nutrition of the parts to which these nerves 
 go. If this is true, a subluxation of a vertebra would directly 
 affect the trophic function of any part of the body supplied 
 by that segment of the cord corresponding to the location 
 of the subluxation. The inhibitory and augmentor nerves are 
 generally considered as having a trophic influence on the 
 parts which they govern. That is to say, the nutrition of all 
 parts is maintained by regulating their activity ; during the 
 period of inactivity, the building-up or anabolic processes 
 take place. If, therefore, the cardio-inhibitory nerves are 
 prevented from conducting their impulses to the heart mus- 
 cle, its nutrition will suffer since its period of activity is 
 in excess of its period of rest. Similarly the nutrition of 
 every part of the body is governed by the harmonious action 
 of the augmentor and inhibitory nerves. If a subluxation 
 interferes with the conduction of the inhibitory impulses 
 which retard or suspend the activity of an organ for a suffi-
 
 206 SPINAL ADJUSTMENT 
 
 cient length of time to permit the necessary reparative 
 processes to take place, its nutrition will necessarily suffer. 
 
 Effect of Vertebral Subluxations on Secretion and Ex- 
 cretion. — The processes of secretion and excretion are con- 
 trolled by the cerebro-spinal and sympathetic nerves, and are 
 entirely involuntary. A subluxation, by interfering with the 
 conductivity of the nerves, results in changes in the char- 
 acter of the secretion and interference with the functional 
 activity of the organ affected. 
 
 As examples of such disturbances, the following may be 
 cited : A subluxation of the fifth, sixth, or seventh dorsal 
 vertebrae may affect the secretion of the gastric juice, and 
 thus lead to indigestion ; a subluxation in the upper cervical 
 region would also have such an effect. A subluxation in the 
 upper cervical region, or affecting the fourth dorsal vertebra 
 would cause a diminished secretion of bile. 
 
 A constant flow of efferent impulses also governs the 
 secretory activity of certain glands, as those* which have an 
 internal secretion, for example, the thyroid gland and spleen. 
 For this reason, subluxation of the fourth or sixth cervical 
 vertebra results in a depraved action of the thyroid gland. 
 In disorders of the spleen a subluxation of the ninth to 
 eleventh dorsal vertebrae are very often found. 
 
 The effect of vertebral subluxations on the function of 
 excretion is far-reaching in its effects. It is scarcely neces- 
 sary to go into detail regarding the vast number of affections 
 which may be traced to a perverted function of the excretory 
 organs. The common condition, called autointoxication is a 
 very good example of this form of disturbance of nerve 
 function. 
 
 The principal way in which subluxations of vertebrae 
 affect the functions of secretion and excretion is by their in- 
 fluence in preventing the flow of efferent impulses to those 
 organs concerned in these functions, by interrupting the mo- 
 tor impulses to the secretory cells. It must be borne in 
 mind that nerves are identical and so also the impulse. The 
 dift'erent action produced at their terminals depends upon 
 the nature of the cells in which they terminate. ,If a nerve 
 ends in a muscle, contraction of the muscle follows an effer- 
 ent impulse to it. If it ends in a gland cell, the effect of an
 
 VERTEBRAL SUBLUXATIONS ON NERVE FUNCTION 207 
 
 efferent impulse will be secretion or excretion. If, there- 
 fore, these efferent impulses are impeded, a deficient secretory 
 activity, or excretory activity, will follow in those parts 
 supplied by the affected nerve. 
 
 Effect of Vertebral Subluxations on Existing Action. — 
 Subluxations by cutting oft" the necessary impulses to a part 
 or organ of the body may cause it to become overactive. On 
 the other hand, it may cause a decreased activity of a part. 
 
 This is well illustrated by the inhibitory action of the 
 vagus upon the activity of the heart. Since the vagus is con- 
 nected with the superior cervical ganglion of the sympa- 
 thetic system, it may be- influenced through the upper 
 cervical vertebrae. A subluxation in that region of the spine 
 is therefore influential in producing a rapid action of the 
 heart by interfering with the inhibitory action of the vagus 
 upon it. 
 
 Effect of Vertebral Subluxations on Temperature. — The 
 amount of heat produced in the body varies with the metabol- 
 ism of the tissues of the body. The amount of heat lost by 
 the body depends upon the radiation and conduction of heat 
 from its surface, evaporation of water, respiration, etc. The 
 normal temperature of the body is maintained under the 
 varying conditions to which the body is exposed by mechan- 
 i.sms which permit variation in the production of heat, and 
 variation in the loss of heat. Thus in normal individuals the 
 loss and gain of heat are so well balanced that a uniform 
 temperature is maintained. 
 
 The influence of the nervous system on the regulation of 
 temperature is very great. The nervous system, by govern- 
 ing metabolism, controls the temperature of the body. By 
 its vaso-motor influence, regulating the calibre of the blood- 
 vessels and consequently the circulation, it also regulates the 
 temperature. In addition to these methods of regulation of 
 the temperature by the nerves, there is a separate nervous 
 apparatus by means of which heat production and heat loss 
 are regulated as circumstances demand. This apparatus, as 
 mentioned in the discussion of this subject under the head 
 of the physiology of the nervous system, consists of centres 
 which may be reflexly stimulated by afferent impulses from 
 the skin, and which act through special efferent nerves sup-
 
 208 SPINAL ADJUSTMENT 
 
 plying the various tissues. Any disturbance of this reflex arc 
 will produce an abnormal temperature. 
 
 So long as the skin is able to communicate to the nervous 
 centres the necessity of an increased or diminished produc- 
 tion of heat, normal bodily temperature exists. In fever, 
 then, there must be come interference in the ordinary channel 
 by which the skin is able to communicate to the nerve cen- 
 tres this necessity. The only logical place at which such an 
 interference with the afferent impulses could occur is at 
 the intervertebral foramina. 
 
 It is not meant to be understood that a subluxation in 
 any region of the vertebral column will cause a rise of the 
 body temperature. The change in the temperature, whether 
 it be higher than normal, or subnormal, is limited to the 
 region of the body supplied by the spinal segment which is 
 involved, and in which the reflex arc is interrupted. Sub- 
 luxations may, however, produce a rise in the general body 
 temperature by lowering the resistance of a certain part of 
 the body and thus making it a favorable culture medium for 
 the multiplication of germs and the elaboration of their toxins. 
 In this connection it must be borne in mind that in any in- 
 fectious disease it is not the germs which produce the fever, 
 but the circulation in the blood of their toxins. It is for this 
 reason, that in typhoid fever, for example, the fever is so 
 rapidly reduced by spinal adjustment of the segments which 
 control the intestines and spleen. These parts form the point 
 of predilection of the typhoid bacilli, and when their 
 resistance is restored to a normal degree, the further forma- 
 tion of toxins by the bacilli is prevented, and the fever 
 subsides. 
 
 Subluxations in the upper cervical region may also direct- 
 ly influence the general body temperature, by disturbing the 
 excitability of the reflex heat centre in the medulla. Thus 
 fever is very often reduced simply by an adjustment of these 
 vertebrae. 
 
 Eflfect of Vertebral Subluxations on Metabolism. — Some- 
 thing has already been said of the effect of subluxation of 
 vertebrae on metabolism in connection with their effect on 
 nutrition. As a matter of fact, the effect of subluxations on 
 metabolism is so closely interwoven with all the other dis-
 
 VERTEBRAL SUBLUXATIONS ON NERVE FUNCTION 209 
 
 turbances of nerve action that discussion of it enters into all 
 of their effects on other functions of the nerves. 
 
 Subluxations, especially by preventing the conduction of 
 the impulses from the sympathetic nerves, cause a disturb- 
 ance in metabolism. When the metabolism of a part is dis- 
 turbed, its functional activity necessarily suffers. Thus when 
 the sympathetic nerve-supply to a gland is withdrawn, by a 
 subluxation in the segment which governs it, the secretion 
 from this gland will be very much less rich in its essential 
 constituents. In this manner, a subluxation in the segment 
 controlling the liver may lead to numerous disorders as a 
 result of the functional inactivity of that organ, with a con- 
 sequent diminished flow of bile. Also a subluxation in the 
 segment governing the pancreas may produce a total cessa- 
 tion of its secretory activity, and lead to diabetes, which is 
 generally classed among the diseases of metabolism. In like 
 manner all the many diseases of metabolism may be traced 
 to mal-alignment of certain vertebrae. 
 
 Effect of Vertebral Subluxations on Circulation. — The 
 connection between subluxations and the circulation of the 
 blood is exceedingly close. Physiological experiments show 
 that pressure upon the sympathetic nerves sufficient to pre- 
 vent the conduction of their efferent impulses will produce 
 vascular congestion of the parts supplied by it. This is ex- 
 actly what occurs when, as a result of a subluxation, the 
 margins of the intervertebral foramina press upon the white 
 rami communicantes. 
 
 As an example of the results of the effects of vertebral 
 subluxations on the circulation the following may be cited : 
 The superior cervical ganglion of the sympathetic system 
 governs the circulation of the blood to the cranium. A sub- 
 luxation in this region of the vertebral column will therefore 
 very frequently produce cerebral congestion. In like man- 
 ner congestion in any part of the body is induced by a sub- 
 luxation affecting the segment controlling such a part. The 
 disturbances in the functional activity and organic integrity 
 of parts so affected are very numerous, and all respond to 
 correction of the subluxation by spinal adjustment. 
 
 Effect of Vertebral Subluxations on the Organs.— Aside 
 from the derangements produced in the organs by subluxa-
 
 210 SPINAL ADJUSTMENT 
 
 tions influencing their functional activity indirectly, they are 
 also influenced directly. This is true for the reason that the 
 sympathetic system has an action entirely independent of the 
 cerebro-spinal system in those organs in which terminal 
 ganglia are located. 
 
 Thus a subluxation of any of the upper cervical vertebrae 
 will directly influence the action of the heart. This is ac- 
 complished as follows : The displaced vertebra, by produc- 
 ing pressure upon the rami to the cervical gangha, prevents 
 the condition of impulses to the cardiac ganglia and disturbed 
 action of the heart follows. Again subluxations in the mid- 
 dorsal region cause disturbances of the stomach, by a similar 
 effect upon the splanchnics. 
 
 Effect of Vertebral Subluxations on Reflex Action. — Re- 
 flex actions which are performed in health have a distinct 
 purpose, and are adapted to producing some end which is 
 desirable and necessary for the well-being of the body. All 
 reflex actions are motor, and depend upon the unimpeded 
 conductivity of the nerves involved in the action. Thus pres- 
 sure upon the afferent and efferent nerves consequent upon a 
 vertebral mal-alignment prevents the conduction of the im- 
 pulses from the periphery to the spinal centre, or the conduc- 
 tion of the outgoing impulses from the spinal centre to the 
 part for which they are destined. 
 
 For example, it is through the afferent impulses excited in 
 the wall of the bowel that the centre in the spinal cord regu- 
 lating the movement of their muscular coat sends out im- 
 pulses producing this movement. If, however, a subluxation 
 exists in the lower dorsal or upper lumbar region of the 
 spinal column, the reflex arc is broken, and the impulses 
 which are reflexly produced as a result of the stimulation 
 in the wall of the bowel, never reach its musculature. As a 
 consequence of this lack of muscular action, constipation 
 results. 
 
 Another example of the reflex action being interrupted 
 is that in which secretion is stopped as a result of it. Thus 
 if the impulses which are sent to the stomach, producing the 
 secretion of gastric juice when food enters it, are prevented 
 from reaching it, as a result of a subluxation, indigestion 
 will follow.
 
 VERTEBRAL SUBLUXATIONS ON NERVE FUNCTION 211 
 
 Effect of Vertebral Subluxations on the Cranial Nerve 
 Functions. — Subluxations in the upper cervical region, and of 
 any of the upper six dorsal vertebrae will affect the function 
 of the cranial nerves. The manner in w^hich this is brought 
 about is as follows : All anatomists are agreed that the gray 
 rami communicantes of the superior cervical ganglion of the 
 gangliated cord communicate with all the cranial nerves. 
 Some of the fibres of the gray rami pass to the origin of the 
 cranial nerves in the brain, while others accompany the nerves 
 throughout their distribution. Since the superior cervical 
 ganglion connects with the first four spinal nerves through 
 the medium of both gray and white rami, the cranial nerves 
 communicate directly with these spinal nerves. Impulses, 
 therefore, which pass through the spinal nerves, through the 
 rami communicantes, to the cranial nerves may thus be inter- 
 rupted by impingement of the first four spinal nerves. Ref- 
 erence to the chapter dealing with the connection between 
 the sympathetic system and the cranial nerves will give the 
 reader an exact idea of how vertebral subluxations may 
 influence individual cranial nerves in any given case. 
 
 As an example of the influence of subluxations on the 
 action of the cranial nerves, we will consider the disturbances 
 of the third cranial nerve as a result of a break in the con- 
 tinuity of the reflex arc. As is well known, perfect vision 
 depends partly upon the power of accommodation, as regu- 
 lated by the proper contraction and dilatation of the pupil. 
 The pupillary reflex is governed by the motor oculi, or third 
 cranial nerve. Having reached the cilio-spinal centres in 
 the cord, from the brain, the optic impulses take one of two 
 possible courses : They leave the cord through the anterior 
 roots of the upper thoracic nerves and run, in succession, 
 through the rami communicantes, the cervical portion of the 
 gangliated cord of the sympathetic, the cavernous plexus, 
 the ciliary ganglion and the short ciliary nerves to the radiat- 
 ing fibres of the iris, producing dilatation of the pupil. It can 
 be readily appreciated what would happen to these impulses 
 were the power of conduction of the upper dorsal spinal nerves 
 to be destroyed by pressure upon them of the displaced 
 margins of one of the intervertebral foramina in this region. 
 The contraction of the pupil is prevented in the same manner.
 
 212 SPINAL ADJUSTMENT 
 
 In this way, by tracing the nerve-supply of any part hav- 
 ing connection with the cranial nerves, the effects of a verte- 
 bral subluxation upon the function of that nerve may be 
 readily determined.
 
 SECTION FIVE 
 Spinal Analysis 
 
 CHAPTER I 
 
 Segmentation and Localization 
 
 The first requisite to a scientific application of spinal 
 analysis is a knowledge of the vertebral column as a whole, 
 and of the various groups of vertebrae which comprise it, to- 
 gether with their ligaments. The next essential is an exact 
 knowledge of the segmentation of the spine and of the point 
 of emergence of the spinal nerves. 
 
 The Vertebral Column. — The spine is a flexible and flexu- 
 ous column composed of a series of bones, called vertebrae 
 (from vertere, to turn). There are 33 vertebrae, divided into 
 five groups, and named according to the region which they 
 occupy, as, 7 cervical (in the neck), 12 thoracic (at the level 
 of the thorax), 5 lumbar (at the level of the abdomen), 5 
 sacral (at the level of the pelvis), and 4 coccygeal (forming 
 the coccyx). Those of the upper three regions, namely the 
 first twenty-four vertebrae, are separate throughout life, and 
 are known as movable or true vertebrae. The succeeding 
 five, or sacral, become united in the adult to form the sacrum, 
 and the last four, or coccygeal, unite to form the tip of the 
 spine, or coccyx; these lower nine vertebrae are accordingly 
 called fixed or false vertebrae, since they have no mobility 
 and are not individual bones. 
 
 Although the vertebrae differ markedly in some respects, 
 each vertebra is constructed on a common plan, which is 
 more or less modified in diflferent regions to meet special 
 requirements. Thus each vertebra consists of two parts, a 
 solid part, or body, in front, and a circular part, or arch, 
 behind. The bodies are set one upon the other, forming a 
 
 213
 
 214 SPINAL ADJUSTMENT 
 
 strong pillar to support the head and trunk ; the arches also 
 set one upon the other and form a cylinder which contains 
 the spinal cord. Between the bodies there are placed cushion- 
 like pads of cartilage which prevent jarring and act in the 
 same capacity that the cartilaginous covering of the articular 
 ends of all bones do, namely prevent friction between the 
 bones and promote the greatest freedom of movement. Each 
 arch contains a notch on its upper and lower surface, and 
 when these are united with the corresponding ones above 
 and below, circular openings are formed through which the 
 spinal nerves pass outward. 
 
 The body, or centrum, is a solid disc of bone, about three- 
 fourths of an inch in thickness and from one to two inches 
 in diameter. It is convex in front, and concave behind, from 
 side to side. It is concave from above downward in front, 
 and nearly flat behind. Its anterior surface is perforated by 
 a few small openings for the entrance of nutrient vessels ; its 
 posterior surface has one large opening for the exit of the 
 vein. 
 
 The intervertebral cartilaginous discs are placed between 
 the bodies of the vertebrae, whose upper and lower surfaces 
 are slightly concave and rough for their attachment. 
 
 The pedicles are two- short, thick pieces of bone which 
 project backward from the upper and outer corner of the 
 posterior aspect of the body. Upon the upper and lower 
 surfaces of these are located the notches whose union forms 
 the intervertebral foramina. 
 
 The laminae are two broad, fiat, sloping plates, joined to 
 the pedicles on each side, and, passing backward, are joined 
 to each other behind. They complete the foramen which en- 
 closes and protects the spinal cord, and which is termed 
 the spinal foramen. Their borders are rough for the 
 attachment of the ligamenta flava. 
 
 The spinous process projects backward from the junction 
 of the two laminae and serves for the attachment of muscles 
 and ligaments. Palpation of these processes is used to de- 
 termine from their relation to each other if there is any 
 displacement of the vertebrae. 
 
 The transverse processes, two in number, project outward 
 at each side from the junction of the pedicles and laminae.
 
 SEGMENTATION AND LOCALIZATION 215 
 
 They also serve for the attachment of muscles and Hgaments. 
 These processes are of even greater importance than the 
 spinous process in determining the existence of a subluxation 
 and its character. 
 
 The articular processes, two on each side, namely the 
 superior and inferior, project upward and downward from 
 the junction of the laminae and pedicles. Their surfaces are 
 smooth, and when the vertebrae are joined, they articulate 
 with the ones above and below. 
 
 Let us next consider the special characteristics of the 
 vertebrae of each region of the spinal column, as these fac- 
 tors have an important bearing on the possible varieties of 
 subluxations of the vertebrae of each region. 
 
 The Cervical Vertebrae. — The body of these vertebrae is 
 small, and broader from side to side than from before back- 
 ward. The anterior and posterior surfaces are flattened and 
 of equal depth. Its upper surface is concave transversely, 
 and has a projecting lip on each side; its lower surface is con- 
 vex transversely, and has a shallow groove on each side which 
 receives the lip of the vertebra below. The pedicles are di- 
 rected outward and backward, and spring from the body 
 about midway between the upper and lower borders. The 
 superior and inferior notches are nearly equal in depth, though 
 the inferior are generally somewhat deeper. The laminae are 
 long and narrow, and overlap each other behind ; they enclose 
 the spinal foramen which is very large and of triangular form. 
 The spinous process is short, and its extremity bifid. The 
 articular processes are situated at the junction of the laminae 
 and pedicles, and are obliquely placed, and their surface is 
 flat. The superior projects backward and upward, the inferior 
 forward and downward. 
 
 The Thoracic Vertebrae. — The body of these vertebrae is 
 heart-shaped, and as broad from before backward as from 
 side to side. It is thicker behind than in front, which pro- 
 duces the curve of the spinal column in the thoracic region. 
 The upper and lower surfaces are flat ; it is convex in front, and 
 deeply concave behind. On each side of the body where it 
 joins the arch are placed two semilunar depressions ; these 
 unite with the ones above and below to form complete articu- 
 lar facets for the heads of the ribs. The upper and lower
 
 216 SPINAL ADJUSTMENT 
 
 thoracic vertebrae somewhat resemble the cervical and lum- 
 bar vertebrae respectively. The pedicles are directed back- 
 ward, and the intervertebral notches on their under surface 
 are large and deeper than in any other region of the spine. 
 The laminae are broad and thick, and overlap each other. The 
 spinal foramen is small and circular. The spinous process is 
 long, three-sided, and directed obliquely downward ; they over- 
 lap each other especially from the fifth to the eighth. The 
 articular processes project from the upper and lower surfaces 
 of the pedicles ; their surfaces are placed nearly vertical, and 
 are flat ; the superior is directed backward and upward, the 
 inferior, forward and downward. The transverse processes 
 are thick, strong, of great length, and directed obliquely back- 
 ward and outward ; their end is clubbed and tipped with a 
 small concave surface for articulation with the tubercle of a 
 rib. 
 
 The Lumbar Vertebrae. — The body of these vertebrae is 
 large, kidney-shaped, and slightly thicker in front than be- 
 hind, which forms the lumbar curve of the spine. The pedicles 
 are very strong, and extend directly backward from the upper 
 part of the body, which makes the intervertebral notches very 
 deep. The laminae are broad, short, and strong. The spinal 
 foramen is triangular ; it is larger than in the thoracic, and 
 smaller than in the cervical region. The spinous processes 
 are thick, broad, quadrilateral, and horizontal in direction ; 
 they are thicker below than above, and end in a rough, un- 
 even border. The articular processes are thick and strong; 
 the superior are concave, and look backward and inward ; the 
 inferior are convex, and look forward and outward. The 
 transverse processes are long, slender, and spatula-shaped ; 
 they are directed transversely outward in the upper three 
 lumbar vertebrae, and slant a little upward in the lower two. 
 
 The Normal Curves of the Spine. — As a further assistant 
 to the making of a correct spinal analysis a knowledge of the 
 curves of the spine is very useful. 
 
 When the spine is viewed from the side, it will be noted 
 that there are four curves ; that in the cervical region, in 
 which the convexity is anteriorly directed ; that in the thoracic 
 region, in which the convexity is posteriorly directed ; that in 
 the lumbar region, in which the convexity is again directed
 
 SEGMENTATION AND LOCALIZATION 217 
 
 anteriorly ; lastly, the sacral curve the convexity of which is 
 directed backward. 
 
 The curves vary in different individuals, and also accord- 
 ing to age, sex, occupation, etc. A difference in the curves is 
 also noted at different times of the day, owing to the com- 
 pression of the discs due to the upright posture. It is very 
 important to determine any abnormality of these curves, from 
 the standpoint of spinal adjustment, and this will be consid- 
 ered in detail further on. 
 
 The twenty-three intervertebral discs between the bodies 
 of the vertebrae tend to give the spine as a whole its great 
 flexibility; the muscles and ligaments attached to its sur- 
 faces and processes also assist in this, and are important fac- 
 tors in maintaining its normal poise and preventing subluxa- 
 tions. By viewing the spinal column anteriorly, it will be 
 noted that the extremities of the transverse processes of the 
 atlas extend laterally to about the same distance as those of 
 the first thoracic vertebra. The transverse processes of the 
 other cervical vertebrae are rudimentary, and increase in 
 length in proportion to the increase in the width of the bodies, 
 until the first thoracic vertebra is reached. The transverse 
 processes gradually decrease in length from this point to the 
 twelfth thoracic vertebra. In the lumbar region, the trans- 
 verse processes of the first lumbar vertebra extend laterally 
 further than those of the first thoracic ; those of the second 
 lumbar are longer than those of the first ; those of the third 
 are longer than those of the second. From this point diminu- 
 tion in length again is noted, the fourth corresponding to the 
 first, and the fifth to the second lumbar vertebra. 
 
 Movements of the Spine. — It will be noted, in considering 
 the movements of the spine, that in the adult a little more than 
 one-fifth of this movement occurs in the neck, and that a little 
 less than one-third of this movement occurs in the lumbar 
 region. Various peculiarities of the vertebrae in the different 
 regions of the spinal column modify the degree of motion of 
 the spine as a whole. Thus the differences in the thickness 
 of the discs, the vertical measurements of the bodies, and the 
 fact that the bodies are not perfectly circular modify the move- 
 ments of the spine in certain regions. The shape and place- 
 ment of the articular processes also influence the degree of
 
 218 SPINAL ADJUSTMENT 
 
 certain movements in various regions of the spine. In the 
 dorsal region, the attachment of the ribs to the bodies of the 
 vertebrae also makes some movements more restricted than 
 in other regions. The ligaments of the spine also have a 
 tendency, when perfect balance exists on both sides, to limit 
 the degree of movement of the spine, when excessive, by the 
 tension which is produced in the ligaments on the side of the 
 bodies opposite to the direction of the motion. The resistance 
 to compression of that side of the intervertebral disc toward 
 which the motion occurs also tends to limit any excessive 
 movement of the vertebrae. 
 
 The amount of all movements of the spine varies in dif- 
 ferent individuals, and as age advances there is a progressive 
 decrease in the limits of mobility of the vertebral column. 
 This is simply due to the varying degrees of elasticity of the 
 parts involved. 
 
 The movements of which the spine is capable are : 
 
 1. Flexion. 
 
 2. Extension. 
 
 3. Rotation. 
 
 4. Lateral motion. 
 
 5. Mixed motion. 
 
 Flexion, or forward bending, is more free in the cervical 
 region than extension, which is limited by the locking of the 
 laminae when the head is thrown back as far as possible. In 
 the lower thoracic and lumbar regions flexion is comparatively 
 free. Before the consolidation of the spine, flexion of a slight 
 degree is possible throughout the vertebral column. 
 
 , Extension in the neck is limited by the locking of the 
 laminae. In the other regions of the spine it is speedily 
 checked by the locking of the laminae and spinous processes;, 
 this movement is chiefly limited to the last two thoracic and 
 the lumbar vertebrae. 
 
 Lateral movement is greatest in the cervical region, fol- 
 lowed by that of the thoracic and lumbar regions. 
 
 Rotation is freest in the cervical region, considerable in 
 the thoraic region, and least in the lumbar region. 
 
 Mixed movements are combinations of any of the above 
 movements. Thus lateral movement is nearly always associ- 
 ated with rotation.
 
 SEGMENTATION AND LOCALIZATION 219 
 
 Position of the Vertebrae. — As a further means of assis- 
 tance in the making of a correct spinal analysis the location 
 of the various vertebrae is very essential. The following are 
 the surface landmarks of the different vertebrae : 
 
 1st Cervical: This vertebra has no spinous process, and 
 the posterior arch is between the occiput and the spine of the 
 axis. The transverse processes are just below and in front of 
 the tips of the mastoid processes. 
 
 2nd Cervical : This vertebra is most easily recognized as 
 being the first spinous process below the occiput. 
 
 3rd Cervical : The spinous process of this vertebra is 
 very difficult to palpate, since it lies beneath the overlapping 
 spinous process of the axis, and can only be felt when the 
 neck is flexed. It is the second below the occiput. 
 
 4th Cervical : The spinous process of this vertebra is the 
 third one palpated when the neck is flexed. This vertebra is 
 opposite the hyoid bone. 
 
 5th Cervical : This vertebra is recognized as being the 
 fourth palpated when the neck is flexed. 
 
 6th Cervical : This vertebra is on a line with the cricoid 
 cartilage. Its spinous process is directly above that of the 
 vertebra prominens. 
 
 7th Cervical : This vertebra is easily recognized by the 
 great length of its spinous process, which is used as a land- 
 mark in counting the spinous processes upward and down- 
 ward. 
 
 1st Thoracic : The spinous process of this vertebra is on 
 a line with the superior portion of the spine of the scapula, 
 and is detected by placing the thumbs on the spinous process 
 which is on a line with the fingers placed on the superior 
 surface of the spines of the scapulae. 
 
 2nd Thoracic : The spinous process of this vertebra corre- 
 sponds to head of the third rib. It is located by noting it as 
 being the first one below the first thoracic. 
 
 3rd Thoracic : The spinous process of this vertebra is on 
 a line with the inner edge of the spine of the scapula. It is 
 the second spinous process below the first thoracic. 
 
 4th Thoracic : The spinous process of this vertebra is 
 opposite the junction of the first and second parts of the
 
 220 SPINAL ADJUSTMENT 
 
 sternum. It is located by counting downward from the first 
 thoracic, or upward from the seventh thoracic spine. 
 
 5th Thoracic : The spinous process of this vertebra is 
 most easily determined by counting upward from the seventh. 
 
 6th Thoracic : The spinous process of this vertebra is 
 directly above that of the seventh. 
 
 7th Thoracic : The spinous process of this vertebra cor- 
 responds to the inferior angle of the scapula when the sub- 
 ject is sitting with the arms hanging at the sides, and half an 
 inch above when the subject is lying prone. It is located by 
 placing the thumb on a line with the finger placed on the 
 inferior angle of the scapula. 
 
 8th Thoracic : The spinous process of this vertebra is 
 most readily located by determining the position of the 
 seventh and then palpating the one below it. 
 
 9th Thoracic : The spinous process of this vertebra is also 
 most easily determined by first noting the position of the 
 seventh, and then counting downward from this point. 
 
 10th Thoracic : The spinous process of this vertebra cor- 
 responds to the level of the ensiform cartilage of the sternum. 
 It is located about half an inch below the attachment of the 
 tenth rib, which is followed from its prominence to the spine. 
 
 lltli Thoracic: The spinous process of this vertebra is 
 best located by first determining the position of the tenth 
 thoracic vertebra. 
 
 12th Thoracic : The spinous process of this vertebra cor- 
 responds to the head of the last rib. It is located either by 
 counting downward from the seventh or the tenth thoracic 
 spinous process. 
 
 1st Lumbar: The spinous process of this vertebra is 
 most easily recognized by an upward count from the fourth 
 lumbar spinous process. 
 
 2nd Lumbar : The spinous process of this vertebra is 
 also most readily located by counting upward from the spine 
 of the fourth lumbar. 
 
 3rd Lumbar: The spinous process of this vertebra like the 
 first and second is determined by counting upward from the 
 fourth, being directly above that vertebra. 
 
 4th Lumbar: The spinous process of this vertebra is 
 situated at the level of a line drawn between the iliac crests.
 
 SEGMENTATION AND LOCALIZATION 221 
 
 It is located by palpating the sacrum and fifth lumbar which 
 are immediately below it, or by placing- the thumbs midway 
 between the fingers placed upon the crests of the ilia on both 
 sides. 
 
 5th Lumbar: The spinous process of this vertebra is lo- 
 cated below that of the fourth lumbar vertebra and above the 
 sacrum. 
 
 Tabulated Attachment of Spinal Nerves to Cord. — The 
 following table by Reid gives the topography of the attach- 
 ment of the spinal nerves to the cord : A marking the highest 
 and B the lowest level. A thorough study of this table will 
 aid the reader in segment localization. 
 
 NERVES : 
 
 1st Cervical connects opposite superior margin of Foramen 
 Magnum and just below the inferior margin. 
 
 2nd Cervical: (A) A little above posterior arch of atlas. 
 
 2nd Cervical : (B) Midway between the posterior arch of 
 atlas and spine of axis. 
 
 3rd Cervical : (A) A little below posterior arch of atlas. 
 
 3rd Cervical: (B) Junction of upper two-thirds and lower 
 third of spine of axis. 
 
 4th Cervical : (A) Just below upper border of spine of 
 axis. 
 
 4th Cervical: (B) Middle of spine of third cervical ver- 
 tebra. 
 
 5th Cervical : (A) Just below the lower border of spine 
 of axis. 
 
 5th Cervical: (B) Just below lower border of spine of 
 fourth cervical. 
 
 6th Cervical : (A) Lower border of spine of third cer- 
 vical vertebra. 
 
 6th Cervical: (B) Lower border of spine of fifth cervical 
 vertebra. 
 
 7th Cervical : (A) Just below upper border of spine of 
 fourth cervical vertebra. 
 
 7th Cervical: (B) Just above lower border of spine of 
 sixth cervical vertebra. 
 
 8th Cervical : (A) Upper border of spine of fifth cervical 
 vertebra.
 
 222 • SPINAL ADJUSTMENT 
 
 8th Cervical : (B) Upper border of spine of seventh cer- 
 vical vertebra. 
 
 1st Thoracic: (A) Midway between spines of fifth cer- 
 vical and sixth cervical vertebrae. 
 
 1st Thoracic: (B) Junction of upper two-thirds and lower 
 third of interval between seventh cervical and first thoracic. 
 
 2nd Thoracic : (A) Lower border of spine of sixth cer- 
 vical vertebra. 
 
 2nd Thoracic : (B) Just above lower border of spine of 
 first thoracic. 
 
 3rd Thoracic : (A) Just above middle of spine of seventh 
 cervical vertebra. 
 
 3rd Thoracic: (B) Lower border of spine of second 
 thoracic vertebra. 
 
 4th Thoracic : (A) Just below upper border of spine of 
 first thoracic. 
 
 4th Thoracic: (B) Junction of upper third and lower 
 two-thirds of spine of third thoracic vertebra. 
 
 5th Thoracic : (A) Upper border of spine of second 
 thoracic vertebra. 
 
 5th Thoracic : (B) Junction of upper quarter and lower 
 three-quarters of spine of fourth thoracic vertebra. 
 
 6th Thoracic : (A) Lower border of spine of second 
 thoracic vertebra. 
 
 6th Thoracic : (B) Just below upper border of spine of 
 fifth thoracic. 
 
 7th Thoracic : (A) Junction of upper third and lower 
 two-thirds of spine of fourth thoracic vertebra. 
 
 7th Thoracic : (B) Just above lower border of fifth 
 thoracic. 
 
 8th Thoracic : (A) Junction of upper two-thirds and 
 lower third of interval between spines of fourth thoracic and 
 fifth thoracic vertebrae. 
 
 8th Thoracic : (B) Junction of upper quarter and lower 
 three-quarters of spine of sixth thoracic vertebra. 
 
 9th Thoracic : (A) Midway between spines of fifth tho- 
 racic and sixth thoracic vertebrae. 
 
 9th Thoracic: (B) Upper border of spine of seventh 
 thoracic vertebra.
 
 SEGMENTATION. AND LOCALIZATION 223 
 
 10th Thoracic : (A) Midway between spines of sixth and 
 seventh thoracic vertebra. 
 
 10th Thoracic: (B) Middle of spine of eighth thoracic 
 vertebra. 
 
 11th Thoracic: (A) Junction of upper quarter and lower 
 three-quarters of spine of seventh thoracic. 
 
 12th Thoracic: (B) Just below spine of ninth thoracic 
 vertebra. 
 
 1st Lumbar: (A) Midway between spines of eighth 
 thoracic and ninth thoracic vertebra. 
 
 1st Lumbar: (B) Lower border of spine of tenth tho- 
 racic vertebra. 
 
 2nd Lumbar: (A) Middle of spine of ninth thoracic 
 vertebra. 
 
 2nd Lumbar: (B) Junction of upper third and lower 
 two-thirds of spine of eleventh thoracic vertebra. 
 
 3rd Lumbar : (A) Middle of spine of tenth thoracic ver- 
 tebra. 
 
 3rd Lumbar: (B) Just below spine of eleventh thoracic. 
 
 4th Lumbar : (A) Just below spine of tenth thoracic 
 vertebra. 
 
 4th Lumbar: (B) Junction of upper quarter and lower 
 three-quarters of spine of twelfth thoracic vertebra. 
 
 5th Lumbar: (A) Junction of upper third and lower 
 two-thirds of spine of eleventh thoracic vertebra. 
 
 5th Lumbar : (B) Middle of spine of twelfth thoracic ver- 
 tebra. 
 
 1st Sacral to 5th Sacral: (A) Just above lower border of 
 spine of eleventh thoracic vertebra. 
 
 1st Sacral to 5th Sacral: (B) Lower border of spine of 
 first lumbar vertebra. 
 
 Coccygeal : (A) Lower border of spine of first lumbar 
 vertebra. 
 
 Coccygeal : (B) Just below upper border of spine of 
 second lumbar vertebra. 
 
 The Exit of the Spinal Nerves in Respect to the Spinous 
 Processes. — The following table gives the surface markings 
 of the emergence of the spinal nerves from the intervertebral 
 foramina, in respect to the spinous processes ; the roots of the 
 spinal nerves from their origin in the cord run obliquely
 
 224 SPINAL ADJUSTMENT 
 
 downward to their point of exit from the intervertebral 
 foramina, the amount of obliquity varying in different regions 
 of the spine, and being greater in the lower than upper part. 
 Thus the level of their emergence from the intervertebral 
 foramina does not correspond to the point of emergence of 
 the nerve from the cord. For example, the ninth thoracic 
 nerve emerges from the cord at the level of the seventh 
 thoracic spinous process, while the level of its emergence 
 from the intervertebral foramen is at the eighth thoracic 
 spinous process. In the preceding table the relation between 
 the emergence from the cord and the spinous processes was 
 given ; in the following table the relation of the exit of the 
 spinal nerves from the intervertebral foramina to the spinous 
 processes will be shown. 
 
 Spinal Nerve Level of Emergence 
 
 C I Between occiput and spine of axis. 
 
 C II Middle of spine of axis. 
 
 C III End of spine of axis. 
 
 C IV Spine of third cervical vertebra. 
 
 C V Spine of fourth cervical vertebra. 
 
 C VI Spine of fifth cervical vertebra. 
 
 C VII Spine of sixth cervical vertebra. 
 C VIII Spine of vertebra prominens. 
 D I Between seventh cervical and first dorsal spines. 
 
 D II Between spines of first and second dorsal verte- 
 
 brae. 
 D III Between spines of second and third dorsal verte- 
 brae. 
 
 Spine of third dorsal vertebra. 
 
 Spine of fourth dorsal vertebra. 
 
 Spine of fifth dorsal vertebra. 
 
 Between spines of fifth and sixth dorsal vertebrae. 
 
 Between spines of sixth and seventh dorsal ver- 
 tebrae. 
 
 Spine of seventh dorsal vertebra. 
 
 Spine of eighth dorsal vertebra. 
 
 Between spines of ninth and tenth dorsal ver- 
 tebrae. 
 D XII Spine of eleventh dorsal vertebra. 
 
 DIV 
 
 DV 
 
 DVI 
 
 DVII 
 
 DVIII 
 
 DIX 
 
 DX 
 
 DXI
 
 SEGMENTATION AND LOCALIZATION 225 
 
 Spinal Nerve Level of Emergence 
 
 L I Spine of twelfth dorsal vertebra. 
 
 L II Between spines uf first and second lumbar verte- 
 
 brae. 
 L III Spine of third lumbar vertebra. 
 
 L rV Spine of fourth lumbar vertebra. 
 
 L V Spine of fifth lumbar vertebra. 
 
 Segmental Localization. — "A spinal segment is that part of 
 the cord contained between two sets of roots. Each segment 
 must be regarded as a unit endowed with motor, sensory, 
 trophic, vasomotor, and reflex functions in respect to the parts 
 supplied by the roots of the nerves which emerge from and 
 enter it. A segment is named from the nerve-roots which 
 take their origin from it, and not from the vertebra with 
 which it corresponds." (Abrams.) 
 
 The following table, by Sherrington, slightly modified, 
 shows the different segments and the various parts which 
 they control. This table is compiled from data collected from 
 sources both clinical and experimental ; the latter are dis- 
 tinguished by being printed in italics, and rest on observations 
 obtained chiefly from the dog and monkey.
 
 226 
 
 SPINAL ADJUSTMENT 
 
 AFFERENT ROOT. 
 
 No. of 
 
 Nerve. 
 
 Skin. 
 
 Muscle. 
 
 Viscera. 
 
 Reflex Movement. 
 
 Level of 
 Surface 
 Origin. 
 
 Ci. 
 
 No afferent root 
 usually present. 
 
 Just 
 above arch 
 of atlas. 
 
 C II. Side of head from mid- 
 
 line of scalp to mid-line 
 under mouth behind chin. 
 Ant. border lies about 
 midway between root of 
 pinna and outer angle 
 of orbit, and about 
 midway between hind 
 edge of ascend, ramus of 
 lower jaw and angle of 
 mouth. Post, border 
 from belotv external oc- 
 ripit. protiib. runs well 
 behind pinna, to the cri- 
 coid cartilage. 
 
 Same 
 as 
 
 Same 
 
 as 
 motor. 
 
 Drawing up of 
 shoulder, down of 
 head to same side ; 
 turning of chin 
 toward oppos. 
 shoulder with the 
 neck. 
 
 Ranges 
 from just 
 a b o V e to 
 just be- 
 low spine 
 of atlas. 
 
 C III. From mid-scalp little 
 
 behind halfway between 
 top of occiput and ext. 
 occipt. protub. the ant. 
 border runs behind pinna 
 and post, edge of low. 
 jaw to reach the thyroid 
 cartilage. The post, bor- 
 der passes from the mid- 
 dorsal line of neck below 
 level of fourth cervical 
 spine and slopes to root 
 of acromion, turns and 
 forms a characteristic 
 notch, then crosses chest 
 below clavicle to reach 
 sternum at second costal 
 cartilage. 
 
 Same 
 
 E I e V a tion of At or a 
 
 shoulder, drawing little 
 
 down of h e a d to above the 
 
 same side; flexion spine of 
 
 of elbow feeble the axis. 
 and occasional. 
 
 C IV. Ant. edge runs from 
 
 just above exter. occipit. 
 pro tuberance outward 
 close behind root of 
 pinna and well behind 
 angle of jaiv to reach be- 
 low cricoid. Post, edge 
 runs from mid-line of 
 back on level tcith top of 
 scapula, slopes over root 
 of scapular spine, crosses 
 infra-spinous fossa to 
 leave mid-ioay between 
 acromion and inferior 
 angle, winds halfway 
 down upper arm, turns 
 upon coracobrachialis 
 over pectoral fold to pass 
 ivell above the nipple to 
 third cost. cart. 
 
 Same 
 
 as 
 motor. 
 
 Retraction o f 
 shoulder, some- 
 times lifting of 
 shoulder ic4th pro- 
 traction; flexion 
 at elbow, but not 
 invariably ; lat- 
 eral flexion of 
 neck; occasion- 
 ally flexion ad- 
 duction of thumb. 
 
 Ranges 
 from spine 
 of axis to 
 spine of 
 third cer- 
 vical ver- 
 tebra.
 
 SEGMENTATION AND LOCALIZATION 
 
 227 
 
 EFFERENT ROOT. 
 
 Striped Muscle. 
 
 Chief Movement 
 Effected. 
 
 Blood- 
 Vessels. 
 
 <j!Iands of 
 Viscera. 
 
 Rectus cap, post. maj. 
 et. min. Obliq. cap. sup. et 
 inf., Trapezius, S t e r n o- 
 mastoid. Sternohyoid, 
 Sternothyroid, Omohyoid 
 (esp. ant. belly), Rectus 
 later.. Rectus cap. ant. 
 min.. Geniohyoid, Thyro- 
 hyoid ( ?Complexus). 
 
 Lateral flexion 
 of head and neck 
 toirard the side 
 stimulated, with- 
 out rotation of 
 the head. 
 
 Through 
 c o n n e c tion 
 with sympa- 
 t h e t i c sup- 
 plies vis cera 
 as s h o w n in 
 chapter on 
 Innervation. 
 
 Through 
 c o n n e c tion 
 with sympa- 
 t h e t i c sup- 
 plies vis cera 
 as s h o w n in 
 chapter on 
 Innervation. 
 
 Rectus cap. ant. maj., 
 Longus colli, Sternomas- 
 toid, Geniohyoid, Sterno- 
 hyoid, Sternothyroid, Thy- 
 rohyoid, Omohyoid (espec 
 post, belly), Cervicalls as- 
 cendens, Trapezius, Com- 
 plexus, O b I i q u u s inf., 
 Trachelomastoid. 
 
 Lateral flexion 
 of the neck to the 
 side stimulated, 
 irith some retrac- 
 tion; little or no 
 rotation of the 
 head, but the chin 
 may be turned 
 slightly t o ward 
 oposite side. 
 
 Rectus cap. ant. maj., 
 Longus colli, Levat. ang. 
 scap.. Omohyoid (post, 
 belly). Sternohyoid (low- 
 er part), Complexus, Sple- 
 n 1 u s, Trachelomastoid, 
 Trapezius, Cervicalls as- 
 cendens, Transversi spi- 
 n a 1 e s ( ?Sternomastoid, 
 Diaphragm). 
 
 Lateral flexion 
 of the neck to- 
 irard the side 
 stimulated, with 
 marked retrac- 
 tion and a little 
 turning of the 
 neck, so that chin 
 is thrust up to 
 opposite side. 
 
 Levator scapulae, Longus 
 colli. Scalenus med.. Tra- 
 pezius Subclavius, D i a- 
 phragm (front or sternal 
 portion), Complexus, Sple- 
 n i u s, Trachelomastoid, 
 Cervicalls ascendens, 
 Transversospinales ( ?Sca- 
 lenus anticus). 
 
 E I e V a tion of 
 .fhoulder, dr a g- 
 ging it headward 
 and toward spinal 
 column; slight 
 lateral flexion to- 
 ward side stimu- 
 lated tc-ith marked 
 retraction. With 
 shoulder fixed the 
 turning of the 
 head toward op- 
 p sit e side is 
 more marked.
 
 228 
 
 SPINAL ADJUSTMENT 
 
 AB^FERENT ROOT. 
 
 No. of 
 Nerve. 
 
 Skin. 
 
 Musc'lo. 
 
 Viscera. 
 
 Reflex Movement. 
 
 Level of 
 Surface 
 Origin. 
 
 C V. Ant. border, from near Same 
 
 spine of third cerv. vert., as 
 passes down to outer motor. 
 third of clavicle and 
 along it, runs inward to 
 mid-line of chest. Post, 
 border, from below spine 
 of seventh cerv. vert., 
 s IV e e p s outioard over 
 base of spine of scapula, 
 enters arm beloxo and be- 
 hind deltoid, gets on to 
 supinator longus and re- 
 curves on that nearly 
 halfway down forearm; 
 c7-osses the chest two 
 fingers' breadths above 
 nipple on the third cost. 
 eart. 
 
 C VI. A long field occupying Same 
 
 the outer and radial as- as 
 
 pect of the arm from motor. 
 just below the deltoid 
 insertion above to the 
 thumb below, and no- 
 where reaching the chest 
 or t r u n k. /Sometimes 
 more or less of the index 
 finger is included; some- 
 times, however, the field 
 does not come down to 
 as far as the styloid 
 process of the radius. 
 
 Same 
 
 Flexion a t eU 
 b o w ; movement 
 at shoulder, some- 
 times retraction, 
 sometimes eleva- 
 t i o n; adduction 
 and flexion o f 
 thumb; occasion- 
 ally simple adduc- 
 tion at shoulder. 
 
 Flexion at el- 
 bow; adduction 
 and flexion o f 
 thumb; flexion of 
 other digits; re- 
 traction of shoul- 
 der. 
 
 Ranges 
 from low- 
 er edge of 
 spine of 
 axis to 
 that of 
 fourth 
 cerv. ver- 
 tebra. 
 
 Ranges 
 from low- 
 er edge of 
 spine of 
 third to 
 that of 
 fifth cer- 
 vical ver- 
 tebra. 
 
 CVII. The outer (radial) side 
 
 of lowest third of upper 
 and of ichole of forearm, 
 and hand including all 
 the fingers except the 
 minimus and ulnar side 
 of ring finger. 
 
 Same 
 
 as 
 
 motor. 
 
 Triceps 
 
 tap. 
 
 Adduction and 
 flexion of thumb, 
 and flexion o f 
 other d i g -Rt s; 
 flexion at elbow; 
 retraction at 
 shoulder. Perios- 
 teal reflex of ra- 
 dius and ulna 
 (Starr, G o 1 d- 
 scheider.) 
 
 Ranges 
 b e t w een 
 top of 
 fourth and 
 bottom o f 
 sixth spi- 
 nous proc- 
 ess.
 
 SEGMENTATION AND LOCALIZATION 
 
 229 
 
 EFFERENT ROOT. 
 
 Striped Muscle. 
 
 Chief Movement 
 Efifected. 
 
 Blood- 
 vessels. 
 
 Glands of 
 Viscera. 
 
 Levator ang. soap., 
 Longus colli, Erector 
 spinse, Transversospinales, 
 Rhomboid, Subclavius, 
 Diaphragm, Serratus mag- 
 nus, Scalen. med., Deltoi- 
 deus, Teres minor. Sub- 
 scapularis, Supraspinatus, 
 Infraspinatus, Pectoralis 
 maj. (clavicular portion), 
 Biceps, Brachialis ant., 
 Coracobrach., Ext. carpi 
 rad. long., Supinator 
 longus, in Macacus. 
 
 Elevation, ab- 
 duction, and some 
 outward rotation 
 of 8 h u I d e r; 
 flexion at elbow, 
 wrist being slight- 
 ly s u p i n a t ed ; 
 slight radial ab- 
 duction at wrist; 
 slight lateral 
 flexion of n e c k, 
 with some retrac- 
 tion of head to- 
 ward side stimu- 
 lated. 
 
 Through 
 c o n n e c tion 
 with sympa- 
 t h e ti c sup- 
 plies vis cera 
 as shown in 
 chapter on 
 Innervation. 
 
 Through 
 c o n n e c tion 
 with sj'mpa- 
 t h e t i c sup- 
 plies V i s cera 
 as s h o w n in 
 chapter on 
 Innervation. 
 
 Longus colli, Erector 
 spinas, Transversospinales, 
 R h m boids. Diaphragm, 
 Subclavius, Serratus mag- 
 nus, Scaleni, Deltoid, 
 Teres minor. Teres major, 
 Subscapularis. Supraspi- 
 natus, Infraspinatus Pec- 
 toralis major (clavicular 
 head), Latissimus dorsi, 
 Biceps, Brachial-anticus, 
 Coracobrachialis, Triceps 
 (outer and long head), 
 Ext. carpi rad. long, et 
 brevior. Pronator teres. 
 Supinator long, et brevis.. 
 Flexor carpi radialis. 
 Flexor carpi ulnaris 
 (feeble), Extensor com- 
 munis digitorum, in Maca- 
 cus. 
 
 Moderate ad- 
 duction of shoul- 
 der ; at e I b 10 
 strong flexion ; 
 some supination 
 of w r i s t, slight 
 extension of wrist 
 in most indi- 
 viduals, but in 
 others flexion at 
 wrist; slight ex- 
 tension of d/igits 
 in most indi- 
 viduals ; slight 
 lateral flexion of 
 head to side stim- 
 ulated, id th slight 
 retraction of 
 head. 
 
 Longus colli, Erector 
 spinse, Transversospinales. 
 Scaleni, Serratus magnus. 
 Deltoid (from spine of 
 scapula). Teres maj.. In- 
 fraspinatus, P e c t rails 
 minor and maj. (sternal)., 
 Latissimus dorsi, Coraco- 
 brachialis, Triceps, Anco- 
 neus, Ext. carp. rad. long, 
 et brev., Pronat. teres, Ex- 
 tensor comm. dig., Ext. 
 carp, ulnaris, Ext. long, 
 poll., Ext. metac. pollicis, 
 Flex. carp, rad.. Flex, 
 carp, ulnar., Ext. min, 
 dig. (slight). Flex. prop, 
 digit.. Flex, sublim. digit, 
 (slight). Superficial short 
 thumb muscles. Extensor 
 indicis and Teres minor, 
 and Palmaris longus, in 
 Macacus. 
 
 Retraction and 
 strong adduction 
 at shoulder, with 
 some inward rota- 
 tion of arm; arm 
 is carried across 
 the body; exten- 
 sion at elbow; 
 slight flexion at 
 wrist, with some 
 pronation ; slight 
 flexion of fingers; 
 shoulder is drawn 
 down; slight re- 
 traction and lat- 
 eral flexion of 
 neck.
 
 230 
 
 SPINAL ADJUSTMENT 
 
 AFFERENT ROOT. 
 
 No. of 
 Nerve. 
 
 Skin. 
 
 Muscle. 
 
 Viscera. 
 
 Reflex Movement. 
 
 Level of 
 Surface 
 Origin. 
 
 C VIII. The radial side of the 
 
 lower two-thirds 0/ fore- 
 arm; the whole of the 
 hand and wrist, both 
 back and front, and a 
 small piece of the ulnar 
 side of the forearm just 
 above wrist. Destrtiction 
 of this root — Jar(je as it 
 is — produces no anesthe- 
 sia anywhere. 
 
 Same 
 
 Same 
 
 as 
 
 as 
 
 motor. 
 
 motor 
 
 Triceps 
 
 
 tap. 
 
 
 Adduction and Ranges 
 
 flexion of thumb ; bet ween 
 flexion of t h e r top of 
 digits; flexion or fifth and 
 often extension at top of sev- 
 wrist; dratcinp enth spin. 
 inwards and proc. 
 downward of 
 shoulder; retrac- 
 tion of upper 
 arm ; at e I b ic 
 sometimes exten- 
 s i n, sometimes 
 flexion. 
 
 D I. The ulnar side of the 
 
 hand, including three 
 fingers of that side; the 
 ulnar side of the fore- 
 arm, including the skin 
 over the olecranon. De- 
 struction of this root 
 causes a patch of anal- 
 gesia on ulnar side of 
 flexor aspect of forearm. 
 
 Same 
 
 as 
 
 motor. 
 
 Triceps 
 
 tap. 
 
 Move ment at 
 shoulder, s o m e- 
 times retraction; 
 contraction of tri- 
 c e p s in part; 
 flexion of digits 
 with adduction of 
 thumb; extension 
 at el b IV, some- 
 times flexion ; 
 some flexion and 
 pronation at 
 wrist. 
 
 Ranges 
 bet ween 
 above 
 sixtb and 
 below sev- 
 enth spin, 
 proc. 
 
 D IT. The inner and poste- 
 
 rior aspect of the upper 
 arm and the inner aspect 
 of the highest quarter of 
 t h e forearm, including 
 the inner condyle and 
 the bracMal wall of the 
 axillary space. 
 
 Same 
 
 as 
 motor. 
 
 Heart 
 (ven- 
 tricle) 
 and 
 lungs. 
 
 M o V e ment at 
 slioulder; slight 
 flexion of thumb 
 and digits; some- 
 times contraction 
 in triceps; some- 
 times dilatation 
 f homonymous 
 pupil. 
 
 Ranges 
 from low- 
 er edge of 
 sixth cerv. 
 spine to 
 that of 
 first dors. 
 
 D III. Zone passing from 
 
 sternum to back, sweep- 
 ing round close above 
 nipple and bounded by 
 axial lines of limb above. 
 Sirecps down axillary 
 aspect of upper arm half- 
 >ray to elbow. Over mid- 
 dle of scapula and over 
 third rib inside mamniil- 
 lary line (Head). 
 
 D IV. Zone of skin passing 
 
 round chest, including 
 axilla (lower part) and 
 nipple. Reaches axial 
 lines only near mid-dor- 
 sal and m i d-v enter. 
 Width of band is from 
 third intercost. space 
 down to sixth rib (Mer- 
 tens). 
 
 D V. Zone behind lies just 
 
 over angle of scapula; 
 its upper edge rises to 
 include nipple. Head 
 finds this the field to 
 which nipple really be- 
 longs in man. Width 
 extends from fourth rib 
 to top edge of seventh 
 IMertens). 
 
 Same 
 
 Heart 
 
 as 
 
 (ven- 
 
 motor. 
 
 tricle) 
 
 
 and 
 
 
 lungs. 
 
 Same 
 
 as 
 motor. 
 
 Heart 
 (ven- 
 tricle) 
 
 and 
 lungs. 
 
 Retraction o f 
 shoulders; c o n- 
 trac. of part of 
 triceps. 
 
 Retraction o f 
 shoulder; o c c a- 
 sionully contrac- 
 tion of triceps. 
 
 Ranges 
 from up- 
 per edge of 
 s e v enth 
 cerv. spine 
 t o lower 
 edge of 
 second 
 dorsal. 
 
 Ranges 
 from top 
 edge of 
 first dors, 
 spine to 
 that of 
 third. 
 
 Same 
 
 Heart 
 
 2Iuscles of back 
 
 Ranges 
 
 as 
 
 and 
 
 and side of chest; 
 
 from top 
 
 motor. 
 
 lungs. 
 
 the i n t e r costal 
 
 edge of 
 
 
 
 spaces involved 
 
 second to 
 
 
 
 are chiefly flfth 
 
 top of 
 
 
 
 and sixth; occa- 
 
 fourth 
 
 
 
 sional retrac. of 
 
 dorsal 
 
 
 
 shoulder. 
 
 spine.
 
 SEGMENTATION AND LOCALIZATION 
 
 231 
 
 EFFERENT ROOT. 
 
 Striped Muscle. 
 
 Chief Movement 
 Effected. 
 
 Blood- 
 vessels. 
 
 Clauds of 
 Viscera. 
 
 Ix)ngus colli, Erector 
 spinas, Transversospinales, 
 Serratus magnus, Scalcni, 
 Pectoralis minor and maj. 
 (sternal part), Latissim. 
 dorsi. Triceps, Anconeus, 
 Extensor carpi ulnaris. 
 Flexor carpi radialis, Flex, 
 carp, ulnar.. Extensor in- 
 dlcis, Exten. communis 
 digit., Ext. long, pollicis, 
 Ext. metac. pollicis, Ext. 
 min. digit., Palmaris long.. 
 Flex. long, pollicis. Flex, 
 prof, digit.. Flex, sublim. 
 digit., Superficial and deep 
 short muscles of thumb 
 and little finger, the three 
 most radial lumbricales 
 and palmar interossei and 
 all the dorsal interossei. 
 Pronator quadratus. 
 
 Erector spinse. Levator 
 costse, Transversospinales, 
 Serratus postic. sup., In- 
 tercost., Scaleni, Pector. 
 ma. et min.. Triceps, 
 Latiss. dorsi, Flex. carp, 
 ulnar.. Pronator quad- 
 ratus. Flexor long, poll., 
 Flex. prof, et sublim. digi- 
 tor., Palmaris long., Ext. 
 minimi digiti, Lumbricales 
 and interossei, Short mus- 
 cles of thumb and of little 
 finger. Extensor carpi ul- 
 naris in Macacus. 
 
 Erector spinfe, Levator 
 costse, Transversospinales, 
 Serratus postic. sup. Sca- 
 leni, Intercostales, Flej-or 
 long, pollic. Flex, sublim. 
 et prof, digit., deep short 
 muscles of thumb, short 
 muscles of little finfjer ; 
 Interossei a n d lumbri- 
 cales; in Macacus. 
 
 Erector spinae, Levator 
 costse, Transversospinales, 
 Intercostales, S e r r a tus 
 posticus superior, Trian- 
 gularis sterni. 
 
 Shoulder drawn 
 doivn; some ad- 
 duction of shoul- 
 der; rotation in- 
 \rard of arm; 
 flexion and prona- 
 tion at w r I *• / ; 
 flexion of fingers 
 and of thumb 
 with opposition. 
 
 Retraction o f 
 ■■ihoulder; slight 
 lateral flexion 
 and retraction of 
 neck; slight ex- 
 tension at elbow ; 
 flexion at uyrist 
 w i t h pronation; 
 slight abduction 
 of wrist at ulnar 
 s I d e; flexion of 
 fingers and thumb 
 ir i t h opposition 
 of latter. 
 
 Retraction o f 
 shoulder; slight 
 flexion of wrist ; 
 flexion of fingers 
 and thumb with 
 opposition of lat- 
 ter; lateral curv- 
 ing of the spinal 
 column. 
 
 T h r o u g li 
 c o n n e c tion 
 with sj'nipa- 
 t h e t i c sup- 
 plies V i s cera 
 as s h o w n in 
 chapter on 
 Innervation. 
 
 Slight to 
 vessels of head 
 on same side. 
 
 Bl 00 d-ves- 
 sels of face 
 and head on 
 same side 
 (tongue, ear, 
 gums, thyroid, 
 etc.); acceler- 
 ation of heart. 
 
 As for D II., 
 and vasomotor 
 to I u n g s. 
 ? V a s o m. to 
 hand. 
 
 T h r o u g li 
 e o n n e c tion 
 with sympa- 
 t h e 1 1 c sup- 
 plies vis cera 
 as s h o w n in 
 chapter on 
 Innervation. 
 
 Dilatation of 
 pupil with 
 widening o f 
 p a 1 p e b r a 1 
 opening. 
 
 Dilatation of 
 pupil : opening 
 p alp eb r al 
 fiss. ; secretion 
 o f submaxill. 
 gland. 
 
 Slight dilat. 
 of pupil; open- 
 ing of palp, 
 fiss.; secret, 
 from Whar- 
 ton's duct. 
 
 Same as D III. 
 
 As for D 
 III., but slight- 
 er effect, ex- 
 cept to lungs, 
 where strong- 
 er, vasomiitiir 
 to hand. 
 
 Slight open- 
 ing palp. ^«.v. .• 
 secret. Whar- 
 ton's duct; 
 sweat glands 
 of arm and 
 hand. 
 
 Erector Spinse, Levator 
 costse, Transversospinales, 
 Intercostales, Triangularis 
 sterni, Obliq. extern, abd., 
 Rect. abdom. 
 
 Slight to 
 vessels of 
 head and face; 
 to forearm 
 and hand 
 (strong), lung; 
 slight acceler- 
 ation of heart; 
 slight con- 
 s t r i ction of 
 portal vein. 
 
 S u b maxill. 
 s ecretion 
 (slight): sweat 
 glands of 
 h and; co n - 
 tract. of spleen.
 
 22>2 
 
 SPINAL ADJUSTAIENT 
 
 AFFERENT ROOT. 
 
 No. of 
 Nerve. 
 
 Skin 
 
 Muscle. 
 
 Viscera. 
 
 Reflex Movement. 
 
 Level of 
 Surface 
 Origin. 
 
 D VI. Lower border of 
 
 zone runs from 
 eighth dorsal spiiio 
 to end in front below 
 the attachment o i' 
 the xiphoid cart 
 (Head). 
 
 Same 
 
 Heart, lungs, 
 stomach (car- 
 diac end) , hile 
 duct and yall 
 bladder. 
 
 Muscles of back 
 and side of chest ; 
 the i n t e r costal 
 spaces incolved 
 are chiefly fifth 
 and sixth; occa- 
 sional retrac: of 
 shoulder. 
 
 Ranges from 
 lower edge of 
 second dors, 
 spine to upper 
 of fifth. 
 
 DVIL L o w e r border of Same 
 
 zone at ninth dors. as 
 
 spine passes to end motor, 
 at junction of upper 
 with middle third of 
 space between xiphoid 
 and umbilicus 
 (Head). 
 
 DVIII L w e r border of ^ame 
 zone at eleventh dors. ^^ 
 
 spine to end in front motor, 
 at junction of middle 
 with lowest third of 
 space between xiphoid 
 and umbilicus 
 (Head). 
 
 D IX. Lower border of Same 
 
 zone at twelfth dors. as 
 
 spine to end in front motor, 
 at the umbilicus 
 (Head). According to 
 Head the umbilicus 
 lies between ninth 
 and tenth dorsal 
 fields. 
 
 D X. Lower border of Same 
 
 zone at third lumbar as 
 spine to end in front motor, 
 midway down be- 
 tween umbilicus and 
 symphysis (Head). 
 
 D XI. Lower edge of zone Same 
 
 at fifth lumbar spine as 
 to end in front at motor, 
 junction of m i d d I e 
 and lower thirds of 
 space between sym- 
 physis and umbilicus 
 (Head). The groin 
 just above Pourpart's 
 lig. lies in this field. 
 
 D XII. Lower edge of zone Same 
 
 crosses below crista as 
 ilii and on the outer motor, 
 s i d e of thigh below 
 Pourpart's ligament ; 
 this border gives a 
 characteristic short 
 tongue-shaped flap on 
 front of thigh. The 
 first lumbar field of 
 Macacus corresponds 
 Kith Man's D XII. 
 
 Heart (auri- 
 cle), lungs, 
 stomach 
 (card, end), 
 liver, and gall 
 bladder. 
 
 Heart (auri- 
 cle), lungs, 
 stomach, liver, 
 and gall blad- 
 der. 
 
 Muscles of back 
 and side of chest; 
 some of the more 
 super ficial re- 
 spond more read- 
 ily than do those 
 of the intercost. 
 space. Those of 
 the seventh, 
 eighth, and sixth 
 spaces do re- 
 spond. 
 
 Stomach Epigastric re- 
 (pyloric), liv- flex (Dinkier), 
 er,' gall blad- 
 der and intes- 
 tine. 
 
 Ranges from 
 top of fourth 
 t o bottom o f 
 fifth dorsal 
 spine. 
 
 Ranges from 
 top of fifth to 
 top of sixth 
 spinous p. 
 
 Ranges from 
 midway be- 
 t w e e n fifth 
 and sixth dor- 
 sal spines 
 down to top of 
 seventh. 
 
 Liver, gall 
 bladder, intes- 
 tine, prostate, 
 testis, ovary, 
 kidney, and 
 top of ureter. 
 
 I n t e s tine, 
 kidney, ureter, 
 prostate, epi- 
 didymis, and 
 uterus (not 
 OS), ovarian 
 appendages. 
 
 Dilatation of Ranges from 
 
 renal vessel s lower edge of 
 
 c har a ct eristic sixth to upper 
 
 (Bradford). of eighth dors. 
 
 spine. 
 
 Muscles of 
 flank, a b d o men 
 a n d intercostal 
 space; renal dila- 
 tation character- 
 istic. With mod- 
 erate s t i m. no 
 movement of 
 limbs. 
 
 Ranges from 
 top of seventh 
 dors, spine to 
 top of eighth. 
 
 I n t e s tine. Muscles of Ranges be- 
 
 kidney, ureter, flank contract; tween top of 
 
 e p i d i dymis, retraction of ab- eighth dors, 
 
 uterus (not dominal wall loir spine and bot- 
 
 os), urinary doicn; flexion at torn of ninth, 
 
 bladder, ova- hip; renal dilata- 
 
 rian append- tion char acier- 
 
 ages. istie.
 
 SEGMENTATION AND LOCALIZATION 
 
 233 
 
 EFFERENT ROOT. 
 
 Striped Muscle. 
 
 Chief Movement 
 Effected. 
 
 Blood- 
 Vessels. 
 
 Glands of 
 Viscera. 
 
 Same as D V. 
 
 Erector spina;, Leva- 
 tor costse, Transverso- 
 spinal, Subcostalis, In- 
 tercostales, Obliq. ext. 
 abd. et int. abd.. Rectus 
 abd. and Transvers. 
 abd. 
 
 Same as D VII. 
 
 Retraction o f 
 shoulder; slight 
 flexion of wrist; 
 flexion of fingers 
 and thumb icilli 
 opposition of lat- 
 ter; lateral curv- 
 ing of the spinal 
 column. 
 
 Constriction 
 in forearm and 
 h an d, lung, 
 liver, portal 
 system, pan- 
 creas and in- 
 t e s t i n e ; 
 slightly in 
 kidney. 
 
 Of I u n (I 
 slip htly, of 
 hand, portal 
 system, liver, 
 pancreas and 
 intestine 
 strongly, of 
 kidney dis- 
 tinctly. 
 
 Of forearm 
 and hand, por- 
 tal system, 
 kidney, liver, 
 pancreas and 
 intestine. 
 
 Secretion in 
 sweat glands 
 of hand; con- 
 traction of 
 spleen. 
 
 Sweating of 
 hand; mo-re- 
 nt ent of spleen 
 and intestine. 
 
 Sweating of 
 hand; move- 
 ments in 
 spleen and in- 
 testine. 
 
 Erect, spin., Lev. cost., 
 Transv. spin., Subcos- 
 tales, Intercost., Obllq. 
 ext. et int. abd., Trans- 
 versus abd., Rect. abd., 
 Serrat. post. inf. 
 
 Of forearm 
 and hand 
 (slip h t), of 
 portal venous 
 system, liver, 
 pancreas, in- 
 testine, and 
 kidneys. 
 
 Sweating of 
 hand; mo ve- 
 nt e n t s i n 
 spleen and in- 
 testine. 
 
 Same as D IX. 
 
 Of kidney, 
 liver, pancreas 
 and intestine. 
 
 Movements 
 in spleen and 
 intestine. 
 
 Same as D IX. 
 
 Of liver, 
 pancreas and 
 intestine ; 
 constriction in 
 leg and foot 
 (slight). 
 
 Movements 
 in intestine; 
 siren ting of 
 foot (slight). 
 
 Erect, spin., Lev. cost., 
 Transv. spin., Subcos- 
 talis, Intercostales, Ob- 
 liq. ext. et Int. abd., 
 Transvers. abd., Rect. 
 abd., Pyramidalis 
 (Quadratus lumborum). 
 
 Retraction o f 
 abdominal wall; 
 no movement of 
 limb. 
 
 Of liver, 
 pancreas. 
 imtesPine, leg 
 and foot. 
 
 Movement 
 of intestine: 
 streat glands 
 of foot.
 
 234 
 
 SPINAL ADJUSTMENT 
 
 AFFERENT ROOT. 
 
 No. of 
 Nerve. 
 
 Skin. 
 
 Muscle. 
 
 Viscera. 
 
 Reflex Movement. 
 
 Level of 
 Surface 
 Origin. 
 
 LI. S e c n d lumh. of Same 
 
 M acacus (=Man's as 
 L I.). motor. 
 
 Lower edge of zone 
 sweeps from sacrum 
 across huttock ahoiit 
 midway h et w ee n 
 gluteal fold a n d 
 crista ilii, comes 
 more than one-third 
 down front of thigh 
 and recurves to sym- 
 physis. 
 
 ^ ^^" L III. of Macacus Same 
 
 (=L II. of Man). ^s 
 
 Lower edge sweeps motor. 
 from dorsal aa-ial line 
 of limb over outer 
 side of thigh a n d 
 passes across close 
 above or on patella 
 to return along the 
 adductors and ven- 
 tral axial line to 
 symphysis. 
 
 L 111- L IV. Macacus (^ Knee- 
 
 L III. Man). Jerk. 
 
 From the d r s a 1 Name 
 axi a I line of limb as 
 sweeps over ilium motor. 
 down extensor face 
 of thigh, over knee 
 and inner face of 
 highest half of leg to 
 the ventral axial line 
 of the limb at the in- 
 ner edge of thigh, i. 
 e., skin coverin g 
 gracilis and inner 
 line of attachment of 
 calf muscles. 
 
 L IV. L V. Macacus (=L Knee- 
 
 IV. Man). jerk. 
 
 Field a rough isos- Same 
 celes triangle to it h as 
 apex at hallux, and motor. 
 base on front of and 
 halfway up thig h, 
 exhibiting a deep 
 downioard notchinit. 
 
 Bladder, Ret raction of Ranges be- 
 
 iM-ostate, epi- abd. wall; slight tween top of 
 
 didymis, and flexion at hip, re- ninth dors. 
 
 uterus. traction of testL-i ; spine and bot- 
 
 cremasteric reflex, tom of tenth. 
 
 None known. 
 
 None known. 
 
 None known. 
 
 Curving of Ranges be- 
 
 body toicard side tween ninth 
 stimulated; flex- and eleventh 
 ion at hip, rarely dors, spines. 
 at knee; retrac- 
 tion of test i s; 
 c r e m asteric re- 
 flex. 
 
 Curving of Ranges be- 
 
 body toicard side tween t o p of 
 stimulated; flex- tenth and bot- 
 ion at hip, and at t o m o f elev- 
 knee; flexion of enth dors. 
 h a I lux occasion- spine. 
 ally ; adduction 
 at hip; rarely 
 slight dorso- flex- 
 ion at ankle. 
 
 Flexion at hip, 
 at knee, and of 
 toes, often slight 
 dorso-flexion a t 
 ankle; adduction 
 at hip often as a 
 crossed effect; 
 glutcel reflex. 
 
 Ranges be- 
 tween bottom 
 of tenth and 
 top of twelfth 
 dors, spine. 
 
 ^ V. Field i ncl u d e s 
 
 whole of f o o t a n d 
 ankle, but ivhile bare- 
 ly comprising the in- 
 tern, malleolus, 
 sweeps up the pero- 
 neal side of the leg to 
 reach the outer ham- 
 string at the knee. 
 Area resembles a sock 
 tvith oblique upper 
 edge. 
 
 Flexion at 
 
 Same Prostate, knee; flex, of hip Ranges be- 
 
 as yith some inter- tween t o p of 
 
 motor. nal rotation; flex- eleventh dors. 
 
 ion of hallux and spine and top 
 other digits; of twelfth. 
 dors o-flex. o f 
 ankle with tilting 
 outward of foot; 
 crossed adduction 
 of thigh; glutwal 
 reflex; plantar re- 
 flex.
 
 SEGMENTATION AND LOCALIZATION 
 
 235 
 
 EFFERENT ROOT. 
 
 Striped Muscle. 
 
 Chief Movement 
 Effected. 
 
 Blood- 
 vessels. 
 
 Glands of 
 Viscera. 
 
 Erect, spin., Lev. cost., 
 Transv. spin., Quadra- 
 tus lumboruiu, Obliq. 
 abd. internus, Transv. 
 a b d o m., Pyramidalis, 
 Cremaster (Psoas maj., 
 Psoas min.). 
 
 Retraction of 
 nhdominat wall; 
 sUiiht flexion at 
 hip. 
 
 Liier, pan- 
 creas, intes- 
 tine, leg, and 
 loot. 
 
 Movement 
 of intestine 
 and hladder ; 
 intern, sphinc. 
 ani contracts ; 
 stceat {/lands 
 of f o t; vas 
 deferns and 
 ves s e min ; 
 uterus. 
 
 Erector spin., Lev. 
 cost., Transv. spin., 
 Quad, lumb.. Psoas ma. 
 et mi., Iliacus, Pecti- 
 neus. Gracilis. Sartorius 
 (upper part only). Add. 
 long, et brev., Cremas- 
 ter. Data largely ex- 
 perimental. 
 
 Erector spin.. Multi- 
 fid, spin.. Psoas ma. et 
 mi., Iliacus, Pectineus, 
 Obturator e x t., A d d. 
 magnus, brevis, longus, 
 Sartorius (esp. lower 
 part). Vastus media- 
 ns. Rectus f e m o r i s. 
 Vast, lateralis. Crureus, 
 Gracilis. Data largely 
 experimental. 
 
 Retraction o f 
 lower part of ah- 
 dom. wall and 
 testis; flexioti at 
 hip. 
 
 Of leg and 
 foot. 
 
 Retraction a f 
 part of ahdom. 
 irnll ; flexion and 
 adduction at hip; 
 extension at 
 knee. 
 
 None. 
 
 Movement 
 of hladder and 
 intestine; int. 
 sphinc. ani 
 c n t r acts ; 
 stceat glands 
 of foot; 
 uterus; con- 
 tract, of round 
 ligament; vas 
 d e f er ens ; 
 vesic. semi- 
 nalis. 
 
 None. 
 
 Erector spin.. Multi- 
 fid, spin.. Rectus fcm.. 
 Vastus med. et lat., 
 Crureus, Gracilis, Ob- 
 turat. ext., A d d u c t, 
 magn. et brevis. Quad, 
 femoris. Tensor fascife 
 femoris. Tibialis anti- 
 cus, Ext. long, digito- 
 rum, Ext. proprius hal- 
 lucis. Semimembranosus 
 (slight), Glutaeus med. 
 et min. Data largely 
 experimental. 
 
 Erector spin.. Multi- 
 fid, spin.. Tibial, ant., 
 Ext. long, dig., Ext. 
 hall., Glutaeus max. 
 med. et min., Peroneus 
 long., Exten. brev. dig., 
 Gast. (outer head more 
 than medial). Tibialis 
 post.. Flex. long, digi- 
 tor.. Flex. long, hallu- 
 cis. Semimembranosus, 
 Adduct. magnus (con- 
 
 Adduction at 
 hip ; extension at 
 knee; some dor- 
 so-flexion at an- 
 kle, and some 
 extension of hal- 
 lux. 
 
 Extension a t 
 h i p ; adduction 
 of thigh; weak 
 flexion at knee; 
 dorso-flexion a t 
 ankles ; extension 
 of toes; adduc- 
 tion of hallux. 
 
 None. 
 
 None. 
 
 None. 
 
 None.
 
 236 
 
 SPINAL ADJUSTMENT 
 
 AFFERENT ROOT. 
 
 No. of 
 Nerve. 
 
 Skin. 
 
 Muscle. 
 
 Viscera. 
 
 Reflex Movement. 
 
 Level of 
 Surface 
 Origin. 
 
 SI. A long field includ- Foot 
 
 ing the four outer clonus. 
 digits, the outer two- (Zic- 
 thirds of the sole, hen). 
 the posterior aspect 
 of the ankle, the calf 
 and the lower three- 
 fourths of the back 
 of the thigh. 
 
 Prostate. Flexion at Ranges be- 
 
 l:nee; flexion at tween lower 
 
 hallux and digits ; border of 
 
 dors o-flexion of eleventh dors. 
 
 ankle; very rare- spine and top 
 
 ly plantar flexion ; of first lumb. 
 plantar reflex. 
 
 S II. Back of tliigh from 
 
 behind the knee 
 (sometimes upper 
 part of calf) up to 
 the ischial tuberosity 
 and fold of the but- 
 tock. 
 
 Foot P r o s t ate, Flexion of Usually be- 
 
 clonus. bladder, r e c- digits; slight tween twelfth 
 
 Same turn, os uteri, flexion of knee; dors, and first 
 
 as pr otru sion of lumbar spines, 
 
 motor. anus. 
 
 S III. Patch covering peri- Same 
 
 7ieum a 71 d buttock as 
 
 and sweeping for- motor. 
 ward over under sur- 
 face of scrotum and 
 penis. 
 
 S IV. Triangular patch. Same 
 
 ivith apex laterally, as 
 
 lying on sacrum. motor. 
 
 Frost ate, 
 bladder, r e c- 
 tum, OS uteri. 
 
 P r s t ate, 
 bladder, r e c- 
 tum, OS uteri. 
 
 Protrusion o f 
 anus; flexion of 
 hallux; anal re- 
 flex. 
 
 Protrusion o f 
 anus; anal reflex.
 
 SEGMENTATION AND LOCALIZATION 
 
 237 
 
 EFFERENT ROOT. 
 
 Striped Muscle. 
 
 Chief Movement 
 Eflfected. 
 
 Blood- 
 vessels. 
 
 Glands of 
 Viscera. 
 
 dylar portion), Semi- 
 tendinosus. Biceps (cap. 
 long) ; Quadratus femo- 
 rls, Gemell. sup. et inf., 
 Plantaris, Popliteus, Ab- 
 ductor hallucis, Flex, 
 brev. dlgitorum, Obtur. 
 int. (Pyriformis, Ab- 
 ductor min. digiti, and 
 Soleus, all very slightly 
 innervated). Data larye- 
 ly experimental. 
 
 Multifld. spin., Glutfci 
 max. med. et min., Py- 
 riformis (esp. lateral 
 part). Biceps (caput 
 breve and longe). Semi- 
 membranosus, Semiten- 
 dinosus. Gemellus supe- 
 rior, Peroneus brevis, 
 Peroneus longus (slight- 
 ly), Extens, longus digi- 
 torum, Extens. brevis 
 dlgitorum, Ext. b r o v. 
 hallucis. Gastrocnemius, 
 Popliteus, Plantaris, 
 Flex. long, digit.. Flex, 
 long, hallucis, Soleus, 
 Tibialis posticus, Flexor 
 brevis digit., Abduct., 
 hallucis. Abduct, min. 
 digit.. Flex, accessorius, 
 Flex. brev. hall., Flex, 
 brev. min. digit.. Ad- 
 duct, hallucis (Quad- 
 rat, fem. slightly), Ext. 
 sphincter ani. Sphinc- 
 ter vaginae, Lumbricales 
 and interossei. Obtura- 
 tor internus. Data large- 
 ly experimental. 
 
 Multifldus spin., Glu- 
 taeus max.. Biceps (both 
 heads), Semitendinosus, 
 Semimembranosus, Gas- 
 trocnemius, Soleus, Ab- 
 ductor hallucis. Flex, 
 brev. digit.. Flex, acces- 
 sor.. Abductor minim, 
 digiti. Adductor hallu- 
 cis. Obturator internus, 
 Pyriformis (small me- 
 dial part). Flex. brev. 
 hallucis. Flex. brev. 
 min. digit., Lumbricales 
 and Interossei, Ext. 
 sphincter ani, and 
 Sphincter vaginae. Data 
 largely experimental. 
 
 Multifldus splnae, etc., 
 Levator ani. Sphincter 
 ani (in some individ- 
 uals), Perineal muscles. 
 
 Levator ani, Perineal 
 muscles. 
 
 Flexion at 
 Ic n e e; extension 
 usually (i.e. plan- 
 tar flexion) a t 
 ankle J inversion 
 of sole; strong 
 flexion; adduc- 
 tion of hallux; 
 moi^ement of 
 anus. 
 
 Flexion at knee; 
 extension at 
 ankle; flexion of 
 toes; movement 
 of anus. 
 
 Perineal. 
 
 Perineal. 
 
 None known 
 accurately. 
 
 Dilator t o 
 genitalia and 
 lower rectal 
 muc. memh. 
 
 Dilator 1 
 genitalia and 
 lower rectal 
 muc. memh. 
 
 Pro trusion 
 and erection 
 of penis; 
 slight cont. of 
 bladder. 
 
 Contraction 
 of bladder; 
 protrusion and 
 erection of 
 penis with 
 turgor ; de- 
 scending colon 
 and rectum ; 
 int. sphinct. 
 and relaxes. 
 
 Contraction 
 of bladder; 
 turgor of 
 p e n i s ; de- 
 scending colon 
 a n d rectum ; 
 int. sphinct, 
 ani rela.res.
 
 238 SPINAL ADJUSTMENT 
 
 The following table shows the relation of the vertebral 
 spinous process to the segments of the spine. 
 
 Cervical Segments Spinous Processes 
 
 1st 1 
 
 - , V Posterior tubercle of atlas. 
 
 Znd J 
 
 I Spinous process of axis. 
 4th J ^ ^ 
 
 5th Spinous process of 3rd cervical. 
 
 6th Spinous process of 4th cervical. 
 
 Q , ^Spinous process of 5th cervical. 
 
 Thoracic Segments 
 
 ^ , I Spinous process of 6th cervical; 
 
 2nd J 
 
 3rd Spinous process of 7th cervical. 
 
 4th Spinous process of 1st thoracic. 
 
 5th Spinous process of 2nd thoracic. 
 
 6th Spinous process of 3rd thoracic. 
 
 7th Spinous process of 4th thoracic. 
 
 8th Spinous process of 5th thoracic. 
 
 9th Spinous process of 5th thoracic. 
 
 10th Spinous process of 6th thoracic. 
 
 11th Spinous process of 7th thoracic. 
 
 12th Spinous process of 8th thoracic. 
 
 Lumbar Segments 
 
 1st Spinous process of 9th thoracic. 
 
 - , ^ Spinous process of 10th thoracic. 
 
 3rd J 
 
 4th 
 
 5th 
 
 Sacral Segments 
 
 1st 
 
 2nd 
 
 3rd 
 
 4th 
 
 5th 
 
 Coccygeal Segment 
 
 1 Spinous process of 1st lumbar. 
 
 y Spinous process of 11th thoracic. 
 
 ^-Spinous process of 12th thoracic.
 
 CHAPTER II 
 
 Spinal Symptomatology 
 
 Having considered the normal spinal column, vve will 
 now direct our attention to a study of those changes which 
 occur in the spine and its ligaments, the anatomical structures 
 connected with it, and various subjective symptoms resulting 
 from subluxations of the vertebrae. These various signs and 
 symptoms referable to the spine and the parts governed by 
 the nerves of the different segments of the spine point to 
 vertebral subluxations in various segments, and are of great 
 assistance in making a correct spinal analysis. 
 
 As stated in a previous section of this work, proper atten- 
 tion has been given by the medical profession to symptoms 
 indicating gross spinal deformities, such as Pott's disease, 
 scoliosis from occupation, habits, or injury, and lordosis, but 
 those symptoms referring to the possible existence of dis- 
 placements involving a single vertebra instead of a group, 
 have been left uninvestigated. In many cases these symptoms 
 point so clearly to the evident existence of an interference 
 with the nerve-supply of a part that it is surprising that the 
 seat of this interference should for so long a time have re- 
 mained unsought for and unfound. 
 
 To practitioners of spinal adjustment a general knowledge 
 of the symptoms pointing to a vertebral subluxation are very 
 important ; first, they give an accurate knowledge of the ex- 
 istence of a lesion and its location ; second, without such a 
 knowledge proper correction of the diseases produced by the 
 lesion through adjustment of the lesion is impossible. 
 
 The symptoms and signs which indicate the existence of a 
 vertebral subluxation are the following : 
 
 1. Mal-alignment of the vertebrae. 
 
 2. Contraction of the spinal muscles and ligaments. 
 
 3. Diminished mobility of the back. 
 
 4. Pain. 
 
 239
 
 240 SPINAL ADJUSTMENT 
 
 5. Tenderness. 
 
 6. Symptoms referable to certain organs, systems, or 
 parts of the body, 
 
 7. Local zone of increased temperature. 
 
 8. Thickening of the nerve trunks. 
 
 9. Changes in anatomical structures connected with the 
 spine. 
 
 Mal-alignment of the Vertebrae as a Sign of Vertebral Sub- 
 luxations. — By mal-alignment of vertebrae is meant especially 
 that of the spinous processes, as found by examination. 
 Normally the spinous processes should be either seen or felt 
 to be in perfect alignment, with no deviation upward, down- 
 ward, anteriorly, posteriorly, or to either side. When the end 
 of a certain spinous process is found to be out of line with 
 the one above and below it, it usually indicates the presence 
 of a corresponding deviation from its normal position of the 
 vertebra of which it is a part. This is, however, not invariably 
 true, since the spinous process may project from the vertebra 
 of which it is a part at different angles from the normal. For 
 this reason it becomes necessary, for purposes of verifying 
 the findings and conclusions from inspection and palpation 
 of the spinous processes to carefully palpate the transverse 
 processes. If, for example, a certain spinous process pro- 
 jects backward beyond the one above and below it, it may 
 indicate that the entire vertebra is displaced posteriorly; but 
 it may also be merely an abnormally long spinous process re- 
 sulting from over-development, as is frequently seen in oste- 
 ological collections. If, however, it is found that the trans- 
 verse processes are also displaced backward beyond those of 
 the vertebra above and below, it may then be concluded that 
 the vertebra in question is really displaced posteriorly. 
 
 To determine mal-alignment of vertebrae palpation of both 
 the spinous and transverse processes is absolutely essential 
 in every instance. The subject of the detection of mal-align- 
 ment of vertebrae will be considered at full length in the 
 chapter on spinal examinations. This is the foremost symp- 
 tom of vertebral subluxations, and the one which will receive 
 the greatest attention. The finding of mal-alignment of a cer- 
 tain vertebra makes it conclusive that a subluxation exists in
 
 SPINAL SYMPTOMATOLOGY 241 
 
 that segment of the spine, without any further examination 
 being necessary, and all other symptoms and signs are of 
 subsidiary importance. They are, however, of sufficient im- 
 portance to demand a careful study, since they very often 
 give the first evidence that a subluxation is present, when 
 mal-alignment is not evident on inspection, and the spine has 
 not been palpated. 
 
 Contraction of the Spinal Muscles and Ligaments. — At 
 those points where a subhixation exists there will always be 
 found a contracted condition of the corresponding ligaments 
 and muscles. This condition is sometimes so marked that it 
 can be seen on inspection of the spine, but is usually very 
 readily determined by palpation. When the first three fingers 
 of each hand are passed down the spine, along the sides of the 
 spinous processes, there will be noticed at certain points a 
 thickening of the muscles and ligaments. This contraction, 
 as shown in the chapter on reflex subluxations, is more evi- 
 dent on one side of the involved segment, for the reason that 
 the nerve-impulses which caused the tetanic contraction of the 
 muscles were stronger on one side, namely that on which the 
 efiferent impulse following irritation of the nerve-endings at 
 the periphery entered the spinal cord. 
 
 It can be considered as certain that where such contrac- 
 tures are found there will be a misplacement of the corre- 
 sponding vertebra, since the constant contraction of the liga- 
 ments on one side destroys the balance that should exist on 
 both sides, and the vertebra will be drawn toward the side 
 which is contracted. 
 
 These contractures are present in both acute and chronic 
 subluxations, but the hard and indurated condition of the 
 muscles and ligaments in the latter case serves to distinguish 
 it from the former. 
 
 The contracted condition of the muscles may not only be 
 the cause of a reflex subluxation, but is also present in those 
 displacements produced by other causes, as enumerated in 
 the chapter dealing with, the production of vertebral mal- 
 alignment. Muscular rigidity is the earliest sign in nearly 
 every abnormal condition in any part of the body, and it is 
 the observance of such rigidity which first calls attention to 
 the presence of an abnormal condition. All abnormal condi-
 
 242 SPINAL ADJUSTMENT 
 
 tions produce an excessive irritation at the periphery, result- 
 ing in increased reaction of the motor nerves which produces 
 the muscular rigidity. Thus muscular rigidity is one of the 
 earliest signs of Pott's disease, and persists until the condi- 
 tion is cured. It is most pronounced in the immediate region 
 of the affected portion of the spine, although it also extends to 
 some distance in either direction along the back. The muscu- 
 lar rigidity accompanying disease in any joint is a common 
 observance, and illustrates this point. 
 
 If, therefore, muscular rigidity is a constant concomitant 
 of all joint lesions, it follows that it must also occur when in- 
 dividual vertebrae are affected. Further, if its presence in 
 any region of the body points undeniably to an abnormal 
 condition of that part of the body, its detection in certain 
 segments of the vertebral column also indicates an abnormality 
 there. Whenever there is noted the presence of muscular 
 rigidity about any joint in the body, it is at once concluded by 
 the observer that a lesion of that joint is present. It follows 
 therefore, that when muscular rigidity of the muscles and 
 ligaments about a certain segment of the spine is noted that 
 a lesion of the corresponding vertebral articulation must be 
 present. 
 
 Diminished Mobility of the Back. — This is a very im- 
 portant sign of vertebral subluxations, and is of itself suf- 
 ficient evidence that a misplacement must exist. Diminished 
 mobility of any portion of the body is evidence of the existence 
 of some disease process in that region. Thus upon the slight- 
 est involvement of one of the joints of the extremities, there 
 follow muscular rigidity and pain, both of which factors oper- 
 ate in the production of diminished mobility of the part in- 
 volved. 
 
 If, therefore, diminished mobility is an indication of 
 disease in other parts of the body, it must be considered in the 
 same light when it is present in a certain segment of the 
 spine. When, for example, the nodding of the head cannot 
 be executed freely and painlessly, it indicates an implication 
 of the occipito-atlantal articulation. If the face cannot be 
 turned easily from one side to the other, an abnormality of 
 the atlanto-axial articulation is present. If flexion of the 
 head cannot be performed freely and painlessly, it shows that
 
 SPINAL SYMPTOMATOLOGY 243 
 
 there is present a subluxation in the lower cervical region. To 
 determine the degree of motility of the dorsal region of the 
 spine the subject should be instructed to bend forward, with 
 the knees held stiff, until the trunk is horizontal, with the 
 hands hanging down. The operator then views the spine with 
 his head on a level therewith, and notes whether either side of 
 the trunk is more prominent, either generally or locally in 
 certain segments of the column. The patient is next instructed 
 to bend backward as far as possible, and any local contractures 
 indicating diminished movement in that part of the spinal 
 column are carefully noted. Lastly, the subject is instructed 
 to bend toward either side and any local or general lack of 
 motility is looked for. 
 
 If, when the patient is bending forward, there is restricted 
 movement or lack of flexibility, it is an indication that there 
 is a settled condition of the vertebral column or that the 
 muscles and ligaments thereof are contracted. If, instead of 
 bending straight forward, the spine curves toward either side, 
 when the patient bends forward, it indicates a contracted con- 
 dition of the ligaments and muscles on one side. 
 
 Lack of mobility of any portion of the spinal column indi- 
 cates contraction of the ligaments and muscles of the corre- 
 sponding spinal segment. This will of necessity produce a 
 deviation of the vertebra toward the contracted side and re- 
 sult in pressure upon the structures by the displaced margins 
 of the intervertebral foramen through which they pass. 
 
 Pain. — This sympton is always a very important sign of 
 a positive lesion in some part of the body. Usually pain exists 
 at the location of the lesion which produces it. Frequently, 
 however, there is no pain at the seat of the lesion but the sen- 
 sation is referred to distant points. Ordinarily when a sub- 
 luxation of sufficient severity to cause marked pressure to be 
 brought to bear upon a nerve is present, there will be pain felt 
 at the point impinged. More often, however, the patient has 
 no subjective sensation of pain, but tenderness may be elicited 
 by pressure over the afifected area. 
 
 This has long been a mooted question. The question con- 
 stantly arises: Why, if a nerve is pressed upon, is there no 
 pain at the point of pressure? This is so for the reason that in 
 most instances pain is not perceived by the subject at its seat
 
 244 SPINAL ADJUSTMENT 
 
 of production, but is referred to the peripheral distribution 
 of the nerve. Thus when pressure upon a nerve occurs at the 
 point of its emergence from the intervertebral foramen no pain 
 may occur at that point but is perceived at the peripheral 
 distribution of the nerve. 
 
 The perception of pain at the knee in cases of hip disease 
 is the most common example of referred pain. Very often in 
 such cases the patient does not experience the slightest pain 
 at the seat of the lesion in the hip, and disease of that joint is, 
 therefore, frequently overlooked. It is for this very reason 
 that no pain being present at the seat of a subluxation its 
 occurrence is not thought of. Whenever, therefore, pain is 
 complained of by a patient in a certain region of the body, the 
 operator should alw^ays look carefully for a subluxation in 
 that spinal segment from which the nerves w^hich supply such 
 a painful area are derived ; in most instances a subluxation 
 will be found there. 
 
 For example, a patient may complain of pain in the eye- 
 ball ; we know that the upper cervical and also the upper dorsal 
 segments communicate wath nerves to the eye, and by careful 
 palpation of the vertebrae in these regions of the spine a sub- 
 luxation will generally be found. 
 
 Pain thus becomes a very important assistant in the making 
 of a correct spinal analysis, not alone when situated at the 
 point of the producing lesion, namely the impingement, but 
 also when referred to a point at some distance from this. 
 
 Tenderness. — This symptom is a very positive indication 
 of the existence of a subluxation in the area in wdiich it is 
 elicited by pressure upon the nerve. Its importance as a 
 symptom of a subluxation is that immediately after correction 
 of the displacement of the vertebra the tenderness disappears. 
 Pain and tenderness must not be considered synonymous, 
 since, although tenderness on pressure is usually manifested 
 over the seat of pain, this is not always true, as either pain or 
 tenderness may exist separately. Pain is a subjective symptom 
 felt more or less constantly, while tenderness is perceived by 
 the patient only when pressure is made on the aiifected part. 
 
 Symptoms Referable to Certain Systems, Organs, or Parts 
 of the Body. — As has been previously stated, perfect function 
 of all parts of the body is dependent principally upon proper
 
 SPINAL SYMPTOMA rOLOGY 245 
 
 innervation. When, therefore, the nerve-supply to any part is 
 interfered with by inabiHty of the nerves to conduct impulses 
 to it, improper function, with its attendant symptoms will 
 ensue. By a knowledge of the innervation of every part of the 
 body symptoms referable to that part may very readily be 
 referred to the spinal segment which controls it, and in most 
 instances a subluxation will be found at that point. 
 
 Thus, if a patient complains of symptoms referable to a 
 gastric disturbance, careful palpation of the fifth, sixth, and 
 seventh thoracic vertebrae will invariably demonstrate the 
 existence of a misplacement of one of these vertebrae. If 
 together with this some of the other previously enumerated 
 signs of vertebral subluxation are found to be present, it can- 
 rrot be denied that a misplacement is present, and that it has 
 a marked bearing on the disease. 
 
 In the section on Practice the symptoms of disturbances 
 of the various organs are given, and by referring these to the 
 proper organ, and then recalling its innervation, and finding 
 the vertebrae subluxated which result in impingement of 
 these nerves, we see what an important sign of sublu:jcations 
 such symptoms are. 
 
 If disturbed function is present, we know that it is due to 
 disturbed innervation of the involved part; we know further 
 that the only logical place where interference with the con- 
 duction of nerve-impulses could occur is at the point where 
 it passes between movable bones, namely through the inter- 
 vertebral foramina. Vertebral subluxations must therefore be 
 considered the primary factor in the production of disturbed 
 function, not discountenancing the secondary or contributing 
 factors. 
 
 The wide range of disorders which may be produced can 
 readily be appreciated by recalling the efTt'erent functions of 
 nerves, namely, trophic, motor, secretory, and inhibitory or 
 augmentory. 
 
 The first of these functions of the nerves is their influence 
 on nutrition. This in its broadest sense includes digestion, 
 respiration, absorption, and metabolism. The great number 
 of disorders which result from improper digestion, respiration, 
 absorption and metabolism thus all depend for their produc- 
 tion largely upon vertebral mal-alignment.
 
 246 SPINAL ADJUSTMENT 
 
 The second of the functions of the nerves, namely their 
 influence on motion, is exceedingly important, for upon their 
 motor impulses depend the proper functioning of nearly all 
 parts of the body — the contraction of the heart, the move- 
 ments of respiration, the movements of the stomach and in- 
 testines, the secretions of the glands, and so on. A little 
 thought will at once bring to mind many diseases known to 
 result from disturbance of these functional activities, and it 
 is unnecessary to enumerate them here. 
 
 The third function of the nerves, namely secretory, is also 
 important, since a great number of diseases can be traced to 
 disordered secretion. This is apparent when it is recalled 
 how many parts of the body are engaged in this function : 
 Namely, all serous and synovial membranes, the mucous mem- 
 branes with their special glands, as the buccal, gastric and 
 intestinal glands, the salivary glands, the pancreas, mammary 
 glands, liver, lachrymal glands, the skin, the kidneys, the 
 testes, the ovaries, the thyroid gland, the adrenals, the 
 pituitary body, and the spleen. 
 
 As examples of the last of the functions of nerves, namely 
 their influence on existing action, may be cited the inhibitory 
 action of the vagus nerve upon the heart. 
 
 All these functions of the nerves merge more or less 
 closely into each other, and a vertebral subluxation which 
 affects the power of conduction of a certain nerve will, there- 
 fore, afifect all the functions of the parts which that nerve 
 controls. Disturbances of functions in various parts of the 
 body as shown by the symptoms produced thus are an im- 
 portant sign of mal-alignment of vertebrae. They point to 
 the necessity for the occurrence of a subluxation, and also to 
 its location. Anyone who cares to do so, may demonstrate 
 this for himself, on any clinical case. 
 
 Local Zone of Increased Temperature.— By recalling the 
 functions of nerves we find that they control the temperature 
 of all portions of the body. The temperature of the skin 
 varies from hour to hour according to the activity of the 
 cutaneous circulation. The vasomotor nerves of the sym- 
 pathetic system control the circulation, and when their func- 
 tion is in abeyance, vasodilation with increased surface tem- 
 perature results. Thus when a spinal nerve is compressed by
 
 SPINAL SYMPTOMATOLOGY 247 
 
 the margins of the intervertebral foramen of a siil)kixated 
 vertebra, the skin of the corresponding segment of the back 
 is found to be warmer. Conversely, whenever a certain seg- 
 ment of the back is found to be warmer than the adjacent 
 segments, a subluxation will always be found at that point. 
 
 Thickening of the Nerve Trunks.- — In palpating the ver- 
 tebral column along the laminae the nerves will sometimes 
 be felt to be thickened. This is due to a thickened condition 
 of the sheath of the nerve, as a result of congestion of the 
 spinal segment from which the nerve emanates. 
 
 At all points where this thickened condition of the nerves 
 is found a subluxation will always be located, and this then 
 becomes another important sign of vertebral mal-alignment. 
 
 Changes in the Anatomical Structures Connected with the 
 Spine. — Subluxations of the vertebrae may be determined by 
 comparing the height and prominence of the scapulae, the 
 prominence of the angles of the ribs, and the prominence of 
 the iliac crests. If any variation on the two sides of the body 
 is noted, it indicates that a subluxation is present, and is an 
 important symptom, and valuable aid in spinal analysis. The 
 various methods for eliciting these various differences from 
 the normal will be discussed in detail in the chapter dealing 
 with the examination of the vertebral column.
 
 CHAPTER III 
 
 Spinal Diagnosis 
 
 Spinal diagnosis is the determination of disease in a cer- 
 tain system, organ, or part of the body by the detection of a 
 vertebral subluxation which interferes with the conductivity 
 of the nerves supplying that part. 
 
 Ability to make a correct diagnosis from the palpation of 
 a vertebral subluxation depends upon a thorough knowledge 
 of the nervous system, the nerve-supply to the different parts 
 of the body, and the function of the nerves emanating from 
 each spinal segment. 
 
 A ready familiarity with the pathological changes which 
 may occur in every organ is also very essential, in order that 
 the condition of the part which is improperly innervated may 
 be known. 
 
 It is impossible from the spinal analysis alone to make a 
 diagnosis of the nature of the disease. What the spinal 
 analysis determines is that disease of a certain organ exists ; 
 the special examination of the organ then establishes the 
 exact nature of the disease. For example, detection of a sub- 
 luxation at the fourth thoracic segment determines the fact 
 that there is disease of the liver, but whether the disease is 
 cancer or congestion it is impossible to state ; only the special 
 examination of the liver and the general symptom complex 
 can determine this. 
 
 A thorough understanding of the above principle makes 
 the diagnosis of disease in certain parts of the body extremely 
 accurate, and the palpation of the vertebral column for the 
 detection of subluxations is one of the most valuable aids in 
 the making of a correct diagnosis that we have at our com- 
 mand. For example, diagnosis of conditions in the abdomen 
 is often very difficult ; this is true for the reason that we are 
 dealing with a number of organs, all adjacent to each other 
 and the condition of which is constantly changing. Thus the 
 Stomach at one time contains solids, at another liquids, at 
 
 248
 
 SPINAL DIAGNOSIS 249 
 
 another time gas ; a tumor in the abdomen may be connected 
 with the Hver, the kidney on the right side, the stomach, the 
 ovary, it may be an enlarged mesenteric gland, an enlarged 
 spleen, a cyst of the omentum, or simply a mass of fecal mat- 
 ter. There is no necessity for calling attention to the fact 
 of the differing diagnoses of dilYerent physicians in regard to 
 abdominal conditions, and how often wrong diagnoses are 
 made; often, alas, to the patient's detriment. These differ- 
 ences in diagnosis are very often not alone in respect to the 
 nature of the disease with which a certain organ is affected, 
 but frequently differences of opinion exist as to what organ 
 is affected. This is not surprising when we consider that the 
 abdominal organs are loosely packed in the abdomen, and 
 reliance must be placed entirely on palpation and percussion 
 in the physical examination of the parts. 
 
 An enlarged liver may be confused with an enlargement 
 of the right kidney, an enlarged spleen, a tumor of the 
 pyloric end of the stomach, or impaction of the hepatic flex- 
 ure of the colon. By palpation of the mass it is frequently 
 impossible to state with which of these organs the tumor 
 is connected. Often percussion does not give any assistance, 
 since the dulness elicited by percussion is so similar over all 
 the organs that the slight shade of difference cannot be dis- 
 tinguished. By palpation of the vertebral column, and the 
 detection of a subluxation in a certain segment, however, the 
 exact organ affected can be readily determined. 
 
 Let us carry the above illustration farther, and suppose 
 that a tumor mass is palpated in the abdomen, but by all 
 the usual methods of examination it has been impossible to 
 determine which of the organs is affected. If the spine is then 
 palpated, the following findings will establish which of the 
 organs is affected. If the fourth thoracic vertebra is sub- 
 luxated, the tumor is in connection with the liver ; if the fifth, 
 sixth, or seventh thoracic vertebra is subluxated, it is con- 
 nected with the stomach ; if the eighth thoracic vertebra is 
 the one subluxated, it may be concluded that the spleen is 
 involved ; if the tenth thoracic vertebra is subluxated, the 
 kidney is the organ affected; if the lower thoracic or upper 
 lumbar vertebrae are the seat of subluxations, the trouble is 
 located in the intestines. These findings are constant, that
 
 250 SPINAL ADJUSTMENT 
 
 is to say, if the disease is of the liver, a subluxation will in- 
 variably be found at the fourth thoracic vertebra, and simi- 
 larly of the other viscera as outlined above. By such a 
 process we are able to determine exactly which organ is 
 affected in conditions affecting the abdominal viscera. 
 
 There is one difficulty in the making of a diagnosis by 
 spinal analysis. This is the fact that in a few instances the 
 same nerve supplies different organs, and if this nerve alone 
 were impinged it would naturally be impossible to state which 
 of these organs is affected, and a consideration of the symp- 
 toms and signs would be necessary. However, no disease 
 process exists long in any organ before reflex subluxations 
 are produced in those segments from which the organ in 
 question derives its innervation, as explained fully in the 
 chapter on the reflex production of mal-alignments of vertebra. 
 From these secondary subluxations it then becomes possible 
 to determine the organ which is involved. After the specific 
 organ involved has been decided upon, the special examina- 
 tion of the organ and the careful consideration of all symptoms 
 and signs present, together with chemical and microscopical 
 analysis of urine, feces, blood, gastric contents, sputum, and 
 other methods of diagnosis should be used. 
 
 In the past many practitioners of spinal adjustment have 
 made the claim that they were able from the analysis of the 
 spine to make an absolute diagnosis of the patient's disease. 
 Some were honest in this claim, but simply ignorant of the 
 fact that it is one thing to know what organ is affected, and 
 another how that organ is affected. These persons had no 
 knowledge of pathology. They simply considered it suffi- 
 cient to know what organ is affected, and it possibly never 
 occurred to them to ascertain how that organ was affected. 
 Many who may have thought of this feature paid no further 
 attention to the subject, but were content with using spinal 
 adjustment and considered it sufficient to know that the 
 patient was cured. This is an extremely unscientific manner of 
 treating disease, however, and leads to many gross errors. 
 As a matter of fact, the patient is usually himself aware before 
 he consults a physician what organ is diseased, and wishes 
 to know how that organ is affected. For example, a patient 
 complains of a group of symptoms which point directly to
 
 SPINAL DIAGNOSIS 251 
 
 disease of the liver; he is however unable to interpret these 
 symptoms correctly, and therefore unable to say what the 
 nature of the disease is. It is his desire to know this that 
 prompts him to consult a physician. Without an exact knowl- 
 edge of the specific nature of the disease the operator is un- 
 able to give a correct prognosis. Here some may differ for 
 the claim is still made by them that all diseases are curable 
 by spinal adjustment, and that, therefore, prognosis is good in 
 all cases. Facts will not bear out such claims, since there are 
 still some diseases for which no remedy has been as yet dis- 
 covered, and spinal adjustment will not cure cancer, for in- 
 stance. From a specific diagnosis we are therefore enabled 
 to state the exact nature of the disease and give an approxi- 
 mately accurate prognosis, as well as treat any of the diseased 
 conditions which so often complicate disease of certain organs. 
 
 The following tables will assist the operator in making 
 a diagnosis as to the organ, part, or system which is affected 
 when vertebral subluxations are found in certain sections 
 of the vertebral column : 
 
 The 1st Cervical Nerve. — Superior and inferior oblique, 
 complexus, rectus capitis posticus major and minor muscles ; 
 skin of occiput; cranium, brain, face, ears, eyes, larynx; chills 
 and fever. 
 
 The 2nd Cervical Nerve. — Complexus, obliquus inferior, 
 semispinalis, multifidus spinae muscles ; posterior half of 
 scalp ; larynx ; fevers. 
 
 The 3rd Cervical Nerve. — Integument of the occiput and 
 posterior cervical region ; eyes, larynx, heart, lungs, dia- 
 phragm ; fevers. 
 
 The 4th Cervical Nerve. — Scaleni, supraspinatus, infras- 
 pinatus, rhomboidei, teres minor muscles ; throat, thyroid 
 gland, eyes, diaphragm, heart ; fevers ; vasomotor nerves. 
 
 The 5th Cervical Nerve. — Subclavius, supraspinatus, in- 
 fraspinatus, subscapularis, teres major and minor, deltoid, 
 brachialis anticus, biceps, serratus magnus, pectoralis major 
 and minor, flexor sublimis digitorum, lumbricales muscles; 
 eye, heart, thyroid gland, throat ; fevers ; smallpox. 
 
 The 6th Cervical Nerve. — Subclavius, supraspinatus, in- 
 fraspinatus, subscapularis, teres major and minor, deltoid, 
 brachialis anticus, biceps, pronator teres, pronator quadratus,
 
 252 
 
 SPINAL ADJUSTMENT 
 
 e C.Ut,3 
 
 Fig. 41. 
 
 Segmentation Chart.
 
 SPINAL DIAGNOSIS 253 
 
 latissimus dorsi, pectoralis major and minor, serratus magnus, 
 triceps, supinator longus and brevis, flexor carpi radialis, 
 palmaris longus, extensor carpi radialis longior and brevior, 
 abductor pollicis, opponens pollicis, flexor pollicis muscles ; 
 eyes, ears, throat, thyroid gland ; chills and fever. 
 
 The 7th Cervical Nerve. — Extensor carpi radialis longior 
 and brevior, opponens pollicis, flexor pollicis, abductor pollicis, 
 serratus magnus, coraco-brachialis, extensor communis digi- 
 torum, extensor pollicis longus and brevis, extensor carpi 
 ulnaris, abductor indicis, abductor minimi digiti, extensor 
 indicis, extensor minimi digiti, latissimus dorsi, triceps, 
 anconeus, pectoralis major; brain. 
 
 The 8th Cervical Nerve. — Latissimus dorsi, triceps, an- 
 coneus, pectoralis major and minor, flexor carpi ulnaris, flexor 
 profundus digitorum, flexor longus pollicis, pronator quad- 
 ratus, flexor sublimis digitorum, lumbricales, interossei, 
 abductor pollicis, flexor brevis pollicis muscles. 
 
 The 1st Thoracic Nerve. — Pronator quadratus, flexor car- 
 pi ulnaris, flexor longus pollicis, flexor profundus digitorum, 
 intrinsic muscles of hand, pupillary fibres ; eye, heart, 
 pericardium, lungs, pleura, liver, integument of the body. 
 
 The 2nd Thoracic Nerve. — Intercostal muscles ; vasomotor 
 nerves ; disorders of the arm ; heart ; fevers ; bronchi ; 
 mediastinum. 
 
 The 3rd Thoracic Nerve. — Intercostal muscles ; heart, 
 lungs and pleura ; liver ; eye ; integument of body. 
 
 The 4th Thoracic Nerve. — Intercostal muscles ; heart, lungs 
 and pleura. 
 
 The 5th Thoracic Nerve. — Intercostal muscles; breasts, 
 pleura, liver, constitutional diseases, stomach, spleen. 
 
 The 6th Thoracic Nerve. — Intercostal muscles ; stomach, 
 spleen. 
 
 The 7th Thoracic Nerve. — Intercostal and abdominal 
 muscles; stomach, spleen, gall bladder. 
 
 The 8th Thoracic Nerve. — Intercostal and abdominal mus- 
 cles; stomach, spleen, gall bladder, cystic duct, pancreas; 
 chills and fever. 
 
 The 9th Thoracic Nerve. — Intercostal and abdominal mus- 
 cles ; gall bladder, spleen, pancreas, stomach, cystic duct; 
 chills and fever.
 
 254 SPINAL ADJUSTMENT 
 
 The 10th Thoracic Nerve. — Intercostal and abdominal 
 muscles ; pancreas, spleen, cystic duct, diaphragm, kidneys 
 and ureters. 
 
 The 11th Thoracic Nerve. — Abdominal muscles; dia- 
 phragm, pancreas, kidneys, bladder, intestines. 
 
 The 12th Thoracic Nerve. — Abdominal muscles; dia- 
 phragm, kidneys and ureters, large and small intestines, ver- 
 miform appendix, uterus, prostate gland, testes, ovaries, 
 epididymis, spermatic cord, penis. 
 
 The 1st Lumbar Nerve. — Quadratus lumborum muscle; 
 large and small intestines, vermiform appendix, uterus, ova- 
 ries, Fallopian tubes, testes, spermatic cord, epididymis, penis, 
 bladder; muscles of the lower extremities. 
 
 The 2nd Lumbar Nerve. — Cremaster and muscles of lower 
 extremity ; intestines, vermiform appendix, uterus, ovaries. 
 Fallopian tubes, testes, epididymis, penis, spermatic cord ; 
 fevers. 
 
 The 3rd Lumbar Nerve. — Gracilis, adductor longus and 
 brevis, quadriceps femoris, obturator externus, uterus, ovaries, 
 Fallopian tubes, prostate gland, spermatic cord, epididymis, 
 testes, penis, bladder. 
 
 The 4th Lumbar Nerve. — Gracilis, abductor longus and 
 brevis, quadriceps femoris, obturator externus, gluteus medius 
 and minimus, tensor fasciae femoris, semimembranosus, pop- 
 liteus, plantaris, quadratus femoris, gemellus inferior, crureus 
 muscles; rectum, anus. 
 
 The 5th Lumbar Nerve. — Adductor longus, gluteus maxi- 
 mus, medius and minimus, tensor fasciae femoris, semimem- 
 branosus, quadratus femoris, popliteus, plantaris, gemellus 
 superior and inferior, flexor longus digitorum, tibialis posticus, 
 flexor brevis digitorum, flexor brevis hallucis, abductor 
 hallucis, obturator internus, semitendinosus, soleus, flexor 
 longus hallucis muscles; bladder, prostate gland, rectum and 
 anus. 
 
 The 1st Sacral Nerve. — Gluteus maximus, medius and min- 
 imus, semimembranosus, semitendinosus, quadratus femoris, 
 superior and inferior gemellus, tensor fasciae femoris, pop- 
 liteus, plantaris, flexor longus digitorum, flexor brevis digi- 
 torum, flexor longus hallucis, flexor brevis hallucis, abductor 
 hallucis, biceps femoris, obturator internus, soleus, pyriformis,
 
 SPINAL DIAGNOSIS 255 
 
 abductor minimi digiti, abductor, transversus and obliquus 
 hallucis, interossei muscles. 
 
 The 2nd Sacral Nerve. — Gemellus superior, obturator in- 
 ternus, gluteus maximus, semitendinosus, soleus, flexo.r longus 
 hallucis, pyriformis, gastrocnemius, abductor minimi digiti, 
 abductor, transversus and obliquus hallucis, biceps femoris 
 muscles. 
 
 The 3rd Sacral Nerve. — Center for erection and ejaculation. 
 
 The 4th Sacral Nerve. — Center for sphincters of anus and 
 bladder.
 
 CHAPTER IV 
 
 Vertebral Subluxations 
 
 As has been already stated, vertebral subluxations have 
 l)een very little studied by the medical profession. The med- 
 ical student does not make a dissection of the vertebral col- 
 umn, and therefore has only a general conception of this 
 portion of the body. The average medical practitioner knows 
 that a vertebra is composed of a body, an arch, intervertebral 
 cartilages, and articular processes ; he may be somewhat 
 familiar with the ligaments of the spine, at least to the extent 
 of holding to the erroneous view that they prevent under any 
 and all circumstances the possibility of displacement of the 
 vertebrae. Anatomists have taught for centuries that dis- 
 placements of the vertebrae are a practical impossibility in 
 the absence of fracture, and all who have followed in their 
 wake have accepted these views as final, and made no personal 
 investigations which might have changed these opinions. 
 
 The fact that slight displacements of the vertebrae not 
 amounting to actual dislocations are possible in the spine 
 has never been investigated, and these minor lesions of the 
 vertebral column have therefore been left unrecognized until 
 recent years. The greatest reason for the tardy acceptance 
 of subluxations as a fact has been the firm adherence to the 
 above views, and an entire unwillingness on the part of the 
 profession to even consider the subject. This has been partly 
 due to the fact that these views were originally put forth by 
 men of very limited education along kindred lines, and who, 
 while their basic principles were correct, made other erroneous 
 statements in connection therewith, which naturally pre- 
 cluded the possibility of any recognition of their views by 
 men versed in the science of disease. It is possible that had 
 these same views been advanced originally by men of superior 
 intelligence and attainments, speedy recognition of vertebral 
 subluxations as a possibility and a factor in the production of 
 disease would have been accorded them. 
 
 256
 
 VERTEBRAL SUBLUXATIONS 257 
 
 In the author's mind, therefore, it has been due to the 
 failure of the medical profession to give the slightest atten- 
 tion to this field of thought, instead of giving it some con- 
 sideration, that has resulted in constant denials of the possi- 
 bility of subluxation of the vertebrae. Men who have not 
 spent one moment's serious consideration of the subject of 
 spinal adjustment deny that there is any truth or logic 
 in the claims made by its advocates. On the contrary, those 
 who do investigate the subject and give it serious thought 
 and study, become convinced of the soundness of its theoretical 
 basis. 
 
 The general opinion has been that by the term "subluxa- 
 tion" a dislocation is implied. Such a construction of this 
 term is, however, erroneous, since it does not imply a com- 
 plete disarticulation. It is freely admitted that a dislocation 
 of a vertebra without fracture is hardly possible. But 
 chiropractic does not claim to deal with dislocations of the 
 vertebrae. When the word subluxation is used, it is meajit 
 to convey the fact that a slight change in the relative position 
 of a vertebra to the contiguous surfaces of the vertebra above 
 and the one below it has occurred. That is to say, instead 
 of the entire surface area of a vertebra being approximated, 
 with die-like precision and accuracy, to its fellows above and 
 below it, it is slightly shifted from this position. There has 
 simply been a shifting in the position of one vertebra upon 
 another, and the greater portion of the surface area of the 
 two vertebrae still oppose each other. This movement is in 
 various directions depending upon the configuration of the 
 articular processes of the vertebrae involved, upon the direc- 
 tion of any external forces which may have produced it, or 
 upon the nature of the ligamentous contraction which has 
 operated to draw the vertebra out of alignment. It is these 
 various forms of displacements which we will consider in 
 this chapter. 
 
 We have considered vertebral subluxations from their 
 anatomical basis, from their etiological basis, and from their 
 effects. Let us now study the physical changes which actu- 
 ally occur when a subluxation takes place, and which tend 
 to make it possible. In the first place it must constantly be 
 borne in mind that a certain change occurs in the ligamentous
 
 258 SPINAL ADJUSTMENT 
 
 structures surrounding the vertebra which is subluxated, 
 and also in the intervertebral cartilaginous disc. Without 
 these changes subluxations are impossible. The vertebra 
 must be looked upon as it is in situ, and not as it would be, 
 disarticulated from the balance of the spine, devoid of liga- 
 ments and of the cartilaginous disc. The failure to 
 thus view the vertebra is what produces the opinion held 
 even today by some chiropractors that the vertebra slips out 
 of place in a certain direction, and an adjustment pushes 
 it back into its proper position. These operators have failed 
 to recognize the physical factors entering into the production 
 of spinal subluxations and their correction by the thrust ap- 
 plied to the vertebrae. What really produces a subluxation 
 is its displacement beyond a certain limit ; and what reduces 
 the subluxation is the forcing back of the vertebra to its 
 normal position. 
 
 That property of ligaments and cartilage by which they 
 possess their function of holding parts in position, and per- 
 mitting of a certain degree of movement between these parts, 
 is their elasticity. Were the ligaments of the vertebrae rigid 
 bands instead of elastic fibres, and were the intervertebral 
 cartilages solid plates instead of elastic discs, not the slightest 
 movement between the various vertebrae would be possible. 
 However, they are elastic, and it is the measure of their elas- 
 ticity which determines the degree of movement which is pos- 
 sible between the vertebrae which they hold in apposition. 
 When the limit of their elasticity is overcome and the force 
 which is responsible for this is continued, they do not return 
 to their former state when the force is finally removed, and 
 the vertebrae remain in this position because the elastic limit 
 of their ligaments and of the cartilages has been passed. 
 
 "The elastic limit of any material is defined as the point 
 at which, under applied loads, the stresses are no longer pro- 
 portional to the loads. Beyond the elastic limit of a material 
 the deformation is no longer proportional to the applied forces, 
 and upon removal of the forces, the material will not return 
 to its original condition, but maintains a permanent set." 
 (Dana.) When, therefore, the ligaments of one side of the 
 vertebrae are contracted and acting as a force which draws 
 the vertebra toward the side on which they are situated,
 
 VERTEBRAL SUBLUXATIONS 259 
 
 the ligaments of the other side are stretched ; if this stretching 
 is beyond the limit of their elasticity, they will not return to 
 their former position when the force is removed, but become 
 set. The contracted ligament remains in its contracted con- 
 dition, and the vertebra is permanently drawn toward the 
 contracted side. 
 
 The same principles apply to the intervertebral cartilages. 
 If these structures are compressed beyond their limit of 
 elasticity, they fail to resume their former shape when the 
 force is removed, but remain set. If, for example, one side 
 of a cartilaginous disc is so compressed, it fails to return to 
 its former thickness and remains permanently thinned. In 
 this manner are produced the various forms of compression 
 subluxation which result in a movement toward each other 
 on the vertebrae between which the disc is thinned, and 
 which produces a narrowing of the intervertebral foramen. 
 This thinning of a disc may be on either side, at its anterior 
 or its posterior aspect. An evenly distributed compression 
 of the entire disc beyond its limit of elasticity will result in 
 an approximation of the vertebra above and the one below it, 
 resulting in a narrowing of the intervertebral foramen on each 
 side. 
 
 Besides compression of the discs as a result of applied 
 forces, there is shearing or slipping. When pressure is 
 brought to bear upon the two surfaces of an intervertebral 
 disc, there may be a sidewise movement of the vertebra 
 above or below it. This is a result of the shearing of the 
 disc and an actual displacement can only be produced by 
 such shearing of the intervertebral cartilaginous disc. The 
 displacement of the vertebra may be to the right or the left, 
 and anteriorly or posteriorly. 
 
 Finally there is one other force acting through the spine, 
 namely rotation or turning. That the vertebrae normally 
 turn upon their axis with reference to each other we know 
 to be a fact, as is witnessed in the lumbar region of the 
 spine when the head and trunk are turned with respect to 
 the hips, and each vertebra twists slightly upon its fellow. 
 This turning movement produces a tension upon the liga- 
 ments on one side of the vertebra, and causes a change in the 
 form of the intervertebral cartilaginous disc. If this turning
 
 260 SPINAL ADJUSTMENT 
 
 movement should become extreme, and exceed the point of 
 limit of elasticity of the ligaments and the disc, these struc- 
 tures will fail to return to their former state, and the vertebra 
 remains set in that twisted or turned position ; in other words, 
 it remains rotated upon its axis. 
 
 These various forms of displacement of the vertebrae do 
 not occur in all regions of the spine, for the reason that the 
 conformation of the articular processes in the different types 
 of vertebrae will prevent movement of the vertebrae in some 
 directions, while it favors movement in certain other direc- 
 tions. We thus find certain forms of displacements peculiar 
 to certain sections of the vertebral column. 
 
 The next factor which has a bearing upon the nature of 
 the subluxation in any section of the spine is the kind and 
 the direction of the applied force. In subluxations produced 
 reflexly the ligamentous contraction is most pronounced on 
 one side, and consequently the corresponding side of the disc 
 will be thinned or compressed, or shearing results and the 
 vertebra is drawn to that side. 
 
 The various forms of subluxations which occur in the 
 vertebral column in the manner above described may there- 
 fore be enumerated as follows : 
 
 Kyphotic. Lateral. 
 
 Lordotic. Anterior. 
 
 Scoliotic, Posterior. 
 
 Compression. Rotary. 
 Supero-Inferior. 
 
 In addition to the above which may be termed simple 
 subluxations, there may be found combinations of two simple 
 displacements, constituting compound subluxations. These 
 are as follows : 
 
 Postero-Lateral. Antero-Rotary. 
 
 Antero-Lateral. Antero-Supero-Inferior. 
 
 Postero-Rotary. Postero-Supero-Inferior. 
 
 Kyphotic Subluxation. — Kyphosis is a backward bending, 
 of a section of the spine. This form of subluxation usually 
 is not confined to a single vertebra but ordinarily involves a
 
 VERTEBRAL SUBLUXATIONS 261 
 
 group of vertebrae, and is seen in connection with Pott's 
 disease. A true kyphotic subluxation is produced by a 
 change in the intervertebral cartilaginous disc, whereby its 
 anterior portion becomes thinned, as a result of some de- 
 structive process, and the vertebrae are thus permitted to 
 approach each other at their anterior aspect. This in reality 
 is a compression subluxation, and would be so classed were 
 the above condition confined to a single vertebra. This 
 is, however, rarely the case, for the disease process which 
 causes the thinning of the disc does not confine itself, as a 
 rule, to one segment but involves several vertcl rae before 
 its progress, is arrested. 
 
 In this form of subluxation the superior articular processes 
 usually remain in their normal position, unless a group of 
 vertebrae are involved, in which case there will be more or 
 less displacement of both the superior and inferior articular 
 processes. The spinous processes are thrown apart as a 
 result of the separation of the posterior portion of each ver- 
 tebra as the anterior portion of each vertebra more and more 
 approaches that of its fellows. A similar condition of sepa- 
 ration of the spinous processes might also occur as a result 
 of a thickening of the posterior portion of the discs without 
 any change in the thickness of their anterior portion, and 
 produce a separation of the articular processes. Such a con- 
 dition will not, however, produce an impingement of the ves- 
 sels and nerves passing through the intervertebral foramina, 
 since their diameter remains unchanged. This form of sub- 
 luxation is therefore of no importance from the standpoint of 
 producing disease, but deformities of this nature should be 
 corrected, since they cause a narrowing of the thorax and 
 are thus apt to lead to pulmonary diseases. Such deformi- 
 ties are the usual condition which is present in cases of 
 "Round Shoulders," and the thickening of the posterior por- 
 tion of the disc is due to the constant stretching of its pos- 
 terior fibres by the habit of bending forward, which results 
 in a species of hypertrophy of that portion of the disc. 
 
 In true kyphotic subluxations the vertical diameter of the 
 intervertebral foramen is increased, while its antero-posterior 
 diameter is diminished as a result of being encroached upon 
 by the inferior articular processes of each vertebra, and
 
 262 SPINAL ADJUSTMENT 
 
 also by the protrusion of the posterior portion of the disc 
 into it. 
 
 The kyphotic subluxations are seen most commonly in the 
 dorsal region of the spine; very much less commonly in the 
 lumbar region ; never in the cervical region, unless a destruc- 
 tive process resulting from syphilis or tuberculosis has 
 destroyed a portion of these vertebrae. Fig. 42. 
 
 Kyphotic Subluxation. 
 
 Lordotic Subluxation.— Lordosis is a forward bending of 
 a section of the spine, and is the opposite to kyphosis. Like 
 kyphosis, lordosis is not limited to a single vertebra, but 
 usually involves a group of vertebrae. A lordotic subluxa- 
 tion is produced by a thinning of the posterior portion of 
 the intervertebral cartilaginous discs, and this permits the 
 involved vertebrae to approach each other at their posterior 
 aspect. The lordotic subluxation is almost invariably asso- 
 ciated with some other form of displacement, usually a pos- 
 terior, being in reality a posterior compression subluxation,
 
 VERTEBRAL SUBLUXA'IIONS 263 
 
 since the posterior part of the intervertebral disc is com- 
 pressed. It is not, however, classed as a compression sublux- 
 ation since the process is not confined to a single vertebra, 
 but affects a number of vertebrae. 
 
 In this form of subluxation the inferior articular processes 
 are displaced posteriorly, while the superior articular processes 
 of the vertebrae below encroach on the intervertebral fora- 
 men. As a result of the thinning of the posterior portion of 
 the discs the vertebrae approach each other posteriorly, and 
 thus the spinous processes are thrown together. 
 
 Primary lordosis affects most pronouncedly the thoracic 
 region of the vertebral column, and is most noticeable in that 
 region of the spine, for the reason that normally there is a 
 backward curvature of the spine here, while in the lumbar 
 and cervical region the back normally curves forward. 
 Lordosis, however, is usually met with as a result of a kypho- 
 tic subluxation, and since this form occurs most commonly 
 in the thoracic region, lordosis is seen most often in the 
 cervical and lumbar regions of the spine. The untoward 
 effects of kyphosis must therefore be looked for in its asso- 
 ciated lordotic displacements, as the loose capsular ligaments 
 permit a forward movement of the superior articular processes 
 of the involved vertebrae. A study of the placement of the 
 articular processes of two vertebrae with reference to each 
 other, with the spine in the vertical position, will show how 
 easily such a condition may be produced ; placing the spine 
 in a horizontal plane, and again studying the placement of 
 the articular processes will show how impossible it would 
 be to cause any shifting of the vertebrae upon each other 
 in this position. When the superimposed weight of the body 
 is placed largely on the bodies of the vertebrae, the inferior 
 processes of the vertebrae are brought firmly up against the 
 superior articular processes of the vertebrae below them, and 
 no displacement can occur. If, however, the head and chest 
 are thrown too far backward, and the weight is thrown upon 
 the articular processes, the inferior articular processes will 
 have a tendency to slide backward on the superior articular 
 processes of the vertebra below, and in this way will force 
 the latter forward into the intervertebral foramen. A careful 
 study of Fig. 43 will show that this is mechanically correct.
 
 264 
 
 SPINAL ADJUSTMENT 
 
 In a lordotic subluxation the intervertebral foramen is in- 
 creased in size vertically, but its antero-posterior diameter is 
 diminished and the vessels and nerves which it transmits com- 
 pressed by being encroached upon by the superior articular 
 processes. Fig. 43. 
 
 Scoliotic Subluxation. — Scoliosis is a lateral curvature of 
 a section of the vertebral column, or of the entire column. 
 True scoliosis is also not confined to a single vertebra, but in- 
 
 Fig. 43. 
 
 Lordotic Subluxation. 
 
 volves at least three vertebrae. What might be termed a 
 physiological scoliosis is commonly seen in individuals who 
 use the right arm almost exclusively in their work, and as a 
 result of the muscular contraction on the right side the 
 spine is slightly drawn toward that side. 
 
 This form of subluxation is due to a thinning of the lateral 
 aspect of the intervertebral cartilaginous discs, which per- 
 mits the sides of the bodies of a group of vertebrae to ap- 
 proach each other. As a result of this lateral approximation of 
 the vertebrae the transverse processes on the contracted side
 
 VERTEBRAL SUBLUXATIONS 
 
 265 
 
 are brought toward each other on that side, while on the op- 
 posite side they are widely separated. This results in a 
 marked diminution in the vertical diameter of the interverte- 
 bral foramina on the compressed side. The spinous processes 
 of the involved vertebrae are displaced laterally. 
 
 Scoliosis is seen in the cervical region of the spine in 
 cases of wry-neck. It is, however, met with most commonly 
 in the thoracic region. When the degree of scoliosis is very 
 
 Fig. 44. 
 
 Scoliotic Subluxatiou. 
 
 marked, a compensation curve in the cervical or lumbar 
 region is produced, which gives the vertebral column the 
 appearance of the capital letter S. Fig. 44. 
 
 Compression Subluxation. — This form of subluxation is, 
 as its name implies, one in which the cartilaginous disc be- 
 tween two vertebrae is thinned. This diminution in the thick- 
 ness of the disc permits the vertebra which rests upon it to 
 approach the vertebra below it, and « produce a decrease 
 in the vertical diameter of the intervertebral foramina between 
 them.
 
 266 SPINAL ADJUSTMENT 
 
 The thinning of the disc is produced by interference with 
 its nutrition as a result of a contracted condition of the liga- 
 ments on both sides of the vertebrae which is brought about 
 by reflex impulses from some diseased part of the body. The 
 disc is thus affected not alone by the pressure thus occasioned, 
 but also by reason of the interference with its nerve-supply 
 as a result of the narrowing of the vertical diameter of the 
 intervertebral foramen. 
 
 A degenerative process, as a result of a syphilitic or tuber- 
 cular infection could also produce a destruction of the disc ; 
 these disease processes, however, also invade the bone, and 
 more especially the anterior or more cancellous portion, and 
 would also not be limited to a single vertebra, but involve 
 a group, in which case there would be one of the forms of 
 subluxation above described. 
 
 A compression subluxation involves only one segment of 
 the spine, and is ordinarily a result of a previous displacement 
 of a vertebra as pointed out above, and which condition it 
 tends to make permanent. It also usually accompanies a 
 posterior subluxation, as a result of the interference with its 
 nutrition which results from the compression of the vessels 
 in that form of subluxation. This variety of subluxation must 
 therefore be considered as a complication of compression or 
 posterior subluxations, the gravity of both being much 
 increased by this complication. 
 
 In a true compression subluxation the vertical diameter 
 of the intervertebral foramen on each side is diminished, 
 and the opening is sufficiently occluded to permit of impinge- 
 ment of the nerves transmitted by them. As the disc be- 
 comes more and more thinned, the body and pedicles of the 
 vertebrae approach each other more closely. The inferior 
 articular processes of the vertebra above the thinned disc 
 glide downward on the superior articular processes of the 
 vertebra below, and as they do so, force the latter forward 
 into the intervertebral foramina on each side. The degree 
 of closure of the foramina will of necessity depend upon the 
 extent of thinning of the disc, and will be extreme if the 
 entire thickness of the disc has been destroyed. If complete 
 destruction takes place so that the bodies of the two verte- 
 brae are in direct apposition, ankylosis will develop as it
 
 VERTEBRAL SUBLUXATIONS 
 
 267 
 
 would in any joint in the body. Before this takes place, how- 
 ever, nature produces a forward bending of the spine in the 
 affected region to prevent complete occlusion of the inter- 
 vertebral foramina, just as occurs in old age when settling 
 of the spine commences, and which is a counterpart of a 
 compression subluxation, except that all the vertebrae are 
 affected in the settling incident to old age. 
 
 Compression subluxations are met with in all regions of 
 the spinal column. They are least noticeable in the cervical 
 
 Fig. 45. 
 Compression Subluxation. 
 
 region, for the reason that here the intervertebral discs are 
 normally not very thick; in the lumbar region they are most 
 pronounced since here the di-scs are very thick in comparison 
 to those of the other regions. Fig. 45. 
 
 Supero-Inferior Subluxation. — This form of subluxation 
 is a counterpart of the scoliotic subluxation, with this excep- 
 tion, namely, that in scoliosis a group of vertebrae are in- 
 volved, while in a supero-inferior subluxation only one 
 vertebra is affected. That is to say, in scoliosis several discs
 
 268 SPINAL ADJUSTMENT 
 
 are compressed laterally, whereas in a siipero-inferior 
 subluxation only one disc is so compressed. 
 
 As a result of the thinning of one of the discs at its 
 lateral aspect, the vertebra which rests upon that disc ap- 
 proaches its fellow on that side, bringing the transverse 
 processes close to each other ; on the other side the disc 
 retains its normal thickness, or is even thicker than normal, 
 owing to the separation which ensues upon that side as a 
 result of the compression on the other side, and the transverse 
 processes are farther apart than normal. 
 
 The intervertebral foramen on the compressed side will 
 be much decreased in size vertically, while on the opposite 
 side the foramen is enlarged. The impingement or the ves- 
 sels and nerves thus occasioned will produce serious conse- 
 quences. The innervation to the parts supplied by the 
 afifected segment of the cord will be interfered with as a 
 result of the compression of the spinal nerve as it passes 
 through the foramen. The compression of the arteries and 
 veins passing through the foramen will produce congestion 
 and irritability of the segment of the spinal cord, and also 
 interfere with its nutrition, so that the normal reflex acts 
 which take place there under normal conditions do not now 
 occur. 
 
 If the supero-inferior subluxation is situated in the cerv- 
 ical region there will be in addition to the impingement of 
 the spinal nerves compression of the vertebral arteries. The 
 costo-transverse processes are displaced downward and press 
 upon the vertebral artery below, which results in a mutiplicity 
 of cranial disturbances due to the vasomotor efifects, since the 
 vertebral arteries afford part of the blood supply to the brain. 
 
 The supero-inferior subluxation is produced as a result 
 of a contraction of the ligaments on one side of the vertebrae, 
 which produces an approximation of the vertebrae of the cor- 
 responding segment. This contracted condition of the liga- 
 ments is occasioned by excessive impulses from a diseased 
 portion of the body, which reflexly produce excessive outgoing 
 impulses causing a contraction of the spinal ligaments of 
 the segment at which the ingoing impulses entered. As will 
 be remembered, it was stated in the consideration of the 
 reflex production of subluxations that the efferent impulse
 
 VERTEBRAL SUBLUXATIONS 
 
 269 
 
 of a reflex act affects principally the muscles of the same 
 side on which the aft'erent impulse entered the cord; conse- 
 quently the spinal muscles' and ligaments on one side will 
 ije contracted, which will compress the disc on that side; if 
 this compression is carried beyond the limit of elasticity of 
 the gfisc, a permanent thinning will be produced. 
 
 ^his form of subluxation may also be a result of direct 
 traumatism, and the fact that the spinous and transverse 
 process on one side are out of alignment is positive evidence 
 that the centrum or body of the displaced vertebra is also 
 moved downward on the compressed side. Fig. 46. 
 
 Fig. i6. 
 Supero-Inferior Subluxation. 
 
 Lateral Subluxation. — A lateral subluxation is one in 
 which a vertebra is displaced to either the right or left. In 
 a true lateral subluxation there is no twisting, turning, or 
 tilting of the affected vertebra. There may, however, be an 
 apparent lateral deviation of a vertebra. Such a condition 
 is produced by a unilateral contraction of the ligaments and 
 muscles of two vertebrae, which, by drawing the vertebra 
 toward that side as a result of compression of the disc, would 
 simulate a direct lateral deviation of the vertebra involved. 
 Such a condition could, however, be differentiated from a
 
 270 SPINAL ADJUSTMENT 
 
 true lateral subluxation by the fact that in the former the 
 transverse processes approach each other, while in a true 
 lateral subluxation the distanc'e between the transverse 
 processes on each side is the same. 
 
 This form of displacement is met with most commonly 
 in the cervical region, since here the surfaces of the articular 
 processes are fiat, and the integrity of the joint is not sup- 
 plemented by the ribs as in the thoracic region, but is de- 
 pendent solely on the muscles and ligaments. In the thoracic 
 region such a subluxation would most readily occur between 
 the tenth and eleventh, and the eleventh and twelfth verte- 
 brae, since these are not reinforced by the ribs. It is, how- 
 ever, seen in all thoracic vertebrae. In the lumbar region 
 the possibility of lateral displacement of the vertebrae is still 
 less on account of the strength of the capsular ligaments, 
 and the fact that the superior articular processes so com- 
 pletely surround the inferior processes of the vertebra above. 
 Lateral subluxations are, therefore, seen only in the cervical 
 region and lower two thoracic vertebrae. 
 
 For the production of a lateral subluxation, even in the 
 cervical region, quite a degree of violence would be necessary ; 
 this is true for the reason that the upper surface of the body 
 of these vertebrae is concave transversely, and presents a 
 projecting lip on each side; the lower surface is convex from 
 side to side, and presents laterally a shallow concavity which 
 receives the corresponding projecting lip of the adjacent 
 vertebra. For this reason there would be more likely to occur 
 a rotation of these vertebrae with a gliding of the surfaces 
 of the articular processes over each other. In such a case the 
 spinous processes would be displaced laterally and give the 
 impression that the vertebra was displaced to the side. To 
 determine whether this is the case, or whether the vertebra 
 is actually displaced laterally, the transverse processes should 
 be palpated. If the vertebra is not rotated, the transverse 
 processes will be on line with each other, while, when the 
 vertebra is rotated the transverse process on one side will be 
 posteriorly displaced while the transverse process on the 
 other side is displaced anteriorly, depending upon the 
 direction of the rotation. 
 
 Subluxations which, from the position of the spinous
 
 VERTEBRAL SUBLUXATIONS 271 
 
 process are apparently lateral, are consequently in most cases 
 either rotary or unilateral compression subluxations. Fig. 47. 
 Anterior Subluxatioji. — An anterior subluxation is one in 
 which a vertebra is £<nterior t its adjacent vertebrae. This 
 form of subluxation js comparatively rare, and a pure ante- 
 rior displacement of a vertebra, without dislocation is prac- 
 tically only possible iu the upper cerv^ical region of the spine. 
 This is true owing to the shape and placement of the articular 
 processes in the thoracic and lumbar regions. In the thoracic 
 region the surfaces of the articular processes are placed 
 against each other in such a manner as to practically entirely 
 
 Fig. 47. 
 Lateral Subluxation. 
 
 preclude the possibility of a forward displacement of one of 
 the vertebrae in this region. There are, however, cases in 
 which by palpation of the transverse processes a vertebra 
 in this region is found to be anterior, but this is usually a 
 thinning of the anterior portion of the disc as a result of 
 which the anterior part of the vertebra which rests upon that 
 disc is displaced downward, while its posterior portion is 
 raised and brought forward ; thus the spinous and transverse 
 processes will be felt as being close to those of the vertebra 
 above the one affected. 
 
 In the lumbar region of the spine the length of the inferior 
 articular processes, and their convex surface fitting into the 
 concavity on the tip of the superior processes of the vertebra
 
 272 
 
 SPINAL ADJUSTMENT 
 
 below, effectively prevent any forward displacement of a 
 vertebra in this region. The fifth lumbar vertebra is, how- 
 ever, an exception to this rule. This vertebra is wedge-shaped, 
 the thicker portion of its body being anterior. This naturally 
 will favor a forward displacement of this vertebra. 
 
 Fig. 48. 
 
 Anterior Subluxation. 
 
 The most likely place in which a pure anterior displace- 
 ment of a vertebra could occur is at the atlas. Here a laxity 
 of the transverse ligament will permit a forward displace- 
 ment of the atlas upon the condyles of the occiput. It must 
 be understood that by this only a slight displacement is im- 
 plied, since a pronounced displacement would necessarily 
 cause a compression of the medulla between the posterior 
 arch of the atlas and the odontoid process of the axis.
 
 VERTEBRAL SUBLUXATIONS 273 
 
 In an anterior subluxation the antero-posterior diameter 
 of the intervertebral foramina is encroached upon and the 
 nerves and vessels transmitted by them are compressed. 
 When the subluxation is in the cervical region, the vertebral 
 arteries are also pressed upon, and the circulation to the brain 
 is interfered with. Fig. 48. 
 
 Posterior Subluxation. — In a posterior subluxation the in- 
 ferior articular processes of a vertebra project backward from 
 the superior articular processes of the vertebra below it. This 
 displacement almost entirely occludes the intervertebral fora- 
 men, compressing the structures passing through it. The 
 surrounding ligaments are contracted; the stellate and other 
 ligaments connecting the ribs with the vertebrae share in 
 this contraction. While in a posterior subluxation all the 
 ligaments are not always affected, they might be. If the 
 displacement is marked, the anterior and posterior, the sub- 
 flava, and the ligaments of the spinous processes will all be 
 involved. The ligamenta subflava, which connect the laminae, 
 can be readily palpated. 
 
 Posterior displacement of a vertebra is limited to a cer- 
 tain extent by the superior articular processes of the vertebra 
 below the one displaced pressing against the posterior part 
 of the vertebra above, or the one which is displaced. In some 
 cases, however, the capsular, anterior, and posterior ligaments 
 have become so lax that they permit of an almost complete 
 backward displacement of the vertebra. 
 
 The gravity of this form of subluxation is still more appar- 
 ent when it is noted that almost invariably when a posterior 
 subluxation is present, such destructive changes occur in 
 the intervertebral disc that a compression subluxation nearly 
 always accompanies it. 
 
 Posterior subluxations occur more frequently in the 
 thoracic than in the cervical or lumbar regions of the spine. 
 This is due to the natural backward curvature of the vertebral 
 column in this section. These subluxations are usually a 
 result of an injury, or are produced by occupations which 
 require a constant stooping position. 
 
 The intervertebral foramen is diminished in size antero- 
 posteriorly, by the backward displacement of the body of 
 the vertebra which forms the anterior wall of the foramen.
 
 274 
 
 SPINAL ADJUSTMENT 
 
 The transverse processes are also displaced backward equally 
 on each side, while the spinous process of the affected vertebra 
 projects beyond that of the vertebrae above and below. 
 Fig. 49. 
 
 Rotary Subluxation. — This form of subluxation is a dis- 
 placement of a vertebra which consists in a turning of the 
 vertebra upon its axis. As a result of this twisting, the 
 
 Fig. 49. 
 Tosterior Subluxation. 
 
 spinous process of the involved vertebra will be found to the 
 right or the left of the spinous process of the vertebra above 
 and the one below it, depending upon the direction of the 
 rotation. The transverse process on one side is displaced 
 posteriorly, while that on the other side is displaced anteriorly. 
 This turning of the vertebra produces a drawing out of 
 alignment of the intervertebral disc, and a tension upon 
 the various ligaments anteriorly, posteriorly, and laterally.
 
 VERTEBRAL SUBLUXATIONS 
 
 275 
 
 The articular processes are displaced posteriorly on one 
 side, and to the side toward which the vertebra is rotated, 
 thus producing a lateral-posterior, but the term rotary is 
 preferable, since the vertebra is turned on its axis, and fur- 
 thermore for the reason that the posterior form of displace- 
 ment occurs in practically all the other forms of subluxation. 
 What has been said of the posterior form will, however, apply 
 here to a less degree, as the displacement is limited by the 
 size of the intervertebral foramen, since the anterior surface 
 of the superior articular process of the vertebra below would 
 come into contact with the posterior surface of the body of 
 
 Fig. 50. 
 Rotary Subluxation. 
 
 the vertebra above it. This form of subluxation is frequently 
 associated with scoliosis. 
 
 Rotary subluxations are possible in all regions of the 
 spine, but occur with least frequency in the cervical region, 
 as the vertebrae in this region are so constructed with a 
 downward tilt of their transverse processes, and a flange at 
 the sides of the upper surface of their body that they are well 
 protected against any radical rotation. The normal spine 
 permits considerable rotation in this region without displace- 
 ment, but this movement is confined principally to the rota- 
 tion of the atlas upon the odontoid process of the axis; the 
 other cervical vertebrae rotate en masse, the rotation of each
 
 276 SPINAL ADJUSTMENT 
 
 individual vertebra being relatively slight, as a rule. How- 
 ever, the rotary displacement in this region may become pro- 
 nounced when associated with one of the other forms of 
 subluxation ; it then becomes a compound subluxation. 
 
 In the lumbar region there may also exist a turning of a 
 vertebra upon its axis sufficient to amount to a rotary 
 subluxation. 
 
 Owing to the posterior and lateral displacement of the 
 articular process on one side in this form of subluxation the 
 antero-posterior and lateral diameters of the intervertebral 
 foramen on that side will be encroached upon and impinge- 
 ment of the vessels and nerves passing through it will result. 
 Fig. 50. 
 
 Subluxations in the Various Regions of the Spinal Column. 
 — We have seen that certain sul)luxations are peculiar to 
 certain regions of the spine, owing to the shape and placement 
 of the articular processes, while these same subluxations for 
 the same reason are impossible of occurrence in other regions 
 of the spine. 
 
 Grouped according to the regions in which the different 
 forms of subluxations are met with, we find that the following 
 regions permit of these forms of displacements : 
 
 Region of Spine. Forms of Subluxations. 
 
 Cervical. Lordc^tic (secondary to kyphotic). 
 
 Scoliotic. 
 
 Compression. 
 
 Supero-Inferior. 
 
 Lateral. 
 
 Anterior. 
 
 Rotary. 
 Thoracic. Posterior. 
 
 Kyphotic. 
 
 Primary Lordotic. 
 
 Scoliotic. 
 
 Compression. 
 
 Supero-Inferior. 
 
 •Lateral. 
 
 Rotary.
 
 VERTEBRAL SUBLUXATIONS 277 
 
 Lumbar. Kyphotic. 
 
 Lordotic (secondary to kyphotic). 
 
 Scoliotic. 
 
 Compression. 
 
 Supero-Inferior. 
 
 Anterior (5th only). 
 
 Posterior. 
 
 Rotary. 
 
 The following table shows the regions of the spine in 
 which the various forms of subluxations may occur : 
 
 Posterior Thoracic region. 
 
 Kyphotic Thoracic region, especially. 
 
 Lumbar region. 
 Lordotic Primary, Thoracic region. 
 
 Secondary to kyphotic. Cervical and Lum- 
 bar regions. 
 Scoliotic Primary, Thoracic region. 
 
 Compensatory, Cervical and Lumbar re- 
 gions. 
 Compression ....Cervical region. 
 
 Thoracic region. 
 
 Lumbar region. 
 Supero-Inferior.. .Cervical region. 
 
 Thoracic region. 
 
 Lumbar region. 
 Lateral Cervical region. 
 
 Thoracic region, especially the 11th and 12th. 
 Anterior Cervical, especially the Atlas. 
 
 Fifth Lumbar (spondylolisthesis). 
 Posterior Cervical region. 
 
 Thoracic region. 
 
 Lumbar region. 
 Rotary Cervical region. 
 
 Thoracic region. 
 
 Lumbar region. 
 
 Compound Subluxations. — As stated above, these are com- 
 binations of the simple forms of subluxation described, and 
 require no especial description. Compound subluxations are
 
 278 SPINAL ADJUSTMENT 
 
 usually the only kind found, since, as already mentioned the 
 vertebra is also displaced posteriorly in nearly all other 
 forms of displacement. A lordotic and an anterior subluxa- 
 tion are the only ones in which a backward displacement of 
 the afifected vertebra does not occur in combination with 
 the displacement in other directions.
 
 CHAPTER V 
 
 Spinal Analysis 
 
 Ha\ing studied the various forms of subluxations, it now 
 becomes necessary to consider the various methods which 
 are used for the detection and determination of these 
 displacements. 
 
 For the purpose of making a correct spinal analysis it is 
 necessary, first of all to become familiar with the signs of 
 vertebral subluxations. These signs and symptoms are in- 
 variably present wherever a subluxation exists. After having 
 determined that a subluxation is present in a certain spinal 
 segment, it next becomes necessary to use those methods 
 which will show what the exact nature of the displacement 
 is. It is only through such a knowledge that we are enabled 
 to apply the proper thrust for the reduction of subluxation. 
 
 Under the chapter on spinal symptomatology the signs 
 of vertebral subluxations were described, and the manner 
 of eliciting these signs will be considered in this place. 
 
 Signs of Vertebral Subluxations 
 
 The symptoms and signs pointing to the existence of a 
 displacement of a vertebra are the following: 
 
 1. Pain. 
 
 2. Tenderness of the nerves. 
 
 3. Thickened nerve-trunks. 
 
 4. Variation in temperature. 
 
 5. Disturbed function. 
 
 6. Contracted ligaments. 
 
 7. Diminished mobility of the back. 
 
 8. Changes in the anatomical structures connected with 
 the spine. 
 
 9. Mal-alignment of the spinous processes. 
 10. Mal-alignment of the transverse processes. 
 
 279
 
 280 SPINAL ADJUSTMENT 
 
 These symptoms and signs are at times difficult to deter- 
 mine, owing to the excessive muscular development of some 
 patients, and the amount of adipose tissue which intervenes 
 between the bones of the spinal column and the integument. 
 Usually, however, these disadvantages are not- sufficiently 
 marked to entirely prevent the making of a correct spinal 
 analysis. 
 
 Pain. — This is an unfailing symptom of subluxation, and 
 points undeniably to some lesion of a nerve. The pain is not 
 located at the point of the subluxation, but is referred to the 
 peripheral distribution of the nerve which takes its origin 
 in the spinal segment which is involved by the subluxation. 
 Pain, being a subjective symptom, its presence can only be 
 determined by questioning the patient. After the location 
 of the pain has been ascertained the segment controlling 
 that part of the body is examined, and invariably a subluxation 
 of the vertebra in that segment will be found. 
 
 Tenderness of the Nerves. — When a subluxation exists 
 between two vertebrae, there will be a hypersensitive area 
 found in the corresponding spinal segment, which is produced 
 by the impingement of the spinal nerve. By palpating along 
 the laminae this tenderness of the nerve is readily elicited, 
 and the patient complains of pain. On finding the point of 
 greatest tenderness, the end of the index finger should be 
 pressed down between the transverse processes, as this will 
 bring it into contact with the posterior primary division of 
 the spinal nerve, as it passes backward, and before it gives 
 ofif its internal and external branches. 
 
 Thickened Nerve-trunks. — The sheath which contains the 
 spinal nerve and the blood-vessels is usually found to be 
 thickened and congested as a result of impingement. This 
 thickening of the nerve sheath is readily determined by 
 passing the index finger downward along the laminae, when 
 the nerve will be felt to roll beneath the finger. At all places 
 where such a condition of the nerve sheaths obtains, a sub- 
 luxation will be found. At times it is rather difficult to pal- 
 pate the nerve, especially if the overlying muscles are large 
 or if there is present a marked contraction of the spinal liga- 
 ments. Ordinarily, however, the thickened nerve may be 
 palpated by pressing aside the muscles and ligaments. When
 
 SPINAL ANALYSIS 281 
 
 in addition tenderness is found, it may be assumed that the 
 cord which rolls beneath the fingers is the nerve. 
 
 Variations in Temperature. — In the chapter on spinal 
 symptomatology we saw that whenever a subluxation is 
 present in a certain spinal segment, the cutaneous surface 
 over that segment will be found to be of a higher temperature 
 than that over the segments above and below it. 
 
 Whenever a spinal nerve is irritated the temperature of 
 the spinal segment which it controls is increased. This is 
 a positive indication that a subluxation exists at that point. 
 
 The temperature of the different sections of the back is 
 determined by gently placing the palmar surface of the hand 
 over the spine, commencing in the upper thoracic region, and 
 passing down the entire length of the vertel^ral column. 
 Should there be an acute subluxation of a serious nature, 
 the spine will be hotter at that point ; if the subluxation is 
 a chronic one, the spine will be cooler at that point. When 
 a considerable area of the spine is involved in the abnormal 
 condition, the spine will be found hot to the touch through- 
 out its entire extent. Testing the temperature thus becomes 
 a valuable means of locating an acute subluxation. This 
 method of locating a subluxation is also known as the "Heat 
 Test." 
 
 Disturbed Function.^ — One of the most positive symptoms 
 or signs of vertebral subluxation is deranged function of a 
 certain part, organ, or system of the body. This is true for 
 the reason that the functional activity and organic integrity 
 of every part of the body are dependent upon proper inner- 
 vation of that part. If, therefore, abnormal functioning is 
 present in any portion of the body, it is an indication that 
 there exists at some point interference with the conduction 
 of the nerve-impulses essential to proper and uninterrupted 
 activity of such a part. The place at which this interference 
 occurs is at the intervertebral foramen where the nerve 
 passes between movable vertebrae. If symptoms referable 
 to a certain organ of the body are present, and the spinal 
 segments from which this organ receives its innervation are 
 then examined, it will always be noted that a subluxation of 
 the vertebrae in this section is present. 
 
 Deranged function thus is a positive sign of subluxation
 
 282 SPINAL ADJUSTMENT 
 
 of a certain vertebra when a certain organ is affected. It 
 thus becomes just as possible to say with certainty that a 
 subluxation will be found at a certain segment of the spine 
 when it is known that a certain organ is affected, as it is to 
 state that a certain organ is affected when a subluxation is 
 found in the segment which controls that organ. 
 
 Contracted Ligaments. — As has been previously explained, 
 no abnormal condition exists in the body for any length of 
 time without the production of rigidity of the muscles in the 
 vicinity of the lesion. So also, in the case of vertebral sub- 
 luxations there is always found a contraction of the muscles 
 and ligaments in the vicinity of the subluxated vertebrae. 
 This contraction is sometimes due to the subluxation when 
 the latter is produced by external influences ; on the other 
 hand, it may itself be the producing cause of the subluxation, 
 as where displacements are produced refiexly. In any event, 
 contraction of the ligaments in a certain spinal segment is a 
 positive sign of the existence in that segment of a subluxation. 
 If the muscles are hard and indurated, showing that they 
 have been contracted for a prolonged period, it is an indi- 
 cation that the subluxation has existed for a long time ; in 
 other words is chronic. If, however, the ligaments are merely 
 contracted, it shows that the subluxation is more recent, and, 
 therefore, acute. 
 
 Ligamentous and muscular contractions are detected by 
 palpating the spine, by passing the fingers along the laminae. 
 
 If the muscular and ligamentous contraction is only on 
 one side it will indicate that the vertebra is probably dis- 
 placed toward that side. If the contraction exists on both 
 sides of a vertebra, it is a sign that the vertebra is not dis- 
 placed toward one side more than another. In this way 
 contractures of the ligaments not only are a sign of a sub- 
 luxation, but also assist in the determination of the nature 
 of the vertebral displacement. 
 
 That contracted ligaments are a sign of subluxations and 
 also a cause, is proven by the fact that as soon as a dis- 
 placement of a vertebra is adjusted the contraction of the 
 ligament disappears. In fact, it is by relieving the contrac- 
 tion of the ligaments, in most cases, that we reduce the sub- 
 luxation when the thrust is applied. It can be safely assumed
 
 SPINAL ANALYSIS 283 
 
 that the majority of subluxations are either partly or entirely 
 dependent for their existence upon contraction of the liga- 
 ments which normally hold the vertebrae in their proper 
 position. It is this contraction which draws the vertebra out 
 of alignment, and then makes the condition permanent be- 
 cause of the continuous contraction or because the ligament 
 has been drawn beyond the limit of its elasticity and is unable 
 to return to its original state. As a result of this contracted 
 condition the vertebra remains in its abnormal position until 
 the displacement is mechanically corrected. 
 
 Diminished Mobility of the Spine. — When a joint in any 
 part of the body is diseased, rigidity of the surrounding mus- 
 cles, and immobility are invariably present. This is true also 
 of the spinal column, and diminished mobility of the spine 
 therefore, is one of the most certain and constant symptoms 
 of a subluxation of a vertebra or group of vertebrae. 
 
 Various tests are used to determine subluxation of cer- 
 tain portions of the vertebral column by the degree of motion 
 possible in them. The signs of subluxation in different regions 
 of the spine are as follows : 
 
 Subluxation of the Atlas is indicated by inability to 
 execute the nodding movement of the head freely and 
 painlessly. 
 
 Subluxation of the Axis is shown by inability to turn the 
 face easily from one side to the other. 
 
 Subluxation of the other cervical vertebrae is determined 
 by inability to flex the head freely and painlessly. 
 
 Subluxation of the thoracic vertebrae is indicated by in- 
 creased prominence of one side of the trunk, diminished flexi- 
 bility of a portion of the spine, or a deviation of the vertebral 
 column toward one side, when the patient is instructed to 
 bend the body forward, and then backward. These signs 
 point to contraction of the ligaments and diminished mobility 
 of the vertebral column, which are signs of subluxation. Should 
 ankylosis of the bodies of the vertebrae be present, there will 
 exist a space involving two or more vertebrae, where the 
 spinous processes do not separate, with the production of a 
 sharp angle in the spine at the point where the ankylosis dis- 
 continues, in flexion and extension movements alike. To test 
 still further for ankylosis, especially in the lower dorsal and
 
 284 SPINAL ADJUSTMENT 
 
 upper lumbar regions, the patient should flex sideways, then 
 rotate the body from side to side and backwards. This test is 
 positive, since the nature of the joints of the vertebral column 
 should admit of a certain degree of movement in any direction 
 in each joint, that is to the extent permitted by conformation 
 of the bones and the limitations of muscular and ligamentous 
 tension. A further test for ankylosis in the lower dorsal and 
 lumbar regions is the following: Place the patient in the 
 prone position ; with the right hand of the operator placed 
 under the anterior superior portion of the ilium of the opposite 
 side to that on which he stands, and the heel of the left hand 
 against the spinous processes nearest him, he draws the ilium 
 towards himself and at the same time pushes the spinous 
 processes in the opposite direction ; if the vertebrae do not 
 move laterally, it is a sign that lateral ankylosis is present. 
 To determine ankylosis of the bodies of the vertebrae the left 
 hand is placed on the tips of the spinous processes and pres- 
 sure applied, while traction is made upon the pelvis with the 
 right hand ; if then the vertebrae fail to move, it indicates 
 ankylosis of the bodies of the vertebrae. To determine the 
 presence of ankylosis of the spinous processes, articular proc- 
 esses, or laminae the patient is instructed to bend forward 
 while the operator places his hand on the spinous processes ; 
 if the spines fail to separate, ankylosis of the spinous processes 
 is present. 
 
 Subluxation of the lumbar vertebrae is detected in the same 
 manner as that of the dorsal region. 
 
 Changes in the Anatomical Structures Connected with the 
 Spine. — Changes in the height and prominence of the scapulae, 
 the prominence of the angles of the ribs, and the prominence 
 of the iliac crests are signs of vertebral subluxation. 
 
 To ascertain any undue unilateral prominence of the angles 
 of the ribs the patient is placed in the Adams position, namely, 
 standing with the heels together, and the body bending 
 forward until the head and trunk are horizontal, and with 
 the arms hanging. The angles of the ribs are then left 
 uncovered by the scapulae and any prominence on either 
 side may be readily noted. Such unilateral prominence of 
 the angles of the ribs indicates a rotation of the vertebrae on 
 their axes.
 
 SPINAL ANALYSIS 285 
 
 Dififerences in the height of the scapulae or iliac crests arc 
 noted by having the patient in the erect posture either sitting 
 or standing, with the arms hanging at his sides. Such dififer- 
 ences, when present, indicate scoliosis. 
 
 Mal-Alignment of the Spinous Processes. — The position of 
 the spinous processes is a valuable sign of a subluxation. 
 This is especially true in the cervical and lumbar region. In 
 the thoracic region, however, the spinous processes may pro- 
 ject from the union of the laminae at an abnormal angle. Pal- 
 pation of the tips of the si)inous processes may in such cases 
 become misleading, and in any case is not to be entirely de- 
 pended upon; confirmatory evidence must be obtained in all 
 instances by palpation of the transverse processes. If it can 
 l>e definitely ascertained that the spinous process of a certain 
 vertebra is really out of alignment, then it becomes positive 
 evidence that the vertebra of which it is a part is moved in 
 its entirety, for one part of a vertebra can not be moved inde- 
 pendently of its other portions. 
 
 Mal-Alignment of the Transverse Processes. — The position 
 of the transverse processes is a more positive indication of the 
 presence and nature of a vertebral subluxation in any region 
 of the spine than is that of the spinous processes. Palpation 
 of the transverse processes is sometimes difficult in subjects 
 who are very muscular or adipose, but after some experience 
 in palpation this difficulty is overcome, and palpation of the 
 transverse processes is readily performed. 
 
 Method of Palpation of the Spinous Processes. — In pal- 
 pating the tips of the spinous processes one may commence 
 either in the lumbar region and pass upward, or begin with 
 the first thoracic vertebra and pass downward. Some prefer 
 the former method, while others follow the latter procedure. 
 There is no apparent advantage in either method, and it is 
 largely a question of habit. Some find it easier to keep in 
 mind the exact vertebra palpated by counting from below up- 
 ward, while others find the downward palpation and counting 
 more easy. 
 
 In palpating the spinous processes each one should be 
 felt and the exact point of position of its tip marked on the 
 skin overlying it. 
 
 The spine as a whole is then inspected with a view to
 
 286 
 
 SPINAL ADJUSTMENT 
 
 Fig. 51. 
 Palpation of Transvej'se Processes.
 
 SPINAL ANALYSIS 287 
 
 determining the correctness of the findings on palpation, since 
 inspection of the tips of the spines is often a more certain and 
 accurate method than is palpation. 
 
 Method of Palpation of the Transverse Processes. — As 
 mentioned above, excessive adiposity or great muscular de- 
 velopment sometimes prevent the satisfactory palpation of 
 the transverse processes. In such an event we must rely 
 upon the palpation of the spinous processes and the finding of 
 contracted ligaments on one side of the affected segment, and 
 also tenderness of the nerve on that side. 
 
 In palpating the transverse processes some authors ad- 
 vise the use of the tips of the first three fingers of each hand; 
 one finger being placed on a transverse process in such a man- 
 ner as to enable the palpator to make comparison between 
 three vertebrae. This method has its advantages in that the 
 operator is enabled by this means to quickly make a diagnosis 
 of the position of a vertebra with reference to that of the 
 vertebrae above and below it. 
 
 It however requires much experience to become proficient 
 in this method of palpation of the transverse processes. This 
 is true for the reason that the ability to distinguish between 
 the three distinct sensations of the three fingers used is 
 acquired only after much practise by all operators, while some 
 are never able to master it. The sensation is always more 
 acute in one finger and palpation of a single vertebra at a 
 time is therefore to be preferred. This is true especially in 
 those who are learning spinal analysis, and in whose finger 
 tips the sense of touch is not highly developed. 
 
 In our opinion, therefore, palpation of the transverse proc- 
 esses is best performed by using that finger in which the 
 sense of touch is most highly developed, which varies in differ- 
 ent individuals. In this way the transverse process of a ver- 
 tebra can be palpated on each side and comparison then made 
 with the ones above and below it. There is no special ad- 
 vantage to be derived in feeling the transverse processes of 
 three vertebrae simultaneously. The index finger may, for 
 example, be placed on the skin in such a manner that it can be 
 made to glide over the transverse processes of three vertebrae 
 in one movement by simply moving the skin along over the 
 vertebrae. In this way diflferences in the position of the
 
 288 
 
 SPINAL ADJUSTMENT 
 
 F;g. 52. 
 The Adams Position.
 
 SPINAL ANALYSIS 289 
 
 transverse processes of any of these three vertebrae will be 
 readily noted. 
 
 Position of the Patient 
 
 In making examinations of the spine a certain definite 
 procedure should be followed. The first essential to a 
 thorough and complete examination of the spine is the proper 
 position of the patient. Some displacements of the vertebrae 
 are more recognizable in one position than another, and it 
 therefore becomes necessary to place the patient in various 
 positions in order that nothing may escape the attention of 
 the examiner. 
 
 For the purpose of making a spinal analysis the following 
 positions are the most useful : 
 
 The Erect position. 
 The Prone position. 
 The Dorsal position. 
 The Adams position. 
 
 The Adams Position. — In this position the patient stands 
 with his heels together and bends forward without flexing the 
 knees until the trunk is in a horizontal position, with the arms 
 hanging. 
 
 With the patient in this attitude we note the position of the 
 spinous processes, and observe any that may be out of align- 
 ment. Further, we note any diminution of mobility in any 
 section or segment of the spine. If a certain section of the 
 spine shows diminished elasticity, it is an indication of the 
 presence of ankylosis; there will exist a space involving two 
 or more vertebrae where the spinous processes do not sepa- 
 rate, and there is evident a more or less sharp angle at the 
 point where the ankylosis discontinues, wdiich will also be 
 true when the patient bends the trunk backward. To test 
 still further for ankylosis, especially in the lower dorsal and 
 upper lumbar regions, have the patient flex the trunk side- 
 ways, then rotate from side to side. This test is positive as 
 the nature of the joints of the spinal column is such that they 
 should permit of a certain degree of motion in any direction, 
 in each joint, to the extent of the limitation due to contact of 
 the bones and muscular and ligamentous tension. Diminished
 
 290 
 
 SPINAL ADJUSTxMENT 
 
 Fig. 53. 
 
 The Erect Position.
 
 SPINAL ANALYSIS 291 
 
 mobility of a certain segment of the spine indicates contrac- 
 tion of the ligaments of that particular segment. When the 
 spine does not become flexed in a perfectly straight Hne, it 
 indicates a contracted condition of the muscles and ligaments 
 on the side toward which the deviation occurs. Lastly this 
 position will reveal any unilateral prominence of the angles 
 of the ribs which is present when the vertebrae are rotated. 
 
 • The Prone Position. — In this position the patient lies face 
 down on a flat table. While in this position we note the posi- 
 tion of the spinous and transverse processes. The temperature 
 variations which are present are also noted with the patient 
 in the prone position. Tenderness of the nerves, thickening 
 of the nerve-trunks, and contractures of the ligaments of the 
 spine are also palpated. This is the position which we have 
 the patient assume for the purpose of palpation of the spine 
 and parts associated therewith. 
 
 Further, a test for ankylosis is made with the patient in 
 the prone position. Place the right hand under the anterior 
 superior portion of the ilium of the side opposite to that on 
 which the examiner stands. The operator then draws the 
 pelvis upward and presses the spinous processes in the op- 
 posite direction ; this will determine the presence or absence 
 of ankylosis of the articular processes. To ascertain the 
 presence of ankylosis of the bodies of the vertebrae place the 
 left hand on the tips of the spinous processes and press down- 
 ward, at the same time raising the pelvis with the right hand. 
 
 The Dorsal Position. — In this position the patient lies on 
 a flat table on his back. This is the only position in which the 
 cervical vertebrae may be palpated. By flexing the neck and 
 supporting the head with the hands the spinous processes can 
 be easily palpated, and any changes from the normal in their 
 position noted. The transverse processes are next palpated 
 with the index and middle finger. 
 
 The Erect Position. — The patient may either be seated 
 upon a chair, or stand erect with his heels together and his 
 hands hanging at his side. (Fig. 53.)* The following observa- 
 tions are made with the patient in this position : The position 
 of the spinous processes is first noted. The curvatures of the 
 spine are also noted with the patient in this position, and 
 viewed from the side. The angles of the ribs are observed,
 
 292 
 
 SPINAL ADJUSTMENT 
 
 Fig. 54. 
 
 Spinal Adjustment Table.
 
 SPINAL ANALYSIS 293 
 
 and any prominence of a certain rib due to a rotation of the 
 vertebra with which it is connected noted with the patient 
 erect. The comparative height and prominence of the scap- 
 ulae is seen. The pelvic inclination and the comparative 
 height of the iliac crests is noted with the patient in this 
 posture. 
 
 The Diagnosis of Subluxations 
 
 In addition to the symptoms and signs of subluxations 
 which are subjective, and have already been described, three 
 other methods are used for the determination of the exact 
 nature of the subluxation. By the methods thus far con- 
 sidered we are enabled to say positively that a displacement 
 of a vertebra is present ; the direction of this displacement can, 
 however, only be determined by the following methods : 
 
 Inspection. 
 Palpation. 
 The X-ray. 
 
 Inspection. — By inspection we note the following points: 
 
 1. Alal-alignment of the spinous processes. 
 
 Lateral deviation of a spinous process indicates a lateral 
 or rotary subluxation, and is noted by yiewing the patient 
 from behind in the erect position, or looking at the spine with 
 the patient in the prone position. If a group of vertebrae 
 are thus affected it indicates scoliosis. 
 
 Approximation of a spinous process with the one below 
 it indicates a compression subluxation, or a supero-inferior 
 subluxation. 
 
 Backward deviation of a spinous process denotes a pos- 
 terior subluxation. If a group of vertebrae are thus affected, 
 it indicates kyphosis. 
 
 Forward displacement of a spinous process is a sign of an 
 anterior subluxation. If there is a forward deviation of a 
 group of vertebrae it means lordosis. 
 
 2. Diminished mobility of the back. 
 
 3. Undue prominence of the angle of a rib or number of 
 the ribs. 
 
 If this prominence is bilateral it denotes a posterior sub- 
 luxation or kyphosis.
 
 294 
 
 SPINAL ADJUSTMENT 
 
 Fig. 55. 
 
 Spinal Adjnstiuoiit Table.
 
 SPINAL ANALYSIS 295 
 
 When it is unilateral it indicates a rotary subluxation or 
 scoliosis. 
 
 4. Tilting of the pelvis. 
 
 The pelvis is lower on the side toward which a scoliosis is 
 directed. 
 
 Palpation. — By palpation we note the following: ' 
 
 1. Local zone of increased temperature, which points to 
 the existence of a subluxation at that point, but does not give 
 any clew as to the nature of the displacement. 
 
 2. Contraction of the spinal muscles and ligaments. 
 
 If this is unilateral, it denotes a deviation of the vertebra 
 toward that side on which the contraction exists. There may 
 thus be a lateral, rotary, supero-inferior, or scoliotic sub- 
 luxation in such a case. 
 
 If the ligamentous contraction is bilateral, it indicates 
 either a posterior, anterior, kyphotic, or lordotic subluxation. 
 
 3. Tenderness on palpation of a nerve indicates a sub- 
 luxation at the spinal segment from which that nerve arises, 
 but afifords no information regarding the nature of the ver- 
 tebral displacement. 
 
 4. Thickening of the nerve-trunk, as felt on palpation, is 
 also conclusive evidence of a subluxation at that segment, 
 but is of no value in determining the direction of the dis- 
 placement of the vertebra. 
 
 5. Mal-alignment of the Spinous and Transverse Processes. 
 — Palpation of the individual vertebrae is the most important 
 method of determining the presence of a subluxation and its 
 character. 
 
 Various methods have been devised for palpating the 
 spinous and transverse processes, none of which is perfect 
 in itself, for the reason that a method which suits one palpator 
 will be impossible of use by another. In the author's opinion 
 no set rule should be laid down for the method of palpating 
 the vertebrae, but this should be left to the individual prefer- 
 ence of the operator. We prefer the use of only one finger 
 in palpation of the spine, since the sense of touch is more 
 acute in one finger than when two or three fingers are em- 
 ployed at the same time. 
 
 The position of the patient is important. For palpation 
 of the thoracic and lumbar vertebrae he should lie prone upon
 
 296 
 
 SPINAL ADJUSTMENT 
 
 Fig. 56. 
 Prone Position — Palpation of Spinous Processes.
 
 SPINAL ANALYSIS 297 
 
 an adjustment table, the front section of which is slightly 
 lowered. The portion of the table which supports the chest 
 should be narrower than other parts of the table in order to 
 permit the arms to hang vertically. The table should afford 
 perfect comfort to the patient so that complete relaxation 
 obtains. In palpating the cervical vertebrae the patient 
 should be in the dorsal position, with the neck slightly flexed. 
 (Figs. 54 and 55.) 
 
 In palpating the spinous processes the balls of the first 
 three fingers may be used. The ends of the fingers are placed 
 directly upon the tips of three spinous processes, and their 
 relative position then carefully noted. (Fig. 56.) The same 
 findings enumerated under the heading of inspection of the 
 spinous processes apply here, and repetition is unnecessary. 
 In any event palpation of the spinous processes is of far less 
 importance than that of the transverse processes, for the rea- 
 son that there is often a deviation in the direction of projection 
 of the spinous processes, as our dissections of spines frequently 
 demonstrate. Were the position of the tip of the spinous 
 process, therefore, to be taken as the sole guide in the diag- 
 nosis of the nature of a subluxation many erroneous con- 
 clusions would constantly be drawn therefrom. In dissection 
 of the human body we have found many times that what ap- 
 peared upon the surface to be a subluxation, judged by the 
 position of the tip of the spinous process, was afterward 
 found to be simply a distorted spinous process ; either it was 
 twisted, or it had grown in an abnormal direction. Such 
 evidence as is obtained by palpation of the spinous processes 
 is therefore not to be relied upon, but in every instance con- 
 firmatory evidence must be sought for by a careful palpation 
 of the transverse processes. 
 
 In palpating the transverse processes the palmar surface 
 of the index-finger should be used. (Fig. 57.) The use of the 
 three first fingers in palpation is confusing, especially to the 
 novice, and in fact requires long experience to educate the 
 sense of touch in the three fingers to such a degree as to 
 make it possible for one to interpret the three sensations 
 simultaneously. The palmar surface of the index finger 
 should be placed firmly on the transverse processes on either 
 side of the spinous processes. The fingers should then be
 
 298 
 
 SPINAL ADJUSTMENT 
 
 Fig. 57. 
 Palpation- of Transverse Processes.
 
 SPINAL ANALYSIS 299 
 
 made to glide over three transverse processes in one move- 
 ment, moving the skin along beneath them. In this way the 
 position of three transverse processes is determined with 
 reference to each other. Individual palpation of each trans- 
 verse process may then follow, and the position of the trans- 
 verse process on each side of the vertebra which is displaced 
 should be determined for the purpose of ascertaining the exact 
 nature of the subluxation. The following are the conclusions 
 to be drawn from the position of the transverse processes : 
 
 When the transverse processes of a vertebra are displaced 
 backward equally on each side, it indicates that the vertebra 
 is displaced backward as a whole, and denotes a posterior 
 subluxation. 
 
 If the transverse processes of a vertebra are displaced for- 
 ward to an equal extent on each side, it indicates an anterior 
 subluxation. 
 
 When the transverse processes project laterally, as shown 
 in the cervical region by palpating their extremities, and in 
 the thoracic region by noting that the transverse process on 
 one side is drawn toward the line of the spinous processes 
 while the one on the other side is drawn away from this line, 
 a lateral subluxation is present. In this case the transverse 
 process on either side does not project backward, but both 
 are perfectly level. 
 
 If the transverse process on one side of a vertebra is dis- 
 placed forward, while that on the other side is backward, it 
 shows that the vertebra is turned on its axis, and a rotary 
 subluxation is present. 
 
 When the transverse processes of a vertebra are nearer 
 the vertebra below than the vertebra above, it indicates that 
 the upper vertebra is approximated to the one below it, and 
 that the disc between them is thinned. This condition is 
 known as a compression subluxation. 
 
 If the transverse process of one side of a vertebra is 
 nearer than normal to the corresponding transverse process of 
 the vertebra below, a compression of that side of the inter- 
 vertebral disc is present. The vertebra in such instances is 
 nearer the vertebra on that side, while on the other side the 
 distance between the two vertebrae is increased. This is 
 known as a supero-inferior subluxation.
 
 300 SPINAL ADJUSTMENT 
 
 When the transverse processes of a group of vertebrae are 
 displaced backward and are close to each other, a kyphosis is 
 present. 
 
 When the transverse processes of a group of vertebrae are 
 displaced forward a lordotic subluxation is indicated. 
 
 When the transverse processes are displaced toward the 
 side, a scoliosis is indicated. A rotary subluxation is fre- 
 quently associated with scoliosis, in which case there will be 
 a backward displacement of the transverse process on one 
 side. 
 
 Diagnostic Signs of Each Form of Subluxation, 
 
 Posterior Subluxation. — The spinous process is displaced 
 backward. 
 
 The transverse processes are displaced backward to the 
 same extent on each side. 
 
 The ligaments on both sides are contracted. 
 
 The nerve-trunks on each side are thickened. 
 
 There is tenderness of the nerves on pressure, unless the 
 subluxation is chronic. 
 
 There may be a local zone of increased temperature, 
 especially if the subluxation is acute. 
 
 Disease in a certain organ, system, or part of the body. 
 
 The angles of the ribs will be prominent in the thoracic 
 region. 
 
 Anterior Subluxation. — The spinous process is displaced 
 forward. 
 
 The transverse processes are displaced forward equally on 
 each side. 
 
 The ligaments on both sides are contracted. 
 
 The nerve-trunks on each side are thickened. 
 
 There is tenderness of the nerves on each side, unless the 
 subluxation is chronic. 
 
 There may be a local zone of increased temperature.' 
 
 Disease in some organ, part, or system of the body. 
 
 Compression Subluxation. — The spinous processes of two 
 vertebrae are approximated, that of the subluxated vertebra 
 downward upon the vertebra below. 
 
 The transverse processes on both sides of two vertebrae 
 are approximated.
 
 SPINAL ANALYSIS 301 
 
 The ligaments on both sides are contracted. 
 
 The nerve-trunks on each side are thickened.' 
 
 There is tenderness of the nerves on each side unless the 
 subluxation is chronic. 
 
 The temperature of the corresponding part of the back 
 may be increased. 
 
 Disease in a certain part of the body. 
 
 Supero-Inferior Subluxation. — The spinous process is 
 displaced toward the side away from the side compressed. 
 
 The transverse process is displaced downward on the 
 compressed side, while that of the other side is raised. 
 
 The ligaments on the side which is displaced downward 
 are contracted. 
 
 The nerve-trunks on the compressed side are thickened. 
 
 There is tenderness of the nerve on the side which is com- 
 pressed. 
 
 The temperature of the zone supplied by the impinged 
 nerve is increased. 
 
 Disease in a certain portion of the body. 
 
 Lateral Subluxation. — The spinous process is displaced to 
 one side. 
 
 The transverse process projects laterally in the cervical 
 region, and in the thoracic region the transverse process on 
 one side is drawn away from the line of the spinous processes, 
 while on the other side it approaches this line. 
 
 The ligaments on the side toward which the vertebra is 
 displaced are contracted. 
 
 The nerve-trunks on the side toward which the vertebra is 
 displaced are thickened. 
 
 There is tenderness on the side toward which the vertebra 
 is displaced. 
 
 There is a zone of increased temperature corresponding to 
 the segment supplied by the impinged nerve. 
 
 Disease in a certain portion of the body. 
 
 Rotary Subluxation. — The spinous process is displaced 
 slightly to one side. 
 
 The transverse process of one side is forward, while on 
 the side on which the subluxation exists it is backwardly dis- 
 placed. 
 
 The ligaments on the subluxated side are contracted.
 
 302 SPINAL ADJUSTMENT 
 
 The nerve-trunks on the subluxated side are thickened. 
 
 There is tenderness on the subluxated side. 
 
 The temperature of the corresponding segment of the back 
 is increased. 
 
 The angle of the corresponding rib is displaced backward. 
 
 Disease in the parts supplied by the impinged nerve, de- 
 pending on the location of the subluxation. 
 
 Kyphotic Subluxation. — The spinous processes are dis- 
 placed and the distance between them increased. 
 
 The transverse processes are displaced posteriorly and 
 separated. 
 
 The ligaments of the corresponding part of the vertebral 
 column are contracted. 
 
 The nerve-trunks are thickened. 
 
 There is tenderness. 
 
 The temperature of the part of the back affected is in- 
 creased. 
 
 The angles of the ribs are prominent on both sides. 
 
 Mobility of the aft'ected portion of the back is diminished 
 or absent. 
 
 Lordotic Subluxation. — The spinous processes are dis- 
 placed anteriorly and set close to each other. 
 
 The transverse processes on both sides are displaced for- 
 ward and approximated. 
 
 The ligaments are contracted on both sides. 
 
 The nerve-trunks are thickened. 
 
 Tenderness is present, unless the subluxation is chronic 
 and the nerve is compressed. 
 
 The temperature of the corresponding portion of the back 
 is increased. 
 
 Mobility of the affected part of the vertebral column is 
 diminished or absent. 
 
 The pelvic inclination is increased. 
 
 Scoliotic Subluxation. — The spinous processes are dis- 
 placed laterally. 
 
 The transverse processes are displaced to the side, and 
 rotation of the vertebrae is frequently present. 
 
 The ligaments on the impinged side are contracted and 
 indurated. 
 
 The nerve-trunks on the subluxated side are thickened.
 
 SPINAL ANALYSIS 303 
 
 Tenderness is present unless the condition is chronic. 
 
 The temperature of the affected portion of the back is 
 increased. 
 
 The angles of the ribs on the side toward which the lateral 
 curvature is directed are prominent. 
 
 The pelvis is tilted up on the side toward which the 
 curvature is directed and down on the other side. 
 
 The scapulae are affected in the same manner as the pelvis, 
 namely that on the side toward which the scoliosis is directed 
 they are raised, while the other is lowered. 
 
 Palpation of Various Vertebrae 
 
 Palpation of the Atlas. — The first vertel)ra to be considered 
 is the atlas and its articulation with the occipital bone. Sub- 
 luxation of this joint is very common, and at the same time 
 of much importance by reason of its close proximity to the 
 base of the nerve supply since the slightest displacement at 
 this joint produces a disturbance in the innervation of the 
 brain substance itself. 
 
 The condyles of the occipital bone are kidney-shaped, and 
 convex antero-posteriorly, their posterior edge extending to 
 about the middle of the foramen magnum and following the 
 margin of the foramen for about one-sixth of its circumfer- 
 ence, thus forming practically a centre of gravity on which 
 to support the head. The articular surfaces on the lateral 
 masses of the atlas are concave in the same direction that the 
 condyles are convex, thus forming a U-shaped articulation 
 from before backward, and constituting a perfect hinge-joint. 
 Laterally, however, there is but limited motion. The same 
 restrictions apply to rotation, yet there is sufificient motion 
 possible to permit the occurrence of all the primary forms of 
 subluxation. 
 
 The anterior, posterior, and lateral ligaments are mainly 
 depended upon for the maintenance of the approximation of 
 the surfaces of the bones forming this articulation, as the 
 capsular ligaments are very loose. An anterior displacement 
 of the occiput will be shown by a forward position of the 
 chin. The production of this form of displacement is favored 
 by irritation of the nerves which supply the sterno-mastoid 
 and trapezius muscles, contraction of these muscles following.
 
 304 SPINAL ADJUSTMENT 
 
 There are also cases in which the jugular processes of the 
 occipital bone and the mastoid processes of the temporal bone 
 are ankylosed. Sometimes the atlas is ankylosed to the 
 occiput, either entirely or in part, as a result of a destruction 
 of the joint or to a faulty development of the atlas ; in the 
 latter instance the condition is congenital and cannot be cor- 
 rected. Such conditions are to be suspected when the subject 
 is unable to execute the nodding movements of the head and 
 making lateral movements. Abnormalities of this kind should 
 only be adjusted after a very careful examination has been 
 made, as should the ankylosis involve the entire margin of the 
 foramen and the anterior, posterior and lateral ligaments, we 
 would question the advisability of breaking this union, be- 
 cause the most vital part of the spinal cord is encircled by 
 this articulation. It must always be borne in mind that the 
 ligaments of a joint are the real means of restraint of its 
 movements, and it can therefore readily be seen what would 
 occur in such a case as the above were the ligaments broken. 
 The integrity of the joint would then depend upon the con- 
 traction of the muscles involved in the movements of the 
 joint; in this case a complete dislocation would likely develop 
 with compression of the medulla. Any form of subluxation 
 of this joint will disturb the circulation and irritate the nerves 
 of the brain and scalp. 
 
 The diagnosis of subluxation of the occipito-atlantal articu- 
 lation is fortunately quite easy, as the body of the atlas is 
 represented by the lateral masses, which set practically to the 
 edge of the transverse processes of the other cervical ver- 
 tebrae; since they are also placed just below the mastoid 
 processes, the latter are taken as a guide to the detection and 
 determination of subluxations of the atlas. Normally, both 
 transverse processes should be equi-distant from the adjacent 
 mastoid process. If one side presents a greater depression 
 between the transverse process and the corresponding mastoid 
 process than the other, a subluxation should be suspected. It 
 is, however, not uncommon for one transverse process to be 
 more fully developed than the other ; hence to avoid 
 mistaking an overgrowth of bone for a subluxation, 
 further comparisons must be made. Note whether or 
 not the posterior tubercle of the atlas corresponds to the
 
 SPINAL ANALYSIS 305, 
 
 center of the occiput; then follow the posterior arch of the 
 atlas around to the front and ascertain if they correspond in 
 prominence laterally and posteriorly to the corresponding 
 surfaces of the occiput, bearing in mind the different forms 
 of subluxations possible. Attention must also be given the 
 fact that any turn of the head, if the articulation is normal, 
 will change the relation of the transverse processes to the 
 various points of comparison. If, further, the extreme move- 
 ments of the joint can be executed without any sense of pain 
 or discomfort, no subluxation exists. The muscles and liga- 
 ments immediately adjacent to the joint on the side on which 
 the nerve is impinged are contracted. By pressing the index 
 fingers up close to the occiput the subject will experience 
 considerable tenderness. This tenderness is similar to that 
 produced when the posterior branch of the spinal nerve is 
 pressed upon in other regions of the spine. The recurrent 
 branch to the meninges and the body of the vertebra arises 
 by two roots, one from the spinal and the other from the 
 sympathetic ganglion. The operator's fingers do not come 
 into direct contact with this nerve as it is usually well pro- 
 tected by the jaw and the mastoid process ; it is the posterior 
 muscular nerve which branches from the same nerve that im- 
 parts the sensation. Pressure upon this nerve produces vaso- 
 motor disturbances within the cord as well as in the meninges 
 and bone. 
 
 In an occipito-atlantal subluxation the superior cervical 
 ganglion is compressed by the transverse process and vaso- 
 motor changes in the vessels of the brain, eyes, and meninges 
 result. Anemia or hyperemia of the brain will follow. 
 
 In a posterior displacement of the occiput on the atlas the 
 same general rules must be followed, in fact this must be done 
 in all cases regardless of the location of the displacement. 
 The main points of comparison are the transverse processes 
 of the atlas with the mastoid processes, and the posterior 
 tubercle of the atlas with the external occipital protuberance. 
 
 In making an examination for an occipital displacement 
 the relation of the atlas to the axis must also be determined, 
 as in such a subluxation there will be some displacement of 
 the suspensory and check ligaments which connect the axis 
 with the occiput. There will also be present the same con-
 
 306 
 
 SPINAL ADJUSTMENT 
 
 Fig. 58. 
 Palpation of Cervical Vertebrae.
 
 SPINAL ANALYSIS 307 
 
 traction of the ligaments which unite the atlas and the occipital 
 bone as are found in other regions of the spine when the 
 laminae are palpated. The unilateral contraction of these 
 ligaments is readily determined. 
 
 It must be remembered further that the cartilage which 
 separates the atlas from the occipital bone and from the axis 
 resembles hyaline cartilage, and is not of the same fibro- 
 cartilaginous quality as is that which composes the discs 
 which are placed between the other vertebrae. In case of 
 tilting or any displacements in which a space is left between 
 the articular surfaces, the cartilage may thicken and when 
 this occurs the displacement will resist correction for a greater 
 length of time. 
 
 In a lateral displacement it will be found that the trans- 
 verse process on the side which is displaced downward is 
 nearer the mastoid process, while on the opposite side a space 
 greater than normal exists. 
 
 In a rotary subluxation of this joint the atlas is involved, 
 and the superior cervical ganglion is influenced as a result of 
 the continuous compression of the spinal nerves which com- 
 municate with it. This form of subluxation is brought about 
 by a unilateral contracted condition of the rectus capitis 
 anticus minor muscle which normally produces rotation, since 
 it arises from the anterior surface of the lateral mass and the 
 root of the transverse process of the atlas, and, passing 
 upward and inward, is inserted into the basilar process of 
 the occipital bone. Its proximity to the cervical ganglion 
 will cause it to press upon this structure when it is con- 
 tract'ed. 
 
 In palpating atlas displacements the peculiar construction 
 of the atlas and its association with the axis should be kept 
 in mind. There is always sufficient space laterally between 
 the odontoid process and the lateral margins of the anterior 
 arch of the atlas to admit of a lateral displacement great 
 enough to produce serious results. Usually, however, the 
 greatest lateral displacements at the occipito-atlantal joint 
 are due to a slipping of the condyles upon the atlas, and not 
 of the atlas itself upon the condyles. When the atlas is in- 
 volved mostly, there will usually be also rotation. 
 
 Tilting forward of the atlas is also a serious form of dis-
 
 308 
 
 SPINAL ADJUSTMENT 
 
 ^ 
 
 f , P 
 
 D 
 
 lo ( P 
 
 " 
 
 IM 
 
 " 
 
 N 
 
 ' l^\ 
 
 - 
 
 ( 
 
 3 
 
 ' r. 
 
 t 
 
 ^ 
 
 \ ^ 
 
 - / 
 
 Fig. 59. 
 Spinal Analysis Chart.
 
 SPINAL ANALYSIS 309 
 
 placement, and distinction must be made between a tilting 
 of the occiput and that of the atlas. A tilting downward and 
 forward of the occiput is limited by the posterior arch 
 of the atlas; but a tilting downward and forward of the 
 atlas may occur without any displacement of the occiput; 
 such a subluxation is made possible by a laxness of the 
 transverse ligament, or by a persistent contraction of the 
 anterior ligaments. A lack of tone in the sterno-mastoid 
 or upper part of the trapezius muscles will also predispose to 
 the production of this form of subluxation. The same com- 
 parison must be made as when the occiput is palpated. The 
 relation of the transverse processes to the mastoid processes 
 and to the transverse processes of the other cervical vertebrae 
 should be determined. The posterior arch should be palpated 
 in relation with the spinous process and laminae of the axis. 
 Rotation is usually associated with atlas displacements and 
 is indicated by a fullness on the side to which the subluxation 
 is inclined. This is readily determined by palpation, and cor- 
 responds to the method of palpating the other vertebrae ex- 
 cept that in this instance the posterior arch instead of the 
 transverse processes and laminae is palpated. 
 
 Palpation of the Axis. — The most common form of sub- 
 luxation of the axis is the rotary. Lateral displacement when 
 present produces the greatest degree of irritation and con- 
 gestion, as a result of pressure upon the nerves and blood- 
 vessels emerging from the intervertebral foramina between 
 the axis and third cervical vertebra. The manner of de- 
 termining subluxations of the axis is the same as that em- 
 ployed in the examination of the other cervical vertebrae. 
 The patient should be in the dorsal position. The spinous 
 process of the axis is then located, and the laminae are fol- 
 lowed forward until the tips of the transverse processes are 
 reached ; these are then compared with those of the atlas and 
 the third cervical vertebra. In this way lateral, rotary, supero- 
 inferior, compression and scoliotic subluxations of this ver- 
 tebra will be easily detected. Kyphosis and lordosis can be 
 detected by inspection. 
 
 Palpation of the Other Cervical Vertebrae, — Subluxations 
 of the cervical vertebrae can be detected in the same way as 
 that just described under palpation of the axis. There will
 
 310 SPINAL ADJUSTMENT 
 
 .—» Cot^)/>r^^''i on 
 
 Lotbot'it^ 
 
 ^Co"iie"bl<i. 
 
 F ig. 60. 
 Signs Showing Various Sul)luxations.
 
 SPINAL ANALYSIS 311 
 
 be, however, a slight difference imparted to the touch by 
 reason of the fact that in the axis the transverse processes 
 spring from the base of the inferior articular processes, and 
 owing to the absence of the costal process in this vertebra 
 the groove between the costal and transverse processes is 
 lacking; this difference is, however, of no practical importance. 
 (Fig. 58.)^ 
 
 Palpation of the Thoracic Vertebrae. — In palpating the 
 thoracic vertebrae one must not be misled by the position of 
 the spinous processes, since, as previously mentioned, their 
 angle of direction with the body of the vertebrae may be ab- 
 normal. Such an error may be avoided by palpating the 
 transverse processes, and also noting the presence or absence 
 of other signs of subluxation, as contracted ligaments, hyper- 
 aesthesia, and increased temperature. 
 
 The spinous processes of the upper thoracic vertebrae are 
 longer than those of the lower, and therefore extend down- 
 .ward much farther from a line drawn horizontally through 
 the transverse processes. This downward direction of the 
 spinous processes of these vertebrae must be borne in mind 
 in palpation ; usually the transverse processes of a vertebra 
 the spinous process of wdiich has just been palpated are 
 situated at the level of the spinous process of the vertebra 
 above. 
 
 Another point to be remembered is that the transverse 
 processes should follow gradually an oblique line from the 
 upper thoracic vertebrae inward tow^ard the spinous process of 
 the twelfth thoracic vertebra. This line is formed by the grad- 
 ual decrease in length of the transverse processes from the first 
 to the twelfth. The transverse processes of the twelfth tho- 
 racic are usually very rudimentary, being merely a tubercle 
 projecting backward and outward from the junction of the 
 articular processes with the pedicles. The tenth thoracic also 
 sometimes possesses such a rudimentary transverse process, 
 from the upper surface of which a prominent tubercle projects 
 toward the spinous process of the vertebra above, as normally 
 occurs on the twelfth thoracic vertebra. This tubercle is just 
 posterior to the superior articular process, and may be present 
 on the tenth, eleventh, or twelfth thoracic vertebra, according 
 to which is the transitional one.
 
 312 
 
 SPINAL ADJUSTMENT 
 
 7 
 
 ■> 
 
 X 
 
 L( ^4* 
 
 r 
 
 Z'' 
 
 7^ 
 
 X 
 
 Fig. 61. 
 Record of Spinal Analysis.
 
 SPINAL ANALYSIS 313 
 
 Palpation of the Lumbar Vertebrae. — By examining the 
 lumbar vertebrae the transverse processes will be seen to ex- 
 tend laterally and backward, while the articular processes 
 project posteriorly. Palpation of the vertebrae in this region 
 of the spine will be easy if the operator keeps in mind the 
 characteristics of each vertebra. The transition from the 
 lumbar to the sacral type will be noted from the fact that the 
 inferior articular processes are much farther apart in the fifth 
 than in the fourth vertebra. In palpating the vertebrae of the 
 lumbar region, test for ankylosis between the fifth lumbar 
 vertebra and the sacrum, and also remember the possibility 
 of an individual first sacral vertebra. 
 
 The X-ray in the Diagnosis of Subluxations. — In the de- 
 termination of subluxations the X-ray is of great utility, and 
 should be used whenever doubt exists as to the real nature of 
 the displacement. The technique of the use of the X-ray 
 cannot be given in a work of this kind, but the operator can 
 become familiar with this by referring to any standard book 
 on electro-therapeutics. . 
 
 Method of Using the Spinal Analysis Chart. — Having made 
 a careful spinal analysis, the operator should next make a 
 record of the findings. For this purpose a suitable chart is 
 used and certain signs are used to indicate the nature of the 
 subluxations found in the different segments of the vertebral 
 column. 
 
 The chart to be used for recording the different subluxa- 
 tions is shown in Fig. 59. The signs to be used are illustrated 
 in Fig. 60. A specimen chart showing the record of a spinal 
 analysis is shown in Fig. 61. 
 
 Each time that the patient presents himself for a treatment, 
 however, the spine should be carefully examined, to determine 
 any changes which have occurred in the interim. 
 
 The use of specific adjustments for certain conditions has 
 passed. For example, it was formerly the custom when a 
 patient sufifered from a group of symptoms indicating kidney 
 disease to adjust the 10th dorsal vertebra, which was styled 
 "Kidney Place" or, abbreviated, K. P. Such a method is very 
 unscientific since we find very often that kidney disease may 
 exist when other diseased conditions are present, and it is 
 only by correcting these conditions that the kidney trouble
 
 314 SPINAL AnjUSTMENT 
 
 will be relieved. For example, in valvular disease of the 
 heart one often meets with congestion of the kidneys and even 
 a slight albuminuria is present; evidently adjustment of the 
 tenth dorsal vertebra in such a case will not relieve the kid- 
 ney trouble, since so long as the heart is affected the kidney 
 will also be abnormal. 
 
 A further reason that specific subluxations are unscientific 
 and ineffective is that nearly every spinal segment affects or 
 controls different organs even though they more particularly 
 influence a certain part of the body. Accordingly the tenth 
 dorsal vertebra may be subluxated and other diseases than 
 kidney disease result. 
 
 Still another reason that such a method cannot be used 
 with certainty is that different spinal segments control one 
 and the same organ. We accordingly find that in all cases of 
 kidney disease the tenth dorsal vertebra is not necessarily 
 affected, but the subluxation may be of the eleventh or twelfth 
 dorsal. 
 
 The only proper method to follow, therefore, is to make 
 a general examination of each patient to determine if pos- 
 sible what part, organ or system of the body is affected. The 
 special examination of the patient should then be made for 
 the purpose of determining exactly how this part is affected. 
 This should be followed by the spinal analysis, the findings of 
 which should be recorded in the manner above illustrated, 
 which will show which vertebra is subluxated and the nature 
 of the subluxation. The operator is then prepared to make 
 the proper adjustment of the vertebral displacement, as will 
 be shown in the next section.
 
 SECTION SIX 
 
 Spinal Adjustment 
 
 CHAPTER I 
 General Considerations 
 
 Briefly defined, spinal adjustment is the replacement to 
 their normal position of snbluxated vertebrae for the purpose 
 of relieving pressure upon the nerves, and thus restoring to 
 the parts supplied by these nerves their proper innervation. 
 
 This replacement of subluxated vertebrae is accomplished 
 by the application of a definite thrust by the hands of the 
 operator in contact with the affected vertebra. 
 
 Spinal adjustment must not be considered as the pushing 
 of a vertebra back, so to speak, to its proper position, as that 
 is not the primary effect of the thrust v^hich is applied to the 
 vertebra. The immediate effect of the thrust upon the ver- 
 tebra is a momentary relaxation of the ligaments of one side 
 permitting the ligaments of the opposite side which had been 
 stretched beyond the limit of their elasticity to return to their 
 original condition. 
 
 To overcome the contraction of the ligaments which are 
 drawing the displaced vertebra out of alignmeitt the thrust 
 must be spontaneous, and be applied at the moment of most 
 complete relaxation of the patient. A slow, continuous pres- 
 sure, regardless of how heavy it might be, will not accomplish 
 the desired eft'ect ; on the contrary, it will tend to aggravate 
 the contraction of the ligaments. A familiar example at this 
 point will serve to make clear this important phase of spinal 
 adjustment. We are all familiar with the cramp of the plantar 
 muscles, and have observed how this cramp draws the bones 
 of the foot in various directions. A sudden blow upon the 
 contracted muscles brings instant relief by causing the muscles 
 to relax, which permits the bones of the foot to return to their 
 
 315
 
 316 SPINAL ADJUSTMENT 
 
 normal position. This is exactly what occurs in the vertebral 
 column ; a certain ligament is contracted and draws the ver- 
 tebra with which it is connected out of alignment ; the spon- 
 taneity of the thrust causes the contracted ligament to be- 
 come relaxed, and the vertebra returns to its normal position. 
 The first prerequisite to successful spinal adjustment, there- 
 fore, is that the thrust be spontaneous. This spontaneity is 
 well illustrated by the sharp, quick blow of a hammer upon a 
 hard surface, like an anvil. The rebound of the hammer is 
 caused by the rapidity of the stroke rather than by the strength 
 or continuity of the force applied. Another and still better 
 illustration may be given by taking a pile of individual blocks : 
 A sharp, quick blow against one of the blocks will move the 
 individual block against which the stroke is directed without 
 affecting the pile as a whole, whereas steady pressure, lack- 
 ing the spontaneity referred to, would simply push over the 
 entire column or pile of blocks. 
 
 In the application of the thrust no great expenditure of 
 force is required. William Jay Dana, B. S., says in respect 
 to this that, "It can be easily shown mathematically that if a 
 spine can stand a tension of 750 pounds, it would only take a 
 blow with a velocity of five feet a second, given by a man 
 who could put ten pounds of his weight behind his adjustment, 
 in order to move a vertebra one-sixteenth of an inch. This 
 kind of a blow is obviously within the capacity of any aver- 
 age man." 
 
 How replacement of the vertebra occurs is also very ac- 
 curately explained by Dana, as follows: "Mechanical shear- 
 ing occurs when two equal and opposite forces act at right 
 angles to a bar. When tension is transmitted through two 
 overlapping boiler plates riveted together, the first eft'ect is 
 a sidewise compression on the rivets, tending to cut them off. 
 To move one vertebra with respect to another, shearing forces 
 must be used. The intervertebral cartilaginous disc must be 
 sheared to produce an actual molecular displacement or separa- 
 tion. The high speed adjustment accomplishes this, separating 
 the vertebrae, and relieving the pressure at the foramina. An 
 adjustment causes a slight injury; hence an increased 
 metabolism of the surrounding tissues ; the blood is rushed 
 to the tissues for reparative purposes, compressed cartilages
 
 GENERAL CONSIDERATIONS 317 
 
 are built up, thereby relieving the pressure exerted by the 
 previously approximated vertebrae." 
 
 To obtain the greatest degree of spontaneity in giving the 
 thrust several things must be observed. 
 
 The first of these relates to the manner of delivering the 
 thrust. On having determined the exact nature of the sub- 
 luxation, the operator places the proper contact point of the 
 hand on the desired point of the vertebra to be adjusted. A 
 firm degree of pressure should exist at the contact point, and 
 should not be increased or diminished during the delivery of 
 the thrust. The operator should stand near to and directly 
 over the patient so that the arms are perfectly perpendicular 
 to the patient's back. The arms should be held rigid, with the 
 elbows locked. The shoulders are then raised to the greatest 
 degree consistent with the maintenance of the desired pres- 
 sure on the spine at the contact points. The thrust is then 
 delivered by a quick downward movement of the shoulders, 
 arms and back, with the hip-joint as an axis. As soon as the 
 thrust has been made the hands should be removed from the 
 back. The thrust should be made as soon as the correct 
 contact with the vertebra to be adjusted has been applied, 
 since any delay in executing the thrust permits contraction 
 of the spinal musculature from apprehension on the part of 
 the patient. The precise direction of the movement is gov- 
 erned by the nature of the subluxation and the region of the 
 spine in which it is located. 
 
 The second essential to the proper delivery of the thrust 
 relates to the operator's position. The object and importance 
 of a correct position for the delivery of the thrust should be 
 constantly borne in mind. Unless perfect poise is secured and 
 maintained, the operator will not be able to accumulate the 
 force necessary to deliver the thrust at the right time and in 
 the right direction. The prime essential to the success of the 
 thrust, namely that it be spontaneous, can only be secured 
 when the operator is perfectly poised. This poise enables 
 him to be in a state of readiness to take advantage of the 
 momentary relaxation of the patient, which is most apparent 
 at the end of expiration. It also enables the operator to feign 
 a thrust in a very sensitive or hysterical patient. This is 
 done by pressing down on the patient's back, and making a
 
 318 SPINAL ADJUSTMENT 
 
 short, mild thrust, followed by one of greater force at the 
 moment of relaxation on the part of the patient from the first 
 thrust. It also permits of delivery of the thrust at the proper 
 angle. The poise should be such as will enable the force to 
 be carried downward equally along each arm to the point of 
 contact, when a double hold is employed. When a single 
 hold is used, the force is carried along the arm which applies 
 the thrust, and in the direction which is necessary for the 
 correction of the subluxation. Lastly the proper poise is of 
 importance since it permits the thrust to be given without 
 the slightest discomfort to the patient, and with the greatest 
 ease to the operator. 
 
 The third requisite to the successful delivery of the thrust 
 is that it be applied at the moment of extreme relaxation of 
 the patient. It will be found in this connection that the best 
 rule to follow will be to deliver the thrust as soon as the 
 proper contact with the vertebra to be adjusted has been 
 made, and before any contraction of the muscles of the 
 patient's back, due to apprehension on his part, has had time 
 to develop. If, however, the patient continuously contracts 
 the muscles, a feint thrust, immediately followed by one of 
 greater force, should be given, since after the milder thrust 
 there occurs a period of momentary relaxation. If even this 
 is unsuccessful, the operator should wait until the patient is 
 breathing naturally, and then apply the thrust at the point 
 of extreme exhalation. One of these methods will enable the 
 thrust to be successfully delivered. In any event, however, 
 it is advisable to instruct the patient in regard to the neces- 
 sity of perfect relaxation on his part, and this may be acquired 
 by his own volition. If an adjustment is made in spite of 
 the fact that the patient is not completely relaxed, consider- 
 able soreness at the point over which the thrust is made will 
 be experienced for some time. Every means should therefore 
 be employed to secure perfect relaxation of the patient before 
 the thrust is applied, and one of the above methods will always 
 suffice to produce this. 
 
 Equal in importance with the manner of delivering the 
 thrust is the mode of contact of the operator's hand with the 
 vertebra to be adjusted, which in chiropractic terminology is 
 known as the "Hold." The reader will note in future chapters
 
 GENERAL CONSIDERATIONS 319 
 
 that these holds are not all in direct connection with the 
 vertebral column. It may be said, however, that whenever a 
 specific vertebra is to be adjusted, the hands should be in 
 contact with the vertebra itself. In the giving of the thrust 
 the spinous or transverse processes are used as levers, while 
 the force which acts through these levers to produce a move- 
 ment of the vertebra as a whole is applied by the contact hand. 
 There are in vogue among Chiropractors a great variety of 
 holds, since nearly every operator favors some particular form 
 of contact which he uses almost exclusively in all regions of 
 the spine, with slight variations. There thus appear in this 
 work holds which are highly endorsed by some and which 
 are equally condemned by other Chiropractors. However, it 
 is our opinion that not one of the holds mentioned is entirely 
 devoid of some merit. In general the operator will find that a 
 few holds will suffice ; there are, however, cases in which none 
 of the commonly used holds will serve to produce the desired 
 effect, and it becomes necessary to use a hold which, though 
 it is seldom resorted to, still has a place in just this class of 
 cases. In the descriptions of the various holds those having 
 the greatest range of usefulness are therefore placed first; 
 if it is found, as occasionally happens, that one of these holds 
 will not produce the adjustment, one of the others should 
 be employed. 
 
 In the great majority of cases it will be found that contact 
 with the transverse processes is much to be preferred to that 
 with the spinous processes. The reasons for this are obvious 
 to any one who uses both methods for a time, and compares 
 the effects of each. Chief among the reasons why the use of 
 the transverse processes as levers is preferable is the fact that 
 the force can be directed with greater accuracy. Some chiro- 
 practors disregard the transverse processes entirely, even in 
 palpation, and therefore also in adjustment, and limit them- 
 selves to the spinous processes exclusively. From what has 
 been said in preceding chapters the reader must appreciate 
 that such methods must fail in some instances. Another im- 
 portant reason for using the transverse processes rather than 
 the spinous wherever possible is that by using the former 
 as levers the possibility of producing soreness following the 
 adjustment is greatly minimized.
 
 320 
 
 SPINAL ADJUSTMENT 
 
 Fig. 62. 
 
 Showing the Contact Points 
 on the Hand.
 
 GENERAL CONSIDERATIONS 321 
 
 The final essential to the proper delivery of the thrust is 
 the point of contact of the operator's hand. Fii^. 62 illustrates 
 these points which are named as follows: 
 
 1. The Calcanear contact. 
 
 2. The Pisiform contact. 
 
 3. The Hypothenar contact. 
 
 4. The Thenar contact. 
 
 5. The Thumb contact. 
 
 The indications for the use of each of these various forms 
 of contact are given under the various holds described in the 
 following chapters.
 
 CHAPTER II 
 
 Adjustment of the Cervical Vertebrae 
 
 The Temporo-Transverse Hold. — Indications. — This hold 
 is the best for general use in the cervical region. It lacks en- 
 tirely the element of harshness present in other holds used 
 for adjustment of the vertebrae in this region. It is especially- 
 adapted to correction of lateral, rotary, scoliotic, and supero- 
 inferior subluxations. 
 
 Position of the patient. — The patient should be in the 
 dorsal position. 
 
 Points of contact. — The head of the patient rests in one 
 hand of the operator, while the thenar eminence of the other 
 hand is placed against the transverse process. In rotary 
 subluxations the contact is with the posterior surface of the 
 transverse process which is posterior; in lateral subluxations 
 the contact is on the union of the transverse and costal proc- 
 esses which are displaced away from the line of the spinous 
 processes ; in supero-inferior subluxations the contact is with 
 the inferior surface of the transverse process of the side of the 
 vertebra which is displaced downward; in scoliosis each ver- 
 tebra should be separately adjusted as rotary or lateral sub- 
 luxations, in addition to which the parieto-transverse and 
 fronto-transverse holds, together with traction, should be em- 
 ployed. The thumb of the hand in contact with the vertebra 
 should be supported on the side of the patient's lower jaw. 
 
 Method of delivery. — The head is raised, with the patient's 
 face turned away from the contact hand, and flexed in the 
 direction of the hand in contact with the vertebra to be ad- 
 justed. When completely flexed, a spontaneous thrust is made 
 against the transverse process at the same time that the head 
 is brought in the direction of the contact hand. The direction 
 of the thrust depends upon the nature of the subluxation, 
 namely in the direction that will place the vertebra in proper 
 alignment. 
 
 This hold is illustrated in Figs. 63 and 64. 
 
 322
 
 CERVICAL VERTEBRAE 
 
 323 
 
 Fig. 63. 
 
 Temporo-Trnnsverse Hold.
 
 324 
 
 SPINAL ADJUSTMENT 
 
 Fig. 64. 
 Temporo-Transverse Hold.
 
 CERVICAL VERTEBRAE 
 
 325 
 
 Fig. 65. 
 Fronto-Transverse Hold.
 
 326 
 
 SPINAL ADJUSTMENT 
 
 Fig. 66. 
 Parieto-Transverse Hold,
 
 CERViCAi- vj:rtebrae 
 
 327 
 
 Fig. 67. 
 
 Bilateral I'isifonn-Trausvcrse 
 Anterior Hold.
 
 328 SPINAL ADJUSTMENT 
 
 The Fronto-Transverse Hold. — Indications. — This is an 
 excellent movement in certain cases of compression subluxa- 
 tions of the cervical vertebrae. 
 
 Position of the patient. — The patient is in the dorsal po- 
 sition. 
 
 Points of contact. — One hand is placed on the patient's 
 forehead and the other just posterior to the transverse proc- 
 esses; the four fingers are used, each being placed on the 
 transverse process of a single vertebra. 
 
 Method of delivery. — In making the movement, the hand 
 on the forehead is held firm and steady, while that in contact 
 with the posterior surface of the transverse processes is 
 drawn up toward the operator ; at each such movement a 
 different finger is employed. For example, if the index finger 
 is in contact with the posterior surface of the transverse 
 process of the third cervical, the first movement is made at 
 this point ; the next movement is made in the same manner 
 with the second finger in contact with the posterior surface 
 of the transverse process of the fourth cervical vertebra ; the 
 third movement is the same with the third finger in contact 
 in the same manner with the fifth vertebra ; and the fourth 
 movement with the finger in contact with the sixth vertebra. 
 Repeat the movements in the same order several times. Then 
 rotate the head as shown in Fig. 66, which illustrates the 
 Parieto-Transverse hold. Repeat the movements with the 
 hands in the position shown in the Parieto-Transverse hold, 
 finishing with an exaggerated lateral flexion with the finger 
 on the transverse process of the subluxated vertebra. This 
 should be executed in the same spontaneous manner as 
 previously described. 
 
 This hold is illustrated in Figs. 65 and 66. 
 
 The Pisiform-Transverse Anterior Hold. — Indications. — 
 Anterior subluxations of the cer\-ical vertebrae. 
 
 Position of patient. — The patient is in the dorsal position. 
 
 Points of contact. — The pisiform processes are placed on 
 the anterior surface of the transverse processes of the sub- 
 luxated vertebra. Great care must be exercised in applying 
 this hold that the vessels of the neck are pushed forward and 
 not compressed between the hands and the transverse proc- 
 esses.
 
 CERVICAL VERTEBRAE 329 
 
 Method of delivery. — The movement is straight posteriorly, 
 and the force is conveyed equally through both arms spon- 
 taneously and with a downward movement of the shoulders. 
 Care should be taken not to permit the hands to slip when 
 the thrust is being delivered. 
 
 This hold is illustrated in Fig. 67. 
 
 The Malar-Transverse Hold. — Indications. — This is a 
 method for correcting certain forms of rotary subluxations of 
 the cervical group which will occasionally serve the operator 
 to good advantage. 
 
 Position of the patient. — The patient should be placed in 
 the prone position. 
 
 Points of contact. — The thumb is placed back of the trans- 
 verse process which is posterior, while the other hand is 
 placed on the side of the patient's face over the malar bone ; 
 the operator stands on the side of the patient away from the 
 subluxated side. 
 
 Method of delivery. — The face of the patient is turned 
 away from the operator and the head raised. A simultaneous 
 thrust is made with the two hands toward each other. The 
 same hold may be employed with the patient in the erect 
 position. 
 
 This hold is illustrated in Figs. 68 and 69. 
 
 The T. M. or Thumb Movement Hold. — Indications. — This 
 hold is very useful in correcting rotary and lateral subluxa- 
 tions in the lower cervical region, and may be used in that 
 region when the operator is unable to obtain a perfect contact 
 with the vertebra to be adjusted by the temporo-transverse 
 hold. 
 
 This hold is fully described and illustrated under adjust- 
 ment of the thoracic vertebrae, q. v. 
 
 The Unilateral Pisiform-Transverse Anterior Hold. — In- 
 dications. — In some instances when the cervical vertebrae, and 
 especially the atlas, are displaced anteriorly on one side, in 
 other words rotated, it rarely becomes necessary to use this 
 hold. 
 
 Position of the patient. — The patient should be in the 
 dorsal position. 
 
 Points of contact. — The pisiform process of one hand is 
 placed in contact with the anterior surface of the transverse
 
 330 
 
 SPINAL ADJUSTMENT 
 
 Fig. 68. 
 Malar-Transverse Hold.
 
 CERVICAL VERTEBRAE 
 
 331 
 
 0^ 
 
 gl^ 
 
 ^^^^^^^^^H^^i 
 
 ^ 
 
 1 'l 
 
 - 
 
 ^^■jj^Hk r 
 
 iM 
 
 Fig. 69. 
 Malar-Transverse HolU.
 
 32,2 
 
 SPINAL ADJUSTMENT 
 
 Fig. 70. 
 Unilateral Pisiform-Transverse Hold.
 
 CERVICAL VF.RTF.r.RAl- 
 
 333 
 
 Fig. 71. 
 
 Teinporo-Cpntruiii Hold.
 
 334 SPINAL ADJUSTMENT 
 
 process which is displaced forward; the other hand grasps 
 the wrist of the contact hand. In order to facilitate the ob- 
 taining of the proper contact the patient's face is turned away 
 from the contact point on the vertebra to be adjusted. 
 
 Method of delivery. — The thrust is directed directly back- 
 ward. This relieves the contraction of the ligaments on this 
 side and permits the vertebra to return to its proper position. 
 It must be remembered in this connection that when a ver- 
 tebra is rotated upon its axis it may be due to a contraction 
 of the ligaments of one side drawing the corresponding side 
 of the vertebra backward; or it may be a contraction of the 
 ligaments on the other side which draws that side of the 
 vertebra forward. In either case the vertebra is rotated in 
 exactly the same direction, and only the contraction of the 
 ligaments will serve to distinguish between them. In the 
 latter form this hold is therefore necessary. 
 
 This hold is illustrated in Fig. 70. 
 
 The Temporo-Centrum Hold. — Indications. — This hold is 
 applicable in certain cases in which the cervical vertebrae are 
 laterally displaced, and adjustment by other holds is unsuc- 
 cessful. 
 
 Position of the patient. — The patient is in the erect posi- 
 tion, and seated. The operator stands facing the patient. 
 
 Points of contact. — The thenar eminence of one hand is 
 placed upon the side of the body of the vertebra which pro- 
 jects beyond that of the vertebrae above and below it, or if 
 this is not feasible, on the end of the transverse process which 
 projects farthest laterally. The other hand is placed upon 
 the side of the patient's head. 
 
 Method of delivery. — The patient's head is turned slightly 
 away from the contact hand; the neck is then flexed toward 
 the side of the contact point until all slack is taken up. At 
 the same time pressure is made with the contact hand upon 
 the vertebra to be adjusted. When the flexion is complete, the 
 tension is momentarily released to a very slight degree, and at 
 the same instant a simultaneous thrust of the hands is made 
 toward each other, the force of the thrust made by the hand 
 in contact with the vertebra being directed on a line with the 
 transverse processes of the vertebra being adjusted. 
 
 This hold is illustrated in Fig. 71.
 
 CERVICAL VERTEBRAE 335 
 
 The Occipito-Mandibular Hold A. — Indications. — This 
 hold is useful in relieving an approximated condition of the 
 occipital condyles and the superior articular processes of the 
 atlas, a form of compression subluxation. 
 
 Position of the patient. — In this hold the patient is prone. 
 The operator stands at the patient's head. 
 
 Points of contact. — The patient's face is turned to the 
 side. The operator grasps the lower jaw with one hand, and 
 the occiput with the other hand. 
 
 Method of delivery. — The neck is extended as much as 
 possible. At the same time the head is rotated to the greatest 
 possible extent. The tension is then momentarily released, 
 and at the same instant a spontaneous movement is made. 
 For relieving the same condition on the opposite side, the 
 movement and hold are reversed. 
 
 This hold is illustrated in Fig. 72. 
 
 The Occipito-Mandibular Hold B. — Indications. — Same as 
 above. 
 
 Position of the patient. — The patient's body is prone, 
 while the head is turned markedly. The operator stands at 
 the head of the patient. 
 
 Points of contact. — One hand grasps the lower jaw, and 
 the other hand the occiput. 
 
 Method of delivery. — Extension of the neck is made at 
 the same time that the head is rotated. This is followed by 
 a momentary release of the tension thus produced, and im- 
 mediately thereupon a spontaneous movement of the hands 
 is made. 
 
 This hold is illustrated in Fig. 73. 
 
 The Occipito-Mandibular Hold C. — Indications. — Same as 
 above. This hold is of advantage in that it requires no equip- 
 ment of any kind, and often produces results not otherwise 
 obtained. 
 
 Position of the patient.— The patient is in the erect posi- 
 tion and seated. The operator stands to one side of the 
 patient. 
 
 Points of contact. — One hand is placed firmly under the 
 patient's lower jaw, while the other grasps the occiput.
 
 336 
 
 SPINAL ADJUSTMENT 
 
 Fig. 72. 
 (»((l|)itii-Mani]iluilar Hold A.
 
 CERVICAL VERTEBRAE 
 
 337 
 
 Fig. 73. 
 di'cijiitn >[an(liliiil:ir Hold li.
 
 338 
 
 SPINAL ADJUSTMENT 
 
 Fig. 74. 
 Occipito-Mandibular Hold C.
 
 CERVICAL VERTEBRAE 
 
 339 
 
 Fig. 75. 
 Tempoio-Occipital Hold.
 
 340 SPINAL ADJUSTMENT 
 
 Method of delivery. — Upward traction is made with both 
 hands for the purpose of stretching the muscles of this region. 
 The head is then turned toward one side. When the rotation 
 of the head is complete, the tension is slightly released and 
 immediately thereafter a spontaneous movement is made. 
 For correcting a like condition on the opposite side the hold 
 is reversed. 
 
 This hold is illustrated in Fig. 74, 
 
 The Temporo-Occipital Hold. — Indications. — This hold is 
 especially applicable in cases in which either the posterior or 
 the anterior arch of the atlas is compressed against the occiput. 
 
 Position of the patient. — The patient is in the prone posi- 
 tion. 
 
 Points of contact. — The patient's face is resting on one 
 side. One hand is placed on the side of the patient's face, 
 while the other hand grasps the occiput. 
 
 Method of delivery. — The contact having been obtained, 
 the thrust is applied against the face and occiput simul- 
 taneously. When the anterior arch of the atlas is compressed 
 against the occiput the greater force should be directed against 
 the patient's face ; when the anterior arch is compressed 
 against the occiput, the greater force is directed against the 
 occiput. 
 
 This hold is illustrated in Fig. 75.
 
 CHAPTER III 
 
 Adjustment of the Thoracic Vertebrae 
 
 The Thumb-Transverse Hold. — Indications. — This hold is 
 principally used fur adjustment of the upper thoracic ver- 
 tebrae in delicate patients, women, and children up to the 
 age of eight or ten years. In young children it is a convenient 
 hold for the entire thoracic and lumbar regions. It is used 
 in the correction of posterior, compression, supero-inferior, 
 and rotary subluxations. 
 
 Position of the patient. — The patient is in the prone posi- 
 tion. The two sections of the table should be separated, and 
 care should be taken to see that the chest should rest on the 
 chest-support of the table. The operator stands on the side 
 of the table which is most convenient for him in delivering 
 the thrust. When it is not convenient to place a very young 
 child upon the table, the following contact may be used : The 
 child should be taken in the arms of the operator so that its 
 chest presses against his chest; after the nature of the sub- 
 luxation has been determined, a thrust is made with the mid- 
 dle finger in contact with the transverse processes of the 
 vertebra to be adjusted. Whenever possible, however, the 
 table should be used, and the thumb-transverse hold employed. 
 
 Points of contact. — The balls of the thumbs are placed on 
 the transverse processes, being supported by the first and 
 second phalanges of the index finger, which, in very young 
 children rests on the angle of the ribs. 
 
 Method of delivery. — The contact having been obtained, 
 a spontaneous thrust is made. This will vary according to 
 the nature of the subluxation. In a posterior subluxation the 
 force is directed downward equally along each arm ; in com- 
 pression subluxations the contact is on the inferior surface of 
 the transverse processes, and the force directed toward the 
 head ; in a supero-inferior subluxation the thumb is placed 
 on the inferior surface of the transverse process of that side 
 of the vertebra which is displaced downward, and the force 
 directed toward the head ; when in a supero-inferior subluxa- 
 
 341
 
 342 
 
 SPINAL ADJUSTMENT 
 
 Fig. 76. 
 
 Thumb Transverse Hold.
 
 THORACIC VER rEBRAK 
 
 343 
 
 Fig. 77. 
 Crossed Thumb-Transverse Hold.
 
 344 
 
 SPINAL ADJUSTMENT 
 
 Fig. 78. 
 Crossed Bilateral Pisiforni-Transvcrse Hold.
 
 THORACIC \'Kr<l F.F^RAi: 
 
 345 
 
 Fig. 79. 
 Pisiforni-Spinous Hold.
 
 346 SPINAL ADJUSTMENT 
 
 tion the ligamentous contraction is drawing one side of a 
 vertebra upward, the thumb should be placed upon the supe- 
 rior surface of the transverse process which is displaced supe- 
 riorly, and the thrust directed toward the sacrum ; in a rotary 
 subluxation the greater force is directed along the arm which 
 is in contact with the posteriorly displaced transverse process. 
 
 This hold is illustrated in Fig. 76. 
 
 The Crossed Thumb-Transverse Hold. — Indications. — 
 These are the same as those for the hold described above. 
 
 Position of the patient. — The patient is in the prone posi- 
 tion, with the sections of the table separated, and the operator 
 standing at either side. 
 
 Points of contact. — The thumbs instead of being applied 
 on the transverse processes of the corresponding sides are 
 crossed. 
 
 Method of delivery. — This is the same as that described 
 under the Thumb-Transverse hold. 
 
 This hold is illustrated in Fig. 77 . 
 
 The Crossed Bilateral Pisiform-Transverse Hold. — Indica- 
 tions. — This is the best hold for correction of subluxations of 
 the upper eight thoracic vertebrae. It is adapted to the cor- 
 rection of posterior, compression, supero-inferior, and rotary 
 subluxations. 
 
 Position of the patient. — The patient is in the prone posi- 
 tion. 
 
 Points of contact. — The pisiform process of the operator's 
 right hand is placed upon the transverse process of the right 
 side of the vertebra to be adjusted ; the pisiform process of 
 the operator's left hand is placed on the transverse process 
 of the right side. 
 
 Method of delivery.- — The operator should stand at the 
 side of the patient and near him, with the center of his body 
 opposite the point of contact with the vertebra to be adjusted. 
 This position will obviate the possibility of the crossed wrists 
 interfering with each other. Care must also be exercised to 
 secure the proper poise before making the thrust with this 
 hold, as otherwise the force of the thrust will not be properly 
 delivered. The arms should be perpendicular to the back of 
 the patient, and the elbows rigid. The application and direc- 
 tion of the force will depend upon the nature of the subluxa-
 
 THORACIC VER'lEBRAE 347 
 
 tion which is being adjusted. In a posterior subluxation the 
 force is directed directly downward equally along each arm 
 to the contact points. In a compression subluxation in which 
 a vertebra is approximated toward the one below it, the con- 
 tact is with the inferior surface of the transverse processes 
 and the force of the thrust is directed toward the head ; if 
 the ligamentous contraction draws a vertebra upward against 
 the vertebra above, the contact is with the superior surface 
 of the transverse processes, and the force of the thrust is 
 directed toward the sacrum. In cases of supero-inferior sub- 
 luxations the same rules apply as for compression subluxations 
 except that the thrust is directed against only one transverse 
 process. In a rotary subluxation the force is directed 
 downward upon the transverse process which is posteriorly 
 displaced. 
 
 This hold is illustrated in Fig. 78. 
 
 The Bilateral Pisiform-Transverse Hold. — Indications. — 
 This is a very useful hold, and is best adapted to correction 
 of subluxations from the seventh to the twelfth thoracic, and 
 in all the lumbar vertebrae. In some cases it may be used 
 in the entire thoracic region ; this will, however, depend upon 
 the conformity of the patient's back and the operator's ability 
 to acquire the hold. A milder movement may be made" with 
 this hold than with the same hold with the hands crossed. 
 When a very mild adjustment is desired, there is no better 
 hold than this, as spontaneity can be obtained without the 
 peculiar shock characteristic of some of the other holds where 
 rigidity of the arms is an essential factor to a successful de- 
 livery. This hold is used in correcting posterior, kyphotic, 
 compression, and rotary subluxations. 
 
 Position of the patient. — The patient should be in the 
 prone position, with the sections of the table separated and 
 the front section lowered. 
 
 Points of contact. — By the term pisiform-transverse hold 
 it is not meant to be understood that the pisiform processes 
 are placed directly on the transverse processes; on the con- 
 trary, they are placed immediately in front, behind, or to the 
 side, as is made necessary by the nature of the subluxation. 
 The right hand is placed on the transverse process of the 
 right side, while the left hand is in contact with the left
 
 348 
 
 SPINAL ADJUSTMENT 
 
 Fig. 80. 
 Unilateral Pisiform-Tiansverse Hold.
 
 THORACIC VERTEBRAE 
 
 349 
 
 Fig. 81. 
 
 T'liui SpiiiDiis Ho](l.
 
 350 
 
 SPINAL ADJUSTMENT 
 
 Fig. 82. 
 
 Calcaneo-Pislform-Trans verso Hold.
 
 THORACIC VERTEBRAE 
 
 351 
 
 Fig. 83. 
 
 Uilateial Digito-Transverse Hold.
 
 352 SPINAL ADJUSTMENT 
 
 transverse process. When a vertebra is displaced posteriorly 
 the contact is directly on the transverse processes. When the 
 subluxation is rotary, the contact is similar, but the greater 
 force is directed toward the transverse process which is pos- 
 teriorly displaced. In an upward approximation of a vertebra, 
 the contact is with the superior surface of the transverse 
 processes ; when it is inferiorly approximated the contact is 
 with the inferior surface of the transverse processes. 
 
 Method of delivery. — The proper contact, as above indi- 
 cated, having been secured, a spontaneous movement from 
 the forearms, and an upward turn of the wrist should be 
 made. The direction of the force is determined by the nature 
 of the subluxation. In a posterior or kyphotic subluxation, 
 it is directed downward. When a rotary subluxation is pres- 
 ent the force is directed principally along one arm, namely 
 that in contact with the posteriorly displaced transverse 
 process. In a compression subluxation, when the vertebra 
 is drawn upward the thrust is directed toward the sacrum ; 
 when it is inferiorly displaced the force is directed toward 
 the head. 
 
 This hold is illustrated in Fig. 91 in the chapter on the 
 adjustment of the lumbar vertebrae. 
 
 The Pisiform-Spinous Hold.^ — Indications. — This hold is 
 used principally for the correction of kyphotic subluxations, 
 and in some forms of lumbar subluxations in certain cases. 
 This hold may, however, be used for the correction of any 
 form of subluxation, but will prove to be more severe and 
 disagreeable to the patient than other holds here suggested, 
 and its use should therefore be limited to the indications above 
 mentioned. 
 
 Position of the patient. — The patient should be in the 
 prone position ; the operator stands to either side as necessary. 
 
 Points of contact. — The pisiform process of one hand is 
 placed upon the spinous process of the vertebra to be adjusted ; 
 the other hand grasps the wrist of the contact hand. 
 
 Method of delivery. — In giving the thrust the arm which 
 grasps the wrist of the contact hand should be held rigid ; 
 a peculiar swing of the shoulders is then made and the force 
 directed in the proper direction. 
 
 This hold is illustrated in Fif?. 79.
 
 THORACIC VERTEBRAE 353 
 
 The Unilateral Pisiform-Transverse Hold.— Indications. 
 — Rotary, lateral, and supero-inferior subluxations in the 
 dorsal region of the spine. 
 
 Position of the patient. — The patient should be in the 
 prone position. The two sections of the table should be 
 separated, and the front section depressed. 
 
 Points of contact. — The pisiform process directly upon 
 the transverse process which is posterior in rotary subluxa- 
 tions. In supero-inferior subluxations in which the contrac- 
 tion of the ligaments is on the side which is drawn upward 
 the contact should be on that side and upon the superior 
 surface of the transverse process; when the contraction of 
 the ligaments is such as to draw the vertebra downward on 
 one side the contact should be with the inferior surface of 
 the transverse process which is inferiorly displaced. In lateral 
 or scoliotic subluxations the contact is on the transverse 
 process, but the force is directed against the side of the 
 spinous process. The other hand grasps the wrist of the 
 contact hand. 
 
 Method of delivery. — The contact having been obtained, 
 the force of the thrust is directed principally through the con- 
 tact hand, and in that direction necessary to the proper re- 
 placement of the subluxated vertebra. The points of contact 
 will indicate the direction in which the force should be 
 delivered. 
 
 This hold is illustrated in Fig. 80. 
 
 The Ulno-Spinous Hold. — Indications. — The indications, 
 position of the patient, and method of delivery when this hold 
 is used are the same as those of the pisiform-spinous hold. 
 The only difference is in the mode of contact, which in this 
 hold is made with the ulnar border of the hand upon the 
 spinous process; this becomes necessary in individuals who 
 are very sensitive. 
 
 This hold is illustrated in Fig. 81. 
 
 The Calcaneo-Pisiform-Transverse Hold. — Indications. — 
 This hold is employed for the correction of rotary and lateral 
 displacements. 
 
 Position of the patient. — The patient is in the prone 
 position.
 
 354 
 
 SPINAL ADJUSTMENT
 
 THORACIC VERTEBRAE 
 
 35: 
 
 Fig. 85. 
 Maiidilmlo Spinnns Hold.
 
 356 
 
 SPINAL ADJUSTMENT 
 
 Fig. 86. 
 Calcaneo-Spinous Hold.
 
 THORACIC VERTEBRAE 
 
 357 
 
 Fig. 87. 
 Sacro-Spinous Hold.
 
 358 SPINAL ADJUSTMENT 
 
 Points of contact. — One hand is placed perpendicularly to 
 the long axis of the spine, with the pisiform process on the 
 transverse process which is posteriorly displaced in a rotary 
 subluxation ; or in a lateral subluxation, on the side toward 
 which the vertebra is displaced. The other hand is placed 
 horizontally to the long axis of the spine, and the crease be- 
 tween the pisiform process and the base of the thumb is in 
 contact with the transverse process of the other side. 
 
 Method of delivery. — The manner of delivery of the thrust 
 is the same as that described in the preceding holds. The 
 principal force is, however, directed to the hand in contact 
 with the spine which is placed perpendicularly to the long 
 axis of the spine. A small portion of the force is directed to 
 the other hand, which is applied principally as a guard against 
 slipping of the tissues, and as a gauge in the delivery of the 
 thrust. In a rotary subluxation the force is directed directly 
 downward ; in a lateral subluxation it is directed toward the 
 side from which the vertebra is displaced. 
 
 This hold is illustrated in Fig. 82. 
 
 The Bilateral Digito-Transverse Hold. — Indications. — Pos- 
 terior and rotary subluxations from the fourth to the ninth 
 thoracic vertebrae. 
 
 Position of the patient. — The patient should be in the 
 prone position. 
 
 Points of contact. — The index and middle finger of the 
 contact hand are placed upon the transverse process of one 
 side of the vertebra to be adjusted; the ring and little finger 
 are placed upon the transverse process of the other side. The 
 other hand is placed on the dorsal surface of the contact 
 hand to assist in giving the proper force to- the thrust. 
 
 Method of delivery. — In a posterior subluxation the force 
 is directed upon both transverse processes equally, with the 
 characteristic spontaneous thrust. In a rotary subluxation 
 the greater force is directed toward one side, namely upon 
 the transverse process which is posteriorly displaced. 
 
 This hold is illustrated in Fig. 83. 
 
 The T. M. Hold. — Indications. — This hold is useful in 
 adjustment of the upper three or four dorsal vertebrae, in 
 addition to the lower cervical. It is adapted to correction 
 of lateral and rotary subluxations.
 
 THORACIC Vl'lkl J'P.KAl'-. 339 
 
 Position of the patient. — The patient is in the ereet posi- 
 tion and seated. The operator stands behind the patient, or 
 slightly to one side. 
 
 Points of eontact. — The thnndj of one hand is plaeed 
 against the side of the spinous process while the hand as a 
 whole is supported by resting the fingers upon the patient's 
 shoulder; the thumb is placed on that side of the spinous 
 process toward which the vertebra is displaced. The other 
 hand is placed against the side of the patient's face and head, 
 and the elbow may rest on the patient's shoulder on that side. 
 
 Method of delivery.— The patient's head is flexed toward 
 the contact point to the farthest extent, and a simultaneous 
 thrust made with both hands toward each other. Care must, 
 be exercised to prevent slipping of the thumb at the moment 
 the thrust is made against the side of the spinous process. 
 
 This hold is illustrated in Fig. 84. 
 
 The Mandibulo-Spinous Hold. — Indications. — Rotary sub- 
 luxations in the upper thoracic region. 
 
 Position of the patient. — The patient is in the erect position 
 and seated. 
 
 Points of contact. — The contact of the hand with the ver- 
 tebra to be adjusted is the same in this hold as it is in the 
 T. M. hold, namely, with the thumb placed against the side 
 of the spinous process toward which thcj vertebra is rotated, 
 with the fingers placed on the shoulder of the patient. The 
 other hand grasps the patient's chin. 
 
 Method of delivery. — The patient's face is turned away 
 from the side on which the contact hand is placed. When 
 the limit of rotation of the head has been reached, a thrust 
 is given with both hands at the same time, the direction of 
 the force being applied toward each other. 
 
 This hold is illustrated in Fig. 85. 
 
 The Calcaneo-Spinous Hold. — Indications. — This hold is 
 adapted to correction of posterior and compression subluxa- 
 tions in the thoracic and lumbar regions. 
 
 Position of the patient.^ — The patient should be in the 
 prone position. 
 
 Points of contact. — In a posterior subluxation the groove 
 between the pisiform bone and the base of the thumb is 
 placed directly upon the tip of the spinous process. In an
 
 360 
 
 SPINAL ADJUSTMENT 
 
 Fig. 88. 
 Thoracic Extension Hold I.
 
 THORACIC VJiRIEBRAE 
 
 361 
 
 Fig. 89. 
 Thoracic Extension Hold II.
 
 362 
 
 SPINAL ADJUSTMENT 
 
 Fig. 90. 
 The "Recoil" (Palmer).
 
 THORACIC VERTEBRAE 363 
 
 approximation or compression subluxation the contact of the 
 heel of the hand is with the superior surface of tiie spinous 
 process when the vertebra is superiorly approximated, and 
 with the inferior surface of the tip of the spinous process 
 when the vertebra is inferiorly approximated. The wrist of 
 the contact hand is grasped by the other hand. 
 
 Method of delivery. — The fingers of the contact hand ex- 
 tend along the patient's spine, and the arm of the contact 
 hand is perfectly straight and rigid. In a posterior subluxa- 
 tion the force of the thrust is directed directly downward, 
 perpendicularly to the patient's back. When the vertebra is 
 approximated superiorly, the force of the thrust is directed 
 toward the sacrum ; when the vertebra is approximated with 
 the one below it, the force of the thrust is directed toward 
 the head of the patient. 
 
 This hold is illustrated in Fig. 86. 
 
 The Sacro-Spinous Hold. — Indications. — This is not a spe- 
 cific method of adjustment, but may be used for the purpose 
 of causing extension of the vertebral column, and may be 
 used to advantage especially in lordotic displacement of a 
 section of the spine. 
 
 Position' of the patient. — The patient should be in the 
 prone position, with front section of the table depressed. 
 
 Points of contact. — One hand is placed on the sacrum, 
 while the other is in contact with the spinous processes. 
 
 Method of delivery. — No specific thrust is given. The 
 hands press upon the sacrum and spinous process simultane- 
 ously, very forcibly and steadily, in this way obtaining a 
 considerable extension of the spine. 
 
 This hold is illustrated in Fig. 87. 
 
 The Thoracic Extension Hold I. — Indications. — This also 
 is not a specific method of adjustment, and is used for opening 
 the thoracic articulations and relieving contractured condi- 
 tions of the vertebral ligaments. In what is commonly known 
 as "backache" and which is simply a settling of the vertebrae 
 upon each other application of this hold gives great relief. 
 
 Position of the patient. — The patient should stand erect 
 and reclining slightly backward, with the hands folded and 
 placed behind the head, which is thrown a little forward. The 
 operator stands behind the patient facing the latter's back.
 
 364 SPINAL ADJUSTMENT 
 
 Points of contact. — The operator passes his hands under 
 the patient' arms and grasps the wrists. 
 
 Method of delivery. — The patient is lifted suddenly from 
 the floor and at the same time a quick upward jerk is given the 
 body. 
 
 This hold is illustrated in Fig. 88. 
 
 The Thoracic Extension Hold II. — Indications. — ^The indi- 
 cations for this movement are the same as those for the 
 preceding. In some instances it is preferable. 
 
 Position of the patient. — The patient is erect, with the 
 elbows flexed and brought together, while the hands are 
 placed on either side of the face. 
 
 Points of contact. — The operator stands directly behind 
 the patient, with the latter's elbows in the hollow of his 
 hands. 
 
 Method of delivery. — The patient is suddenly lifted from 
 the floor, and at the same instant a quick upward jerk is 
 given the body. 
 
 This hold is illustrated in Fig. 89. 
 
 The "Recoil." — This hold is the exclusive method of ad- 
 justment used by some operators in all regions of the spine 
 and for all forms of subluxation, the contact being upon the 
 spinous processes in every instance. The force of the thrust 
 is directed in the direction in which the vertebra is to be 
 replaced. The advantages claimed for this hold by its advo- 
 cates and the disadvantages ascribed to it by its opponents 
 practically outweigh each other in the opinion of the author. 
 We make use of the spinous processes in many instances but 
 feel that there are cases in which the use of the transverse 
 processes of the subluxated vertebra as the levers is much to 
 be preferred. 
 
 This hold is illustrated in Fig. 90.
 
 CHAPTER IV 
 
 Adjustment of the Lumbar Vertebrae 
 
 The Bilateral Pisiform-Transverse Hold. — This hold will 
 be found described fully in chapter three of this section, and 
 is illustrated in Fig, 91. 
 
 The Ulno-Spinous Hold. — This hold is also described in 
 the chapter dealing with the adjustment of the dorsal 
 vertebrae. 
 
 Figure 92 illustrates this hold, which shows the force of 
 the thrust directed downward toward the sacrum, while in 
 the previous chapter the illustration of this hold shows the 
 thrust being delivered toward the patient's head. 
 
 The Ilio-Spinous Hold.— Indications. — This is more in the 
 nature of a gymnastic or passive movement than a specific 
 thrust. It is, however, very useful in correcting scoliosis in 
 both the lumbar and thoracic regions. 
 
 Position of the patient. — The patient is in the prone posi- 
 tion; the table is closed, and both sections are at the same 
 level. 
 
 Points of contact. — One hand of the operator grasps the 
 anterior superior spine of the ilium, while the heel of the other 
 hand is pressed firmly against the spinous processes on the 
 side toward which the curve is directed. 
 
 Method of delivery. — The hand in contact with the spinous 
 processes pushes them over to the opposite side to that in 
 which the curve is directed, while at the same time the other 
 hand draws up the patient's hip. This movement is repeated 
 a number of times as made necessary by the degree of the 
 scoliosis. 
 
 This hold is illustrated in Fig. 93. 
 
 The Thumb-Transverse Hold. — Indications. — This hold is 
 adapted to correction of posterior, kyphotic, and rotary sub- 
 luxations in the lumbar region. 
 
 For other points concerning this hold the reader is re- 
 
 365
 
 366 
 
 SPINAL ADJUSTMENT 
 
 Fig. 91. 
 HilatiM'al Pisifonn-Transvorpp Hold.
 
 LUMBAR VERTEBRAE 
 
 367 
 
 Fig. 92. 
 Ulno SpiiKins Hold.
 
 368 
 
 SPINAL ADJUSTMENT 
 
 Fig. 93. 
 
 Ilio-Spinous Hold.
 
 LUMBAR VERTEBRAE 
 
 369 
 
 Fig. 94. 
 Supra Sacral Held.
 
 370 SPINAL ADJUSTMENT 
 
 ferred to the preceding chapter in which the methods of de- 
 livery and points of contact are fully described. 
 
 The Pisiform-Spinous Hold. — Indications. — This hold 
 which is fully described in the preceding chapter is indicated 
 in posterior, compression, and rotary subluxations of the 
 lumbar region. 
 
 The Unilateral Pisiform-Transverse Hold. — This hold is 
 described and illustrated in the preceding chapter. In the 
 lumbar region it is indicated in rotary and supero-inferior 
 subluxations. 
 
 The Supra-Sacral Hold. — Indications.-^This hold is used 
 for the purpose of freeing the articulation between the fifth 
 lumbar vertebra and the sacrum. 
 
 Position of the patient. — The patient is in the prone posi- 
 tion. The front section of the table is lowered, thus elevating 
 the sacral region. 
 
 Points of contact. — The right hand of the operator is placed 
 upon the sacrum, and the wrist of the contact hand is grasped 
 by the other hand. 
 
 Method of delivery.— -The contact having been secured, a 
 quick, spontaneous, downward thrust is made. 
 
 This hold is illustrated in Fig. 94. 
 
 The Supra-Iliac Hold. — Indications. — This hold is useful 
 in correcting approximation of the fifth lumbar vertebra and 
 the sacrum. This condition will be noted by the difference 
 which exists in the height of the crests of the ilia when the 
 compression exists on one side of the disc between the fifth 
 lumbar verte1:)ra and the sacrum, namely a supero-inferior 
 subluxation. 
 
 Position of the patient. — The patient should be in the prone 
 position. The front section of the table is lowered, thus 
 throwing the pelvis of the patient upward. 
 
 Points of contact. — One hand is placed upon the crest of 
 the ilium, and the wrist of the contact hand grasped with the 
 other hand. 
 
 Method of delivery. — The contact with the higher ilium 
 having been obtained, a sudden thrust downward is delivered. 
 
 This hold is illustrated in Fig. 95. 
 
 The Infra-Iliac Hold. — Indications. — These are the same 
 as those for the preceding hold.
 
 LUMBAR VERTEBRAE 371 
 
 Position of the patient. — The patient is in the prone 
 position with the pelvis elevated. 
 
 Points of contact. — One hand is placed below the crest 
 of the ilium, and the wrist of the contact hand grasped by the 
 other hand. 
 
 Method of delivery. — The thrust in this case is directed 
 upward. 
 
 This hold is illustrated in Fig. 96. 
 
 The Genu-Spinous Hold. — Indications. — This hold is 
 adapted to a correction of compression subluxations in the 
 lumbar region, and is a counterpart of the Fronto-Transversc 
 and Parieto-Transverse holds used in the cervical region. It 
 is also used for correcting posterior, scoliotic, supero-inferior, 
 and rotary subluxations in the lumbar region, which it 
 accomplishes by causing a relaxation of the ligaments. 
 
 Position of the patient. — The patient should be in the prone 
 position, with the front section of the table slightly lowered. 
 
 Points of contact. — The heel of the contact hand is placed 
 against the spinous processes of the vertebrae to be adjusted, 
 wdiile the other hand grasps the knee. 
 
 Method of delivery. — The leg is raised and drawn toward 
 the operator, until the spine is markedly flexed. At the same 
 time firm pressure is made against the spinous processes by 
 the hand in contact therewith. A sudden thrust is then given 
 with the contact hand and at the same time the leg is drawn 
 upward. The direction of the thrust will depend upon the 
 nature of the subluxation. In a posterior subluxation the 
 force is directed downward. In a rotary subluxation the con- 
 tact is with the side of the spinous process toward which the 
 vertebra is rotated, and the force of the thrust is applied in 
 the opposite direction. In a compression subluxation the 
 force is directed downward, as well as in a supero-inferior 
 subluxation, since this will relieve ligamentous contraction, 
 and permit the vertebra to return into alignment. 
 
 This hold is illustrated in Fig. 97. 
 
 The Ilio-Deltoid Hold. — Indications. — This hold is very 
 useful in loosening up the lumbar and lower thoracic articula- 
 tions. This is not a specific method for adjusting the verte- 
 brae 1)ut it is fdllowed by very good results in settling of this 
 part of the s])ine and in lumbago.
 
 372 
 
 SPINAL ADJUSTMENT 
 
 Fig. 95. 
 Supra-Iliac Hold.
 
 LUMBAR VERTEBRAE 
 
 Z7Z 
 
 Fig. 96. 
 lufra-Iliac Hold.
 
 374 
 
 SPINAL ADJUSTMENT
 
 LUMBAR VKKri:i'.K.\E 
 
 375 
 
 Fig. 98. 
 Ilio-Deltoid Hold.
 
 Z76 
 
 SPINAL ADJUSTMENT 
 
 Fia. 99. 
 Geuu-Deltoid Hold.
 
 LUMBAR VERTEBRAE Z77 
 
 Position of the patient. — The patient should he on the 
 side, with the arm which is next the table placed under the 
 head. 
 
 Points of contact. — The operator should stand at one side 
 of the patient and facing the subject. One hand is placed 
 upon the posterior portion of the ilium, while the other hand 
 grasps the anterior portion of the shoulder. 
 
 Method of delivery. — -The contact having been obtained, 
 the shoulder of the patient is pushed backward while 
 the hip is drawn forward to the limit of normal motion. 
 A simultaneous thrust of both hands is then made. 
 
 This hold is illustrated in Fig. 98. 
 
 The Genu-Deltoid Hold. — Indications. — These are the 
 same as those for the preceding hold. 
 
 Position of the patient. — The patient's position is the same 
 as above. 
 
 Points of contact. — One hand grasps the anterior portion 
 of the shoulder, while the other holds the .under surface of 
 the knee. 
 
 Method of delivery. — The patient is drawn toward the edge 
 of the table. The leg next the table should be extended. The 
 other is brought down over the edge of the table, the operator 
 grasping the under aspect of the knee. The thigh is then 
 sharply flexed upon the abdomen, and the knee also is flexed, 
 and brought to a point midway between the operator's knees, 
 the foot resting upon his thigh. Downward pressure is next 
 made with the hand upon the knee; at the same time the 
 shoulder is pushed backward by the hand in contact therewith, 
 thus producing by these movements a decided rotation of the 
 lower part of the spine. When the tension thus produced has 
 reached the normal limit a quick thrust is given with either 
 hand, namely the hips are brought forcibly forward and at 
 the same time the shoulder is forced backward. The other 
 side of the spine may be similarly afifected by simply reversing 
 the hold. 
 
 This hold is illustrated in Fig. 99.
 
 CHAPTER V 
 
 Regional Classification of Holds 
 
 In the following table the various subluxations in the 
 different regions of the spinal column are given, together with 
 the holds applicable in each : 
 
 Megion of Spine Subluxations 
 
 Cervical Eotary 
 
 Lateral 
 
 Dorsal 
 
 Supero-Inferior 
 Compression 
 
 Scoliotic 
 Anterior 
 
 Posterior 
 
 Kyphotic 
 
 Lordotic 
 
 Scoliotic 
 
 Compression 
 
 Holds to Be Used 
 Tcni|ioroTransverse Hold 
 T. M. Hold 
 
 Unilateral Pisiform-Transverse Ante- 
 rior Hold 
 TemporoTransverse Hold 
 T. M. Hold 
 Temporo-Centrum Hold 
 
 Temporo-Transverse Hold 
 Fronto-Transverse Hold 
 Parieto-Transverse Hold 
 Temporo-Occipital Hold (for atlas) 
 Occipito-Mandibular Hold I 
 Occjpito-Mandibular Hold II 
 Occipito-Mandibular Hold III 
 Temporo-Transverse Hold 
 Bilateral Pisiform-Transverse Ante- 
 rior Hold 
 Thumb-Transverse Hold 
 Crossed Thumb-Transverte Hold 
 Ch-ossed Pisiform-Transverse Hold 
 Bilateral Pisiform-Transverse Hold 
 Bilateral Digito-Transverse Hold 
 Calcaneo-Spinous Hold 
 
 Thumb-Transverse Hold 
 
 Crossed Bilateral Pisiform-Transverse 
 
 Hold 
 Bilateral Pisiform-Transverse Hold 
 Pisiform-Spinous Hold 
 Ulno-Spinous Hold 
 Sacro-Spinous Hold 
 Traction 
 
 Unilateral Pisiform- Transverse Hold 
 T. M. Hold (in upper dorsals) 
 Ilio-Spinous Hold 
 Traction 
 
 Thumb-Transverse Hold 
 Crossed Thumb-Transverse Hold 
 Crossed Bilateral Pisiform-Transverse 
 
 Hold 
 Bilateral Pisiform-Transverse Hold 
 Calcaneo-Spinous Hold 
 
 378
 
 CLASSIFICAIIUN ()!• ilULUS 
 
 379 
 
 Region of Spine Subluxations 
 Sii2)cro-Inferior 
 
 Lateral 
 
 Eotary 
 
 Lumbar 
 
 Posterior 
 
 Kyphotic 
 
 Lordotic 
 
 Scoliotic 
 
 Compression 
 
 Supero-Iuferior 
 
 Anterior (5L.) 
 
 Eotary 
 
 Uuld.s to ]{( U.scd 
 Thuiiil)-Tran.svcr;^i; Hold 
 Crossed Thurnh-Transvcrso Hold 
 Crossed Bilateral Pisiform-Transverse 
 
 Hold 
 Bilateral Pisiform-Transverse Hold 
 Unilateral Pisiform-Transverse Hold 
 
 Unilateral Pisiform-Transverse Hold 
 Calcaneo-Pisiform-Tiansverse Hold 
 T. M. Hold 
 
 Thumb-Transverse Hold 
 Crossed Tliumb-Transvcr^o Hold 
 Crossed Bilateral Pisiform-Transvcrs-e 
 
 Hold 
 Bilateral Pisiform-Transverse Hold 
 Unilateral I'isiform-Transverse Hold 
 Calcaneo-Pisiform-Transversc Hold 
 Bilateral Digito-Transver^e Hold 
 Mandibulo-Spinous Hold 
 T. M. Hold 
 
 Bilateral Pisiform-Transverse Hold 
 Calcaneo Spinous Hold 
 Thumb-Transverse Hold 
 Pisiform-Spinous HoM 
 Genu-Spinous Hold 
 
 Bilateral Pisiform-Transverf-e Hold 
 Thumb-Transverse Hold 
 
 Sacro-Spinous Hold 
 Traction 
 
 Ilio-Spinous Hold 
 Genu-Spinous Hold 
 
 Calcaneo Spinous Hold 
 Pisiform-Spinous Hold 
 Genu-Spinous Hold 
 Genu-Deltoid Hold 
 
 Bilateral Pisiform-Transverse Hold 
 Unilateral Pisiform-Transverse Hold 
 Genu-Spinous Hold 
 Genu-Deltoid Hold 
 
 Supra-Sacral Hold 
 Bilateral Pisiform-Transverse Hold 
 (applied on the 4th lumbar) 
 
 Thumb-Transverse Hold 
 Pisiform-Spinous Hold 
 Unilateral Pisiform-Transverse Hold 
 Bilateral Pisiform-Transverse Hold 
 Genu-Spinous Hold 
 
 In the following table are given the different forms of 
 subluxations, and the holds adapted to the correction of each 
 depending upon the region of the spine in which thev are 
 situated.
 
 380 SPINAL ADJUSTMENT 
 
 Lateral Subluxation: 
 Cervical Region — 
 
 Temporo-Transverse Hold. 
 T. M. Hold (6-7C). 
 Temporo-Centrum Hold. 
 Dorsal Region — 
 
 Unilateral Pisiform-Transverse Hold. 
 Calcaneo-Pisiform-Transverse Hold. 
 T. M. Hold (1-2-3D). 
 
 Rotary Subluxation: 
 Cervical Region — 
 
 Temporo-Transverse Hold. 
 
 T. M. Hold (6-7C). 
 
 Unilateral Pisiform-Transverse Anterior Hold. 
 Dorsal Region — 
 
 Thumb-iTransverse Hold. 
 
 Crossed Thumb-Transverse Hold. 
 
 Crossed Bilateral Pisiform-Transverse Hold. 
 
 Bilateral Pisiform-Transverse Hold. 
 
 Unilateral Pisiform-Transverse Hold. 
 
 Calcaneo-Pisiform-Transverse Hold. 
 
 Bilateral Digito-Transverse Hold. 
 
 T. M. Hold (1-2-3D). 
 
 Mandibulo-Spinous Hold. 
 Lumbar Region — 
 
 Bilateral Pisiform-Transverse Hold. 
 
 Unilateral Pisiform-Transverse Hold. 
 
 Pisiform-Spinous Hold. 
 
 Genu-Spinous Hold. 
 
 Supero-Inferior Subluxation : 
 Cervical Region — 
 
 Temporo-Transverse Hold. 
 Dorsal Region — 
 
 Thumb-Transverse Hold. 
 , Crossed Thumb-Transverse Hold. 
 
 Crossed Bilateral Pisiform-Transverse Hold. 
 
 Bilateral Pisiform-Transverse Hold. 
 
 Unilateral Pisiform-Transverse Hold. 
 
 Genu-Spinous Hold.
 
 CLASSIFICATION OF HOLDS 381 
 
 Lumbar Region — 
 
 Bilateral Pisiform-Transverse Hold. 
 Unilateral Pisiform-Transverse Hold. 
 Genu-Spinous Hold. 
 Genu-Deltoid Hold. 
 
 Compression Subluxation : 
 Cervical Region — 
 
 Fronto-Transverse Hold, 
 
 Parieto-Transverse Hold. 
 
 Occipito-Mandibular Hold. 
 
 Temporo-Occipital Hold. 
 Dorsal Region — 
 
 Thumb-Transverse Hold. 
 
 Crossed Thumb-Transverse Hold. 
 
 Crossed Bilateral Pisiform-Transverse Hold. 
 
 Bilateral Pisiform-Transverse Hold. 
 
 Calcaneo-Spinous Hold. 
 Lumbar Region — 
 
 Calcaneo-Spinous Hold. 
 
 Pisiform-Spinous Hold. 
 
 Genu-Spinous Hold. 
 
 Genu-Deltoid Hold. 
 
 Posterior Subluxation: 
 Dorsal Region — 
 
 Thumb-Transverse Hold. 
 
 Crossed Thumb-Transverse Hold. 
 
 Crossed Bilateral Pisiform-Transverse Hold. 
 
 Bilateral Pisiform-Transverse Hold. 
 
 Bilateral Digito-Transverse Hold. 
 
 Calcaneo-Spinous Hold. 
 Lumbar Region — 
 
 Bilateral Pisiform-Transverse Hold. 
 
 Calcaneo-Spinous Hold. 
 
 Pisiform-Spinous Hold. 
 
 Genu-Spinous Hold. 
 
 Anterior Subluxation: 
 
 Cervical Region — 
 
 Bilateral Pisiform-Transverse Anterior Hold.
 
 382 SPINAL ADJUSTMENT 
 
 Dorsal Region- — • 
 
 Bilateral Pisiform-Transverse Hold (on vertebra 
 
 above and below the one subluxated). 
 Crossed Bilateral Pisiform-Transverse Hold (on ver- 
 tebra above and below the one subluxated) . 
 Lumbar Region — 
 
 Supra-sacral Hold. 
 
 Bilateral Pisiform-Transverse Hold (on the fourth 
 lumbar vertebra). 
 
 Kyphotic Subluxation: 
 Dorsal Region — 
 
 Thumb-Transverse Hold. 
 
 Crossed Thumb-Transverse Hold. 
 
 Crossed Bilateral Pisiform-Transverse Hold. 
 
 Bilateral Pisiform-Transverse Hold. 
 
 Pisiform-Spinous Hold. 
 Lumbar Region — 
 
 Bilateral Pisiform-Transverse Hold. 
 
 Thumb-Transverse Hold. 
 
 Scoliotic Subluxation: 
 Cervical Region — 
 
 Temporo-Transverse Hold. 
 
 T. M. Hold (in lower two cervical vertebrae). 
 Dorsal Region — 
 
 T. M. Hold (in upper three dorsal vertebrae). 
 
 Ilio-Spinous Hold. 
 Lumbar Region — 
 
 Ilio-Spinous Hold. 
 
 Genu-Spinous Hold. 
 
 Lordotic Subluxation: 
 
 Cervical Region — 
 
 Bilateral Pisiform-Transverse Anterior Hold. 
 Dorsal Region — 
 
 Sacro-Spinous Hold. 
 
 Traction. 
 Lumbar Region — 
 
 Sacro-Spinous Hold. 
 
 Traction.
 
 SECTION SEVEN 
 Practice of Spinal Adjustment 
 
 CHAPTER I 
 
 Vertebral Subluxations and Disease 
 
 Before taking up the practical application of spinal adjust- 
 ment, we wish to present for the reader's consideration the 
 relationship between disease and vertebral subluxations. 
 
 The etiological factors in the production of disease have 
 been considered at length in a number of the preceding chap- 
 ters. We have seen that the functional activity and organic 
 integrity of all parts of the body, and their harmonious rela- 
 tionship, depend upon proper innervation. The withdrawal of 
 this nervous influence, either entirely or in part, renders the 
 affected parts of the body susceptible to disease. Often this 
 lack of innervation is sufficient of itself to result in the devel- 
 opment of disease ; in other cases the superimposition of con- 
 tributing factors is necessary. For example, a subluxation 
 in the middle cervical or upper dorsal region will not cause 
 tuberculosis; but the invasion of the respiratory tract by 
 tubercle bacilli, in the face of a lowered vitality, is necessary 
 to produce this disease. A lowered vitality is thus the pri- 
 mary factor in permitting the development of pulmonary 
 tuberculosis, but the resistance of the patient could be abso- 
 lutely nil. and yet he would not develop tuberculosis in the 
 absence of the bacilli. On the other hand the lack of resist- 
 ance need not depend upon a lowering of the general vitality, 
 but may be confined to the atrium of infection solely. Tuber- 
 cle bacilli gain access to the lungs through the upper part 
 of the respiratory tract ; if this portion of the body is not 
 normal, it permits of the multiplication of the bacilli and the 
 elaboration of their toxins in the area of special predilection 
 of that particular bacterium. The normal condition of any 
 part of the body is dependent uixui ])r()per innervation, and 
 
 383
 
 384 SPINAL ADJUSTMENT 
 
 since the flow of nerve-impulses is most readily interfered 
 with at the intervertebral foramina, vertebral subluxations 
 must be considered as that factor which makes the develop- 
 ment of disease possible. In other words, subluxations are the 
 predisposing causes of disease in many instances. By this it 
 is not meant that no disease can occur unless a vertebral sub- 
 luxation is previously induced, since other factors may act 
 as predisposing causes of diseases. Thus, in the example 
 under consideration, heredity may be a predisposing cause, 
 the patient having inherited from a tubercular parent a tend- 
 ency to contract this disease. Again, occupations necessi- 
 tating the assuming of cramped positions may, by preventing 
 free aeration of the lungs, act as predisposing factors in the 
 production of the disease. Residence in unhygienic surround- 
 ings, alcoholism, syphilis, and Bright's disease, may similarly 
 predispose the patient toward the contracting of tuberculosis 
 when he is exposed to the exciting cause. It must, however, 
 be remembered that even though the general .health may be 
 very much depraved, by any of the above-mentioned diseases, 
 tuberculosis may not develop. We do not see tuberculosis in 
 every patient suffering from chronic alcoholism, syphilis, or 
 Bright's disease, even though the general health is extremely 
 low. There must be a further reason why tuberculosis will 
 develop in one such patient and not in another, both of whom 
 are equally exposed to the bacilli, and in the same receptive 
 condition. 
 
 The cause for this apparent anomaly must be sought for 
 in the respiratory tract itself. When this is done, it will 
 nearly always be found that the atrium of infection, namely 
 the respiratory tract in the patient who has not developed 
 tuberculosis is in a condition that does not permit of the 
 growth of the bacilli. In the other patient a depraved condi- 
 tion of the respiratory tract is present, and dependent upon 
 readily demonstrable spinal lesions in the middle cervical 
 and upper dorsal region. This example is equally applicable 
 m a majority of diseases and shows that the primary, predis- 
 posing and indirect cause of disease is subluxations in the 
 spinal segment from which the affected part derives its inner- 
 vation. The exciting, direct or contributing causes are those 
 which affect a particular part of the body, and by their
 
 VERTEBRAL SUBLUXATIONS 385 
 
 character determine the nature of the disease process that 
 follows. 
 
 It may be asked, why, in view of the fact tiiat a certain 
 segment controls so many different organs and parts of the 
 body, are they not all affected when a subluxation is present 
 in that segment? This is explained very readily. If a cer- 
 tain segment is the seat of a subluxation it is true that all 
 the structures supplied by that segment suffer from faulty 
 innervation ; that is to say, their inherent resistance is im- 
 paired. They thus are constantly in a receptive condition to 
 the invasion of the secondary or contributing causes of disease. 
 Were their innervation, and consequently their organic integ- 
 rity perfect, they would not so easily be aft'ected by extraneous 
 influences. For example, if the fourth cervical vertebra is 
 subluxated and pressure upon the corresponding nerves suf^- 
 cient to obstruct the conduction of impulses along them is 
 present, the structures of the head and face will not receive 
 their proper amount of nerve supply. No actual disease 
 process may occur in these parts so long as no other influences 
 are superimposed. If, however, such an individual uses the 
 voice excessively, he will more readily suft'er from laryngitis; 
 if an infection enters the tonsils, they will succumb to its 
 invasion more surely; if the eyes are subjected to any delete- 
 rious influences, they become more easily affected. Thus the 
 contributing causes are really secondary, and determine what 
 part will become affected. For that reason we may have 
 laryngitis, or tonsilitis, or conjunctivitis, and all may be re- 
 lieved by adjustment of the fourth cervical vertebra, since a 
 subluxation of that vertebra is the primary and predisposing 
 cause of all these affections. The exact nature of the disease 
 and the part involved depend, therefore, upon the character 
 of the contributing causes and the structure which they af- 
 fect. It is for this reason that the contributory etiology of 
 diseases must not be overlooked, but must be given careful 
 consideration. It frequently is of great assistance in making 
 a diagnosis of the exact nature of an affection in a certain 
 organ. For example, symptoms may be present, pointing to 
 heart disease, and the spinal findings may also show this 
 to be the case. Yet the symptoms may not be sufficiently 
 characteristic to make an exact diagnosis possible. It is here
 
 386 SPINAL ADJUSTMENT 
 
 that reference to the possible cause may solve the problem ; 
 thus rheumatism, scarlet.fever, or typhoid fever may be found 
 to be contributing causes, in which case valvular lesions may 
 be suspected ; again, excessive use of tea, coffee or tobacco 
 may be found to be contributing causes, in which event the 
 affection of the heart would in all probability be a neurosis. 
 
 While thus recognizing the almost constant occurrence of 
 spinal lesions as etiological factors in the production of dis- 
 ease, the contributing causes must never be overlooked since 
 they are what directly produces the morbid process in most 
 instances. 
 
 As already mentioned, vertebral subluxations predispose 
 those parts innervated by the impinged nerves to disease. The 
 contributing causes determine which of these parts will be- 
 come affected and the nature of the affection. Briefly stated, 
 therefore the proposition is this: Given a vertebral subluxa- 
 tion, disease is made possible ; given a contributing cause its 
 occurrence is made certain. Both factors must be present in 
 most cases. 
 
 Reference has already been made in the chapter on spinal 
 diagnosis in respect to the impossibility of making a correct 
 diagnosis from the spinal analysis alone. The spinal analysis 
 determines in what part, organ, or system of the body a dis- 
 ease process may be presumed to exist. It does not, however, 
 give any clue as to the exact nature of the disease. 
 
 Thus, if a subluxation is found in the lower lumbar region, 
 disease of the uterus may be suspected. But whether it be 
 endometritis or cancer only the symptoms present will deter- 
 mine. For this reason a mental picture of the symptom-com- 
 plex of every disease is essential. If the practitioner will, 
 therefore, familiarize himself first with the innervation of the 
 various parts of the body, the spinal analysis will at once 
 show him what organ is affected; a consideration of the 
 symptoms and signs present then determine the exact nature 
 of the affection. For this reason the leading symptoms of all 
 the diseases given are included, since only by a ready 
 familiarity therewith is accuracy in diagnosis made possible. 
 
 It may be asked, why, if the vertebral subluxations are the 
 primary and predisposing cause of a certain disease, will ad- 
 justment of the subluxated vertebra not of itself cure such a
 
 VERTEBRAL SUBLUXATIONS 387 
 
 disease? Why, on the other hand, are accessory methods 
 recommended? 
 
 Adjunct measures are used in the treatment of some dis- 
 eases for the following reasons: 1. They increase or add to 
 the effectiveness of the spinal adjustment. For example, in 
 chronic constipation, while the restoration of the nerve-supply 
 of the bowel is accomplished by adjustment of the subluxated 
 vertebrae, massage is recommended to assist the bowels in 
 evacuating their contents until their muscular coat has re- 
 gained its normal tone ; correction of the diet is necessary 
 to make the work of the intestines as light as possible during 
 the period when extra demands are being put upon them. 
 Exercises are valuable in building up the muscular structures 
 of the body and consequently also of the abdominal walls and 
 intestines. During these treatments spinal adjustment is 
 continued, and is the prime factor in the restoration of normal 
 function. The fact that other methods are used in connec- 
 tion therewith does not detract from the merits of the spinal 
 adjustment, since these adjunct measures are merely as- 
 sistive agents, in any case, in the same manner that drugs 
 are, be it constipation or any other disease. 
 
 2. Adjunct measures are used for the elimination of the 
 contributing causes. For example, if the patient is suffering 
 from Bright's disease, the contributing causes must be recog- 
 nized and attention given them. It is evidently not sufficient 
 in a case of this kind to adjust the tenth to twelfth dorsal 
 vertebrae. This has been done many times, and no results 
 obtained; and yet we know that the nerves emanating from 
 these spinal segments influence the kidneys more than any 
 others. For this reason a careful spinal analysis should be 
 made in all cases to determine the existence of subluxations 
 elsewhere. It would be manifestly folly to permit a patient 
 with Bright's disease to eat irritating foods, one suffering 
 from heart disease to exercise violently, or one having cir- 
 rhosis of the liver to use alcohol. On the other hand, a proper 
 diet should be prescribed, moderate exercises advised, and 
 liquors interdicted in each case respectively. 
 
 3. Nearly all diseases are accompanied by a greater or 
 less toxemia of some kind or nature. It is true that restora- 
 tion of the functional activity of the secretory and excretory
 
 388 SPINAL ADJUSTMENT 
 
 organs through spinal adjustment will ultimately rid the 
 organism of these toxins. Nevertheless, accessory methods 
 greatly assist a more rapid elimination of the toxins and 
 make the spinal adjustment so much more effective. In many 
 acute diseases it is the toxemia which produces dangerous 
 symptoms, and speedy elimination is absolutely necessary. 
 For this reason, adjustment at the tenth dorsal segment which 
 stimulates the kidneys, and at the upper lumbar segments 
 which influence the bowels, is advised in such conditions. In 
 connection therewith hot baths, hot enemata, etc , are given 
 to still further increase the eliminative function of the skin 
 and bowels. 
 
 4. Dangerous symptoms may arise at any time in the 
 course of some diseases, and even result in the patient's death 
 before the cause can possibly be corrected, and the dangers 
 obviated, by spinal adjustment. The temperature in an acute 
 disease, as typhoid fever, may rise to a degree that may 
 menace the life of the patient. This fever is due to an un- 
 usually virulent toxemia and immediate steps must be taken, 
 to employ not only spinal adjustments, but eliminative meas- 
 ures, and combine these with methods directed against the 
 fever itself, namely cold baths, sponges, compresses, etc. 
 Various symptoms must be given appropriate treatment, the 
 above being an example illustrating the necessity for using 
 adjunct measures. 
 
 5. Other measures of treatment have shown their effec- 
 tiveness in different diseases, and should therefore be used. 
 Spinal adjustment is not to be regarded as all in all in the 
 treatment of disease and other measures which are of proven 
 value should be considered. Such measures as massage, 
 hydrotherapy, spinal concussion, elimination, diet, exercises, 
 etc., may be successfully combined with spinal adjustment. 
 Reasons for the desirability of using some of these adjunct 
 measures have been given above. These illustrations should 
 serve to show that their use is a rational and logical procedure, 
 yet does not detract in the slightest from the merits of spinal 
 adjustment. 
 
 6. Lastly, there are certain diseases and conditions that 
 are impossible of cure by any known method of treatment and 
 it would therefore be folly to employ spinal adjustment in
 
 VERTEBRAL SUBLUXATIONS 389 
 
 them. Such diseases as advanced tuberculosis, cancer, etc., 
 are accompanied by such profound destruction of tissue ele- 
 ments that recovery is impossible. Not only the organs pri- 
 marily affected, but the entire "house in which we live" is 
 falling to pieces, and nothing can replace that which has 
 been destroyed. 
 
 There are other conditions which belong so manifestly in 
 the realm of surgery that attempts to relieve them by 
 spinal adjustment alone are irrational and ill-conceived, 
 and show an ignorance of pathology. Most tumors, for in- 
 stance, are amenable to no treatment other than excision. 
 
 With all these facts in mind, it remains true, as clinical 
 results conclusively show, that of all methods of treatment 
 of disease. Spinal Adjustment is the most valuable single 
 measure known.
 
 CHAPTER II 
 
 Infectious Diseases 
 Typhoid Fever 
 
 Etiology. — The direct and secondary cause is the bacillus 
 typhosus, while the indirect but primary cause is subluxation 
 of the vertebrae, which prevents the conduction of nerve im- 
 pulses to the intestines, thus lowering their resistance and 
 permitting the growth of the bacilli and the elaboration of 
 their toxins. Contributing etiological factors are adolescence, 
 temperate climate, spring and autumn months, contaminated 
 water and milk. 
 
 Pathology. — The Peyer's patches undergo enlargement, 
 death, ulceration, and finally scar-formation. The lower part 
 of the small intestine and the upper portion of the large 
 intestine are principally affected. Enlargement of the spleen 
 and mesenteric glands is present. 
 
 Symptoms. — The onset is gradual, lasting about two 
 weeks, during which time there may be headache, malaise, 
 loss of appetite, and nose-bleed. Sometimes the disease be- 
 gins as meningitis, or pneumonia, or acute Bright's disease. 
 The diagnosis is sometimes difficult, in these cases. FIRST 
 WEEK — Fever, which in typical cases rises gradually, being 
 a degree higher each day, while the morning temperature is 
 one degree lower than that of the preceding evening. The 
 abdomen is distended, tender, and bubbling and gurgling on 
 the right side is frequent. Cough is common. Headache is 
 constant and severe. The pulse is dicrotic. There may be 
 diarrhea. SECOND WEEK — The symptoms of the first 
 week continue, and are aggravated. Rose-spots appear upon 
 the abdomen and chest, and rarely over the entire body. These 
 spots are very small, slightly raised, bright red, and disappear 
 on pressure. The fever is continuously high, 103° to 106° 
 and about one degree lower in the morning than in the 
 evening. The spleen is enlarged. The pulse is feeble, but 
 
 390
 
 INFECTIOUS ])ISF-:ASKS 391 
 
 relatively slow, around 100, and not at all in proportion to the 
 height of the fever, which is characteristic. The tongue is 
 coated except at the tip and edges, where it has a red, glossy 
 appearance. The nervous symptoms include delirium, stupor, 
 mental apathy and in severe cases, the "typhoid state," which 
 is a condition of profound collapse. The more violent the 
 delirium, the better the prognosis, while the outlook in a 
 patient with low, muttering delirium is bad. THIRD WEEK 
 — The fever gradually falls, but the general weakness is in- 
 creased. There is emaciation, rapid pulse, and spasms of 
 the muscles. The general condition, however, is marked by 
 gradual improvement. But in the worst cases the symptoms 
 of the second week continue and become progressively worse. 
 FOURTH WEEK — Convalescence commences, and the 
 symptoms gradually disappear. Other less common symp- 
 toms occurring during the course of the disease include per- 
 spiration, jaundice, hemorrhages, erythema, hiccough, and 
 persistence of the appetite. The temperature may be of any 
 kind or type. 
 
 There is present marked tenderness of the twelfth pair of 
 thoracic nerves, especially the one on the right side. This 
 is due to the pathological condition of the lower portion of 
 the ileum, which receives its innervation from the eighth 
 segment of the spinal cord, and which nerves make their 
 exit between the twelfth thoracic and first lumbar vertebrae. 
 There is contraction of the ligaments on the right side of the 
 twelfth thoracic segment, marked tenderness of the twelfth 
 thoracic nerve on the right side, and increase of tempera- 
 ture of this segment, owing to the pathological changes in 
 Peyer's patches. There is tenderness of the nerve at the 
 sixth thoracic spinal segment on the left side, contraction 
 of the ligaments and increased temperature, owing to the 
 involvement of the spleen. 
 
 Treatment. — When the case is seen early, all the symp- 
 toms enumerated above usually do not develop, unless the 
 infection is exceptionally virulent or the vital resistance of 
 the patient is very low. Adjust the atlas to relieve nervous 
 symptoms; the fifth cervical for stimulation of the innerva- 
 tion to the thyroid glands; the sixth thoracic for its eflfect 
 upon the spleen; the eighth, tenth and twelfth thoracic for
 
 392 SPINAL ADJUSTMENT 
 
 their effect upon the intestines and the second kimbar, if so 
 indicated. Adjust the cervicals for the fever. 
 
 Accessory Treatment. — When the disease is first sus- 
 pected, the patient, after having been properly adjusted, is 
 given a bath, put to bed, given an enema, put on a liquid diet, 
 and an ice-cap placed on the head. The patient should not 
 leave the bed until recovery is complete. Every morning a 
 bath is given, the back is sponged with alcohol, and dusted 
 with talcum powder to prevent development of bed-sores. In 
 cases with marked delirium or high fever, different kinds of 
 baths are valuable. -The cold tub, the sponge bath, the cold 
 pack and the alcohol sponge are all useful. The kind of bath 
 depends upon the strength of the patient, and the severity 
 of the nervous symptoms. If the temperature is not above 
 103°, baths may be discontinued. If the temperature is high 
 only in the evening, and the nervous symptoms are not severe, 
 a cold sponge during the course of the night will suffice. 
 In grave cases, the sponge bath, or any of the other varie- 
 ties of baths, can be employed. It is advisable to give baths 
 not oftener than every three hours in any case. The water 
 should be about 80°, and the patient should remain in the 
 bath not longer than twenty minutes. Vigorous massage of 
 the extremities adds to the efficacy of the bath. It is not 
 advisable to move the patient to any extent. 
 
 Diet. — Thin meat broth or milk every three hours, about 
 a cupful at a time. Water should be taken in large quantities. 
 Other articles permitted during the height of the fever are 
 lemonade, water with a little white of egg added, buttermilk, 
 orange juice, and purees of barley, oat-meal and rice. When 
 the temperature goes down, one or two egg-nogs a day may 
 be given. If the bowels do not move during the day, give an 
 enema of soap-suds. For diarrhea, change the diet; if milk 
 is being given, boil it ; or change to meat broths, if diarrhea 
 persists. 
 
 Small-Pox 
 
 Etiology. — The primary and indirect cause is a low state 
 of vital resistance as a result of faulty innervation. This 
 permits the growth of the organisms and the elaboration of 
 their toxins in the system to take place. The direct and 
 secondary cause is probably an intra-cellular parasitic pro-
 
 INFECTIOUS DISEASES 393 
 
 tozoon, the Cyloryctes variolae. There is no period from the 
 initial fever to the period of peeling when the disease is not 
 contagious, although during the stage of suppuration the 
 disease is most communicable. 
 
 Pathology. — The eruption with its four stages, namely, 
 macule, papule, vesicle and pustule, is the only distinctive 
 pathology. A depressed spot in the apex of the pustule indi- 
 cates the area of necrosis. Granular and fatty degeneration of 
 the liver, spleen, heart and kidneys is present. The pustules 
 sometimes are seen in the larynx, trachea, bronchial tubes, 
 and pleura. 
 
 Symptoms. — There is an incubation period of from ten 
 to fifteen days. The onset is sudden with a chill, vomiting, 
 and severe pain in the head and back. The initial rash ap- 
 pears on the first or second day and resembles that of measles 
 or scarlet fever ; this rash appears principally on the inner 
 surfaces of the thighs. On the fourth day of the disease, the 
 true eruption of small-pox appears, on the forehead, wrists, 
 back and elsewhere, as macules having a hard shotty feel. On 
 the fifth and sixth day these change to vesicles, the apex of 
 which is sunken, and which do not collapse when pricked 
 with a needle. On the eighth day pustules appear, surrounded 
 by a red zone. On the eleventh day crusts form, which later 
 fall oflf. The initial fever rapidly rises to 103°-104°, with a 
 drop to normal from the fourth to the eighth day. When the 
 true eruption appears, a secondary rise of temperature oc- 
 curs. Constitutional disturbances are severe, and delirium 
 and the "typhoid state" frequently are met with. Tenderness 
 of the nerves of the fifth and seventh thoracic segments is 
 present in nearly all cases of small-pox. 
 
 Treatment. — Adjust the fifth cer\^ical and the fifth or sixth 
 and tenth thoracic vertebrae. Adjustment of the fifth cer\'ical 
 vertebra is claimed by some to be a specific in the treatment 
 of small-pox. The diet should consist of milk, broths, and 
 other easily digestible foods. For fever and nervous symptoms 
 use cold baths or sponges. 
 
 Varicella (Chicken-Pox) 
 
 Etiology.— The direct cause of this disease is unknown. 
 Being of an infectious and contagious nature, however, it may
 
 394 SPINAL ADJUSTMENT 
 
 be correctly assumed that the primary and indirect cause 
 is a state of impaired resistance, due to faulty innervation. 
 
 Symptoms. — The incubation period is from ten to four- 
 teen days. The onset is sudden, with vomiting and backache 
 at times. A moderate rise in temperature. The eruption, 
 at first papular, soon becomes vesicular. The vesicles appear 
 on the first day of the disease, and are commonly single, 
 distributed over the entire body, few in number, and collapse 
 on pricking with a needle. On the third or fourth day pustules 
 appear, which soon dry up and form brownish crusts. 
 
 Treatment. — Adjust the fifth cervical and fifth and tenth 
 thoracic vertebrae. The disease always terminates favorably 
 under this mode of treatment. Otherwise the therapy is 
 symptomatic. 
 
 Scarlet Fever 
 
 Etiology. — The direct and secondary cause is a special 
 micro-organism, which retains its infecting power for at 
 least one year. The poison is scattered by the scales in the 
 air, clothes, food, etc. The respiratory tract is generally the 
 atrium of infection, but the digestive tract may also convey 
 the poison. Children are most susceptible to this disease. 
 Second attacks are unusual, but do occur. The indirect and 
 primary cause is a lack of resistance due to faulty innervation, 
 as a result of vertebral subluxations. 
 
 Pathology. — There is no characteristic morbid anatomy. 
 The skin is the seat of acute inflammation which fades away. 
 There is granular degeneration of the liver, spleen, stom- 
 ach, kidneys, heart and muscles. The throat is the seat of 
 inflammation, and sometimes ulceration. 
 
 Symptoms. — The incubation period varies from two to 
 four days. The onset is sudden, often with a chill, vomiting, 
 and spasms. The condition of the throat varies from a mild 
 angina to severe ulceration. The eruption appears on the 
 first or second day, and resembles a vivid red blush ; it first 
 invades the neck, chest and arms, and then becomes general ; 
 a characteristic feature is that a portion of the face about the 
 mouth is not covered by the eruption and appears very white 
 in contrast with the balance of the face. It fades rapidly, and 
 it may be quite itchy. The peeling is characteristrc, and be- 
 gins soon after the eruption disappears. It is fine and scaly
 
 INFFXTIOUS DISEASES 395 
 
 on the body, but from the feet and hands whole casts may 
 come off; it lasts two weeks or more. The fever rises rapidly 
 to 103°-106°, and there is rapid pulse and often delirium. It 
 falls to normal in from three to ten days. The tongue has the 
 appearance of a strawberry, showing enlarged fungiform 
 papillae. The cervical glands are enlarged. Acute Bright's 
 disease is apt to develop from the 3rd week, and the urine 
 contain albumin. In all cases the kidneys are affected early. 
 If, however, albumin is still present in the urine after the 
 third week, permanent kidney trouble will probably result. 
 Complications and sequelae include nephritis, middle ear 
 disease. Arthritis, Endocarditis, Myocarditis, Pericarditis, 
 Pleurisy, Ludwig's angina. Broncho-pneumonia, Chorea, 
 Paralyses, and Noma. 
 
 Treatment. — Adjust the 4th cervical and the 5th and 10th 
 thoracic vertebrae, and make any other adjustments which 
 may be indicated, after a careful spinal analysis has been made. 
 Strict quarantine until desquamation is complete. The patient 
 should be isolated. Disinfecting measures to the saliva and 
 peeled skin. Diet should consist of milk. An abundance of 
 water should be drunk, to relieve the work of the kidneys as 
 far as possible. Apply olive oil or carbolated vaseline to the 
 skin when peeling commences to prevent scattering of the 
 scales. Supportive measures as required. The patient should 
 not be allowed to leave the bed, until after the third week on 
 account of the danger of complications, especially Bright's 
 disease. 
 
 Measles 
 
 Etiology. — The cause is an unknown microorganism, 
 which may be transmitted through a third party, and in various 
 other ways. It is seen usually in children, although adults 
 sometimes contract it. It is generally epidemic. Second at- 
 tacks are uncommon, but may occur. 
 
 Pathology. — No characteristic lesions are present. The 
 kidneys may be the seat of albuminous degeneration or acute 
 nephritis. Bronchopneumonia or enlargement of the bron- 
 chial lymph glands may develop. 
 
 Symptoms. — The incubation period varies from ten to 
 fourteen days. The onset of the disease is sudden, a chill or 
 chilliness, fever of 101° to 102° F., muscular soreness, head-
 
 396 SPINAL ADJUSTMENT 
 
 ache, and intense catarrh of the nose and throat, being the 
 first symptoms. There are present also redness of the eyes, 
 aversion to light, sneezing and coughing. On the second day 
 the fever drops, but rises again on the fourth day, when an 
 eruption of small, dark red, velvety papules appears, first on 
 the face, and rapidly spreads over the entire body. The 
 catarrhal symptoms still persist. There is itching and burn- 
 ing. On about the ninth day the rash begins to fade and 
 soon disappears entirely by bran-like desquamation. Koplik's 
 spots which are bluish white spots found on the mucous mem- 
 brane of the cheeks, are supposed to be pathognomonic of 
 measles. Black measles is that variety in which the eruption 
 is hemorrhagic and there is great prostration. It is encoun- 
 tered in places in which faulty hygiene exists. 
 
 The most common complications are catarrhal pneumonia 
 and catarrh of the stomach and intestines. The most common 
 sequelae are tonsillitis, tuberculosis, and cancrum oris. 
 
 Treatment.- — Adjust the 4th and 6th cervicals, and the 3rd, 
 5th and 10th dorsals. The patient should be kept in bed, ki a 
 warm but well ventilated room. The eyes should be kept 
 clean and protected from the light. The mouth also should 
 be frequently cleansed. For high fever, sponging or tepid 
 baths gradually cooled. During desquamation oil and bathe 
 the skin. Guard the patient against exposure during con- 
 valescence, in order to avoid broncho-pneumonia and tuber- 
 culosis. 
 
 Rubella (German Measles) 
 
 Etiology. — The direct cause is unknown. The disease is 
 seen in epidemic form most often, and spreads rapidly. 
 
 Symptoms. — The incubation period is from 10 to 14 days. 
 The onset is sudden, and the rash appears at once, and con- 
 sists of bright red macules and papules. The cervical lymph 
 glands are often enlarged. Slight rise in temperature. Mild 
 coryza and sore throat. 
 
 Treatment. — There is no special treatment ; the measures 
 indicated under measles are applicable to this disease. 
 
 Epidemic Parotitis (Mumps) 
 Etiology. — The specific cause is at present unknown. It 
 occurs in epidemic form although sporadic cases are seen.
 
 INFECTIOUS DISEASES 397 
 
 Females are less susceptible than males, and the disease oc- 
 curs most commonly between the ages of 5 and 15 years. 
 
 Pathology. — One or both parotid glands are inflamed and 
 in severe epidemics the cellular tissue of the gland is involved. 
 The inflammation first involves the gland ducts and quickly 
 extends to the gland proper. Sometimes the submaxillary 
 gland, the ovaries, testes and mammary glands are involved. 
 Secondary parotitis occurs as a complication in severe blood- 
 poisoning, and ends in suppuration and destruction of gland- 
 structure. 
 
 Symptoms. — The incubation period lasts from 2 to 3 weeks. 
 The onset is sudden and marked by mild fever. One parotid 
 gland is swollen and painful ; two or three days after the op- 
 posite gland becomes affected. Dysphagia and often earache ; 
 inflammation of the testes in the adult may be the only evi- 
 dence of the disease, which lasts about one week. Orchitis 
 is the most common sequel, and may result in sterility. Chronic 
 enlargement of the gland, and deafness may also result. 
 
 Treatment. — Give adjustments in the upper cervical region, 
 since from here is derived the innervation to the salivary 
 glands ; the 5th dorsal vertebra should be adjusted, since from 
 this segment there seems to be a specific influence in this 
 disease. The disease, if treated early in this way, may be 
 cut short. The lower dorsal vertebrae should also be adjusted. 
 Locally, a hot compress or an ice bag is of service. Other- 
 wise the treatment is symptomatic. 
 
 Whooping Cough (Pertussis) 
 
 Etiology. — The disease is contagious and is due to an un- 
 known microorganism, which attacks patients of low vitality, 
 the primary cause of which is disturbed innervation. It is a 
 disease of childhood, fully one-half of the cases occurring dur- 
 ing the first two years of life. Adults may, however, be af- 
 fected. Second attacks are uncommon. 
 
 Pathology. — No characteristic lesions are present. 
 
 Symptoms. — The incubation period varies from 1 to 2 
 weeks. For the first one or two weeks there is cough, which 
 gradually becomes spasmodic. Slight fever, and coryza then 
 develop. This stage is followed by the characteristic whoop, 
 which is a sharp, inspiratory sound following a series of short
 
 398 SPINAL ADJUSTMENT 
 
 expiratory coughs. Such paroxysms occur many times a day, 
 and during the paroxysm the face becomes blue, the eyeballs 
 protrude, and an anxious expression of the face is present 
 and involuntary urination occurs. Loss of weight and 
 strength, and anemia often follow. Nearly all forms of lung 
 diseases may occur as complications of, or sequelae to, 
 whooping cough, as well as disorders which result from 
 the violent coughing, as apoplexy, cardiac dilatation, and 
 conjunctivitis. 
 
 Treatment. — Adjust the 4th and 6th cervical for the relief 
 of the catarrhal symptoms. Adjustment of the 3rd and 5th 
 dorsals has a specific action on this disease, and if this treat- 
 ment is given at the onset of the disease, will serve to cut it 
 short. The patient should be isolated if possible; in severe 
 cases rest in bed is indicated. 
 
 Influenza (La Grippe) 
 
 Etiology. — The direct and secondary cause is the influenza 
 bacillus (Pfeififer). The indirect and primary cause is faulty 
 resistance, due to improper innervation, and it is only in the 
 presence of such a state of depleted vitality that the disease 
 can develop. 
 
 Pathology. — No characteristic lesions are present. Some- 
 times an exudative inflammation of the respiratory, nervous 
 and digestive systems is present. 
 
 Symptoms. — The incubation period lasts from three to 
 four days. The onset is usually sudden, with a chill and all 
 symptoms of a fever due to a general infection. The symp- 
 toms depend upon the region affected. There are several 
 forms of Influenza, among which the following are the most 
 common : (a) The Respiratory form, which begins like a 
 severe coryza, with fever, pain in the eyes, backache, pains 
 in the extremities, and profound prostration. Symptoms of 
 bronchitis, pleurisy, or pneumonia may develop, (b) The 
 Nervous form, in which the characteristic symptoms are 
 severe headache, pain in the back and extremities, and pros- 
 tration. The disease may, however, be so severe that symp- 
 toms of meningitis, neuritis, and mental disorders develop, 
 (c) Gastro-Intestinal form, which begins with symptoms of 
 acute gastritis, namely, nausea, vomiting, epigastric pain and
 
 INFECTIOUS DISEASES 399 
 
 fever; or of acute colitis, namely fever, colic, diarrhea and 
 occasionally jaundice. 
 
 Treatment. — Adjust the 4th cervical and the 3rd, 5th, 7th 
 and 10th dorsal vertebrae. Concussion over the 7th cervical 
 may abort the attack. The patient should remain in bed in 
 a v^arm, well-ventilated room ; the bowels should be regulated. 
 Liquid diet. Hot baths to induce free perspiration. 
 
 Erysipelas 
 
 Etiology. — The direct cause is the Streptococous erysipela- 
 tus; the primary and indirect cause is vertebral subluxations, 
 which, by diminishing the innervation, produce a low grade 
 of vital resistance. The disease is seen most commonly in 
 March and April, in alcoholics, or patients having Bright's 
 disease. 
 
 Pathology. — The involved skin is inflamed, thickened and 
 edematous. Suppuration or gangrene of the skin may develop ; 
 meningitis from extension ; and involvement of various viscera. 
 
 Symptoms. — The incubation period is from 3 to 7 days. 
 The onset is sudden, with a chill. The eruption is a bright 
 red flush and its margin is raised and clean-cut. The eruption 
 commences on the bridge of the nose and to either side of it, 
 and extends to the mouth, ears, neck and even the arms. The 
 face is disfigured ; the eye-balls are swollen, and the con- 
 junctiva is inflamed ; the skin is hard and edematous, and 
 large blisters may form. The temperature is raised to 104° or 
 even 106°. The disease lasts 4 or 5 days, when the fever falls 
 by crisis ; if however, the area affected is large, the disease 
 is prolonged for some time. 
 
 Treatment. — Adjust in accordance with the location of 
 the disease ; adjust the 10th dorsal vertebra in all cases. Com- 
 presses should be applied to the aflfected parts. The bowels 
 should be regulated. Liquid diet. The fever can be reduced 
 by cold sponging. 
 
 Rheumatic Fever (Acute Articular Rheumatism) 
 Etiology. — The primary cause of rheumatic fever is faulty 
 innervation first of the tonsils which makes them a favorable 
 culture medium for the bacteria which are the direct cause of 
 the disease; second, the nervous system in general may be 
 disturbed ; third, subluxations present may result in defective
 
 400 SPINAL ADJUSTMENT 
 
 metabolism with consequent accumulation in the body of 
 poisonous substances. 
 
 Pathology. — The affected joints are markedly hyperemic 
 and the synovial membrane and surrounding ligaments are 
 swollen. Erosions of the cartilages. Edema of the joint and 
 surrounding structures occasions considerable swelling and 
 the pain is no doubt due to the stretching of the tissues and 
 pressure on the nerves. 
 
 Symptoms. — The disease commences suddenly, with a rise 
 in temperature to 103°-105°. The affected joints are red, 
 swollen, intensely painful and tender. A characteristic fea- 
 ture is the migration from one joint to another. Acid sweats, 
 which produce tiny vesicles. The urine contains a heavy 
 sediment of urates. Skin eruptions are common. There is a 
 tendency to recurrence. Simple Endocarditis is a very com- 
 mon complication. Myocarditis and Pericarditis are sequelae. 
 The disease may be complicated by pneumonia, Bright's 
 disease, or chorea, or may merge into the chronic form if re- 
 flex vertebral subluxations are not corrected; these lesions 
 invariably occur in the spinal segment which controls the 
 affected joint. 
 
 Treatment. — Adjust the 5th and 10th dorsals, and also the 
 segments controlling the parts which are affected. This will 
 cause a favorable termination, prevent chronic rheumatism, 
 and obviate complications. One of the most effective remedies 
 in acute articular rheumatism is the application of hot packs 
 over the affected joints. In all cases the patient should be 
 placed at absolute rest in bed. He should wear woolen gar- 
 ments, and blankets should be used, care being taken to pro- 
 tect the inflamed joint from excessive weight of the coverings, 
 by using a tent. The diet should consist of easily digested 
 substances, preferably milk. Water, especially the alkaline 
 mineral waters, should be freely used. After the process has 
 become subacute, warm baths, together with cautious mas- 
 sage are often helpful in removing the stiffness of the joints. 
 
 Dysentery (Bloody Flux) 
 
 Etiology. — The primary cause of this disease is vertebral 
 subluxations in the lumbar region, which, by interfering with 
 the innervation of the intestine, render it susceptible to the
 
 INFECTIOUS DISEASES 401 
 
 invasion of the contributing causes, which are most com- 
 monly errors in diet, impure drinking water, sudden changes 
 in temperature, and faulty hygiene. It occurs most frequently 
 during the summer and autumn months, and in tropical 
 climates. 
 
 Pathology. — Inflammation, enlargement of the lymph 
 follicles, excessive secretion of mucus, and sometimes ulcera- 
 tion of the large bowel. 
 
 Symptoms. — The incubation period is one or two days. 
 The onset is sudden, with fever, pain in the abdomen, and 
 diarrhea. The stools contain mucus and later blood ; they 
 become very frequent, with extreme thirst, and violent pain. 
 The fever may be 103° to 104°. The acute catarrhal dysentery 
 is the mild variety. Diphtheritic dysentery is a type in which 
 there is great congestion and necrosis of the lining of the in- 
 testine, and it often follows other diseases, as pneumonia, 
 heart disease, and Bright's disease. 
 
 Treatment. — Adjust the 10th dorsal and 2nd lumbar ver- 
 tebrae. Rectal dilatation is very useful in the chronic forms. 
 The patient should be continuously confined to bed in even 
 the mildest attacks. The discharges should be disinfected. 
 The diet should be bland and unirritating. Substances such 
 as milk and lime-water, broths and egg-albumin should be 
 given in acute attacks. In chronic cases the diet may be semi- 
 solid. 
 
 Tuberculosis 
 
 Etiology. — The direct and secondary cause is the tubercle 
 bacillus. The indirect and primary causes are spinal lesions, 
 producing faulty innervation, and resulting in a low grade 
 of resistance. Predisposing causes are a family predisposi- 
 tion ; unhygienic surroundings ; debilitated states ; improper 
 food ; occupations requiring the breathing of fine particles of 
 dust or mineral matter; other lung diseases; chronic diseases 
 of all kinds ; trauma. 
 
 Pathology. — The characteristic lesion is the tubercle. This 
 is usually in the lungs in adults; lymph glands, bones and 
 joints in children. At the site of the infection the germs 
 multiply rapidly; at the same time leucocytes gather at this 
 point and the cells proliferate. This entire mass is devoid of 
 blood-vessels and constitutes the tubercles which are irregu-
 
 402 SPINAL ADJUSTMENT 
 
 larly round, pearly and gray. The action of the germs and 
 their toxins and the absence of blood supply causes the center 
 of the tubercle to become necrotic until the whole is con- 
 verted into a yellowish, cheesy mass. This may either become 
 encapsulated and calcified ; or the process may continue until 
 cavities are formed in the parts afi^ected. 
 
 Pulmonary Tuberculosis (Consumption; Phthisis) 
 
 There are four varieties of Pulmonary Tuberculosis: 1, 
 Acute miliary tuberculosis ; 2, Pneumonic phthisis ; 3, Tuber- 
 cular phthisis ; 4, Fibroid phthisis. 
 
 Acute Miliary Tuberculosis (Acute Phthisis; Galloping Consumption) 
 
 Etiology. — In the majority of cases it is the result of an 
 autoinfection, arising from either an active or latent tuber- 
 culous focus in persons of a low grade of vital resistance due 
 to faulty innervation. It sometimes follows measles, whoop- 
 ing cough, small-pox, and la grippe. It is most common be- 
 tween the age of puberty and middle life. For the deposition 
 through the body of the tubercles, under the influence of cer- 
 tain forms of irritation, it is essential that the resistance of 
 the patient be diminished. 
 
 Pathology. — The miliary tubercle consists of a fine net- 
 work of fibers, containing a mass of cells and granules, and 
 often having a giant cell for its center. The deposit is gen- 
 erally over both lungs, and the bronchial tubes, and is fol- 
 lowed by congestion, a viscid secretion, and all tissues with 
 which it comes into contact are destroyed. 
 
 Symptoms. — Several forms are met with : (a) The typhoid 
 form, in which the fever very much resembles that of typhoid. 
 The other symptoms of the latter disease are, however, want- 
 ing, (b) The meningeal form, in which symptoms of basal 
 meningitis, tubercular meningitis, and hydrocephalus are 
 present, (c) The Pulmonary form, in which the usual symp- 
 toms of tuberculosis are present in an aggravated form. 
 
 Pneumonic Phthisis (Chronic Catarrhal Pneumonia) 
 
 Etiology. — This form of tuberculosis is dependent pri- 
 marily upon a low resistance which permits of the multiplica- 
 tion of the tubercle bacilli, and the elaboration of their toxins.
 
 INFECTIOUS DISEASES 403 
 
 Among contributing causes may be mentioned poor hygienic 
 surroundings, a scrofulous tendency, catarrhal pneumonia, 
 especially at the apex of the lung, and the continuous inhala- 
 tion of irritant particles. Sometimes the disease follows one 
 of the acute infectious fevers. 
 
 Pathology. — The bronchioles and air vesicles are filled with 
 a cheesy material, which is a necrotic mass of dead leucocytes, 
 germs, cells, etc. The affected areas of the lung soften and 
 are converted into abscess cavities. The process is situated 
 most commonly at the apex of the lung. The pleura are prone 
 to be affected. 
 
 Symptoms. — Pneumonic phthisis is seen in three forms: 
 Acute, subacute and chronic. 
 
 The acute form runs a very rapid course-, beginning either 
 as a croupous or catarrhal pneumonia, which aft'ects one whole 
 lung or parts of each lung, and is accompanied by a high tem- 
 perature ; night-sweats ; dyspnea ; severe cough ; abundant 
 purulent, and blood-streaked expectoration ; impaired diges- 
 tion and loss of appetite ; rapid loss of flesh and strength. 
 
 The subacute variety is generally preceded by pneumonia 
 of one or two weeks' duration, from wdiich the patient does 
 not entirely recover. After a few weeks or months, softening 
 of the lung, followed by destruction and the formation of 
 cavities occurs. These changes are accompanied by the usual 
 symptoms of pulmonary tuberculosis, and in untreated cases 
 the course is about one year. 
 
 The chronic form commences insidiously, a history of 
 previous susceptibility to colds and catarrh being present. 
 A chronic cough with muco-purulent expectoration develops, 
 and each time the patient has a "cold," fever, pain in the 
 chest, and mild haemoptysis accompany it. Finally the char- 
 acteristic symptoms of tuberculosis, namely morning chills, 
 evening rise in temperature, profuse night-sweats, distressing 
 cough and expectoration are present. 
 
 Physical Signs. — Inspection shows the respiratory move- 
 ments over diseased portions of the lungs, increased in fre- 
 quency and diminished in force. Palpation over consolidated 
 areas shows increased vocal fremitus. The percussion note 
 at the apex varies from slight impairment of the normal note 
 to dulness, and when cavities are formed there are present
 
 404 SPINAL ADJUSTMENT 
 
 scattered areas over which the tympanitic or hollow note is 
 obtained. When the cavities are filled with exudation the 
 percussion note will be dull, but after expulsion of the exudate, 
 the tympanitic sound is again obtained. Auscultation shows 
 no change ; the normal vesicular murmur is heard in those 
 portions of the lung free from disease ; the respiratory mur- 
 mur is feeble if many bronchioles are obstructed, and harsh 
 or blowing if the bronchioles are narrowed. The crepitant 
 rale is also heard. If bronchitis is present subcrepitant and 
 mucous rales are also detected. When cavities form, bron- 
 chial or cavernous respiration is heard, associated with gur- 
 gling rales. If the cavity is empty, and has walls which do 
 not collapse, the breathing is amphoric. 
 
 Tubercular Phthisis (Tuberculosis; Consumption; Chronic Phthisis) 
 
 Etiology.- — As in other forms of tuberculosis, the primary 
 cause is a low grade of resistance due to faulty innervation 
 of the respiratory tract which is the atrium of the infection. 
 The direct cause, when such favorable conditions obtain, is 
 the tubercle bacillus. Contributing factors are poor hygienic 
 surroundings, family predisposition, and exhausting diseases. 
 
 Pathology. — The bronchial glands contain numerous 
 minute tubercles, and cheesy foci. Adhesions and thickening 
 of the pleurae. There is often a serous, purulent, or bloody 
 effusion. Pyopneumothorax is sometimes present. The 
 lesions in the lungs are generally situated at the apex. Other 
 organs, especially the larynx and intestines are often the seat 
 of tuberculous lesions. 
 
 Symptoms.— The symptoms of early tuberculosis are 
 slight fever, every evening, increase in the pulse-rate, spitting 
 of blood, bronchial cough, pains in the thorax, and gastric 
 disturbances. As the disease advances, distressing cough, 
 which becomes worse, and expectoration, which at first is 
 muco-purulent and later becomes yellowish or greenish. 
 Dyspnea becomes more marked as the destruction of lung 
 tissue continues. The fever which at first is moderate, be- 
 comes hectic, and is accompanied by chills and sweats. Chest 
 pains are due to the associated pleurisy and violent coughing. 
 Later still, night sweats and hemoptysis become severe. 
 Progressive loss in flesh and strength, which is least notice-
 
 INFECTIOUS DISEASES 405 
 
 able upon the face. Insomnia, nausea and vomiting, and 
 diarrhea. 
 
 The earliest physical signs are a slight sinking in and fail- 
 ure of expansion of the upper part of the thorax ; this may be 
 so slight as to be scarcely noticeable except by comparison 
 with the healthy side. On palpation a slight diminution of 
 the vocal fremitus is detected. On percussion the normal 
 vesicular resonance is diminished. On auscultation a crepitant 
 rale is heard ; if this rale is present day after day, at the same 
 spot, for a period of two weeks, tuberculosis may be strongly 
 suspected. These signs must be recognized, as only an- early 
 diagnosis of tuberculosis is of practical value. Later on, as 
 consolidation of the lung becomes more marked, all the above 
 signs are increased. Later still, when cavity formation has 
 commenced, bubbling rales are heard, the percussion note is 
 tympanitic, breathing is cavernous, and metallic tinkling, suc- 
 cussion, and cracked-pot resonance may all be present. 
 
 Fibroid Phthisis (Chronic Interstitial Pneumonia; Cirrhosis of the 
 
 Lungs) 
 
 Etiology. — The primary cause is faulty resistance while 
 the direct cause is the tubercle bacillus. Predisposing factors 
 are occupation, heredity, and previous pulmonary diseases, 
 and chronic wasting diseases, which by the production of 
 reflex subluxations in the segments that control the lungs, 
 render them liable to tuberculosis in the presence of the 
 bacilli. 
 
 Pathology. — Marked development of fibrous tissue in ad- 
 dition to the tubercular process in the lung, wnth consequent 
 shrinking of the afifected lung. 
 
 Symptoms. — This disease commences as a bronchial 
 catarrh, w^hich is worse in winter and better in summer, and 
 runs a chronic course. In the more advanced stages of this 
 disease, the cough is more persistent and the expectoration 
 more abundant, consisting of muco-purulent material. Later 
 on fever, with night-sweats, and dyspnea and rapid emacia- 
 tion develop. Edema of the ankles is a late symptom and is 
 due to failure of the circulation. Inspection shows the thorax 
 retracted on the afifected side. The percussion note is dimin- 
 ished in resonance or dull. Auscultation shows broncho-
 
 406 SPINAL ADJUSTMENT 
 
 vesicular respiration, and suljcrepitant, mucous and bubbling 
 rales. Later on bronchial and cavernous breathing are heard. 
 
 Treatment of Tuberculosis 
 
 The patient should sleep alone, in a well-ventilated room. 
 All articles soiled by the sputum, as bed linen, eating utensils, 
 etc., should be disinfected. Sputum cups, v^hich may be 
 burned, should be used. The patient should live in the open 
 air, in a tent. A dry, equable climate is best, as in Arizona, 
 Colorado and New Mexico. If unable to do this, sleeping in a 
 tent in' the yard, sleeping on the porch, or with window tents, 
 may be substituted. At least six eggs and one quart of milk 
 a day should be taken in addition to the regular meals. Daily 
 cold sponge baths of the chest. Moderate exercise is beneficial, 
 but should not be carried to the point of causing a rise in 
 temperature. Hemorrhages are seldom fatal. The best 
 routine treatment is absolute rest ; ice to suck, and an ice-bag 
 on the affected side. When cough is severe enough to pro- 
 duce vomiting, or to disturb the sleep, inhalations of steam. 
 Rest in bed when fever is high; if it is over 103°. cold spong- 
 ing. Careful selection of the diet and regulation of the bowels. 
 Enemata for digestive disturbances. A careful spinal analysis 
 should' be made in every case on account of the existence of 
 complications in different organs. The 3rd thoracic vertebra 
 is adjusted for the apex of the lungs; the 7th cervical vertebra, 
 and the 1st and 2nd thoracic vertebrae are adjusted for the 
 catarrh of the bronchial tubes ; for the lower portion of the 
 lungs adjustments are made as far down as the 5th thoracic 
 vertebra. Since involvement of the liver, kidneys, spleen, 
 and gastro-intestinal system is frequent in this disease, at- 
 tention should be paid to the spinal segments which control 
 these parts of the body, and adjustments made wherever in- 
 dicated. Rectal dilatation, having decided eft'ects upon the 
 nervous system, through stimulation of the ganglion impar 
 and upon the circulation in general, is a very good measure 
 in the treatment of all varieties of tuberculosis. It is claimed 
 that rectal dilatation will produce a cure in a majority of 
 cases of early tuberculosis. Some authors claim that the per- 
 sistent use of the sponge bath for two or three days, giving 
 as high as 20 baths a day, will often do away with grave
 
 INFECTIOUS DISEASES 407 
 
 symptoms. Others advise a fast in the treatment of tuber- 
 culosis, claiming that a fast of two or three weeks enables the 
 system to eliminate all toxic materials, and permit the nervous 
 system to produce that measure of resistance necessary to an 
 eradication of the disease, but the author does not share this 
 opinion, holding that any gain in weight is always a favor- 
 able sign in tuberculosis. 
 
 Tuberculosis of the Larynx 
 
 Etiology. — This condition is secondary to tuberculosis of 
 the lungs, and is due to the production of reflex subluxations 
 in the segments which govern the larynx. 
 
 Pathology. — Tubercles which undergo caseation and ulcer- 
 ation first appear on the mucous membrane, and then involve 
 the cartilage. The ulcers are saucer-like, have irregular bor- 
 ders, and their base is gray. The process invades the sur- 
 rounding tissues. 
 
 Symptoms. — The first sign is slight hoarseness. Finally 
 all the symptoms of chronic laryngitis are present. Later 
 on dysphagia develops. 
 
 Treatment. — Adjust the 4th cervical and the 2nd and 5th 
 thoracic vertebrae. Give general treatment as indicated above 
 under the heading of "The Treatment of Tuberculosis." 
 
 Tuberculosis of the Alimentary Tract 
 
 Tuberculosis of the lip is rare and simulates cancer. 
 Tuberculosis of the tongue shows as ragged-edged tubercular 
 ulcers. Tuberculosis of the tonsils appears as small tuber- 
 cular ulcers. It is claimed that the tonsil is the usual point 
 at wdiich the bacilli enter the body. Tuberculosis of the 
 stomach is rare. Primary tuberculosis of the intestines afifects 
 children, and the most common symptoms are distension of 
 the abdomen, tenderness, fever, diarrhea, and emaciation. The 
 ulcers may heal, and stricture of the bowel follow. In the 
 secondary form, perforation and hemorrhage may occur. 
 
 Treatment. — Adjust according to the region affected, and 
 give general treatment as mentioned under tuberculosis. 
 
 Tuberculosis of the Genito-Urinary Tract 
 Tuberculosis of the Kidney.-— The pelvis of the kidney and 
 the ureters are involved. The kidney may 'present all stages
 
 _;08 SPINAL ADJUSTMENT 
 
 from miliary tubercles to complete destruction of the organ. 
 Both kidneys are usually affected. The symptoms are fre- 
 quent urination, the urine containing pus and blood. Tender- 
 ness in the lumbar region. Irregular fever. Loss of weight 
 and strength. The treatment includes adjustment of the 10th 
 thoracic vertebra and any other subluxations which may be 
 found. 
 
 Tuberculosis of the Ureter and Bladder. — This usually 
 follows tuberculosis of the kidney and the symptoms are 
 those of an obstinate case of cystitis. Treatment embraces 
 adjustment of the 10th thoracic and the 1st lumbar vertebrae. 
 Give spinal concussion over the spinous processes of the 4th 
 and .Sth lumbar vertebrae. 
 
 Tuberculosis of the Prostate and Seminal Vesicles is evi- 
 denced by a rectal examination, which detects hard nodules, 
 about one-half inch in diameter. Treatment consists of ad- 
 justment of the Sth lumbar vertebra. Use concussion over 
 the 12th thoracic vertebra. Rectal dilatation is also useful. 
 
 Tuberculosis of the Testes is characterized by pain, nodules 
 which may be palpated, and softening of portions of the testes. 
 Adjust the Sth lumbar vertebra. Surgical interference is 
 sometimes necessary. 
 
 Tuberculosis of the Fallopian Tubes is not uncommon, 
 but the uterus arrd ovaries are very rarely afifected. The 
 symptoms are those of chronic salpingitis. 
 
 Treatment. — Adjust the 4th lumbar vertebra. 
 
 Relapsing Fever (Famine Fever, Seven-Day Fever) 
 
 Etiology. — The exciting cause is the spirillum of Ober- 
 meier. The primary cause is a low grade of vital resistance 
 due to faulty innervation. 
 
 Pathology. — No characteristic lesions are present. The 
 spleen is enlarged and softened. The liver and kidneys are 
 congested. Catarrhal inflammation of the stomach and bile- 
 ducts may exist. 
 
 Symptoms. — There is an incubation period of from 5 to 7 
 days. This is followed by a febrile paroxysm lasting about 
 six days ; the onset is sudden with pains in the back and 
 limbs, a severe chill, and rise in temperature to 104°. An 
 intermission, lasting six days, follows, during which the
 
 INFECTIOUS DISEASES - 409 
 
 patient is in fair health. A relapse then occurs, lasting six 
 days. Several such intervals and relapses may occur. Palpa- 
 tion of the vertebral column detects one or two segments 
 which are the seat of a higher temperature than others. That 
 segment in which the temperature is the highest is usually 
 about the 6th and 10th thoracic vertebrae. 
 
 Treatment. — Adjust the 6th, 8th and 10th thoracic ver- 
 tebrae. The patient should be isolated. Careful disinfection 
 is necessary to prevent the spread of the disease. Rest in 
 bed and proper diet. 
 
 Malaria (Ague; Chills and Fever) 
 
 Etiology. — This disease is seen mostly in tropical and 
 temperate climates, and in lowlands, swamps, and the sea- 
 coast. The attacks are most common in the autumn. The ex- 
 citing cause is the plasmodium malariae, a parasite developing 
 in a mosquito, and which is transmitted to man, by the bite 
 of the infected mosquitos. The parasites are of several 
 varieties, and each causes a certain type of the disease. 
 
 Pathology. — In acute cases the red corpuscles and hemo- 
 globin are diminished. The spleen is enlarged, soft, and con- 
 gested. In pernicious types with cerebral symptoms the 
 brain is often congested. Anemia is present in severe cases. 
 In chronic cases the spleen is much enlarged, infiltrated with 
 connective tissue, gray, and pigmented ; its capsule is thick- 
 ened. The liver is similarly affected. The kidneys are the 
 seat of inflammatory changes. ]\Ialaria exists in three forms : 
 (1) Intermittent fever; (2) Remittent fever; (3) Pernicious 
 malaria. 
 
 Intermittent Fever 
 
 This form of malaria is characterized by a chill, a hot and 
 a sweating stage. The chill begins with malaise, headache, 
 and nausea, followed by the chill itself, the skin becoming 
 cold and pale. The temperature rises to 103° or 104°. This 
 stage lasts from a half to one hour. It is followed by the hot 
 stage in which the temperature' goes to 106° or higher. The 
 pulse is tense and rapid. The skin is hot and red. Headache, 
 backache, and thirst are also present. The urine is scanty, 
 high-colored, and of high specific gravity. This stage lasts 
 from one to ten hours, and is followed gradually by the sweat-
 
 410 SPINAL ADJUSTMENT 
 
 ting stage which commences on the forehead, and extends 
 over the entire body. As sweating becomes profuse, the symp- 
 toms subside. This stage lasts about 3 hours. An intermis- 
 sion, varying in length according to the nature of the malarial 
 organism, is followed in turn by another paroxysm. 
 
 Remittent Fever (Bilious Fever) 
 
 In this type of malaria the temperature is continuously 
 above normal, with slight remissions at definite intervals. 
 There are the same stages as in the preceding form, but the 
 cold stage is not so marked, and is sometimes entirely want- 
 ing. The temperature is very high during the hot stage, and 
 severe headache and gastric disturbances are present. The 
 sweating stage is not well-marked, and in many cases entirely 
 absent. Jaundice, and enlargement of the liver and spleen 
 occur. 
 
 Pernicious Malarial Fever (The Congestive Chill) 
 
 This type of malaria exists in three forms, namely, the 
 algid or asthenic, the hemorrhagic, and the comatose. The 
 algid variety commences with great prostration and persistent 
 vomiting. Diarrhea and anuria then develop. The tem- 
 perature may be subnormal. In the hemorrhagic form the 
 characteristic sign is hemoglobinuria which is probably due 
 to the previous use of quinine. In the comatose variety, a 
 high temperature followed by delirium or coma are the char- 
 acteristic symptoms. 
 
 Treatment of Malaria 
 
 Adjust the 6th, 8th and 10th dorsal, and the 5th cervical 
 vertebrae. Concussion of the upper three lumbar vertebrae is 
 Ijeneficial, since it produces contraction of the spleen. Enemas 
 should be given. A lic|uid diet is necessary during the disease. 
 
 Diphtheria 
 
 Etiology. — Irritation of the nerves supplying the air pas- 
 sages with a resulting weakening of the nerve-supply to the 
 air passages, is the chief predisposing cause, as is shown by 
 the fact that adjustment assists in stopping the progress of 
 the disease. Diphtheria is endemic in cities and epidemic in 
 the cold autumn months, the severity varying in different
 
 INFECTIOUS DISEASES 411 
 
 epidemics. Children from two to fifteen years of age are 
 most susceptible. The exciting cause is the Klebs-Loeftler 
 bacillus. 
 
 Pathology. — The affected area shows a grayish, false mem- 
 brane, made up of a fibrinous exudate, and necrotic tissue. 
 
 Symptoms. — The incubation period varies from two to 
 seven days. The invasion may be severe or mild. It is 
 usually marked by chilliness, sometimes convulsions, pain in 
 the back and limbs, and a temperature of 102° to 104° F. 
 
 NASAL DIPHTHERIA.— The nasal cavities are ob- 
 structed by a gray, false membrane. The fever may not' be 
 high, but there are great systemic disturbances. The cervical 
 and submaxillary lymph nodes are enlarged, early in the 
 course of the disease. 
 
 PHARYNGEAL DIPHTHERIA.— Dysphagia ; fever 
 100°- 102°. Considerable systemic disturbance is early. The 
 cervical lymph nodes may be enlarged. A false membrane, 
 commonly situated on the tonsils, is present. When part of 
 this rnembrane is removed, a bleeding surface is left. Late 
 symptoms may be intense toxaemia, cardiac failure, and the 
 typhoid state. 
 
 LARYNGEAL DIPHTHERIA.— Often the onset is 
 gradual and there may be no membrane in the throat, and the 
 operator is called in to see the case because the child, which 
 has been sick with a "cold" for a few days, has developed a 
 croupy cough and shortness of breath. The dyspnea, the 
 aphonia or hoarseness and the croupy cough usually are con- 
 tinuous and progressive. The fever is moderate. The sys- 
 temic disturbances soon become pronounced. The cervical 
 lymph nodes are swollen. Symptoms of asphyxiation may 
 develop. 
 
 Treatment. — If diphtheria is taken sufficiently early, and 
 the proper adjustments are made, there will be no difficulty in 
 checking the progress of the disease. Adjust the middle cer- 
 vical vertebrae, and the 5th thoracic. Rectal dilatation is indi- 
 cated in diphtheria. Swabbing of the throat with an antiseptic 
 is very necessary. Give the patient large amounts of hot 
 water to drink, but no food of any kind. For nasal cases, irri- 
 gation of nose and throat with salt solution. For laryngeal
 
 412 SPINAL ADJUSTMENT 
 
 cases, cold or hot applications to the neck and steam inhala- 
 tions. For paralysis, rest, electricity, massage, etc. For 
 cardiac weakness, rest, and avoidance of all exertion. 
 
 Pellagra 
 
 Etiology. — The primary cause is faulty innervation, result- 
 ing in a low grade of vital resistance. The exciting cause is 
 supposed to be maize ; and "The morbific action of maize 
 has been variously attributed to (a) Deficiency in its nutritive 
 principles, (b) Specific toxic substance contained normally 
 in the grain, (c) Poisons elaborated after it has been in- 
 gested, (d) Toxic substances elaborated during decomposi- 
 tion of the grain, (e) Fungi or bacteria found on maize." 
 (Manson.) 
 
 Symptoms. — The prodromal period is characterized by 
 malaise. The common symptoms following the onset of the 
 disease are pain and tenderness in the epigastric region, con- 
 stipation alternating with bloody diarrhea, pain in the back 
 and extremities, and headache and vertigo. A fine rash covers 
 the body and lasts for 2 or 3 weeks. Reflexes are exaggerated, 
 insomnia and tremors of the tongue are present. 
 
 Treatment. — Adjust the 6th and 10th thoracic vertebrae. 
 Hot baths should be given about twice daily, to promote 
 thorough elimination through the skin. The diet should be 
 carefully regulated, fruits and vegetables being eaten ex- 
 clusively.
 
 CHAPTER III 
 
 Diseases Caused by Animal Parasites 
 Ascariasis 
 
 1. Round Worm (Ascaris Lumbricoides) is similar to tlie 
 angle worm in shape, and of a light brown color. The eggs 
 are small, oval, and brownish-red. Generally only one or two 
 worms are present in a patient, but sometimes many are 
 present. The upper part of the small intestine is where they 
 are generally found, but they may enter any part of the 
 gastro-intestinal or respiratory tract or the bile-ducts and 
 liver. They are most common in children, and picking of the 
 nose, grinding of the teeth, restlessness, or even convulsions 
 are the usual symptoms However, no signs except their 
 presence in the stools may be noted. 
 
 2. Pin Worm (Oxyuris Vermicularis) is a worm of small 
 size commonly seen in children. Its habitat is the lower 
 bowel. The characteristic symptoms are violent itching about 
 the anus, and the presence of the worms in the stools. 
 
 Treatment. — Adjust the 11th and 12th dorsal and 1st and 
 2nd lumbar vertebrae. Wash out the lower bowel every day 
 with a solution of vinegar or salt. 
 
 Anchylostomiasis (Brickmaker's Anemia; Miner's Cachexia) 
 
 Etiology. — Caused by the anchylostorum duodenale, a 
 small worm which is present in the small intestine, attaching 
 itself to the mucous membrane by its hooks, and which lives 
 by sucking blood. The characteristic symptom is the presence 
 of the eggs in the stools. 
 
 Treatment. — The stools should be disposed of and drink- 
 ing water boiled. Adjust the 11th and 12th dorsal and 1st 
 and 2nd lumbar vertebrae. Liquid diet. 
 
 Echinococcus Disease (Hydatid Disease) 
 
 Etiology. — The echinococci are the larvae or embryos of 
 the taenia echinococcus from the dog. 
 
 413
 
 414 SPINAL ADJUSTMENT 
 
 Pathology. — The echinococcus cyst may be found in the 
 liver, lung, spleen, kidney and other organs. The embryo 
 originally has six hooks. When the cyst begins to form, the 
 booklets disappear. The cyst fills with clear fluid. From the 
 inner of the two layers of the parent cyst, multiple daughter 
 cysts form. These become free from the mother cyst, and 
 from the inner layer of the daughter cysts, buds may form 
 granddaughter cysts. Within the cysts scolices are formed 
 which are the heads of new taeniae and are made up of four 
 sucking discs and four booklets. In time the cyst may un- 
 dergo inspissation, suppuration, or rupture. Rarely in the 
 liver, the cyst is multilocular and the fluid gelatinous, — the 
 Multilocular Echinococcus. 
 
 Symptoms. — In the liver. — The symptoms are those of 
 tumor ; increase of liver dulness ; rarely fluctuation ; a soft 
 elastic tumor; and mild or no subjective symptoms. In the 
 Respiratory System. — In the pleura, the signs are those of 
 pleurisy with effusion. In the lung, it generally results in 
 abscess or gangrene, and the diagnosis is made by finding the 
 booklets in the sputum. In the Kidney. — May be latent or 
 resemble a hydronephrosis. In the Nervous System. — 
 Usually located in the cerebrum and resembles brain tumor. 
 
 Treatment. — Give adjustments according to the location 
 of the disease. Surgical measures are sometimes necessary. 
 
 Filariasis 
 
 Definition. — The most common species is the Filaria of 
 Bancroft. The eggs are present in the blood stream while 
 the adult worms are found in the lymphatics. 
 
 Symptoms. — "Filariae may cause no symptoms. If the 
 adult worms or ova block lymph channels they cause hema- 
 tochyluria, lymph scrotum, elephantiasis, etc. (1) HEMA- 
 TOCHYLURIA: The only symptom is the passage at in- 
 tervals of milky, bloody, or chylous urine, which deposits a 
 reddish sediment. It contains minute fat drops, usually red 
 cells, and sometimes the embryos. The passage of blood clots 
 from the bladder may cause pain. (2) LYMPH SCROTUM : 
 The scrotal tissue is much thickened, and enlarged lymphatics 
 are seen." (Dayton.) 
 
 Treatment. — Boil the drinking water. A careful spinal
 
 DISEASES CAUSED P-Y AXIMAL PARASITES 415 
 
 analysis should be made and adjustments made accordingly. 
 The prognosis is however unfavorable. 
 
 Tapeworms 
 
 The pork tapeworm is six to twelve feet long. It has a 
 round head smaller than that of a pin, with a projection, on 
 which is placed a double ring of small hooks and below which 
 are four sucking disks. By means of these hooks and disks 
 the worm attaches itself to the lining of the small intestine of 
 man. Below the head is the neck, which is succeeded by a 
 large number of segments, increasing in size from the neck 
 down. Each segment contains the generative organs of both 
 sexes. The parasite is fully developed in three months. Seg- 
 ments then continually break oiT and are discharged at stool. 
 When swallowed by a pig or man the shells containing the 
 embryo worms are digested and the embryos wander to 
 various parts of the body, where they change to "measles." 
 Each of these contains a tapeworm head. When n'leat con- 
 taining "measles" and which is only partly cooked is eaten, 
 the cyst is dissolved in the human stomach and the freed head 
 attaches itself to the lining of the intestine, and develops into 
 a tapeworm. The beef tapeworm, is the common form in this 
 country. It is larger than the preceding, being fifteen to 
 twenty feet long, has larger segments than the pork tape- 
 worm, and a large head, which possesses no booklets, but is 
 square and has four sucking disks. 
 
 Symptoms. — These are often absent. In some cases, 
 colicky pains, excessive appetite, indigestion, emaciation, con- 
 stipation, palpitation of the heart, faintness, spasms, anemia 
 and itching of the nose and anal region are present. The 
 ingestion of a large meal often removes most of these symp- 
 toms. The finding of one or more segments of the tapeworm 
 in the stools is diagnostic. 
 
 Treatment. — Some Chiropractors claim to be able to cause 
 the removal of tapeworms by spinal adjustment. They base 
 this view on the opinion that tapeworms as well as other 
 animal parasites are simply scavengers in the gastro-intes- 
 tinal tract. This view is, however, incorrect, since the pres- 
 ence of tapeworm in the intestine is due solely to the fact 
 that the patient has eaten meat which contains the eggs.
 
 416 SPINAL ADJUSTMENT 
 
 Under normal conditions a sufficient degree of acidity is 
 probably present to destroy these eggs, and if the gastro- 
 intestinal tract is in such a normal condition, these eggs may 
 be ingested, and destroyed. However, there is not enough 
 acid in the stomach to destroy a tapeworm. In the author's 
 opinion, fasting and giving a vermifuge, or the eating of 
 pumpkin seeds, are the only logical methods of treating this 
 condition. Adjustment of the 5th and 8th thoracic vertebrae 
 may be given for their influence on the secretion of the di- 
 gestive fluids. The 10th and 12th thoracic, and the second 
 lumbar vertebrae may also be adjusted for their influence on 
 the large intestine. 
 
 Trichinosis 
 
 Etiology. — The trichina spiralis, which lives in the small 
 intestine, and the embryos of which migrate to the muscles. 
 
 Symptoms. — A week or two after eating the measled pork, 
 the symptoms begin with a chill and high fever, severe pains 
 and stiffness in the muscles, gastro-intestinal disturbances, 
 edema, and rapid loss of flesh and strength. The stools 
 should be examined. 
 
 Treatment. — Adjust the lower dorsal and upper lumbar 
 vertebrae. Enemas, especially in the early stages, when the 
 parasites are present in the stools. Symptomatic therapy. 
 Hot compresses over the painful muscles.
 
 CHAPTER IV. 
 
 The Intoxications and Sunstroke 
 Alcoholism 
 
 Etiology. — Acute Alcoholism, as its name implies, is due 
 to the consumption of a large amount of alcohol, during a 
 brief period. Chronic Alcoholism is due to the continuous 
 excessive use of alcohol. 
 
 The following symptoms are characteristic of this state : 
 Full pulse ; flushed face. The mental faculties are first stimu- 
 lated, then blunted. There is loss of co-ordination shown by 
 unsteady gait, then relaxation of the muscles, and finally un- 
 consciousness and puffy breathing. Pupils are contracted or 
 dilated, and if the face is struck, dilatation is produced. 
 Temperature is subnormal, reflexes and sensation are de- 
 creased. 
 
 The common symptoms of chronic alcoholism are tremor 
 of the hands, chronic gastritis, atrophic cirrhosis of the liver, 
 hardening of the arteries, neuritis and fatty degeneration of 
 the heart. 
 
 The symptoms of delirium tremens are first insomnia, 
 restlessness and depression. Delirium accompanied by loud 
 talking, and hallucinations then develop and the patient 
 imagines he sees various things and hears different sounds, 
 and becomes very violent. There is marked insomnia. The 
 tongue is heavily coated. This condition continues for several 
 days, at the end of which time restoration of mental and 
 physical faculties takes place. 
 
 Treatment. — Acute alcoholism : Gastric lavage, and a cold 
 bath. Chronic alcoholism : Confinement in a sanitarium, 
 warm magnesium sulphate baths for restlessness and sleep- 
 lessness. Complete withdrawal of alcohol, and nourishing 
 diet. Delirium tremens : Do not forcibly restrain the patient, 
 but confine him, and constantly watch him to prevent self- 
 injury. Alcohol should be entirely withdrawn. A general 
 
 417
 
 418 SPINAL ADJUSTMENT 
 
 adjustment is indicated; pay especial attention, however, to 
 the 5th and 7th thoracic vertebrae. 
 
 Morphine Habit 
 
 Etiology. — The morphine habit is usually acquired by re- 
 peated use of the drug for pain. 
 
 Symptoms. — These include constipation, a yellowish com- 
 plexion, tremors, insomnia, and mental unrest and impair- 
 ment. When the drug is withheld from the patient, he suffers 
 extremely; a general feeling of unrest, anorexia, nausea, 
 diarrhea, neuralgic pains, and ringing of the ears are the chief 
 symptoms present. 
 
 Treatment. — If the case has not progressed too far, general 
 adjustment, a wholesome environment, and a thorough 
 eliminative treatment, followed by a balanced diet, will pro- 
 duce satisfactory results. The fact, however, must not be 
 lost sight of, that some underlying ailment very likely induced 
 morphinism in the first place. See to it that such conditions 
 are removed. Adjust the atlas and the 5th thoracic vertebrae. 
 Hot magnesium sulphate baths are very useful in this disease, 
 by reason of their eliminative effect, which relieves the pain 
 and restlessness. It will often be found in treating a case of 
 this nature, that after the patient has been in this bath for a 
 half hour, he becomes much quieted and will sleep for two or 
 three hours. The pain then returns, and the bath should be 
 repeated. This should be done for two or three days, at the 
 end of which time it will be found that the patient's condition 
 is much improved, if not entirely relieved. 
 
 Cocaine Habit 
 
 Symptoms. — The drug is taken as snufif, in sprays, or 
 hypodermically. Large doses cause great mental excitement, 
 and occasionally convulsions. This is followed by cardiac 
 and respiratory weakness, prostration and coma. The cocaine 
 habit causes digestive disorders, loss of flesh and strength, 
 disordered heart action, mental impairment, nervousness, and 
 moral depravity. 
 
 Treatment. — Same as for morphine habit.
 
 INTOXICATIONS AND SUNSTROKE 419 
 
 Chloral Habit 
 
 • Symptoms. — There is Hrst exhilaration, which is followed 
 I)y mental and physical depression, foul breath, spongy gums, 
 anorexia, indigestion, emaciation, permanent dilatation of 
 cutaneous blood vessels, intermittent pulse, irritability, in- 
 somnia, sensory and motor disturbances, and impairment of 
 mentality. 
 
 Treatment. — Same as for morphine habit. 
 
 Lead Poisoning 
 
 Etiology. — Those engaged in occupations which involve 
 the handling of lead, such as painters, plumbers, and printers, 
 are very liable to contract lead poisoning. 
 
 Symptoms. — The characteristic symptoms and signs are 
 lead colic, retracted abdomen, constipation, a blue line on the 
 gums, wrist drop, headache, tremors, anemia, pains in the 
 joints. Common sequels are wrist drop, arteriosclerosis, 
 nephritis, and optic atrophy. 
 
 Treatment. — Remove the cause. Hot baths for their 
 eliminative effects. Adjust the 5th and 10th dorsal and 3rd 
 lumbar vertebrae. 
 
 Arsenic Poisoning 
 
 Etiology. — Arsenical poisoning can be contracted from 
 arsenical paint, wall paper, and any material containing 
 arsenic with which persons are brought into close daily con- 
 tact. 
 
 Pathology. — Gastro-enteritis, fatty degeneration of liver, 
 spleen, and kidneys, peripheral neuritis. Arsenic is present 
 in tissues. 
 
 Symptoms. — The characteristic signs and symptoms of 
 this form of intoxication are edema of the eyelids, dryness of 
 the throat, gastro-intestinal disturbances, eruptions and pig- 
 mentation of the skin. Paralysis of extremities, especially the 
 legs, with atrophy and numbness, but little pain. 
 
 Treatment. — Remove the cause. Massage and galvanism 
 for paralysis. Otherwise treatment is the same as for lead 
 poisoning, except that spinal adjustment will be most neces- 
 sary in the 5th and 7th thoracic segments.
 
 420 SPINAL ADJUSTMENT 
 
 Food Poisons 
 
 Etiology. — This includes poisoning b_y spoiled meats, fish 
 and oysters, candies, soups, canned foods, cheese and ice 
 cream. 
 
 Symptoms. — Acute gastro-enteritis, with intense prostra- 
 tion terminating in collapse. 
 
 Treatment. — Empty the stomach by giving a solution of 
 soda in tepid water to induce vomiting. Give a high enema. 
 Stimulants may be necessary. Adjust the 5th, 6th and 7th 
 and lower dorsal vertebrae, and the 1st and 2nd lumbar ver- 
 tebrae. 
 
 Sunstroke 
 
 Symptoms. — In severe cases, where exposed to intense 
 heat, the patient falls unconscious, and death occurs almost 
 immediately or after a few hours, from coma, and failure of 
 the heart and respiration. In the usual cases there is sudden 
 arrest of perspiration, headache, vertigo, nausea and vomiting; 
 failing vision, then unconsciousness, which may be temporary 
 or pass into coma. The face is flushed, skin dry and hot, 
 pupils dilated for a time, then usually greatly contracted ; 
 muscular relaxation or spasms; fever is 107° to 110° or even 
 higher; pulse high tension and rapid; respirations deep and 
 labored or snoring. In fatal cases, coma deepens, the pulse 
 becomes weak and rapid, respiration irregular, shallow, and 
 rapid, or of Cheyne-Stokes type, and death occurs in twenty- 
 four to thirty-six hours. In others, consciousness returns, 
 temperature falls, pulse and respiration become normal, and 
 recovery with sequelae occurs. Prominent among the sequels 
 are physical weakness, impaired memory or power of con- 
 centration, or headache and mental disturbance whenever the 
 weather is warm. 
 
 Treatment. — Adjust the 1st and 4th cervical and the 10th 
 dorsal vertebrae. For mild cases rest in a cool place, cold 
 sponging, and stimulants. For severe cases immediate bath- 
 ing in ice water, with friction, and ice water enemas. If ice 
 cannot be obtained, strip and sprinkle with water until tem- 
 perature is reduced. Gastric lavage, especially if alcoholic. 
 Subsequently cold sponging if needed.
 
 CHAPTER V 
 
 Constitutional Diseases 
 Chronic Articular Rheumatism 
 
 Etiology. — The cause of this disease is faulty innervation 
 of the joints, as a result of reflex subluxations produced dur- 
 ing the course of acute rheumatism and superinduced by 
 exposure to cold and wet. 
 
 Pathology, — The capsule of the joint, together with its 
 ligaments and surrounding tissue is thickened. 
 
 Symptoms. — The affected joints are stifif and painful dur- 
 ing damp weather. The movement of the afifected joints be- 
 comes more and more impaired, and the joints distorted, as 
 the disease continues. No severe constitutional disturbances 
 are present in uncomplicated cases. Usually a number of 
 joints are affected. 
 
 Treatment. — Make adjustments in those segments which 
 control the parts affected; also adjust the 6th and 10th thor- 
 acic vertebrae. Massage and passive movements are useful 
 for overcoming stiffness of the joints. Baking of the joints 
 or application of heat in various ways : hot air, electricity, 
 or steam baths are very useful. The diet should be free from 
 meat, and only fresh vegetables should be used. 
 
 Muscular Rheumatism 
 
 Etiology. — This condition is caused by faulty innervation 
 which is produced through a draught of cold air striking a 
 part of the body the afferent impulses from which reflexly 
 produce vertebral subluxations. 
 
 Symptoms. — An acute attack usually occurs, and is marked 
 by a sudden onset, and pain, soreness and rigidity of the 
 affected muscles, increased by motion. There is no rise in 
 temperature. The duration is about one week, and develops 
 frequently into the chronic form, which is marked by acute 
 exacerbations during changes in the weather. 
 
 The disease may affect all or some of the voluntary mus- 
 
 421
 
 422 SPINAL ADJUSTMENT 
 
 cles, but its most frequent and important varieties are: "1. 
 CEPHALODYNIA— Situated in the occipito-frontalis mus- 
 cle. It is distinguished from neuralgia of the trifacial or 
 occipital nerve, by pain on both sides of the head, excited 
 or aggravated by the movements of the muscles and by 
 absence of disseminated points of tenderness. The muscles 
 of the eye may be affected, and movements of that organ excite 
 pain. If the temporal and masseter muscles are attacked, 
 mastication induces pain. 2. TORTICOLLIS — Wry neck, 
 or stiff neck. Situated in the sternomastoid muscles. Gener- 
 ally limited to one side of the neck, toward which side the 
 head is twisted, great pain being excited on attempting to 
 turn to the opposite side. Rheumatism of the muscles of the 
 back of the neck, cervicodynia, may be mistaken for occipital 
 neuralgia. 3. PLEURODYNIA— Situated in the thoracic 
 muscles and may be mistaken for pleuritis, or intercostal neu- 
 ralgia from which it is differentiated by the absence of the 
 diagnostic features of each. Pain is excited by forced breath- 
 ing, coughing and sneezing. 4. LUMBAGO or LUMBODY- 
 NIA — Situated in the mass of muscles and fasciae which oc- 
 cupy the lumbar region. This is the most common variety; 
 and usually affects both sides. It may set in rapidly, and 
 become very severe. Motion of any kind aggravates the 
 pain, which often becomes very sharp or stabbing in char- 
 acter. It is sometimes complicated with acute sciatica, when 
 the suffering is agonizing." (Hughes.) 
 
 Treatment. — Rest is very essential and is accomplished in 
 pleurodynia by firmly strapping the side which is aifected 
 with broad strips of adhesive, extending from the spine to 
 the middle of the sternum. Hot compresses to the affected 
 muscles. Other measures of value are dry heat, such as 
 a warm flat iron, hot air baths, massage and electricity. The 
 bowels should be kept regular. Make adjustments according 
 to the location of the disease. The diet should consist 
 principally of fruits and vegetables. 
 
 Arthritis Deformans (Rheumatoid Arthritis) 
 
 Etiology. — The primary cause is disturbed innervation of 
 the affected parts. Predisposing causes are mental worry. 
 The disease is most common in women.
 
 CONSTITUTIONAL DISEASES 423 
 
 Pathology. — The cartilage of the joint first becomes thick- 
 ened. This is followed by degeneration and absorption, the 
 bone ends being left bare, and becoming smooth and ivory- 
 like. The synovial membrane thickens, and in some places 
 is converted into bone. The muscles surrounding the joint 
 become shrunken. 
 
 Symptoms. — Several distinct types exist. (1) General 
 Progressive type: (a) Acute: Usually in women of twenty 
 to thirty years or at the menopause. Invasion like acute ar- 
 ticular rheumatism, many joints, permanent enlargement ap- 
 pearing early, rarely redness of joints, pain very severe, 
 moderate rise of temperature, malaise, anemia, loss of flesh 
 and strength. The first and later attacks are often associated 
 with pregnancy, labor or lactation, (b) Chronic : Gradual 
 onset of pain or stiffness in one or more joints, usually of the 
 fingers, then of corresponding joints of the other side, then 
 of others. Involvement symmetrical. Swelling at first may 
 be in its soft parts, with joint effusion and tenderness. Pain 
 may be slight or severe. Periods of improvement and exacer- 
 bation alternate, the joints becoming enlarged and deformed, 
 often incompletely ankylosed in partial flexion by thickening 
 of bone and soft parts ; joint crepitus. The muscles moving 
 them atrophy and there may be trophic changes in the skin 
 and nails of the extremities affected. Digestive disturbances 
 and anemia are common. Heart not affected. A few joints 
 only may be attacked or many, with great deformity, before 
 the disease reaches a period of inactivity. (2) Monarticular 
 type : Usually in males over fifty years, one joint or a few 
 large joints may be affected, generally with atrophy of cor- 
 responding muscles. In the case of the hip this is called 
 morbus coxae senilis. (3) Heberden's nodes : Common in 
 women between thirty and forty years. Often preceded by 
 digestive disturbances. With occasional attacks of local pain 
 and swelling, or insidiously, small hard tubercles form at the 
 sides of the dorsal surface of the extremity of the second 
 phalanges. The presence of these nodes may be the only 
 sign of the disease. (Dayton.) 
 
 Treatment. — The chief indications are to relieve the pain 
 and improve the general condition of the patient. This is 
 best accomplished by having him live in a Avarm, dry climate,
 
 424 SPINAL ADJUSTMENT 
 
 and lead a hygienic life, eating substances of the most nutri- 
 tious character. Heat, in the form of baths or hot com 
 presses. Massage is a valuable adjunct measure. General 
 adjustment; also make specific adjustments according to the 
 region involved. 
 
 Gout 
 
 Etiology. — The primary cause is faulty innervation, in 
 che presence of which a deficient amount of exercise, and the 
 ingestion of too much food, act as the chief contributing 
 factors. 
 
 Pathology. — The blood contains an excessive amount of 
 uric acid, and sodium urate is deposited in and about the 
 joints. 
 
 Symptoms. — Preceding an acute attack of gout there are 
 malaise, depression and headache. The attack comes on in 
 the early hours of the morning, and disappears toward the 
 latter part of the day, to recur the following night. There 
 is agonizing pain in the aflfected joint, which is usually the 
 great toe; the joint is hot, swollen, and of a dark red color. 
 There is a slight rise in temperature. The urine is reddish, 
 and on standing, a sediment of urates appears. An acute at- 
 tack of this kind lasts a week or ten days, and a number of 
 such attacks finally merge into the chronic form. In this 
 variety the phalangeal joints become distorted by the 
 deposition of urates about them. Gastric disturbances and 
 arteriosclerosis are present. 
 
 Treatment. — Adjust the 1st cervical, 5th and 10th thoracic, 
 and the 5th lumbar vertebrae. Give daily baths, and use hot 
 compresses locally. The diet should consist principally of 
 fruits and vegetables. 
 
 Rickets 
 
 Etiology. — The prime cause is malnutrition and unhy- 
 gienic surroundings, and a number of its later manifestations 
 are a result of the consequent disturbance of the nerve supply 
 to various parts of the body. 
 
 Pathology. — The bones of the skull, the long bones, and 
 the ribs show the most pronounced morbid changes. Enlarge- 
 ment of the parietal and frontal eminences and flattening of 
 the top and back of the head give it a square outline. The
 
 CONSTITUTIONAL DISEASES 425 
 
 fontanels do not close until the second or third year. The 
 long bones are deficient in lime salts, and consequently be- 
 come soft and bend easily, producing deformities such as 
 bow-legs and curvature of the spine. The sternal ends of the 
 ribs become enlarged and nodular, and these rows of nodules 
 on each side have a beaded appearance and are termed the 
 rachitic rosary. 
 
 Symptoms. — The characteristic symptoms of rickets are 
 disturbed sleep, with profuse perspiration of the head, gen- 
 eral tenderness, abdominal distention, nausea and vomiting, 
 nervousness, and convulsions. Teething is delayed ; the teeth 
 are poorly formed. There is severe muscular asthenia, which 
 prevents the child from sitting erect or walking. 
 
 Treatment. — Adjust the 5th, 8th and 10th thoracic verte- 
 brae, and any other subluxation which may be present. The 
 first indications are to provide hygienic surroundings and 
 proper food for the child. If the child is nursing and the 
 mother's milk is poor, cow's milk should be substituted and 
 properly modified to suit the individual requirements. Older 
 children should be given beef-juice and eggs, in addition to 
 milk. Starches and sugars should be avoided. Orange and 
 lemon juice are beneficial in many cases. Thin gruels may 
 be given. 
 
 Scurvy 
 
 Etiology. — Lack of fresh fruit and vegetables in the diet, 
 and unhygienic surroundings. 
 
 Pathology. — The walls of the blood-vessels are changed, 
 permitting spontaneous hemorrhages to occur into the skin, 
 mucous membranes, viscera and muscles and joints. The 
 blood is dark in color and thin, and anemia is present. Par- 
 enchymatous degeneration of the spleen, liver and kidneys 
 occurs. The gums are swollen and ulcerated and the teeth 
 often fall out. Ulcers of the ileum and .colon may be 
 encountered. 
 
 Symptoms. — The disease commences gradually, the first 
 symptoms being weakness, loss of weight, and anemia. Hem- 
 orrhages next occur in various parts of the body, especially 
 the skin and mucous membranes. As a result of the ulcera- 
 tion of the gums, the breath is fetid. Systemic disturbances
 
 426 SPINAL ADJUSTMENT 
 
 are marked. Palpitation of the heart and edema of the ankles 
 are present. 
 
 Treatment. — Adjust the 4th cervical and 5th thoracic ver- 
 tebrae. The diet should consist of vegetables and fruits. 
 Attend to the hygiene. 
 
 Hemophilia 
 
 Etiology. — This disease is hereditary, and is transmitted 
 by the mother to her male offspring. Fathers, however, 
 transmit it to their daughters who are exempt, the male 
 subjects usually being affected by the disease. 
 
 Symptoms.- — The characteristic feature of this condition 
 is the tendency to severe hemorrhages following slight in- 
 juries. Frequently such hemorrhages occur spontaneously 
 and without any apparent cause. Subcutaneous hemorrhages 
 are common, although bleeding from the nose and mouth is 
 seen in most cases. The blood coagulates very slowly. 
 
 Treatment. — Make adjustments according to the seat of 
 the hemorrhage. Individuals subject to this disease should 
 guard themselves against the possibility of injury. 
 
 Diabetes Mellitus 
 
 Etiology. — Pancreatic disease due to interference with the 
 nerve supply of that organ. The disease is seen most com- 
 monly in adult males, and contributing causes are overwork, 
 cerebral or spinal injuries and diseases, infectious diseases, 
 and obesity. 
 
 Pathology. — In one-half the cases lesions of the pancreas 
 are present. Sometimes the nervous system is the seat of 
 morbid changes, while in some cases no pathological changes 
 at all exist. 
 
 Symptoms. — There is loss of flesh and strength. Increased 
 thirst and appetite. The urine is increased in quantity, of a 
 high specific gravity, and a pale color ; it has a sweetish odor ; 
 it contains varying amounts of sugar, and often albumin, ace- 
 tone, and diacetic acid. Other secretions are diminished, 
 causing dryness of the skin and mouth, and constipation. 
 The temperature is subnormal. Coma frequently developes. 
 
 Boils and carbuncles, eczema, pneumonia, tuberculosis, 
 arteriosclerosis, neuritis, herpes zoster, perforating ulcer of
 
 COXSTITUTTONAL DISEASES 427 
 
 the foot, sterility, cataract, optic atrophy, retinitis, and diabetic 
 coma are the most common complications. 
 
 Treatment. — Adjust the 1st cervical and the 6th, 8th and 
 10th thoracic vertebrae. The diet should be so regulated as 
 to exclude or at least to reduce to a minimum the quantity of 
 starches and sugars. Fresh air, daily bathing, and regular 
 exercise are essential factors to be followed in the treatment. 
 The rooms occupied by the patient should be well ventilated. 
 The use of various mineral waters is very beneficial. Exer- 
 cises should be taken daily, according to the patient's 
 strength, care being taken to prevent overexertion. Flannel 
 underclothing should be continuously worn. 
 
 Diabetes Insipidus 
 
 Etiology. — The primary cause of the excessive secretion 
 of urine consists in dilatation of the renal vessels, the result 
 of paralysis of their muscular coat, caused by derangement 
 of innervation, since the condition can be induced experi- 
 mentally by irritating a certain area in the fourth ventricle, 
 or by section of portions of the sympathetic nerve. The 
 affection is seen in persons under the age of twenty-five years. 
 Contributing causes may be various injuries or diseases of the 
 nervous system in addition to pressure by subluxated ver- 
 tebrae, hysteria, prolonged debility, exhaustion, syphilis, 
 malaria, and intense mental emotions. 
 
 Symptoms. — The characteristic signs of this disease are 
 intense thirst and secretion of very large amounts of clear 
 urine with very low specific gravity (1002-1006) and 
 containing no sugar or albumin. 
 
 Treatment. — Adjust the 1st cervical and the 6th, 8th and 
 10th thoracic vertebrae. Concussion of the 7th cervical ver- 
 tebra. Withdrawal of fluids has no effect on the progress of 
 the disease. Constipation should be avoided by the use of 
 enemas and abdominal massage. Warm clothing, warm baths, 
 friction, fresh air, exercise and so forth, are useful accessory 
 methods of treatment. 
 
 Obesity 
 
 Etiology.- — Disturbed metabolism due to interference with 
 power of conduction of the nerves which govern the metabolic
 
 428 SPINAL ADJUSTMENT 
 
 processes in the organism. Excessive development of fat 
 may be hereditary. It occurs most commonly in middle-aged 
 persons, sometimes in children. Its chief contributing causes 
 are excessive eating and drinking, especially fats and starches, 
 together with deficient exercise. 
 
 Symptoms. — The fat is increased in all places in which it 
 is found normally, and the heart and liver are often the seat 
 of fatty infiltration. The general health may be good, or 
 there may be mental and bodily inactivity, indigestion, and 
 symptoms of fatty heart. The power of resistance to disease 
 is greatly decreased. The replacement of the heart muscle 
 by fat may induce dilation of that organ, and result in sudden 
 death. 
 
 Treatment. — Adjust the 6th and 10th dorsal vertebrae. 
 When there is an accumulation of fat in a certain portion of 
 the body, the vertebrae of those spinal segments which supply 
 the afifected parts should also be adjusted. Hot magnesium 
 sulphate baths are very useful in this disease. Beyond this 
 the treatment is chiefly dietetic. Excess of all kinds of food 
 and drink should be avoided, especially starches and sugar. 
 Hot baths and massage are useful adjunct measures. The 
 patient should take systematic exercises daily.
 
 CHAPTER VI 
 
 Diseases of the Respiratory System 
 
 Diseases of the Nasal Passages 
 
 Acute Nasal Catarrh (Coryza; "Cold in the Head") 
 
 Etiology. — This disease is caused by subluxations, which 
 reduce the vital resistance of the mucous membrane lining 
 the nasal cavities. Atmospheric changes, exposure of the 
 neck to a draught of cold air, or of the ankles to cold and 
 dampness, changing from a warm to a cold atmosphere sud- 
 denly, inhalation of irritant gases and vapors, dust, and pow- 
 ders, such as ipecac and tobacco, irritate the mucous mem- 
 brane of the nose and produce reflexly subluxations in the 
 middle cervical region. These lesions produce an impinge- 
 ment of the nerves to the mucous lining of the nose and 
 congestion and increased secretion follow the irritation of the 
 nerves. Acute coryza is often present in the initial stage of 
 the infectious fevers, such as measles, influenza, and erysipe- 
 las. Syphilis, and potassium iodid in large doses, may at times 
 produce it. Occasionally the affection seems contagious. 
 
 Pathology. — There is an inflammation of the nasal mucous 
 membrane. 
 
 Symptoms. — The onset is sudden, with chilly sensations 
 and sneezing. A slight rise in temperature follows, together 
 with a mucous or muco-purulent discharge from the nose; a 
 mild degree of prostration is present. Herpes on the lips 
 are frequent. 
 
 Treatment. — Adjust the middle cervical vertebrae, espe- 
 cially the 4th. Harden the body against cold and climatic 
 changes by taking cold plunges often. Sleep with the window 
 open. Mild cases require no special therapy. In severe cases, 
 a Turkish bath is an excellent procedure, provided care is 
 taken to not be exposed to the cold for some time thereafter. 
 A cold may be aborted by drinking hot lemonade on going 
 to bed. 
 
 429
 
 430 SPINAL ADJUSTMENT 
 
 Chronic Nasal Catarrh 
 
 Symptoms.— In the simple form there is an obstruction of 
 one or both nostrils, and the mucous membrane is congested 
 and turgid. In the hypertrophic form, the same symptoms 
 are present in a greater degree. In the atrophic form, large 
 dry crusts are present in the nose. There is an exceedingly 
 offensive odor, and anosmia. 
 
 Treatment. — Adjust the 4th cervical and 5th thoracic ver- 
 tebrae. Wherever possible, the patient should live in a warm, 
 equable climate. Hygienic measures, as cold plunges and 
 exercise in the fresh air, are valuable measures. 
 
 Diseases of the Larynx 
 Acute Catarrhal Laryngitis ("Sore Throat") 
 
 Etiology. — When the condition of the larynx is a result 
 of faulty innervation, it is very susceptible to inflammatory 
 changes when influenced by the contributing causes. These 
 are especially exposure to cold and irritating gases, excessive 
 use of the voice and complicating la grippe and measles. 
 
 Symptoms. — There is a slight fever and systemic disturb- 
 ances. Hoarseness, aphonia, a brassy cough, and dyspnea. 
 The disease lasts from a few days to two weeks. 
 
 Pathology. — The mucous lining of the larynx is congested 
 and swollen, and its secretion greatly decreased in amount. 
 Sometimes only sections of the mucous membrane are 
 affected. Later the secretion is markedly increased. 
 
 Treatment. — Adjust the 4th cervical and the 5th dorsal 
 vertebrae. In aggravated cases the patient should go to 
 bed, and refrain from using the voice. Cold compresses 
 should be applied. 
 
 Chronic Laryngitis 
 
 Etiology. — Follows acute attacks as a result of the pro- 
 duction of reflex spinal lesions which interfere with the inner- 
 vation and consequent integrity of the larynx. Contributing 
 causes are inhalation of irritating gases and constant use of 
 the voice. 
 
 Pathology. — The larynx is congested, and there is more or 
 less thickening and relaxation of the vocal cords. Surface 
 erosions, and small outgrowths on the cords may be observed.
 
 DISEASES OE RESPIRATORY SYSTEM 431 
 
 Symptoms. — The characteristic symptoms are a cough, 
 with very little expectoration, hoarseness and pain when using 
 the voice. There may be complete loss of the voice. 
 
 Treatment. — Adjust the 4th cervical and 5th dorsal verte- 
 brae. Cold compresses to the throat several times a day. A 
 change of climate is advisable. 
 
 Edematous Laryngitis 
 
 Etiology. — The primary cause is the same as that of 
 simple laryngitis. The contributing causes, however, modify 
 the course of the disease. These are syphilis, tuberculosis, 
 infectious diseases, and retro-pharyngeal abscess. It is also 
 present when edema from heart or kidney diseases is present 
 in other parts of the body. 
 
 Pathology.— The mucous membrane of the glottis is 
 edematous. 
 
 Symptoms. — Dyspnea ending in symptoms of asphyxia, 
 a dry cough, aphonia and stridulous breathing. The epig- 
 lottis may be so swollen that it is palpable. Expiration is 
 difficult, the lower ribs are contracted, and the abdomen is 
 retracted. 
 
 Treatment. — Adjust the 4th cervical and the 5th dorsal. 
 In many cases only surgical treatment will relieve the 
 condition. 
 
 Spasmodic Laryngitis (Croup) 
 
 Etiology. — This disease is seen in children between the 
 ages of one and six years, and is predisposed to by enlarged 
 tonsils, adenoids, rickets and faulty nutrition. 
 
 Symptoms. — The attack comes on suddenly, during the 
 night, with a dry, brassy cough and suffocation. In about an 
 hour the spasm disappears, breathing becomes normal, the 
 cough less harsh, profuse perspiration occurs, and the child 
 falls asleep again. If the case remains untreated the same 
 thing occurs the next night, and less severely the next, after 
 which there is recovery. 
 
 Treatment. — Adjust the 4th cervical and the 5th dorsal 
 vertebrae. Cold sponging is advisable in severe cases. Dur- 
 ing the attack, the spasm may be relieved by dashing cold 
 water on the abdomen. Regulate the bowels and attend to 
 the diet.
 
 432 SPINAL ADJUSTMENT 
 
 Tonsillitis 
 
 Etiology. — Tonsillitis occurs in four forms: 1. Simple 
 acute tonsillitis. 2. Follicular Tonsillitis. 3. Quinsy. 4. 
 Chronic tonsillitis. Simple acute tonsillitis and follicular ton- 
 sillitis are seen most commonly during youth, and are pri- 
 marily due to a subluxation in the middle cervical region, 
 which interferes with the innervation to the tonsils and ren- 
 ders them susceptible to inflammatory processes when the 
 contributing causes are present. These are most commonly 
 sudden changes in temperature, and exposure to cold and 
 wet. If an infective process is present the previous lack of 
 resistance due to faulty innervation renders the tonsil sus- 
 ceptible to the invasion of pus-forming organisms and quinsy 
 results. The chronic form of tonsillitis is due to repeated 
 attacks of the acute form owing to the progressively 
 diminished resistance of the tonsils. 
 
 Pathology. — In simple acute tonsillitis the inflammatory 
 process is limited chiefly to the mucous membrane of the ton- 
 sil. The organ is enlarged and congested. In follicular 
 tonsillitis there is marked desquamation of the epithelium, 
 which collects in the crypts, and there undergoes necrosis, 
 forming small, cheesy masses, having a fetid odor. In quinsy 
 the parenchymatous portion of the gland is principally in- 
 volved. Necrosis takes place and an abscess forms. In 
 chronic tonsillitis there is hypertrophy of the entire organ. 
 The tonsil has undergone extensive changes, being converted 
 into a mass of fibrous tissue acting as a foreign body in the 
 throat. 
 
 Symptoms. — In simple acute tonsillitis the characteristic 
 symptoms are : sudden onset, with chills and general aching 
 of the body; rapid rise in temperature to 103° or 104° F. ; 
 the throat is hot and dry, and dysphagia is present. In the 
 follicular tonsillitis the general symptoms are similar. The 
 tonsils are enlarged and red and the crypts are filled with 
 cheesy necrotic matter, showing as white spots on the tonsils. 
 
 In quinsy the tonsil is extremely sensitive, and the pain 
 is of a throbbing nature. There is great rigidity of the mus- 
 cles of the neck and the face and the mouth is opened with 
 difficulty. A fluctuating enlargement may be palpated. 
 There are alternating chills and fever.
 
 DISEASES OF RESPJRA'IORY SYSTEM 433 
 
 In chronic tonsillitis the organs are permanently enlarged, 
 giving the voice a nasal tone, causing mouth breathing, snor- 
 ing, and regurgitation of foods through the nose. Partial 
 deafness from inflammation of the Eustachian tube and middle 
 ear may develop. There are recurrent attacks of acute 
 tonsillitis. 
 
 Treatment. — For acute tonsillitis adjust the 1st, 2nd and 
 4th cervical and the 6th and 10th dorsal vertebrae. Give 
 a high rectal enema. Cold compresses should first be applied 
 to the neck. Later hot compresses may be substituted. The 
 diet should be liquid. 
 
 In quinsy hot applications should be applied to the throat. 
 If an abscess forms, surgical measures are necessary, though 
 in some cases early adjustment and constant application of 
 hot compresses may abort it. 
 
 In chronic tonsillitis much has been accomplished by 
 spinal adjustment and attention to the general health of the 
 patient, supplemented by massage. In some instances, 
 however, surgical measures are required. 
 
 Diseases of the Bronchial Tubes 
 Acute Bronchitis 
 
 Etiology. — Faulty innervation will produce a lack of tone 
 in the bronchial mucous membrane, predisposing it to in- 
 flammation as a result of exposure to colds. It is associated 
 with nearly all lung diseases, and with many acute infectious 
 diseases, especially measles, whooping-cough, la grippe and 
 typhoid fever. 
 
 Pathology. — The mucous lining of the bronchial tubes is 
 swollen and congested. The epithelium peels ofT, and the 
 bronchi contain a greater or less amount of mucous or 
 muco-purulent material. 
 
 Symptoms. — There is a heavy feeling in the thorax, be- 
 neath the sternum, pains in the back, and chilly sensations. 
 Other symptoms which then follow are a dry cough and mild 
 fever. There is later on expectoration of mucous or muco- 
 pus, the cough continues, but other symptoms gradually 
 disappear. The characteristic physical signs are sibilant and 
 sonorous rales in the early stage; later the rales become 
 moist, namely subcrepitant and mucous.
 
 434 SPINAL ADJUSTMENT 
 
 Treatment. — Adjust the 6th and 7th cervicals and the 1st, 
 2nd and 4th dorsal vertebrae. Useful adjunct measures are 
 a hot foot-bath and a hot drink at the onset. Cold packs 
 over the chest and inhalations of saline solutions are very 
 beneficial. 
 
 Chronic Bronchitis 
 
 Etiology. — Chronic bronchitis follows repeated acute at- 
 tacks, as a result of the impaired resistance of the bronchial 
 mucous membrane ; during acute attacks reflex subluxations 
 are produced, and the innervation of the bronchi is deficient, 
 thus permitting- morbid changes to occur. Contributing causes 
 are exposure to cold and wet; it also accompanies chronic 
 heart, lung and kidney afifections, and frequently is connected 
 with gout. 
 
 Symptoms. — These vary greatly and may be evident only 
 during the winter months. Characteristic symptoms are cough, 
 worse at night or in the morning, profuse, mucopurulent, or 
 purulent sputum, dyspnea on exertion and slight fever. The 
 characteristic physical signs are sibilant and sonorous rales, 
 subcrepitant rales, and evidences of emphysema. 
 
 Treatment." — Adjust the 6th and 7th cervical and the up- 
 per dorsal vertebrae, especially the 1st and 2nd. Patients 
 should live in a dry, warm climate if possible. A cold wet 
 pack should be applied to the chest for about fifteen minutes 
 every evening followed by a brisk rub. Inhalations of steam- 
 ing saline solutions are useful. Woolen underclothing should 
 be worn in cold and changeable weather. 
 
 Hay Fever 
 
 Etiology. — This disease is due primarily to a hypersensi- 
 tive condition of the Schneiderian membrane of the nose, as 
 a result of interference with the innervation thereof. Predis- 
 posing causes are a nervous temperament and nasal abnor- 
 malities. Certain stimuli, as odor of hay, pollen of plants, and 
 dust are the exciting causes. 
 
 Symptoms. — The leading symptoms are coryza, a wheezy 
 cough, dyspnea, depression. It occurs at a particular season 
 each year. 
 
 Treatment. — Adjust the 4th cervical and the 1st and 2nd 
 dorsal vertebrae. Rectal dilatation is also very useful in
 
 DISEASES OF RESPIRATORY SYSTEM 435 
 
 many cases. Correct any nasal abnormalities which may be 
 present. Regulate the diet. Exercise in the fresh air. Each 
 case should be treated on its own merits, since what will 
 apply in one individual will fail in another. 
 
 Asthma 
 
 Etiology. — The primary cause is irritability of the nerves 
 of the bronchial tubes, resulting in hyperesthesia and spas- 
 modic contractions thereof. Contributing causes are a nerv- 
 ous temperament, climate, heredity, and, reflexly, diseases 
 of the gastro-intestinal or the genito-urinary system. 
 
 Symptoms. — A paroxysm usually commences in the night, 
 with marked dyspnea, which is expiratory, the patient being 
 compelled to sit up leaning forward. There is a sense of 
 oppression in the chest, together with a feeling of suffocation 
 and the face is pale. In aggravated cases the pulse is thready 
 and rapid, the extremities are cold, and the body is covered 
 with a profuse perspiration. Between these attacks there is 
 more or less cough, and expectoration of stringy, viscid mucus. 
 
 Treatment. — Adjust the 2nd and 3rd dorsal vertebrae in 
 bronchial asthma. In cardiac asthma adjust the 4th dorsal 
 vertebra. For neurotic asthma adjust the 6th dorsal vertebra. 
 For renal asthma adjust the 10th dorsal vertebra. For symp- 
 tomatic asthma, adjust as indicated by a causative factor. 
 Interference with the ganglion impar often is a cause for the 
 persistence of asthma, and in such cases rectal dilatation is 
 very good. Concussion is useful in asthma, and the 3rd to 
 8th dorsal spinous processes should be concussed, in these 
 cases. For cardiac asthma concussion of the spinous process 
 of the 7th cervical vertebra is advised. For bronchial asth- 
 ma concussion of the 4th and 5th cervical vertebrae is best. 
 Remove the cause if possible. A great factor in the treat- 
 ment of these cases is a change of climate. The evening meal 
 should be light. Hygienic measures must not be lost sight of. 
 
 Diseases of the Lungs 
 
 Congestion of the Lungs 
 Pulmonary congestion may be either active or passive. 
 Active congestion is the first stage of lobar pneumonia, and 
 is also produced by the inhalation of irritant gases and dust
 
 436 SPINAL ADJUSTMENT 
 
 particles, and by closure of the vessels of other portions of 
 the lungs. 
 
 Passive congestion is of two kinds : Mechanical and 
 hypostatic. 
 
 1. Mechanical Congestion: 
 
 Etiology. — This is due to interference with the return flow 
 of the blood to the heart, as in valvular disease, dilatation, or 
 pressure on the vessels. 
 
 Symptoms. — While the heart is perfectly compensating 
 no symptoms are present. If compensation fails, dyspnea, 
 cough and expectoration occur. 
 
 2. Hypostatic Congestion : 
 
 Etiology. — The common cause of this form of congestion 
 is lying in the dorsal position for a long time. It also 
 accompanies prolonged fevers and chronic diseases. 
 
 Symptoms. — The characteristic symptoms and signs are 
 dyspnea, cough, haemoptysis, dullness on percussion over 
 the lower part of thorax, subcrepitant and mucous rales, and 
 bronchial breathing. 
 
 Treatment. — The treatment consists in determining the 
 exact cause of the condition, and employing measures directed 
 toward the relief thereof. 
 
 Pulmonary Edema 
 
 Etiology. — Pulmonary edema is the result of stasis of the 
 blood, due to the outflow of venous blood in the lung meet- 
 ing an obstacle that cannot be overcome by the right ventri- 
 cle of the heart. This condition is seen in failing compensa- 
 tion of the heart, alcoholism, and nephritis. 
 
 Symptoms. — The condition may appear suddenly or the 
 onset may be gradual. Characteristic symptoms are dyspnea, 
 cough, expectoration of frothy blood-stained sputum, loud 
 mucous rales, slight dulness at base of thorax, rise in 
 temperature and cyanosis. 
 
 Treatment. — Adjust the 3rd cervical and 3rd dorsal verte- 
 brae; also the 10th dorsal. Apply cold compresses over 
 the chest, and heat to the feet. 
 
 Pulmonary Hemorrhage 
 Etiology. — Hemoptysis is a symptom rather than a dis- 
 ease entity, and is seen in tuberculosis, pneumonia, and other
 
 DISEASES OF RESPIRATORY SYSTEM 437 
 
 lung affections. It also is met with in infectious fevers, 
 hemophilia, purpura, and heart and liver diseases. Sometimes 
 it occurs without any demonstrable cause. 
 
 Symptoms. — The expectoration of blood is accompanied 
 by coughing, and the blood is bright red and frothy. Mucous 
 and subcrepitant rales are heard. There is sometimes severe 
 pain beneath the sterum, and dyspnea may become marked. 
 
 Treatment. — Adjust the 4th cervical and 2nd dorsal verte- 
 brae. Complete rest is indicated, and cold compresses, 
 preferably an ice-bag, should be applied to the chest. 
 
 Bronchopneumonia 
 
 Etiology. — Bronchopneumonia is nearly always secondary 
 to some other disease as a complication of measles, scarlet 
 fever, whooping cough, influenza, diphtheria, and bronchitis. 
 It may also complicate Bright's disease, valvular diseases of 
 the heart, and all infectious fevers. It may also be produced 
 by drawing food particles into the lung, or by inhalation of dust. 
 
 Symptoms. — The characteristic symptoms and signs of this 
 disease are a sudden rise of temperature in the course of a 
 pre-existing aft'ection, together with dyspnea, increased pulse 
 and respiration rate, and cough. There is an expression of 
 great anxiety on the face. Cyanosis may develop. On aus- 
 cultation both dry and moist rales are heard, especially over 
 the back. 
 
 Treatment. — Adjust the 3rd cervical and the 1st and 3rd 
 dorsal vertebrae ; also the 10th dorsal. Hot packs over the 
 chest are very beneficial. In all diseases complicated by 
 i:)ronchopneumonia guard against exposure to cold and wet, 
 until the predisposing disease is cured. In acute infectious 
 diseases keep the mouth carefully cleansed. The temperature 
 of the room should be kept the same at all times and about 
 68°. The diet should be liquid and consist principally of 
 albumin water and milk broths. For high fever, and cere- 
 bral symptoms, use the wet pack, or give a gradually cooled 
 bath. For pain in the chest, apply hot compresses. For 
 cardiac failure, give alternating hot and cold douches. 
 
 Lobar Pneumonia (Croupous Pneumonia; Lung Fever) 
 
 Etiology. — The primary and indirect cause is diminished 
 resistance, due to faulty innervation. Predisposing causes
 
 438 SPINAL ADJUSTMENT 
 
 are exposure to cold, trauma and a previous attack. The 
 direct cause is the micrococcus lanceolatus, pneumococcus, or 
 diplococcus pneumoniae. 
 
 Pathology. — One or more entire lobes of the lung are first 
 congested, the capillaries being greatly distended. Red he- 
 patization in which the alveoli are filled with leucocytes, red 
 blood cells and fibrin, and dead epithelial cells ; the lung dur- 
 ing this stage is of a deep red color, very friable, and sinks 
 in water. During the stage of gray hepatization, the exudate 
 consists principally of leucocytes and is becoming necrotic, 
 giving the lung a gray color. 
 
 Symptoms.- — There usually are no premonitory symptoms, 
 the onset being very sudden, with a chill. This is followed 
 by a rapid rise in temperature to 104°-105°. Characteristic 
 symptoms are sharp pains in the affected side, flushed cheek 
 on the affected side, cough, which at first is dry, harsh and 
 painful and later is accompanied by expectoration of a viscid 
 rusty-colored sputum ; marked dyspnea. 
 
 The characteristic physical signs of the first stage of pneu- 
 monia are the crepitant rales. The characteristic signs of 
 the second and third stage are increased vocal fremitus, 
 dulness on percussion, bronchial breathing and bronchial 
 voice. 
 
 Treatment. — Adjust the 3rd cervical and the 1st, 3rd and 
 10th dorsal vertebrae. The diet should be light and large 
 amounts of water should be given the patient. The patient 
 should remain in bed and* an ice-cap applied to the head. If 
 pain is severe cold compresses should be applied to the chest. 
 When the heart is weak sponge baths and administration of 
 whiskey are indicated. 
 
 Diseases of the Pleura 
 Pleurisy 
 
 Etiology. — Primary pleurisy is due to defective innerva- 
 tion of the pleurae, superinduced by exposure to cold and 
 wet. Injuries of the chest walls may also cause it. Sec- 
 ondary pleurisy accompanies pneumonia, tuberculosis, peri- 
 carditis, measles, scarlet fever, smallpox, rheumatism and 
 Bright's disease. Chronic pleurisy follows an acute attack,
 
 DISEASES OF RESPIRATORY SYSTEM 439 
 
 as a result of a low grade of resistance induced thereby in 
 the pleura. It also may be the result of tuberculosis, 
 alcoholism and cancer. 
 
 Pathology. — Pleurisy is divided into four stages. The 
 first stage is called the dry stage; the pleural surfaces are 
 dry and roughened instead of moist and smooth and glistening 
 as they are in health. The second or plastic stage is char- 
 acterized by an effusion of a small amount of viscid fluid, 
 which covers the surfaces of the pleura, and has a tendency 
 to cause them to adhere to each other. The third stage, or 
 stage of liquid effusion, is characterized by the presence of 
 a greater or less amount of fluid in the pleural sac. The fourth 
 stage, or stage of absorption, is that during which the fluid 
 is becoming gradually absorbed. If the effusion is on the 
 left side, the heart is pushed to the right, and if the eff'usion 
 is on the right side, the heart is forced over to the left still 
 further. The lungs are compressed, and displaced upward 
 and against the spinal column. In chronic pleurisy the fluid 
 which is present is pus, which is walled off' by adhesions, 
 which are thrown about the infected area. 
 
 Symptoms.- — The acute variety begins suddenly with a 
 chill, followed by sharp pains in the aff'ected side, which are 
 increased by coughing and respiratory movements. Other 
 symptoms are rapid, shallow respiration, a short, dry cough, 
 rise in temperature, and rapid pulse. As the licjuid accumu- 
 lates, the pain abates, while dyspnea increases, cough becomes 
 aggravated, the heart action is impaired, and cyanosis de- 
 velops. As the fluid becomes absorbed, the symptoms become 
 less pronounced. 
 
 The subacute variety begins gradually after cold and ex- 
 haustion, in individauls in whom the resistance is low, as a 
 result of faulty innervation. The patients usually complain 
 of a sense of fatigue, .dyspnea on exertion, evening rise in 
 temperature, night sweats, and a short, hacking cough with 
 little or no expectoration. The pulse is weak, thready and 
 rapid. No pain is present. 
 
 The chronic variety runs a long course, and characteristic 
 symptoms are irregular chills and fever, palpitation of the 
 heart, dyspnea, night sweats, and more or less ])rostration. 
 
 The physical signs of the first stage are diminished move-
 
 440 SPINAL ADJUSTMENT 
 
 ment of the affected side, and a corresponding increase on the 
 healthy side. Palpation shows slight diminution of the 
 vocal fremitus. Auscultation reveals a friction sound. Dur- 
 ing the second stage there is still more restricted movement 
 on the affected side, vocal fremitus still more diminished, 
 resonance on percussion is lessened, and crackling friction 
 sounds are detected on auscultation. During the third stage 
 inspection reveals absence of respiratory movements on the 
 affected side, the intercostal spaces are widened and bulging; 
 the vocal fremitus is absent; there is flatness on percussion, 
 and the line of flatness varies with changes in the patient's 
 position; auscultation reveals absence of all sounds on the 
 affected side ; mensuration shows the affected side of the chest 
 to be one or two inches larger than the other side. 
 
 Treatment. — Adjust the 3rd cerv-ical and 3rd dorsal verte- 
 brae. The patient should be placed in bed at once. The diet 
 should be confined to liquids or semi-solid substances. Strap 
 the affected side with broad strips of adhesive plaster, to 
 limit the movement and lessen the pain. The heart should 
 receive careful consideration. 
 
 Pneumothorax 
 
 Etiology.- — Perforating wounds of the chest wall ; pointing 
 of abscess of the lungs or empyema through the chest wall ; 
 perforation of the lung by tubercular excavations, or gan- 
 grene ; perforation of the diaphragm in cancer of the esopha- 
 gus, stomach, or intestine. 
 
 Pathology. — The lung is compressed against the spinal 
 column and the pleural cavity is filled with gas. 
 
 Symptoms. — The presence of air in the pleural sac is a rare 
 condition ; the chief symptoms are its sudden onset with 
 intense pain in the side, dyspnea, cyanosis and extreme 
 prostration. 
 
 Physical Signs. — The aft'ected side is enlarged and immo- 
 bile ; the vocal fremitus is diminished ; tympanitic resonance 
 on percussion. If fluid is also present, there will be flatness 
 below its level, which changes with alterations in the patient's 
 position. The respiratory sounds are weak or absent. Suc- 
 cussion, which is performed by grasping the patient by the 
 shoulders, and vigorously shaking him, produces the splash-
 
 DISEASES OF RESPIRATORY SYSTEM 441 
 
 ing sound, when fluid and air are present in the pleural 
 cavity. 
 
 Treatment. — That of pleurisy with effusion. 
 
 Hydrothorax 
 
 Etiology. — An eli'usion of fluid into the pleural cavities is 
 an accompaniment of dropsy in other parts of the body due to 
 heart, liver, and kidney disease. 
 
 Symptoms. — The characteristic signs are cough, dyspnea, 
 and cyanosis. No signs of inflammation are present, and 
 the pulse and temperature are normal. 
 
 Treatment.— Adjust the 3rd cervical and 3rd dorsal verte- 
 brae, and any other subluxations which may be found after 
 a careful spinal analysis has been made. Diseases of the 
 heart, liver or kidneys should be treated. The skin, bowels 
 and kidneys should be kept active.
 
 CHAPTER VII 
 
 Diseases of the Circulatory System 
 Acute Pericarditis 
 
 Etiology. — A primary inflammation of the pericardium 
 rarely occurs, but the disease is usually due to other pre- 
 existing conditions, for example, gout, rheumatism, tonsil- 
 itis, scarlet fever, pneumonia, la grippe, infections, and tuber- 
 culosis. Spinal lesions producing impingement of the sec- 
 ond and third pair of dorsal spinal nerves are very often found 
 in this disease, and indicate that in part at least it is due to 
 this cause. When the disease has existed for a short time 
 reflex subluxations are produced, which prevent raj)id recovery 
 and cause the condition to become chronic. 
 
 Pathology. — During the first stage the surfaces of the 
 pericardium are dry and roughened. In the second stage 
 the surfaces are covered with a viscid material. The third 
 stage is characterized by the formation of a greater or less 
 amount of serous effusion. This effusion may become 
 hemorrhagic or purulent. 
 
 Symptoms.- — There may be no symptoms until eft'usion 
 into the pericardium develops. There may be slight pain 
 over the heart, and a moderate rise in temperature. In the 
 first stage the heart action is irritable and forcible; there is 
 no change in the area of cardiac dullness on percussion. The 
 only characteristic sign of this stage is the pericardial friction 
 sound, which is produced by the rubbing over each other of 
 the roughened surfaces of the pericardium. After the inflam- 
 mation has existed for a short time, effusion into the peri- 
 cardial sac takes place. On inspection we note the pericardial 
 area to be arched forward, and a diminution of the respira- 
 tory movements on the left side of the thorax. Palpation 
 shows the apex impulse displaced upward and to the left ; if, 
 however, the amount of eft'usion is large, the apex beat will 
 not be palpable. If the apex impulse is palpable when the 
 patient is in the recumbent posture and absent when he is 
 
 442
 
 DISEASES OF CIRCULATORY SYSTEM 443 
 
 erect, it is almost certain that effusion into the pericardial 
 sac is present. On percussion the area of cardiac dullness is 
 first increased upward, and later transversely. In this stage 
 the pericardial friction sound becomes more and more indis- 
 tinct, until finally it ceases to be heard. The normal heart 
 sounds are very feeble, and the respiratory sounds are absent 
 over the pericardial area. As recovery takes place there is 
 a gradual return to normal of all the physical signs. 
 
 Treatment. — Adjust the 3rd cervical and the 2nd, 4th, 
 and 6th dorsal vertebrae. The patient should be placed in 
 bed, and absolute rest enforced. The diet should be fluid ; if, 
 however, the amount of eiTusion is large, a dry diet is indi- 
 cated. Either an icebag or hot magnesium sulphate com- 
 presses over the pericardium are indicated. If the amount of 
 efifusion is so large as to cause dyspnea or other pressure 
 symptoms, surgical measures are necessary. 
 
 Chronic Pericarditis 
 
 Etiology. — The chronic form usually follows acute peri- 
 carditis, and this is due to the reflex production of spinal 
 lesions which produce impingement of the nerves which 
 control the heart. Were these subluxations corrected as they 
 developed in the acute form, it is unlikely that the chronic 
 form would result. 
 
 Pathology. — The pericardium is thickened and covered 
 with fibrin. Adhesions are present either between the two 
 layers of the pericardium or between the pericardium and 
 pleura. The heart is very often found dilated and hyper- 
 trophied. 
 
 Symptoms. — These are frequently not characteristic, but 
 may be those of enlargement of the heart or failure of com- 
 pensation. The apex beat is diffused, the area of cardiac 
 dulness increased, and the heart action is irregular. 
 
 Treatment. — Adjust the 3rd cervical and the 2nd and 4th 
 dorsal vertebrae. Moderate exercise and baths. Otherwise 
 the treatment is symptomatic. 
 
 Chronic Myocarditis 
 
 Etiology. — The primary and indirect cause of this dis- 
 ease is the progressive diminution of nerve force which ac-
 
 444 SPINAL ADJUSTMENT 
 
 companies old age, in which period of life the condition gen- 
 erally occurs. It also accompanies pericarditis and endo- 
 carditis and disease of the coronary arteries. Persons sub- 
 ject to arteriosclerosis as a result of deposition of lime salts 
 in the arteries from faulty elimination also are subject to 
 acute myocarditis. 
 
 Pathology. — There is no inflammation of the heart mus- 
 cle but rather a replacement of the heart muscle with fibrous 
 tissue. Hypertrophy of the heart may occur to compensate 
 for the loss of muscle tissue, and this is later followed by 
 aneurysm. 
 
 Symptoms. — There may be no definite symptoms. Those 
 which may be present are dyspnea, rapid heart action, palpi- 
 tation, angina pectoris, cardiac asthma, symptoms of collapse, 
 and mental disturbances. In other cases the symptoms of 
 broken compensation are present, and as a result of the 
 hypertrophy the area of cardiac dullness is increased. 
 
 Treatment. — Adjust the 3rd cervical and the 2nd and 4th 
 dorsal vertebrae. The Schott or Nauheim treatment which 
 consists of graduated resisted exercise is a valuable adjunct 
 in the treatment of these cases. Rectal dilatation has been 
 successfully employed in this disease and is advised. Baths 
 are of value and should be given about three times a week. 
 The patient should be moderate in all things. 
 
 Acute Myocarditis 
 
 Etiology. — When during the course of an acute infectious 
 disease reflex spinal lesions affecting the nerves that control 
 the heart are produced, acute myocarditis frequently develops. 
 This is especially true in typhoid fever, scarlet fever, and 
 diphtheria. It also accompanies acute pericarditis and en- 
 docarditis, in which the muscular coat of the heart becomes 
 afTected simply through extension of the inflammation to it. 
 
 Pathology. — There is granular degeneration of the mus- 
 cle cells, and sometimes small abscesses of the heart wall 
 develop. 
 
 Symptoms. — The characteristic symptoms of this disease 
 are precordial pain, weak circulation, feeble heart action, and 
 symptoms of collapse. The physical signs are those of sepsis 
 and mild dilatation of the heart.
 
 DISEASES OF CIRCULATORY SYSTEM 445 
 
 Treatment. — Adjust the 3rd cervical and the 2nd and 4th 
 dorsal vertebrae. Hot compresses over the heart. Treat the 
 accompanying disease. 
 
 Acute Endocarditis 
 
 Etiology. — There are two varieties of the disease: (1) The 
 simple form ; (2) The malignant form. The simple form of 
 endocarditis usually follows rheumatic fever, typhoid fever, 
 diphtheria, tonsillitis, chorea, and less frequently other infec- 
 tious diseases. The malignant form sometimes follows any 
 of the above diseases, in addition to which it often accom- 
 panies sepsis, tuberculosis, Bright's disease, erysipelas, and 
 gonorrhea. In all cases reflex subluxations are produced in 
 those spinal segments from which the heart receives its inner- 
 vation ; these tend to aggravate the condition, and, unless 
 corrected cause it to be prolonged into the chronic form. 
 
 Pathology. — In plastic or simple exudative endocarditis 
 there is a tendency to overgrowth of the valvular portions of 
 the endocardium, as a result of the products of the inflam- 
 mation, namely the fibrin, blood-platelets and leucocytes be- 
 coming organized. The aortic and mitral valves are most 
 commonly affected. In malignant or ulcerative endocardi- 
 tis portions of the valves are destroyed as a result of the 
 ulceration. 
 
 Symptoms. — In the simple form there may be very few 
 symptoms, among which may be mentioned dyspnea, dis- 
 turbed cardiac action, nausea and vomiting, and a moderate 
 rise in temperature. In the malignant form emboli are quite 
 common and among the eiifects produced by them may be 
 enumerated hematuria, spitting of blood, local gangrene, paral- 
 ysis, and hemorrhage of the retina. The fever is high and 
 may be accompanied by chills and sweats as in sepsis, or by 
 prostration, delirium, and coma as in typhoid fever, or the 
 disturbances may be chiefly cerebral. These varying symp- 
 toms all depend upon the comparative resistance of the re- 
 spective parts of the body, those of low resistance as a result 
 of deficient innervation being the ones which will be most 
 readily affected. 
 
 Treatment. — Adjust the 3rd cervical and the 2nd, 4th and 
 6th dorsal vertebrae. Hot magnesium sulphate compress over
 
 446 SPINAL ADJUSTMENT 
 
 llie precordial region. Rest and avoidance of exposure dur- 
 ing attacks of rheumatism, chorea, or diseases with which 
 endocarditis is commonly associated. Absolute rest after the 
 disease develops. For over-action of the heart, an ice pack 
 over the pericardium, and concussion of the transverse proc- 
 esses of the 1st and 2nd dorsal vertebrae, for its stimulating 
 effects upon the 4th thoracic nerve, which produces an in- 
 hibitory effect on the heart movements. Diet should be 
 chiefly liquid, but not restricted. Stimulation as needed. 
 Avoid early exertion after convalescence. Rectal dilatation 
 is very useful in many cases. 
 
 Chronic Endocarditis (Chronic Valvular Disease) 
 
 Etiology. — When in the course of an acute endocarditis 
 the reflex spinal lesions which must occur, as a result of the 
 excessive flow, to the segments which control the heart, of 
 afferent impulses are left uncorrected, the disease merges into 
 the chronic form. This is due to the fact that the impinge- 
 ment of the nerves to the heart interferes with its innervation 
 and permits of inflammatory changes which would otherwise 
 not be possible. Alost such cases may be traced to rheuma- 
 tism, infectious diseases, and chorea from which the acute 
 form resulted. An endocarditis which is chronic from the 
 very onset may be caused by alcoholism, syphilis, gout, or 
 excessive muscular exertion. In the aged atheromatous or 
 fibroid changes in the lining of the heart may produce chronic 
 endocarditis. Chronic Bright's disease may also cause it. 
 
 Pathology. — This is the same as that of the acute form 
 after the process has become fully developed, namely after 
 there has been either thickening of the valves or partial 
 destruction of one or more of their segments. 
 
 Symptoms. — When the heart is compensating for the leak- 
 age, there may be no symptoms. When, however, compen- 
 sation begins to fail, distress over the heart, irregular car- 
 diac action, palpitation, dyspnea, vertigo, edema of the ankles, 
 and other symptoms develop. When compensation is mark- 
 edly impaired, the above symptoms are aggravated, in addi- 
 tion to which passive congestion in various parts and organs 
 of the body develops, with its concomitant symptoms, as 
 bronchitis, pulsating liver, scanty, albuminous urine, edema
 
 DISEASES OF CIRCULATORY SYSTEM 447 
 
 of the luniks, anasarca, and j^^astroenteritis. The heart action 
 is irregular and the sounds are feeble. Anemia is present. 
 
 Varieties. — 1. Aortic Regurgitation. 2. Aortic Stenosis. 
 3. Mitral Regurgitation. 4. Mitral Stenosis. 5. Pulmon- 
 ary Regurgitation. 6. Pulmonary Stenosis. 7. Tricuspid 
 Regurgitation. 8. Tricuspid Stenosis. 
 
 1. AORTIC REGURGITATION.— The apex beat is dis- 
 placed downward and to the left. The area of heart dullness 
 is increased. A murmur heard with and just after the second 
 sound behind the sternum is heard. 
 
 2. AORTIC STENOSIS.— Slight increase of the heart 
 dullness. A murmur is heard with the first sound of the 
 heart, behind the sternum. Aortic murmurs are the only 
 ones which are transmitted into the vessels of the neck. 
 
 3. MITRAL REGURGITATION.— The apex beat is dis- 
 placed to the left and downward. The area of heart dullness 
 is increased. A murmur is heard with the first sound of the 
 heart with the greatest intensity at the apex, and is trans- 
 mitted toward the left and around to the back on a line with 
 the apex beat. The second pulmonic sound is accentuated. 
 
 4. MITRAL STENOSIS.— There is lateral increase in the 
 heart dullness. The pulse is small. A murmur is heard dur- 
 ing diastole, just preceding the first sound (if the heart. The 
 pulmonary second sound is accentuated. 
 
 5. PULMONARY REGURGITATION.— The murmur is 
 heard best at the second intercostal space to the left of the 
 sternum. It is heard with and following the second sound 
 of the heart. 
 
 6. PULMONARY STENOSIS.— The murmur is heard 
 best at the second intercostal space, to the left of the sternum, 
 and occurs with the first sound of the heart. 
 
 7. TRICUSPID REGURGITATIOiN.— Pulsating jugu- 
 lars. Increase of heart dullness toward the right side. V^en- 
 ous engorgement is pronounced. A murmur is heard with 
 the first sound of the heart, over the uncovered triangular 
 space. 
 
 8. TRICUSPID STENOSIS.— The cardiac dullness is in- 
 creased toward the right side. A murmur is heard just pre-
 
 448 SPINAL ADJUSTMENT 
 
 ceding the first sound of the heart, over the lower sternum, 
 and is not transmitted. 
 
 Treatment. — Adjust the 2nd and 4th dorsal vertebrae and 
 any others which may be found after a careful spinal analysis 
 has been made. Concussion of the 7th cervical vertebrae. 
 Tepid baths, and hot compresses over the precordial region. 
 Rectal dilatation. When compensation is perfect, a regular, 
 quiet mode of life should be followed, and all mental excite- 
 ment, overwork, and worry be studiously avoided. Moderate 
 exercise is very beneficial in these cases, but the patient should 
 be warned of the dangers of excessive physical exertion, as 
 running up stairs, excessive work, etc. Exposure to damp 
 and cold should be guarded against. High altitudes should 
 be avoided, although the author has seen cases whose heart 
 action was better in high altitudes than in low. The diet 
 should be dry and moderate, and all stimulants should be 
 eschewed. Tobacco and alcohol should never be used. When 
 compensation is disturbed absolute rest in bed is indicated. 
 Consultation in such cases is always advisable. 
 
 Hypertrophy of the Heart 
 
 Etiology .^ — Chronic diseases of the lung, for example, em- 
 physema and fibroid phthisis ; chronic pericarditis or endo- 
 carditis. Drugs, as tobacco and alcohol. Anything which 
 causes increased resistance in the circulation, for example, 
 arteriosclerosis, aneurysm, Bright's disease, or gout. 
 
 Pathology. — The heart is increased in size. The walls 
 of that part of the heart which is involved are thicker than 
 normal and the muscle is dark in color and very dense. Arte- 
 riosclerosis may follow on account of the increased strain put 
 upon the vessels, and as a result of this apoplexy is apt to 
 occur. 
 
 Symptoms. — The symptoms depend on the extent of the 
 enlargement. If the heart is only enlarged suf^ciently to 
 compensate for valvular lesions, or other disturbances in the 
 circulation as mentioned under the head of etiology, no symp- 
 toms will be present. But when the enlargement is greater 
 than the requirements, it is shown by the following symp- 
 toms : The heart action is increased in frequency and very 
 forcible ; there are also headache, vertigo, dyspnea on exer-
 
 DISEASES OF CIRCULATORY SYSTEM 449 
 
 tion, redness of the face and eyes, nose-bleed, cough, tinnitus, 
 distress in the precordial region, disturbed sleep, dreaming, 
 and starting during sleep. The arteries are full, and the 
 pulse is hard. The carotid arteries and others pulsate very 
 forcibly. 
 
 Treatment. — Adjust the 2nd and 4th dorsal vertebrae. 
 Spinal concussion of the 7th cervical vertebra. Avoid all ex- 
 cesses, as mental and physical over-exertion. Keep up the 
 general nutrition. All stimulants such as alcohol, tea, coffee, 
 and tobacco, should be interdicted. 
 
 Dilatation of the Heart 
 
 Etiology. — The common causes of dilatation of the heart 
 are impairment of the nutrition of the heart muscles, harden- 
 ing of the coronary arteries, and anemia. In addition to these 
 causes, those operating to produce enlargement of the heart 
 by thickening of its walls, namely, hypertrophy, also cause 
 dilatation. 
 
 Pathology. — Dilatation of the heart is usually associated 
 with hypertrophy, and affects most often the right side of 
 the heart. If the degree of dilatation is marked, the valves 
 will be unable to close the orifices which they normally guard. 
 
 Symptoms. — The symptoms which are present in dila- 
 tation of the heart, are all due to weakening of the heart action, 
 as a result of thinning of its walls, and are as follows : The 
 pulse is feeble, symptoms of collapse are frequent, there is 
 headache, cough, dyspepsia and constipation, dyspnea, scanty 
 urine, dizziness, mental dullness, and finally edema of the 
 ankles develops. 
 
 Treatment. — Adjust the 2nd and 4th dorsal vertebrae. 
 Concussion of the spinous process of the 7th cervical and 4th 
 dorsal. The general nutrition should be improved in as far 
 as possible, by a liberal diet. The amount of exercise taken 
 should be moderate, and the skin, bowels, and kidneys should 
 be kept active. Exercise is employed in three different ways, 
 or sometimes by a combination of these methods : (a) Passive 
 exercise and massage (Swedish or Ling plan) ; (b) Move- 
 ments with limited resistance (Schott plan, which is really a 
 modification of the Swedish method) ; (c) The Oertel method 
 of climbing.
 
 450 SPINAL ADJUSTMENT 
 
 Angina Pectoris 
 
 Etiology. — This disease is usually due to hardening of the 
 coronary arteries. It is seen more in men than in women. 
 It occurs most commonly during middle life. It is very often 
 associated with aortic insufficiency, or when the pericardium 
 is adherent. 
 
 Symptoms. — Following a day of excessive physical or 
 mental exertion, the patient awakens during the middle of 
 the night, suffering from an agonizing pain over the heart, 
 accompanying which is a sense of impending dissolution. The 
 pain usually radiates upward to the left shoulder, and down 
 the left arm. The attack lasts from a few seconds to possibly 
 ten minutes. Following the attack, gas and acid eructation, 
 profuse urination, and exhaustion are present. 
 
 Treatment. — Adjust the 2nd and 4th dorsal vertebrae. In 
 addition to these adjustments, give others for the relief of 
 any possible causative factors. Concussion over the 9th to 
 the 12th thoracic vertebrae is also very beneficial. Hot baths 
 should be used. The Nauheim treatment, especially the hot 
 baths, are indicated in this condition. The constant current, 
 with the positive pole over the sternum, and the negative 
 pole over the lower vertebrae, has been used with success, in 
 conjunction with spinal adjustment. Careful dieting is indi- 
 cated, to prevent the occurrence of flatulence and constipation. 
 All mental strain and physical exertion should be avoided. 
 
 Fatty Heart 
 
 Etiology. — Fatty degeneration of the heart accompanies 
 various conditions the chief of which are wasting diseases, 
 anemia, alcoholism, arsenic or phosphorous poisoning, and 
 diseases of the coronary arteries, pericarditis, or enlargement 
 of the heart. It is seen most frequently in old age. 
 
 Pathology. — The cells of the muscle fibres are degenerated 
 and broken down, while between the muscle fibres there are 
 present numerous fat lobules. 
 
 Symptoms. — There are usually no symptoms until the heart 
 becomes dilated, and the symptoms then are those of dilata- 
 tion of the heart. Pulse is usually very slow, on account of
 
 DISEASES OF CIRCULATORY SYSTEM 451 
 
 the weakness of the heart muscle, which is largely replaced by 
 fat. Dyspnea, collapse, pain over the precordial region are 
 common symptoms. 
 
 Treatment. — Adjustment of the 2nd and 4th dorsal verte- 
 brae ; concussion of the 7th cervical vertebra. "The Oertel 
 and Schott treatment — gradually increased hill climbing with 
 reduction of fluids and fats in the diet — may give good re- 
 sults, especially in cases with general obesity. The Schott 
 or Nauheim method — saline baths charged with carbon diox- 
 ide and graduated resisted exercise — may be employed at 
 Nauheim or in artificail baths at home." (Dayton.) Mental 
 and physical exertion should be avoided. The diet should 
 be generous, and consist of easily digested substances ; meat, 
 fat and starches should be especially forbidden. The patient 
 should lie down for several hours each day. 
 
 Palpitation of the Heart (Irritable Heart) 
 
 Etiology. — This condition is due principally to interference 
 with the conduction of those nerve impulses to the heart 
 which regulate its action ; as a result of this, the inhibitory 
 influence of these nerves upon the action of the heart is 
 withdrawn, and increased rapidity of the cardiac action 
 results. Among the contributing causes may be enumerated 
 anemia, mental worry, hysteria, over-exertion, menstrual 
 disorders, dyspepsia, puberty, long continued use of tobacco, 
 alcohol, tea and cofTee ; it occurs most commonly in the 
 female sex. 
 
 Symptoms. — There may be present and felt only a slight 
 sensation of fluttering of the heart ; on the other hand, there 
 may be hot flushes, forcible pulsation of the arteries, the 
 force of the apex beat may be increased, the pulse is rapid, 
 difficult breathing, and nervousness. The attack of palpita- 
 tion lasts from a few minutes to a number of hours, and usually 
 follows mental or physical exertion. 
 
 Treatment. — Adjust the 2nd and 4th dorsal vertebrae; for 
 stimulation of the vagus to inhibit the heart's action, concus- 
 sion of the atlas and axis, 7th cervical, and the 2nd and 4th 
 thoracic vertebrae is necessary. The diet, sleep and exercise 
 of the patient should be regulated. Cold sponge baths are 
 very useful.
 
 452 SPINAL ADJUSTMENT 
 
 Arrythmia 
 
 Etiology. — The primary cause of this disease is interference 
 with the communicating nerves between the heart and its 
 ganglia. Contributing causes ^^re reflex, as from disease of 
 the lungs, stomach, liver or kidneys ; toxic, as the use of drugs, 
 tea, coffee, alcohol; also organic disease of the brain. 
 
 Symptoms. — The term arrythmia includes either irregu- 
 larity in the action of the heart as to its rhythm, or a skipping 
 of heart beats. In addition to the symptoms referable to the 
 heart itself, there will be present also those of the underlying 
 cause. 
 
 Treatment. — The treatment of this disease is the same as 
 that of palpitation of the heart. 
 
 Bradycardia 
 
 Etiology. — The primary cause of this disease is an inter- 
 ference with the conduction of the nerve impulses which gov- 
 ern the heart's action. Secondary causes are other organic 
 nervous diseases, in addition to which it also accompanies 
 fibroid and fatty degeneration of the heart, and hardening of 
 the coronary arteries. It is also seen very often during con- 
 valescence from such diseases as diphtheria, pneumonia, 
 typhoid fever, rheumatism, and erysipelas. 
 
 Symptoms. — Bradycardia is considered to be present when 
 the pulse beats have been diminished in number to 40 per 
 minute. The slow heart action is the characteristic symptom, 
 and the pulse is accordingly also correspondingly slow in 
 addition to which it is thready. The first sound of the heart 
 is feeble, and indistinct, and the second sound is often not 
 heard at all. Symptoms which are present as a result of a 
 slow heart action, are attacks of fainting, dizziness, ringing in 
 the ears, and sometimes even convulsions. 
 
 Treatment.— Bradycardia being most usually simply a 
 symptom of some other condition, the underlying cause 
 should be determined, and proper treatment instituted. As 
 long as the slowness of the heart action does not interfere 
 with the bodily requirements, no special treatment is indi- 
 cated ; if, however, the opposite obtains, the patient should 
 be put to bed, hot compresses applied over the heart, and per- 
 fect quiet be maintained.
 
 DISEASES OF CIRCULATORY SYSTEM 453 
 
 Tachycardia 
 
 Etiology. — The primary cause is failure of the inhibitory 
 control of the heart, due to interference with the vagus nerve. 
 Among secondary causes may be mentioned neurasthenia, 
 chronic indigestion, continued high fever, excessive smoking, 
 neuritis of the pneumogastric nerve, and the menopause. 
 
 Symptoms. — Preceding the attack there may be dizziness, 
 ringing in the ears, and a foreboding. The attack itself comes 
 on very suddenly, and the heart action is rapidly increased up 
 to 200 beats a minute. The pulse is weak, thready, and ir- 
 regular. The respiration is increased in frequency, there is 
 difficult breathing. The skin is pale, but later becomes 
 flushed. A smothering sensation is present, accompanied by 
 a tight feeling about the heart. Such an attack lasts from a 
 few minutes to a number of hours, or even days. 
 
 Treatment. — Adjust the 1st and 2nd cervical, and the 2nd 
 and 4th dorsal vertebrae. Concussion of the 1st, 2nd and 7th 
 cervical vertebrae. Rest in bed is of great importance. An 
 ice bag should be applied over the heart. In the intervals be- 
 tween attacks the habits should be regulated, and the patient 
 should be forbidden to use any harmful substances such as 
 tea. coffee, alcohol and tobacco. 
 
 Arteriosclerosis 
 
 Etiology. — The primary cause of this affection is defective 
 metabolism, due to faulty innervation, as the result of which 
 the deposition of lime salts in the walls of the arteries is per- 
 mitted to take place ; this converts the arteries from soft tubes 
 into very hard pipe-like structures. Secondary causes may 
 be worry, physical or mental over-exertion, habitual over- 
 eating, chronic poisoning, as by gout, syphilis, tobacco, alco- 
 hol. Chronic interstitial Bright's disease is also a very com- 
 mon cause of this condition. 
 
 Pathology. — The degenerative changes in the vessels may 
 be confined to a certain part of the body, or be general. There 
 is an overgrowth of the tissues of the middle and inner coats 
 of the vessel walls. In advanced cases the arteries are very 
 hard, thickened and tortuous. 
 
 Symptoms. — These are not always evident, and differ ac- 
 cording to the arteries involved. When the sclerosis of the
 
 454 SPINAL ADJUSTMENT 
 
 arteries is general, the vessels near the surface of the body- 
 have a hard, bony feel. The resistance to the circulation of 
 the blood finally results in enlargement of the heart. Sub- 
 jective symptoms present are dizziness, spells of unconscious- 
 ness, and apoplectiform seizures. When the vessels of the 
 kidneys are hardened, Bright's disease develops. When the 
 coronary arteries, or the aorta are hardened, angina pectoris 
 and myocarditis develop. 
 
 Treatment.- — General adjustment, especially also adjust- 
 ment of the atlas, 4th cervical, 5th and 10th dorsal, and 2nd 
 lumbar vertebrae. The mode of life must be regulated. The 
 bowels and kidneys must be kept active. Avoidance of alco- 
 hol, excesses of eating or drinking, exertion, excitement or 
 worry. A dry diet consisting chiefly of vegetables, is to be 
 preferred. A moderate amount of exercise is beneficial. 
 Whenever it is possible to do so, the cause of the sclerosis of 
 the arteries should be corrected. 
 
 Aneurysm 
 
 Etiology. — The primary cause of aneurysm is defective 
 metabolism, which is occasioned by an impaired action of the 
 nerves, due to interference by subluxations of the vertebrae ; 
 as a result of the unbalanced metabolism, arteriosclerosis de- 
 velops, and the vessel walls become weakened, permitting a 
 portion of the wall to become pouched out. This occurs espe- 
 cially after hard work, or sudden exertion, which increases the 
 blood pressure. Among the most common secondary causes 
 may be mentioned alcoholism and syphilis. 
 
 Pathology. — The vessel walls are weakened and at the 
 point of weakening, the vessel becomes dilated. 
 
 Symptoms. — There are two main varieties of aneurysm, 
 which are of importance, namely, aneurysm of the thoracic 
 aorta, and of the abdominal aorta. The symptoms of an 
 aneurysm of the thoracic aorta are a pulsation in the second 
 and third intercostal space on the right side ; prominence and 
 enlargement of the cutaneous veins over the seat of the 
 aneurysm ; the apex beat is displaced ; dullness on percussion ; 
 the pulse in the radial arteries, is unequal, or the pulse is de- 
 layed. As a result of the pressure of the aneurysm upon the 
 trachea, dyspnea, pain, cough, hoarseness, aphonia, dysphagia
 
 DISEASES OF CIRCULATORY SYSTEM 455 
 
 may develop. The symptoms of abdominal aneurysm are 
 epigastric pulsation, abdominal pain, vomiting-, and une{iual 
 occurrence of the femoral pulses. This form of aneurysm 
 may often be felt with the hand. 
 
 Treatment. — Adjustment of the 2nd dorsal vertebra will 
 diminish the pulsation of an aneurysm almost at once, and a 
 course of adjustments have been claimed to have efifected a 
 cure. Concussion of the 7th cervical vertebra is also to be 
 used. If constipation is present, fruits should be eaten. An 
 Epsom bath every second day is a helpful measure. If the 
 case is seen early, absolute rest in bed should be enforced, 
 and the ingestion of fluids limited to the smallest possible 
 amount. In all, cases of aneurysm excitement and worry 
 should be avoided, and the use of stimulants, and over-exer- 
 tion, are forbidden. 
 
 Varicose Veins 
 
 Etiology. — The cause of this condition is increased intra- 
 venous pressure or changes in the vein walls, both of which 
 are primarily due to disturbed innervation, as a result of 
 pressure upon the nerves which control the area involved. 
 
 Symptoms. — The symptoms usually complained of are a 
 feeling of fatigue, and a sense of heaviness of the limb, after 
 prolonged standing or walking. There are also present cold- 
 ness of the feet, edema of the ankles, and a numbness of the 
 legs ; sometimes deep-seated pain is present. The character- 
 istic sign of varicose veins is the twisted, enlarged and knotted 
 veins which may be seen upon the leg. 
 
 Treatment. — Adjustment in the lumbar region. Concus- 
 sion of the 7th cervical and the 1st and 2nd lumbar vertebrae: 
 compresses should be applied on the leg every night. Any- 
 thing which obstructs the circulation must be removed, for 
 example, tight garters. The bowels must be regulated, and 
 prolonged standing and excessive walking should be avoided, 
 although a certain amount of exercise is very beneficial in 
 these cases. If the condition has developed very suddenly, 
 the limb must be rested for a considerable length of time, 
 maintained in the horizontal position, and the vein protected 
 from any strain for at least a month. The general health 
 should be maintained by hygienic measures.
 
 CHAPTER VIII 
 
 Diseases of the Digestive System 
 
 Diseases of the Mouth 
 Catarrhal Stomatitis 
 
 Etiolog-y. — This is the commonest form of inflammation of 
 the mouth and is usually due to various irritants, as tobacco, 
 acids, hot drinks, etc. It is seen most commonly in young 
 children, and is due in those cases to delayed dentition, and 
 also infectious fevers. 
 
 Symptoms. — There are pain, redness, swelling of the 
 mucous membrane of the mouth, bad breath, a slight rise in 
 temperature, and retarded secretion. 
 
 Treatment. — Adjust the 4th cervical and the 5th dorsal 
 vertebrae. Remove the exciting cause. Regulate the diet. 
 Swab out the mouth at frequent intervals with a soft piece 
 of absorbent cotton and ice water. 
 
 Aphthous Stomatitis (Canker) 
 
 Etiology. — This form of inflammatioji of the mouth is seen 
 most commonly in childhood, and is due to delayed dentition, 
 eruptive fevers, indigestion and uncleanliness. These must 
 be considered as the secondary causes of the disease, while 
 the primary cause is an interference with the conduction of 
 normal nerve impulses to the mucous membrane of the mouth. 
 Soon after the disease has developed, reflex subluxations are 
 produced, and as a result of the interference with the nerve 
 supply, the condition becomes aggravated, and may develop 
 into the ulcerative or gangrenous type in some cases. 
 
 Pathology.— The follicles and mucous membrane of the 
 mouth and tongue are first inflamed ; soon small reddish spots 
 form, which later coalesce to form large, white patches, which 
 later rupture and leave an ulcer, which is slow in healing. 
 
 Symptoms. — The chief symptoms of this disease are dys- 
 phagia, pain, slight rise in temperature, and a fetid breath. 
 
 456
 
 DISEASES OF DIGESTIVE SYSTEM 457 
 
 Treatment. — Adjust the 4th cervical and the 5th and 7th 
 thoracic vertebrae. Remove the exciting- cause if possible. 
 The mouth should be cleansed after each feeding in the case 
 of infants, and nursing bottles and nipples should be sterilized 
 by boiling. 
 
 Ulcerative Stomatitis 
 
 Etiology. — This disease frequently follows the aphthous 
 form, and is commonly due to poor hygienic surroundings, 
 and an insufficient amount of proper food. 
 
 Pathology. — Small ulcers having a white or greyish base, 
 are situated most commonly on the gums. 
 
 Symptoms. — The gums are swollen, bleed easily, and are 
 very sensitive. There is enlargement of the submaxillary 
 lymph glands. The flow of saliva is markedly increased, the 
 breath is fetid, and there may be pronounced constitutional 
 symptoms. 
 
 Treatment. — Adjust the 4th cervical and the 5th dorsal 
 vertebrae. In some cases the ulcers are very large and heal 
 with difficulty. In such a case it is advisable to employ 
 medicinal measures. 
 
 Gangrenous Stomatitis (Cancrum Oris, Noma, Water Cancer) 
 
 Etiology. — This disease attacks especially children of low 
 vitality, brought about by faulty innervation. The direct 
 cause may be a microorganism, but its character is not as yet 
 understood. This disease is seen very often as a sequel to 
 typhoid fever, pneumonia, scarlet fever and measles. 
 
 Symptoms. — The disease begins very suddenly. A necrotic 
 spot is first seen on the inside of the cheek, which spreads 
 and finally causes sloughing of a great portion of the tissue, 
 the cheek even becoming perforated at times. The tissue 
 about this gangrenous portion is hard and swollen. There 
 are extreme constitutional symptoms. 
 
 Treatment. — If the case is seen early, adjustment of the 
 4th cervical and the 5th dorsal vertebrae, together with hot 
 compresses over the affected side of the face, may be eflfective. 
 Usually, however, the condition has advanced so far that sur- 
 gical measures are necessary. 
 
 O
 
 458 SPINAL ADJUSTMENT 
 
 Parasitic Stomatitis (Thrush) 
 
 Etiology. — The direct causes of this disease are parasites. 
 The predisposing causes are improper food, uncleanliness, and 
 a low grade of vital resistance. 
 
 Symptoms. — The mouth is the seat of small, whitish spots, 
 which are usually confined to the tongue, but may, however, 
 involve the entire mouth, and even extend to the larynx and 
 esophagus. 
 
 Treatment. — Adjust the 4th cervical and 5th dorsal verte- 
 brae. Regulate the diet. Keep the mouth thoroughly 
 cleansed. 
 
 Mercurial Stomatitis 
 
 Etiology. — The cause of this condition is an excessive 
 amount of mercury in the system. Such a condition may be 
 acquired either by the ingestion of an excessive amount of 
 mercury for medicinal purposes, and in those whose occupa- 
 tion makes it necessary for them to work with mercury. 
 
 Symptoms. — There is salivation, sensitiveness of the gums, 
 fetid breath, a metallic taste, and marked redness of the 
 mucous membrane lining the oral cavity. If the case is ex- 
 treme, the maxillary bones may become necrotic and the teeth 
 fall out. 
 
 Treatment. — Adjust the 4th cervical and 5th thoracic ver- 
 tebrae. The use of mercury should he discontinued im- 
 mediately, or the patient's occupation be changed, as the case 
 may be. Thorough elimination through the skin, bowels and 
 kidneys should be instituted in order to rid the system of 
 mercury as quickly as possible. 
 
 Diseases of the Stomach 
 
 Acute Gastritis 
 
 Etiology. — The primary and indirect cause of Acute Gas- 
 tritis are those different impaired conditions of the system in 
 general, in which, as a result of faulty innervation, due to sub- 
 luxation of the vertebrae, the functional activity of the stom- 
 ach is lessened or changed. Predisposing factors to acute 
 gastritis are improper hygienic surroundings, malnutrition, 
 anemia, and adynamic states. It is seen very frequently in 
 tuberculosis, cancer and malaria ; also in sclerosis of the liver
 
 DISEASES OF DIGESTIVE SYSTEM 459 
 
 and various cardiac and renal diseases. The direct and ex- 
 citing causes are chiefly dietetic. These include eating too 
 much food, food of an improper quality, which is poisonous, 
 or too highly seasoned. 
 
 Pathology. — The lining membrane of the stomach is swol- 
 len, congested, and covered with a grayish, tenacious mucus. 
 The most marked inflammation is at the pyloric end of the 
 stomach. In cases due to poisoning, numerous eroded spots 
 are seen upon the mucous membrane, and destructive changes 
 may be present in the mucous and muscular coats. 
 
 Symptoms. — The symptoms vary in accordance with the 
 degree of the inflammation. In severe cases there may be 
 persistent vomiting of a greenish fluid, which consists of a 
 watery substance mixed with bile. The tongue is heavily 
 coated, the breath is fetid, there is intense thirst, a moderate 
 degree of fever, pain and tenderness in the epigastric region. 
 Headache and general prostration also accompany the con- 
 dition. 
 
 Treatment. — Entire abstinence from food for a period of 
 from 24 to 48 hours. Even water should not be allowed, and 
 to relieve the intense thirst which is present, the patient may 
 be permitted to place in the mouth small lumps of ice. For 
 the pain and tenderness over the epigastric region, hot appli- 
 cations should be used. Rest in bed is also indicated. Adjust 
 the 5th, 6th and 7th thoracic vertebrae. 
 
 Chronic Gastritis 
 
 Etiology. — This is usually due to faulty innervation of the 
 stomach, whereby the functional activity of the stomach is 
 markedly impaired, and permits the contributing factors to 
 still further aggravate the condition. Among the contributing 
 factors are especially improper, hasty, and irregular and ex- 
 cessive eating. In addition to those causes, chronic gastritis 
 also accompanies other diseases of the stomach, for example : 
 Cancer, ulcer, and dilatation, and is seen in diseases of the 
 lungs, especially tuberculosis, in valvular disease of the heart, 
 cirrhosis of the liver, Bright's disease, gout, and diabetes. 
 
 Pathology. — The stomach is usually enlarged, its walls are 
 thickened, and there is an excessive secretion of mucus. The 
 mucous membrane lining the stomach may be degenerated
 
 460 SPINAL ADJUSTMENT 
 
 and erosions be present. The secretory glands of the stomach 
 are dilated and atrophic. 
 
 Symptoms. — The most characteristic symptoms of this 
 disease are morning nausea and vomiting of slimy mucus. 
 The appetite is impaired, the tongue is covered with a brown- 
 ish coat, there is a bad taste in the mouth, and the breath is 
 foul. There are pains and an oppressive feeling in the epigas- 
 trium, after meals, and vomiting frequently occurs immedi- 
 ately after the meal, or several hours thereafter. Headache, 
 nausea, depression and melancholia are common symptoms. 
 Constipation is common. The motor power, secretory and ab- 
 sorptive function of the stomach are markedly impaired. 
 
 Treatment. — Adjust the 5th, 6th and 7th thoracic verte- 
 brae. Adjustments should also be made in the upper cervical 
 vertebrae, for their influence upon the vagus nerves. To stim- 
 ulate contraction of the stomach, concussion of the spinous 
 processes of the 2nd dorsal and 1st, 2nd and 3rd lumbar verte- 
 brae. In all cases in which the catarrhal condition of the 
 stomach is due to some other disease process, as, for example, 
 Bright's disease, attention should be given to such causative 
 factors. Correct the diet, and instruct the patient to drink 
 a glass of hot water an hour before breakfast each morning. 
 Regulate the bowels. Dilatation of the rectum is a very 
 useful measure. Exercises, especially brisk walking in the 
 morning are very useful in these cases. 
 
 Dilatation of the Stomach 
 
 Etiology." — The direct cause of dilatation of the stomach 
 is interference with the conduction of those nerve impulses 
 whicli are essential to its organic integrity. As a result of the 
 withdrawal of these impulses, the muscles of the stomach be- 
 come flabby and weak, and enlargement of the stomach fol- 
 lows. Contributing causes are habitual overeating, a narrowed 
 condition of the pyloric orifice from tumors or following an 
 ulcer, or thickening of a section of the wall at that point in 
 chronic catarrh of the stomach. Weakness of the muscular 
 wall of the stomach also occurs in wasting diseases, as 
 tuberculosis, cancer and anemia, 
 appetite. Loss of flesh and strength. The area of tympanitic 
 
 Symptoms. — There is dull pain over the stomach. Loss of
 
 DISEASES OF DIGESTIVE SYSTEM 461 
 
 resonance on percussion over the stomach is greatly increased. 
 Vomiting occurs several hours after meals, and the vomitus 
 consists of a large amount of undigested food. The motor, 
 secretory and absorptive powers of the stomach are all 
 deficient. 
 
 Treatment. — Adjust the 1st and 2nd cervical, and the 5th, 
 6th and 7th dorsal vertebrae. For producing contraction of 
 the stomach, concussion of the 2nd dorsal and the 1st, 2nd 
 and 3rd lumbar vertebrae are recommended. The stomach 
 should be thoroughly washed out each morning with a solu- 
 tion of bicarbonate of soda in warm water. The diet should 
 be concentrated and dry, liquids being reduced to a minimum. 
 Fat and starches should be eliminated. A fast of a day or two 
 each week is a very beneficial measure in these cases. Rectal 
 dilatation is a very useful adjunct in the treatment. Hot 
 bath^, by assisting in elimination through the skin, are a use- 
 ful measure, and should be taken about three times a week. 
 Daily exercise in the open air. 
 
 Gastric Ulcer 
 
 Etiology. — Ulcers of the stomach are due to a disturbance 
 of the nutrition of a limited section of the mucous lining of 
 the stomach, as a result of faulty innervation of the organ. 
 This section of the stomach is then subject to digestion by 
 the gastric juice, which, in these cases, always contains an 
 excessive amount of acid. Gastric ulcer is seen more com- 
 monly in women than in men, and between the ages of 20 and 
 30. It is common in those whose occupation requires con- 
 tinuous bending forward, such as tailors and shoemakers; in 
 these people the intervertebral foramina of the mid-dorsal 
 region are consequently diminished in size, on account of the 
 compression of the intervertebral discs, and as a result of the 
 consequent impingement of the nerves to the stomach, which 
 are derived from this region, the nutrition of the lining of 
 the stomach suffers. 
 
 Pathology. — A typical gastric ulcer is usually single, and 
 occurs most often at the pyloric end of the stomach. Such 
 an ulcer is usually about one-fourth of an inch in diameter, 
 its edges are clean cut, and its floor is smooth. Such an ulcer 
 may erode into a blood vessel and produce hemorrhage. Some-
 
 462 SPINAL ADJUSTMENT 
 
 times the ulcer penetrates the entire thickness of the stomach 
 wall, and perforation of the stomach, followed by peritonitis, 
 results. Stenosis of the pyloric orifice frequently follows heal- 
 ing of the ulcer, and dilatation of the stomach then is very 
 apt to occur. 
 
 Symptoms. — The most characteristic symptoms of gastric 
 ulcer are circumscribed pain and tenderness, which the patient 
 indicates by pointing with the finger to the spot afifected. 
 Vomiting is common, and the vomitus may contain blood, 
 although it is more common to find blood in the stools. There 
 is distress and a heavy feeling in the stomach, soon after 
 eating, and vomiting very frequently occurs. The pain may 
 occur again several hours after eating, and is then produced 
 by the passage of food into the intestines over the eroded 
 lining of the stomach at the pyloric orifice. When vomiting 
 of blood occurs, the blood is usually bright red, unless it has 
 remained in the stomach for some time, or become partially 
 digested, in which case it will be dark brown. Loss of flesh 
 and strength, and progressive anemia, are common. An 
 excessive amount of acid in the gastric juice is characteristic. 
 
 Treatment. — Adjust the 5th, 6th, 7th and 10th dorsal ver- 
 tebrae. Hot compresses over the stomach, and baths every 
 second day are advisable. For hemorrhage, concussion of 
 the 1st, 2nd and 3rd lumbar and the 2nd dorsal vertebrae to 
 produce contraction of the stomach is advisable. An ice bag 
 should also be placed over the stomach. The patient should 
 be placed in bed for three or four weeks ; during this time 
 the diet should be liquid, and if even this is not tolerated by 
 the patient, rectal feeding must be instituted. 
 
 Cancer of the Stomach 
 
 Etiology. — Cancer usually occurs in parts which have been 
 subjected to long continued irritation, and consequently in the 
 stomach it occurs very commonly in those who have suffered 
 for years from chronic catarrh of the stomach, also following 
 gastric ulcer, or trauma. Family predisposition seems to 
 have some influence. It occurs most usually in persons over 
 40 years of age. No specific cause of cancer of the stomach is 
 known, but many theories have been advanced, and it is pos- 
 sible that defective innervation of the stomach may produce
 
 DISEASES OF DIGESTIVE SYSTEM 463 
 
 it by permitting the overgrowth of a new form of cells to 
 occur, which later constitute what is known as a cancer. 
 
 Pathology. — Several varieties of cancer occur in the stom- 
 ach, namely, scirrhous, colloid, medullary and cylindrical cells. 
 The cylindrical cells and scirrhous forms usually are situated 
 near the pylorus, while the other forms are scattered through- 
 out the stomach. When the growth is located at the pyloric 
 end of the stomach, obstruction occurs and the stomach be- 
 comes dilated ; if, however, the growth is situated at the car- 
 diac end of the stomach, that orifice is constricted, and dilata- 
 tion of the esophagus takes place. 
 
 Symptoms. — The first symptoms of cancer of the stomach 
 are usually indigestion for a short time, together with pro- 
 gressive anemia, and a gradual loss of weight. These symp- 
 toms are followed by loss of appetite, nausea and vomiting, 
 an hour or two after eating, and containing blood which is 
 partially digested and black, and has the appearance of coffee 
 grounds. There is a gnawing, burning pain in the epigastric 
 region, back, and between the shoulders, which is usually in- 
 creased by taking food. Loss of flesh and strength is pro- 
 gressive, secondary anemia develops, and finally the patient 
 becomes cachectic. The skin is pale, yellowish and dry. The 
 tumor can often be felt, and is nodular and freely movable. 
 Analysis of the stomach contents shows absence of hydro- 
 chloric acid, and the presence of lactic acid. 
 
 Treatment.- — The prognosis in cancer of the stomach is 
 generally considered to be decidedly unfavorable. Some 
 Chiropractors claim to be able to cure cancer by means of 
 spinal adjustment, if the case is seen early, but admit its 
 hopelessness if the case is at all advanced. In the author's 
 opinion, the only respite for cancer of the stomach is early ex- 
 cision, before metastases have occured. The treatment is 
 otherwise palliative ; the patient should eat easily digested 
 food ; the stomach should be washed out every second day 
 and supportive measures should be employed. Adjust the 
 5th, 6th, 7th and 10th dorsal vertebrae. 
 
 Neuroses of the Stomach (Nervous Dyspepsia) 
 
 Etiology. — The cause of the various forms of gastric 
 neuroses is an interference with the conduction of those nerve
 
 464 SPINAL ADJUSTMENT 
 
 impulses which are essential to its secretory and motor activ- 
 ity. The stomach requires for its functional activity and or- 
 ganic integrity a continuous and uninterrupted nerve-supply 
 and when this is withdrawn the secretion of the gastric juices 
 becomes deficient, motility is diminished, and various dis- 
 orders supervene. 
 
 Symptoms. — Nervous dyspepsia manifests itself in many 
 different ways, chief among which are the following: 1. The 
 Secretory Neuroses are hyper-acidity, namely, an excessive 
 amount of secretion of hydrochloric acid ; sub-acidity, which 
 is a deficient amount of hydrochloric acid in the gastric juice. 
 
 2. The Motor Neuroses, which are increased motility ; nervous 
 eructations, which are very noisy, and the gas which is ex- 
 pelled is chiefly air which has been previously swallowed ; 
 nervous vomiting, in which there is no nausea or retching ; 
 peristaltic unrest, in which the patient is conscious of the 
 movements of the stomach ; rumination, which is the regurgi- 
 tation and chewing of food ; insufficiency of the cardiac or 
 pyloric orifices ; spasms of the cardiac or pyloric orifices. 
 
 3. The Sensory Neuroses, hyperesthesia, in which various 
 sensations are experienced about the stomach, during diges- 
 tion ; gastralgia, which is characterized by paroxysmal pains 
 about the stomach and radiating to the back, and which is 
 relieved by taking food ; anorexia nervosa which is extreme 
 dislike for food ; akoria, which is the absence of sense of satis- 
 faction following eating ; bulimia, which is the term applied to 
 frequent attacks of excessive hunger. 
 
 Treatment. — In addition to the general nervous basis, 
 namely hysterial or neurasthenic, which so often underlies 
 the gastric neuroses, and which require general adjustment 
 and massage and baths, the adjustment of the specific sub- 
 luxation which interferes with the innervation of the stomach 
 should be attended to ; these are the 5th, 6th and 7th thoracic 
 vertebrae. In addition to adjustment, concussion over the 
 spinous processes of the 2nd dorsal and the 1st, 2nd and 3rd 
 lumbar vertebrae is also necessary. Rectal dilatation is an 
 important and very useful adjunct measure in the treatment 
 of cases of this kind. In addition to these measures, the 
 treatment is chiefly symptomatic and should be directed to 
 the correction of those various disorders which are present.
 
 DISEASES OF DIGESTIVE SYSTEM 465 
 
 Diseases of the Intestines 
 
 Acute Enteritis (Inflammation of the Bowels, Acute Diarrhea, In- 
 testinal Catarrh) 
 
 Etiology. — The most common causes of this condition are 
 excessive eating and drinking, especially of improper food, 
 or food which is indigestible or decomposed ; it is seen 
 especially during the summer season, and follows exposure 
 to cold and wet while perspiring. The disease is seen very 
 frequently in childhood, and follows imperfect hygiene and 
 the presence of foreign bodies in the intestines. 
 
 Pathology. — The mucous membrane lining the intestinal 
 canal is congested, red, swollen and edematous ; later there 
 is a peeling ofif of the epithelium, and an excessive secretion ; 
 as a result of the extreme congestion, numerous capillaries in 
 the walls of the intestines rupture, and hemorrhages ensue. 
 The glands in the stomach are also swollen and congested, 
 and have a tendency to ulcerate. Such a process may involve 
 only sections of the intestinal tract, or the entire tract. 
 
 Symptoms. — The onset is sudden, with extreme diarrhea, 
 stools being watery and colic being present. There is an ex- 
 cessive amount of gas in the intestines, extreme thirst, and 
 symptoms of collapse may supervene. 
 
 Treatment. — Adjust the 11th and 12th dorsal and the 1st 
 and 2nd lumbar vertebrae ; the patient should be confined in 
 bed, in so far as possible, and hot compresses be applied over 
 the abdomen. The diet should be liquid, although with- 
 drawal of all foods is preferable. A high rectal enema should 
 be given to cleanse the bowels. Rectal dilatation is a very 
 useful adjunct measure. Supportive measures should be em- 
 ployed. 
 
 Chronic Enteritis 
 
 Etiology. — This disease may follow the acute form. It is 
 commonly seen in chronic diseases such as Bright's disease, 
 tuberculosis, malaria, and in tubercular or cancerous ulcers 
 of the bowels. It often results from the chronic congestion 
 which is present in obstruction of the portal circulation as 
 seen in atrophic cirrhosis or cancer of the liver. 
 
 Pathology. — The mucous membrane of the intestine is 
 covered with stringy mucus, and shows hemorrhages and
 
 466 SPINAL ADJUSTMENT 
 
 erosions. The sub-mucous and muscular coats of the intestines 
 are thickened, the glands in the mucous lining are atrophied, 
 or the muscular layer may be also atrophied, in which case the 
 intestinal wall as a whole will be very much thinned. 
 
 Symptoms. — These may develop gradually, or may follow 
 at once the acute form of Enteritis. The chief symptom is 
 diarrhea, with or without colic, alternating with constipation. 
 When the large bowel is chiefly affected, the stools are thin 
 and watery and contain a large amount of mucous. When 
 the process involves chiefly the small intestines, portions of 
 undigested foods and a certain amount of mucous are present 
 in the stools. The abdomen is distended with gas. There is 
 gradual loss of weight and strength, and anemia may develop. 
 
 Treatment. — Adjust the 11th and 12th thoracic and the 
 1st and 2nd lumbar vertebrae. Concussion of the second lum- 
 bar vertebra. Rectal dilatation. Hygienic measures, fresh air, 
 warm clothing. The diet should consist principally of milk 
 for several weeks, and the return to the natural diet should 
 be very gradual. Hot compresses over the abdomen are use- 
 ful in cases of this kind. 
 
 Intestinal Indigestion 
 
 Etiology. — This disease is a functional derangement, due 
 to subluxations in the lower dorsal and upper lumbar region, 
 which, by producing impingement upon the nerves which 
 govern the functional activity of the intestinal tract, result 
 in a diminution of the various intestinal secretions and de- 
 ficient peristalsis of the bowels. As a result of the deficiency 
 in the digestive juices in the intestines, and also deficient 
 motility of the bowels, foods are left undigested, and fermen- 
 tation and decomposition result. Other direct causes may 
 be family predisposition, improper diet, or improper methods 
 of eating, excessive use of alcohol and tobacco, mental or 
 physical over-exertion, and diseases of the stomach, liver, 
 kidneys, and pancreas. These different conditions may all 
 directly operate in the production of intestinal indigestion, 
 when the primary causative factor, namely disturbed inner- 
 vation, is present. 
 
 Symptoms. — This disease may be either acute or chronic. 
 The acute variety is usually the result of the presence of some
 
 DISEASES OF DIGESTIVE SYSTEM 467 
 
 form of irritation in the small intestines, the characteristic 
 symptoms of which are a slight rise in temperature, anorexia, 
 headache, diarrhea, coated tongue, and tympanites. In more 
 severe attacks, inflammation may also exist, which, by extend- 
 ing into the bile ducts, causes obstruction to the outflow of 
 bile into the intestines, and jaundice, clay-colored stools, and 
 highly-colored urine are the characteristic symptoms of such 
 a condition. Diarrhea is a common symptom, the stools being 
 at first normal, and later becoming thin and watery, and con- 
 taining large quantities of mucous. 
 
 The symptoms of the chronic form are pain several hours 
 after eating, tenderness of the abdomen, tympanites, and 
 constipation. As the disease progresses, anemia, loss of flesh 
 and strength, and functional disorders of the liver, together 
 with nervousness, develop. All the symptoms of malassimila- 
 tion later develop. 
 
 Treatment. — Adjust the 11th and 12th dorsal, and the 1st 
 and 2nd lumbar vertebrae. In the acute form hot magnesium 
 sulphate compresses over the abdomen should be applied. In 
 the chronic form rectal dilatation is one of the most valuable 
 adjunct measures that can be used. The diet should consist 
 of substances which are bland and non-irritating, and easily 
 digested, and fats and starches should be especially avoided. 
 A fast of three days is indicated. The patient should take a 
 moderate amount of exercise in the open air every day, 
 although not to the point of producing physical exhaustion. 
 When the disease is due to some other affection, treatment 
 should be directed toward the relief of the latter. 
 
 Constipation (Costiveness) 
 
 Etiology. — The primary cause of this disease is a subluxa- 
 tion of the lower dorsal or upper lumbar vertebrae. These 
 spinal lesions produce impingement of the nerves which gov- 
 ern the intestines. The impingement of the afferent nerves 
 prevents the conduction of those impulses from the bowel, 
 which excite the defecation centers to action. The impinge- 
 ment of the efferent nerves interferes with the conduction of 
 those motor impulses which produce the movement of the 
 intestines. Many cases of constipation are due simply to the 
 first mentioned cause, namely impingement upon the afferent
 
 468 SPINAL ADJUSTMENT 
 
 nerves, in which case the impulse to defecation is not per- 
 ceived by the patient. When in addition to this the efferent 
 nerves are also impinged, the motor impulses which excite 
 the bowels to action, never reach the walls of the intestines. 
 When the primary cause of constipation is present, the con- 
 tributing factors, the product of the disease, aggravate the 
 condition, which would be impossible, were the innervation 
 of the bowels perfect. The secondary causes of constipation 
 are a sedentary occupation, individual peculiarity, improper 
 diet, and drugs. The disease also accompanies many other 
 conditions. 
 
 Symptoms. — No special symptoms may be present, 
 although any of the following signs of constipation may be 
 met with : Headache, which is made worse by moving the 
 head, intercurrent attacks of diarrhea, indigestion, dizziness, 
 skin eruptions, and malaise. 
 
 Treatment. — Adjustments should be made of the 11th and 
 12th dorsal, and the 1st and 2nd lumbar vertebrae; a complete 
 spinal analysis should, however, be made, and adjustments 
 made of subluxated vertebrae wherever they exist. The next 
 important measure is to regulate the habits of the patient ; 
 many persons from motives of pride, or inability to move the 
 bowels at a certain time, so derange this function that con- 
 stipation results ; a regular time should therefore be had for 
 attending to this function. Next in importance comes regu- 
 lation of the diet, which in these cases should be meat-free, 
 and consist of substances which are, in the main, laxative. 
 Abdominal massage is a very important measure in these 
 cases, in addition to which certain well regulated exercises 
 should be taken. Rectal dilatation is a very valuable adjunct 
 measure. 
 
 Diarrhea 
 
 Etiology. — The cause of this condition is principally dis- 
 turbed innervation to the intestines producing organic and 
 functional derangements therein. Contributing causes are 
 indigestion, improper food, and intestinal inflammation. 
 Diarrhea also follows sudden changes in temperature, mental 
 shocks, infectious fevers, and occurs in wasting diseases, such 
 as tuberculosis, cancer, diabetes, etc.
 
 DISEASES OF DIGESTIVE SYSTEM 469 
 
 Symptoms. — Diarrhea may be present in two forms, first, 
 the acute, and second, the chronic. The acute form of 
 diarrhea may be of several varieties. For instance, (a) the 
 bilious form which is caused by excessive bile in the bowels, 
 and the symptoms of which are colic, burning of the anus, the 
 stools being yellow or greenish, (b) The feculent form, which 
 is the result of errors in diet, intestinal parasites, and indiges- 
 tion, and the symptoms of which are colic after meals, nausea, 
 a desire for stool, and gas. Stools are very offensive, and are 
 fluid, (c) The lienteric form, in which the food passes through 
 entirely undigested. In addition to the stools containing this 
 undigested food, they also contain mucus and bile. The 
 chronic form is also classified according to the nature of the 
 stools. There are thus mucous stools, watery and serous 
 stools, lienteric stools, black stools, red stools, bloody stools 
 and green stools. 
 
 Treatment. — Adjust the 10th and 11th thoracic, and the 
 2nd lumbar vertebrae, for their influence upon the condition. 
 Subluxations in these regions impinge the nerves which gov- 
 ern the action of the bowels. If necessary, also adjust the 
 5th dorsal vertebra for its influence upon the stomach and the 
 10th dorsal vertebra when the kidneys are inactive. One of 
 the most valuable adjunct measures of treatment is rectal 
 dilatation, which should be used in these cases. In acute cases 
 of diarrhea all food should be withdrawn for a few days; in 
 the chronic variety the diet should be made up of substances 
 which are easily digestible. In the acute form, rest in bed 
 and daily magnesium sulphate (hot) baths are indicated. 
 
 Cholera Morbus 
 
 Etiology. — This disease is seen most commonly during 
 the summer and autumn months, and is brought about by 
 sudden atmospheric chang-es, and the presence of irritants in 
 the intestinal tract, caused by the eating of unripe fruits, 
 vegetables, or the presence of decomposed foods. 
 
 Symptoms. — The disease commences suddenly, with a 
 chill, nausea and vomiting, and diarrhea, with intense intes- 
 tinal colic. The vomitus first consists of the ordinary stom- 
 ach contents, and later is made up of bile, and finally water. 
 The stools at first consist of normal feces, later becoming
 
 470 SPINAL ADJUSTMENT 
 
 green, and finally white, resembling rice-water. Great pros- 
 tration is present. There is intense thirst. Rapid loss of 
 strength and flesh supervene. 
 
 Treatment. — Adjust the 5th, 6th, 7th, 11th and 12th dor- 
 sal, and the 1st lumbar vertebrae. Concussion of the 11th 
 dorsal vertebra is very useful in causing relaxation of the 
 muscular coat of the bowels, and thus influencing the colic. 
 Hot compresses over the abdomen are very beneficial. To 
 relieve the extreme thirst, let the patient dissolve small pieces 
 of ice in the mouth, but he should not be permitted to swallow 
 the water. 
 
 Intestinal Obstruction 
 
 Etiology.- — Intussusception or telescoping of the bowels ; 
 volvulus or twisting of the bowels ; cancer of the wall of the 
 intestines ; stricture of the intestines ; foreign bodies in the 
 intestines ; adhesions ; tumors of neighboring organs pressing 
 upon the intestines; strangulated hernia. 
 
 Symptoms. — The characteristic symptom of this condition 
 is complete constipation although there may be passage of a 
 slight amount of mucus and blood. Vomiting is an early 
 symptom, the vomitus first consisting of stomach contents, 
 then of partially digested food, and finally becoming fecal. 
 There is great prostration. Severe pain is present in the ab- 
 domen, and after peritonitis has developed, as it usually does, 
 marked tenderness is present. When the obstruction is in 
 the small intestines, the umbilical region is distended ; when 
 the obstruction is in the large intestines, the iliac regions are 
 distended. When the obstruction is due to impaction of feces 
 in the rectum, or to new growths in this location, palpation 
 will reveal the condition. 
 
 Treatment. — When the obstruction is situated in the small 
 intestines, adjust the 11th and 12th thoracic vertebrae. When 
 the large bowel is the seat of the obstruction, adjust the 1st 
 and 2nd lumbar vertebrae. Concussion of the 11th thoracic 
 vertebra may relieve the condition if it is due to spasmodic 
 contraction of the bowels, for the reason that concussion 
 over the spinous process of the 11th thoracic vertebra, pro- 
 duces relaxation of the muscular coat of the bowel. Should 
 these measures be unproductive of results, surgical interfer- 
 ence becomes necessary.
 
 DISEASES OF DIGESTIVE SYSTEM 471 
 
 Enteroptosis (Falling of the Viscera) 
 
 Etiology. — Downward displacement of the stomach and 
 intestines, together with the liver, spleen and kidneys ; it is 
 seen most commonly in women who are of a highly nervous 
 temperament. It often accompanies wasting diseases, in which 
 there is a great loss of flesh. It is also due to weakness of 
 the support of these organs, and weakness of the abdominal 
 walls. The failure of the support of the organs to hold them 
 in their proper position is due to the interference with the 
 conduction of those constant impulses which maintain the 
 muscles in a state of slight, permanent contraction. When 
 subluxations occur in certain sections of the spine, and inter- 
 fere with the conduction of these necessary nerve impidses, 
 relaxation of the ligaments and other supports of the internal 
 organs occurs, and falling of the viscera ensues. 
 
 Symptoms. — No special symptoms may be present, 
 although patients frequently complain of headache, indiges- 
 tion, dragging pain in the back, and a constant tired feeling, 
 all of which are dependent upon the nervous basis underlying 
 the condition. The displaced organs can readily be palpated. 
 Constipation is also a common symptom. The abdomen is 
 distended. 
 
 Treatment. — After a careful examination of the abdominal 
 viscera has determined the organs which are affected, and a 
 spinal analysis has shown the location of the lesion, the proper 
 adjustment should be made, and in many cases this restora- 
 tion of the nerve impulses to the affected parts will greatly 
 assist in the production of a cure. When the enteroptosis is 
 due to a previous wasting disease, a diet designed for fatten- 
 ing the patient should be prescribed. In neurasthenic indi- 
 viduals, hygienic and other measures should be employed. 
 Use a firm abdominal binder in those in whom it is deemed 
 
 advisable. 
 
 Intestinal Colic (Enteralgia) 
 
 Etiology. — This condition is more in the nature of a symp- 
 tom than a specific disease, and is seen in persons of a 
 neurotic temperament, being also predisposed to by general 
 debility, mental overwork or worry, and chronic gastro-intes- 
 tinal diseases. The direct causes are exposure to cold and 
 damp, and the presence of some irritation in the bowels. It
 
 472 SPINAL ADJUSTMENT 
 
 is also a frequent accompaniment of cerebro-spinal diseases, 
 locomotor ataxia, and hysteria. 
 
 Symptoms. — The most characteristic symptom is spas- 
 modic pain referred to the umbilical region, and migrating 
 from one section of the abdomen to another; this pain may 
 be either sharp or dull, and is relieved by pressure. There 
 is cold perspiration, the face is pale, and there are symptoms 
 of prostration. The passage of gas or feces usually terminates 
 the condition. 
 
 Treatment. — Adjust the 10th to 12th thoracic and the 1st 
 and 2nd lumbar vertebrae. Concussion of the 11th thoracic 
 vertebra should be used for its relaxing effects upon the 
 musculature of the bowels. For the relief of the colic, the 
 application of hot compresses over the abdomen is very use- 
 ful. In all cases the cause of the intestinal colic should be 
 
 corrected. 
 
 Mucous Colitis 
 
 Etiology. — This disease is seen most commonly in women 
 who are of a neurotic type, or hysterical. Causes which may 
 operate in producing an attack are dyspepsia, indigestion of 
 improper foods, and various emotions. 
 
 Symptoms. — This condition is chronic. There are period- 
 ical attacks, abdominal pain and tenderness, and the passage 
 from the bowel of mucous casts. A great variety of nervous 
 symptoms exist. Constipation is a prominent symptom. 
 
 Treatment. — Adjust the 12th dorsal and 2nd lumbar ver- 
 tebrae. Give an enema of salt solution every day. Attend 
 to the general health of the patient. 
 
 Appendicitis 
 
 Etiology. — The primary cause of appendicitis is an inter- 
 ference with the conduction of the normal nerve impulses to 
 the appendix. The low grade of resistance which then ob- 
 tains in the appendix permits of the inflammation which is 
 produced by the various contributing causes, , chief among 
 which are the fact that the appendix is not drained very 
 readily, and consequently extension to it of an inflammation 
 of the bowels readily closes its lumen, and any substances 
 which may be imprisoned within the appendix, together with 
 bacteria which are constantly present in the bowels, excite
 
 DISEASES OF DIGESTIVE SYSTEM 473 
 
 an inflammatory process therein. It is seen most commonly 
 in young adult males. It may also follow typhoid fever, 
 grippe and tuberculosis, or it may be a result of twisting of 
 the appendix itself. 
 
 Pathology. — In simple cases there is merely a catarrhal 
 inflammation of the appendix. This may go no further and 
 recovery ensue. In some cases, however, there appears to 
 be a marked tendency towards ulceration, especially when the 
 innervation of the appendix is practically nil. In still other 
 cases the appendix rapidly become gangrenous and perfora- 
 tion follows. 
 
 Symptoms. — The onset is usually very sudden, and gener- 
 ally occurs after eating a full meal. The first symptoms are 
 nausea and vomiting; this is followed by a rapid rise in tem- 
 perature, and severe pain, which is at first diffused over the 
 entire abdomen, but later becomes localized to McBurney's 
 point. Rigidity of the muscles in the right iliac region is 
 present, and there is tenderness on light pressure over the 
 appendix. 
 
 Treatment. — In all cases of appendicitis it will be found 
 that the 2nd lumbar vertebra is subluxated, and adjustment 
 should be therefore made at this point. In many cases this 
 will alone be sufficient to limit the disease. Accessory 
 methods of treatment which are advisable to use, are with- 
 drawal of all food, rest in bed, hot compresses over the right 
 iliac region, and enemas of salt solution. In those cases in 
 which the disease is due to a twisting of the appendix or to 
 the presence within it of a foreign substance, concussion of 
 the 11th dorsal vertebra by relaxing the musculature of the 
 bowel, sometimes proves to be of great assistance in such 
 instances. Rectal dilatation also is an invaluable adjunct 
 measure of treatment. 
 
 If these measures fail to give relief, and it is evident that 
 suppuration has taken place, surgical measures will have to 
 be adopted. 
 
 Diseases of the Liver, Gall Bladder and Bile Passages 
 
 Congestion of the Liver (Torpid Liver, Biliousness) 
 
 Etiology. — Congestion of the liver occurs in two forms : 
 First, the passive form which is due to diseases of the heart
 
 474 SPINAL ADJUSTMENT 
 
 and lungs; second, the active form, which is due to chronic 
 constipation, excesses in eating- and drinking, especially of 
 highly seasoned foods and alcoholic beverages. If, in the 
 presence of these contributing causes the innervation of the 
 liver is impaired, congestion will be certain to take place. 
 
 Pathology. — The liver is uniformly enlarged ; its surface 
 is smooth, and the free border is harder than normal, but 
 smooth. 
 
 Symptoms. — There are pain and an uncomfortable feeling 
 in the region of the liver, gastro-intestinal disturbances, and 
 sometimes jaundice. Occasionally there is vomiting of blood, 
 and dropsy. There may be a slight bulging of the hypochon- 
 driac region, and pulsation of the liver may be seen. On per- 
 cussion it is found that the area of liver dullness is increased. 
 
 Treatment. — Adjust the 4th and 5th dorsal vertebrae, and 
 also determine the presence of subluxations in the 7th to 10th 
 dorsals and adjust same. Concussion of the 7th cervical to 
 6th thoracic region should be used for its vaso-constrictor 
 effect. For further constriction of the liver, concussion of 
 the 1st and 2nd lumbar vertebrae is to be used. Apply hot 
 compresses over the liver, and give hot magnesium sulphate 
 baths every second day. Give an enema of salt solution each 
 day. The diet should be corrected and a fast of a day or two 
 at the onset of the disorder is followed by good results. 
 
 Fatty Liver 
 
 Etiology. — The primary cause of this disease is faulty in- 
 nervation, which causes a disturbance in the balanced meta- 
 bolism, and thus permits of the accumulation of fats in the 
 liver. Contributing causes are general obesity, and an 
 adynamic state due to tuberculosis, cancer, or other wasting 
 diseases ; lastly, severe anemia, prolonged use of alcohol, and 
 phosphorus poisoning, all of which produce imperfect oxida- 
 tion of the blood. 
 
 Pathology. — The liver is uniformly enlarged, and the en- 
 largement often extends as far as the umbilicus. The surface 
 of the liver is smooth, its edge is smooth and rounded and 
 soft. 
 
 Symptoms. — Symptoms are usually absent. There may, 
 however, be tenderness and pain in the hepatic region from
 
 DISEASES OF DIGESTIVE SYSTEM 475 
 
 the dragging weight of the enlarged organ, jaundice is rare, 
 and dropsy never occurs in this condition. 
 
 Treatment. — This should be directed first of all to the 
 general obesity which is usually present, by adjustment of 
 4th, 6th and 10th dorsal vertebrae. ■ In addition to these ad- 
 justments, the segments controlling the liver should also be 
 examined, and adjustment of the 7th dorsal vertebra be made. 
 The diet should contain a minimum amount of fats and carbo- 
 hydrates. Hot baths daily at bed-time are very useful. The 
 contributing causes should also be corrected. 
 
 Waxy Liver (Amyloid Liver) 
 
 Etiology. — Waxy degeneration of the liver is seen most 
 commonly in diseases attended by chronic suppuration, 
 especially of the bones. It is also seen in connection with 
 similar degeneration in the spleen and kidneys. It occurs 
 also in connection with some infectious diseases, and in 
 wasting diseases, in cancer, tuberculosis and syphilis. The 
 reason that the liver becomes involved in the above men- 
 tioned conditions, is probably due to the fact that reflex sub- 
 luxations are produced in segments of the spine which control 
 several organs. These spinal lesions, by interfering with the 
 conduction of the normal amount of nerve impulses to the 
 liver, render it more susceptible to involvement by the same 
 process which is aflfecting such other organs. 
 
 Pathology. — The liver is uniformly enlarged, its border is 
 smooth and firmer than normal. The enlargement is extreme, 
 and jaundice and dropsy appear late in the course of the 
 disease. 
 
 Symptoms. — The enlargement of the liver is the only 
 characteristic sign. On percussion the area of liver dullness 
 is shown to be markedly increased. There is no pain. The 
 enlargement of the spleen and kidneys, in connection with 
 the enlargement of the liver, is diagnostic. Gastro-intestinal 
 disturbances and loss of flesh and strength later occur. 
 
 Treatment.— Adjust the 4th, 5th, 7th and 10th dorsal ver- 
 tebrae. Concussion of the 11th and 12th thoracic vertebrae 
 should be used for its vaso-dilatory efifect upon the vessels of 
 the -liver. Daily hot baths, and compresses over the liver 
 should be used. If necessary, the area in which a suppurative
 
 476 SPINAL ADJUSTMENT 
 
 process is existing, should receive surgical attention. The 
 underlying cause should be corrected in as far as possible. 
 
 Cysts of the Liver 
 
 Etiology. — The cause of a cystic condition of the liver has 
 been mentioned under the head of diseases due to animal 
 parasites, being caused by intestinal parasites, the tenia 
 echinococcus, contracted most commonly from the dog. It is 
 rare in this country, but is quite common in localities where 
 conditions make necessary constant use of dogs by- man. The 
 eggs are ingested by man, and on being digested in the stom- 
 ach and intestines, the liberated embryos find their way into 
 the portal circulation, and thus reach the liver. They become 
 lodged there and form the cysts. 
 
 Pathology. — The wall of the cysts consist of two layers, 
 the inner layer being the one from which daughter cysts are 
 formed. The irritation which is occasioned by the presence 
 of these cysts, causes a capsule of connective tissue to be 
 formed about them. Within the capsule is present a clear 
 fluid. The parasite later dies, but the cyst grows slowly, and 
 may later be dried up, or calcified, or changed into an abscess. 
 
 Symptoms. — The liver is enlarged in certain sections, and 
 if the cyst is located on the under surface of the liver, it may 
 be palpated as a round, fluctuating mass. If it is situated on 
 the upper surface of the liver, it points into the pleural sac, 
 and may in such cases resemble pleurisy with effusion. To 
 differentiate these two conditions it must be remembered that 
 the line of flatness in pleurisy with efifusion is perfectly hori- 
 zontal, while in cysts of the liver the upper line of flatness is 
 curved. Jaundice sometimes occurs; dyspnea by pre- sure on 
 the lungs is sometimes present, as well as fever and pain. 
 
 Treatment. — Adjust the 4th, 5th and 7th dorsal vertebrae. 
 Apply hot compresses over the liver, and give hot baths every 
 other day. Concussion over the 1st and 2nd thoracic, and the 
 1st and 2nd lumbar vertebrae. In some cases surgical meas- 
 ures are necessary. 
 
 Abscess of the Liver 
 
 Etiology. — The primary cause of abscesses of the liver is 
 faulty innervation of that organ, with a consequent diminu-
 
 DISEASES OF DIGESTIVE SYSTEM 477 
 
 tion in its vital resistance. In the presence of such a condi- 
 tion, the contributing causes, namely trauma, dysentery, 
 typhoid fever, pelvic abscesses, and intestinal ulcers, in which 
 the affected medium reaches the liver, via the portal circula- 
 tion, produce abscesses in the liver. Abscesses of the liver 
 in such cases are always multiple. Single abscess of the liver 
 usually occurs in tropical countries, following dysentery, and 
 the colon bacillus is the direct cause. 
 
 Pathology. — The liver is irregularly enlarged, and if the 
 abscesses are near the surface they may be palpated as round, 
 fluctuating masses. 
 
 Symptoms. — The characteristic sign of abscess of the liver 
 is the enlargement of that organ. Tenderness is always pres- 
 ent, and a dragging pain which is referred to the right shoul- 
 der is complained of. Jaundice usually occurs. Slight fever 
 may be present, or it may be more of the septic type, namely, 
 alternating with chills. 
 
 Treatment. — Adjustment of the 4th to 8th thoracic ver- 
 tebrae early in the condition may have a favorable influence 
 upon it. Concussion of the 1st and 2nd dorsal, and the 1st 
 and 2nd lumbar vertebrae, for their vaso-dilatory effect upon 
 the vessels of the liver, may help ; in this way an increased 
 amount of blood is drawn toward the liver, which may over- 
 come the infective process. Hot Epsom salt compresses 
 should be kept constantly applied over the hepatic region. 
 Daily enemas should be given, for the purpose of keeping 
 the intestinal tract thoroughly cleansed. Close and constant 
 observation of the patient is necessary at all times, as surgical 
 interference may become necessary. 
 
 Cancer of the Liver 
 
 Etiology. — This disease usually occurs most commonly in 
 men at the age of 40 to 60 years ; heredity seems to have some 
 influence ; there are various kinds of irritation, including 
 trauma which may also be considered as etiological factors. 
 It is rarely primary. Usually it is secondary to cancer in 
 other organs or parts of the body, especially the intestines, 
 stomach, pancreas, or gall bladder. 
 
 Pathology. — The liver is greatly increased in size, in fact, 
 cancer of the liver causes greater enlargement in size than
 
 478 SPINAL ADJUSTMENT 
 
 any other condition. The edge of the liver is nodular, and the 
 nodules are harder than the surrounding liver substance, and 
 are also very tender. The surface of the liver is also nodular. 
 Jaundice is present, and later in the course of the disease, 
 ascites develops. 
 
 Symptoms. — Various gastro-intestinal symptoms precede 
 the actual development of carcinoma of the liver. Later on, 
 however, pain and distress in the abdomen, together with a 
 feeling of weight, are noticed by the patient. Jaundice and 
 dropsy next occur, and the symptoms of cachexia develop. 
 There is no fever unless there are complications toward the 
 end of the disease. Palpation elicits tenderness, and the per- 
 cussion note of dulness is increased. 
 
 Treatment.- — Make adjustments in the mid-dorsal region. 
 Otherwise the treatment is symptomatic. 
 
 Acute Yellow Atrophy 
 
 Etiology. — This disease occurs most commonly in young 
 women between the ages of 20 and 30, during pregnancy. The 
 real cause is uncertain, but it seems to be some form of poison 
 circulating in the blood. 
 
 Pathology.— The liver is greatly decreased in size, and 
 its capsule is wrinkled. The liver cells are degenerated. The 
 spleen is often enlarged, and there is degeneration of the 
 muscles, heart and kidneys. 
 
 Symptoms. — During the first two weeks of the disease 
 there are no symptoms except jaundice. Dangerous symp- 
 toms then rapidly develop, among which may be enumerated, 
 headache, delirium and excessive vomiting. Hemorrhages 
 into the mucous membranes occur. The patient soon passes 
 into collapse and the typhoid state. Stools become clay-col- 
 ored, or contain blood. There is usually no fever, except 
 occasionally just before death. 
 
 Treatment. — Adjust the middle dorsal vertebrae. Other- 
 wise treatment is symptomatic. 
 
 Jaundice (Acute Catarrh of the Bile Ducts) 
 
 Etiology. — Among the most common causes of jaundice 
 may be inentioned an extension of a catarrhal inflammation
 
 DISEASES OF DIGESTIVE SYSTEM 479 
 
 from the stomach or duodenum, gall-stones, rapid congestion 
 of the liver, emotions, and infectious fevers. 
 
 Pathology. — There is inflammation of the duodenum, and 
 the mucous lining of the bile passages ; as a result of this con- 
 dition the mucous lining of the gall ducts become thickened, 
 and closure of the bile passages take place, thus obstructing 
 the outward flow of bile into the intestines. The bile which 
 is thus retained in the bile passages in the liver is absorbed 
 by the blood, and tingeing of the skin follows. 
 
 Symptoms. — The characteristic symptom is a 3'ellowish 
 discoloration of the skin and mucous membranes. 
 
 Other symptoms are clay-colored stools and constipation, 
 pruritus, hemophilia, gastro-intestinal disturbances, debility, 
 insomnia, and mental dulness. 
 
 Treatment. — Adjust the mid-dorsal vertebrae. The best 
 method of treatment is a change of climate, and correction of 
 the mode of life. The bowels should be kept open with a 
 daily enema. Hot baths should be given every day. Rectal 
 dilatation is also a very useful measure.. 
 
 Gall Stones (Cholelithiasis) 
 
 Etiology. — The primary cause of this disease is an inter- 
 ference with the conduction of those nerve-impulses to the 
 liver which govern its secretory activity, and consequently 
 the character of the bile. It is from these changed secretions 
 of the liver that the calculi are partly or entirely derived. In 
 some cases bacteria, especially the typhoid bacilli, form the 
 nucleus about which the bile salts deposit to form a stone; 
 at other times hardened mucous is the nucleus of the stone. 
 The disease is commonly seen in women around the age of 
 40 years, and is predisposed to by obesity, sedentary habits, 
 tight lacing, previous typhoid fever, and excessive eating and 
 drinking. 
 
 Symptoms. — In most cases of gall stones no symptoms are 
 present. It is only when the stone becomes lodged in one 
 of the ducts that symptoms develop. If the stone is situated 
 in the common duct, or the hepatic duct, jaundice is present, 
 owing to the obstruction to the outflow of bile. In addition 
 to jaundice, when the stone is lodged in the common .duct, 
 the bladder is also distended, and is readily palpable beneath
 
 480 SPINAL ADJUSTMENT 
 
 the free border of the ribs, at about the apex of the 9th rib. 
 Upon the obstruction of a duct by a gall stone, hepatic colic 
 develops, and is recognized by the agonizing pain which is 
 experienced in the right side of the abdomen, and which is 
 referred to the right shoulder. Fever may be present, and 
 persistent vomiting and symptoms of collapse may supervene. 
 Such an attack may last from a few minutes to several days. 
 Treatment. — Adjust the 7th to 10th dorsal vertebrae. Ap- 
 ply hot compresses over the right side of the abdomen. Give 
 a high rectal enema. The patient should drink large amounts 
 of water, especially mineral water. Rectal dilatation may be 
 of assistance in the treatment. Complete rest in bed is essen- 
 tial. 
 
 Diseases of the Pancreas 
 
 Acute Pancreatitis 
 
 Etiology. — The primary cause of this disease is a disturb- 
 ance of the innervation to the gland, as a result of which its 
 functional activity and organic integrity are impaired. The 
 disease occurs in three forms : (a) the hemorrhagic form 
 which is seen most commonly in males of middle life, in 
 alcoholics, and may also be due to the entrance of bile into 
 the pancreatic ducts, (b) The suppurative form, which may 
 result from impacted gall-stones, infectious diseases and 
 trauma, (c) The gangrenous form, which follows the hemor- 
 rhagic form in some cases. It may also follow the suppurative 
 form, or result from perforation of a gastric ulcer into the 
 pancreas. 
 
 Pathology. — In hemorrhagic pancreatitis the gland is en- 
 larged, and is the seat of hemorrhages and necrosis of the 
 gland-cells. In suppurative pancreatitis one or more abscesses 
 or diffused purulent infiltration is present. In the gangrenous 
 form, the pancreas is converted into a soft, grey mass. 
 
 Symptoms. — Symptoms of the hemorrhagic form are sud- 
 den onset with colicky pain in the epigastric region, nausea 
 and vomiting, followed by symptoms of collapse. The ab- 
 domen is distended ; fever and delirium are present. The 
 symptoms of the suppurative form run a more chronic course, 
 and there are periods during which no symptoms are present, 
 alternating with attacks in which the following symptoms
 
 DISEASES OF DIGESTIVE SYSTEM 481 
 
 are present, in addition to those previously mentioned : The 
 urine contains sugar, jaundice is present, and the stools con- 
 tain a large amount of fat. The symptoms of the gangrenous 
 form are the same as those mentioned under the other two 
 headings. 
 
 Treatment. — Adjust the 9th to 12th thoracic vertebrae. 
 Concussion of the 4th and 5th thoracic vertebrae. Hot packs 
 should be applied over the epigastric region. 
 
 Chronic Pancreatitis 
 
 Etiology. — This disease usually follows the acute form, as 
 a result of the production of reflex subluxations in the seg- 
 ments controlling the pancreas, and which lesions obstruct 
 the outflow of impulses to the pancreas, which are essential 
 to its organic integrity. It also follows obstruction of the 
 pancreatic ducts, by stones, or the extension of an inflamma- 
 tion into the pancreas from the duodenum. It is also some- 
 times due to syphilis. 
 
 Pathology. — The pancreas is increased or diminished in 
 size, and hard. 
 
 Symptoms. — The symptoms of chronic pancreatitis are 
 very similar to those of the acute form, but are milder and 
 run a more chronic course. The most characteristic symp- 
 toms are jaundice, the presence of sugar in the urine, and 
 fatty stools. 
 
 Treatment.— Adjust the 9th to the 12th thoracic vertebrae. 
 Concussion of the 4th and 5th dorsal vertebrae. Correct the 
 diet. 
 
 Cancer of the Pancreas 
 
 Etiology. — This disease is very rare, and the growth is 
 usually primary, and of the scirrhous variety. It is most com- 
 mon in men past middle life. 
 
 Symptoms. — The most characteristic symptom is the en- 
 largement of the pancreas which is nodular when palpated in 
 the epigastric region. Other symptoms are jaundice, fatty 
 stools, and glycosuria. In connection with these symptoms 
 there may be present gastric disturbances, a dull pain in the 
 epigastrium, and finally cachexia develops. 
 
 Treatm<;nt. — Adjust the 9th to the 12th thoracic vertebrae.
 
 4,82 SPINAL ADJUSTMENT 
 
 Concussion of the 4th and 5th thoracic vertebrae. The treat- 
 ment is largely symptomatic, and in the main the prognosis 
 is hopeless. 
 
 Cysts of the Pancreas 
 
 Etiology. — Cysts of the pancreas are usually of the reten- 
 tion variety, that is to say, due to an obstruction to the out- 
 flow of the pancreatic juice, as a result of closure of the duct 
 of the pancreas by tumors or calculi. They may, however, 
 also be due to echinococcus or malignant tumors. 
 
 Symptoms. — The most characteristic symptom is the pres- 
 ence of an enlargement in the left side of the epigastric region, 
 which is lobular in outline, and resisting. Associated with 
 this condition are jaundice, abdominal pain, digestive dis- 
 turbances, loss of flesh and strength, and clay-colored stools. 
 
 Treatment. — Adjust the 9th to 12th thoracic vertebrae, 
 and use concussion of the 4th and 5th thoracic vertebrae. 
 Otherwise the treatment is surgical. 
 
 Pancreatic Calculi 
 
 Etiology. — The primary cause of calculi in the pancreas 
 or its ducts, is an obstruction to the outflow of those nerve- 
 impulses which govern the secretory activity of the glands. 
 As a result of the withdrawal of this innervation, the secre- 
 tion undergoes changes from the normal, and may contain 
 dried particles, around which salts deposit, forming stones. 
 
 Symptoms. — No characteristic symptoms may be present, 
 or there may be colicky pains in the epigastrium, vomiting, 
 fatty stools, and the passage of the stones in the stools. 
 
 Treatment. — Adjust the 9th to 12th thoracic vertebrae, and 
 use concussion over the 4th and 5th thoracic vertebrae. A 
 high rectal enema of normal salt solution is efificient in some 
 cases. For the colicky pains, hot compresses should be ap- 
 plied over the epigastric region. During the paroxysms the 
 patient should be placed in bed. 
 
 Diseases of the Peritoneum 
 
 Acute General Peritonitis 
 
 Etiology. — Secondary peritonitis may be due to the ex- 
 tension of the inflammation from one of the abdominal or-
 
 DISEASES OF DIGESTIVE SYSTEM 483 
 
 gans, or from penetrating wounds. The most common cause 
 of peritonitis, however, is perforation. Primary peritonitis 
 results from exposure to cold and wet, and may occur late in 
 the course of Bright's disease, arterio-sclerosis, and gout. 
 
 Pathology. — There is local and general congestion of the 
 peritoneum. The intestines are distended, and their coils are 
 adhered to one another. 
 
 Symptoms. — The onset is very sudden, with a chill, and 
 symptoms of collapse. This is followed by a rapid rise of 
 temperature, and extreme tenderness and pain of the ab- 
 domen. The muscles over the affected area are rigid, and the 
 knees are flexed on account of the intense pain. Tympanites 
 and absolute constipation are present. The face has an 
 anxious expression, and is pinched. There is excessive vomit- 
 ing. 
 
 Treatment. — The treatment is primarily directed toward 
 the seat of the cause. Adjustment should therefore be made 
 in those segments which control the parts involved. Adjust 
 also subluxations which may be found from the 8th to the 
 12th dorsal, and from the 1st to 2nd lumbar vertebrae. Rest 
 in bed and absolute quiet should be maintained. Hot com- 
 presses over the abdomen, and rectal dilatation are very im- 
 portant accessory methods of treatment. Hot enemas may 
 also be given. Ice, milk, and cham-pagne may be given, if the 
 stomach is able to retain them. For vomiting, pieces of ice 
 may be dissolved in the mouth. When the peritonitis is due 
 to perforation, surgical measures are necessary. 
 
 The above treatment may also be used in Chronic peri- 
 tonitis, but in most cases surgical measures are required. 
 
 Ascites (Dropsy) 
 
 Etiology. — This condition may accompany the general 
 dropsy which occurs in diseases of the heart, liver and kid- 
 neys. It is also due to chronic peritonitis, abdominal tumors, 
 and obstruction of the portal circulation. 
 
 Symptoms. — The abdomen is uniformly distended, and 
 globular. The superficial abdominal veins are enlarged. On 
 percussion a flat note is obtained in the most dependent por- 
 tions, and a change of the position of the patient will cause 
 a variation in the level of flatness. If, while the patient is
 
 484 SPINAL ADJUSTMENT 
 
 lying on the back, the lumbar region on one side is slightly 
 tapped, the impulse of the fluid may be felt on the other side. 
 Tympanitic resonance may be elicited on percussion in the 
 epigastric region. 
 
 Treatment. — Treatment must be directed to the primary 
 cause of the dropsy. Adjust the 6th to the 10th thoracic ver- 
 tebrae, the 10th for its diuretic and diaphoretic efifect. Con- 
 cussion of the 7th cervical vertebra, and from the 3rd to the 
 8th thoracic vertebrae. Hot baths daily.
 
 CHAPTER IX 
 
 Diseases of the Nervous System 
 
 Diseases of the Cerebrum 
 Meningitis 
 
 1. Pachymeningitis (Inflammation of the dura mater). 
 Etiology. — This affection exists in two forms : It is called 
 
 Pachymeningitis Externa when the external layer of the dura 
 mater is first affected; Pachymeningitis Interna, when the 
 inner layer of the dura is first affected. Pachymeningitis ex- 
 terna is produced by injuries of the skull, and is purely a 
 surgical affection. Pachymeningitis interna is due to trauma 
 of the head, Bright's disease, tuberculosis, syphilis, scurvy 
 and alcoholism. It may also result from the extension of a 
 suppurative process from the middle ear. Gout, erysipelas 
 and sunstroke have also been noted as having caused the con- 
 dition. 
 
 Pathology. — The dura mater is first congested, following 
 which it is covered with an exudation which becomes organ- 
 ized into a new membrane, which contains many blood ves- 
 sels, having thin walls, and from which hemorrhages fre- 
 quently occur. When the disease is due to syphilis, the dura 
 is covered with gummata, which may degenerate and form 
 caseous masses, or be liquified and converted into pus. 
 
 Symptoms. — The characteristic symptoms of this affec- 
 tion are constant headaches, insomnia, dizziness, aversion to 
 light, and impairment of the physical and mental faculties. 
 These symptoms are followed by convulsions, delirium, and 
 coma, or by apoplectiform attacks and paralysis. Epileptic 
 attacks are prone to occur. 
 
 2. Acute Leptomeningitis. 
 
 Etilogy. — Acute leptomeningitis is an intlanimation of the 
 arachnoid and pia mater, and is often seen in the course of 
 acute infections fevers. It may follow disease of the cranial 
 
 485
 
 486 SPINAL ADJUSTMENT 
 
 bones, or of the middle ear, or be secondary to a tubercular 
 process in some other part of the body. Other causes may 
 be insomnia, acute alcoholism, sunstroke, syphilis and over- 
 work. The primary form is due to a low grade of resistance 
 of these membranes, rendering- them susceptible to the in- 
 vasion of the exciting form, which is the diplococcus intra- 
 cellularis. The secondary form is due to the various bacilli 
 which are the cause of the acute infectious diseases which it 
 frequently complicates, primarily induced by a low grade of 
 resistance. 
 
 Pathology.— There is at first hyperemia of the pia and 
 arachnoid ; this is followed by an exudation of a serous fluid, 
 which later becomes fibrinous and finally purulent. This 
 purulent exudation fills the arachnoid space, and when mixed 
 with the cerebro-spinal fluid, renders it turbid. As a result 
 of the inflammatory process the meninges become thickened, 
 and adhesions are formed. 
 
 Symptoms. — The disease may commence very suddenly, 
 but usually the onset is gradual and characterized by malaise, 
 headache, vertigo, irritability, vomiting, rise in temperature, 
 restlessness, and a lack of desire to move about. Following 
 these prodromal symptoms, the disease is initiated by severe 
 chill, and a rapid rise in temperature and increase in the pulse- 
 rate. The eyes are congested, there is violent headache, aver- 
 sion to light, dizziness, nausea and vomiting, tinnitus, and 
 delirium. The stage of excitation next follows, the character- 
 istic symptoms of which are hyperesthesia of the skin, wild 
 delirium, spasms of the muscles, opisthotonos and convulsions. 
 Temperature is high, and the pulse slow and irregular. In- 
 tense headache continues. The duration of this stage of the 
 disease may be one day or as long as two weeks. 
 
 If the stage of collapse develops, various pressure symp- 
 toms, due to the increase of the exudation develop. The de- 
 lirium subsides, and the muscular spasms diminish. The 
 patient gradually passes into deep coma. 
 
 Treatment. — The patient should occupy a quiet, well-ven- 
 tilated room. The head should be elevated, and an ice-bag 
 applied to relieve the headache. The diet should be liquid. 
 Adjustment is often impossible, owing to the severe pain 
 which it induces, together with the difficulty in moving the
 
 DISEASES OF NERVOUS SYSTEM 487 
 
 patient. Continued pressure applied on the nerves controlling 
 segments which are painful will sometimes very speedily over- 
 come the pain and produce relaxation. x\lternating cold and 
 hot applications over the spine are useful measures. Rectal 
 dilatation has also proven to be of value in many cases. Ad- 
 justments should be made of the 1st and 2nd cervical verte- 
 brae, and of any other subluxations which may be found. 
 
 Cerebral Congestion (Congestion of the Brain) 
 
 Etiology. — Congestion of the brain is seen in two forms : 
 when due to fulness of the arterial capillaries, it is known as 
 active congestion ; when occasioned by fulness of the venous 
 capillaries, it is known as passive congestion. The most 
 common causes of active congestion of the brain are a de- 
 creased amount of blood in other parts of the body, enlarge- 
 ment of the heart, a general plethoric condition, prolonged 
 mental labor, acute alcoholism, excessive eating and drinking, 
 and sunstroke. The usual causes of passive congestion of the 
 brain are pressure upon the veins which convey the blood 
 aw^ay from the brain, dilatation of the right side of the heart, 
 and anything which interferes with the venous circulation. 
 Passive congestion is due usually to a subluxation in the upper 
 cervical region, which produces pressure on the vertebral 
 veins. Reflex subluxations, produced by some of the causes 
 above mentioned, often cause active congestion of the brain 
 by their influence on the vasomotor nerves of the cranium. 
 
 Symptoms. — The onset may be sudden or gradual. The 
 characteristic symptoms are paroxysmal headaches, ringing 
 in the ears, deafness, amblyopia, contracted pupils, dizziness, 
 irritability, confusion, insomnia, retraction of the limbs, red- 
 ness of the face, and sometimes in children, convulsions. 
 
 Treatment. — The contributing causes should, in all cases, 
 be eliminated. The patient should be placed in a quiet, well- 
 ventilated room. The head should be elevated, and an ice- 
 cap applied to it, and heat should be applied to the feet. The 
 bowels should be thoroughly cleansed by an enema. Adjust 
 the 1st and 4th cervical vertebrae. Concussion of the 7th 
 cervical vertebra and of the 1st and 2nd cervical. Rectal 
 dilatation has been found to be very useful in the treatment 
 of these cases.
 
 488 SPINAL ADJUSTMENT 
 
 Cerebral Anemia 
 
 Etiology .^ — A diminished amo'int of blood in the cerebral 
 vessels may be general, in which case it is the result of sud- 
 den shock, weak heart action, valvular disease of the heart, 
 general anemia, hemorrhages, wasting diseases, and follow- 
 ing infectious fevers of a severe nature. The anemia may also 
 be local, in which case it is due to the obstruction of a vessel 
 by an embolus or thrombus. 
 
 Pathology. — The brain is of a pale color, and its ventri- 
 cles are filled with fluid. It is upon the quality and quantity 
 of blood circulating in the cerebral vessels, that the normal 
 functional activity of the brain depends. If, therefore, the 
 entire brain, or any portion of it is poorly supplied with blood, 
 its function is disturbed. 
 
 Symptoms. — The characteristic symptoms of anemia of 
 the brain are headache, which is relieved by lying with the 
 head low, dizziness, fainting attacks, and occasionally con- 
 vulsions. If the anemia afifect only a portion of the 
 brain, those muscles supplied by the affected area will be 
 temporarily paretic. 
 
 Treatment. — The causes of the cerebral anemia must first 
 of all receive attention, and if it is due to a general anemia, 
 the treatment should -be directed toward the relief of this 
 condition. The patient should spend a number of hours each 
 day lying down. Adjust the 1st and 2nd cervical vertebrae. 
 Concussion of the 10th dorsal vertebra. 
 
 Cerebral Hemorrhage 
 
 Etiology. — Cerebral hemorrhage, or apoplexy is due pri- 
 marily to arteriosclerosis, which is itself due to faulty metab- 
 olism, occasioned by faulty innervation. Anything which 
 subsequently tends to raise the blood pressure may cause the 
 rupture of one of these arteries in the brain, and a more or 
 less severe hemorrhage result. 
 
 Pathology. — Cerebral hemorrhage occurs most frequently 
 in the region supplied by the central arteries, namely the stri- 
 ate body, optic thalamus, and internal capsule. They occur 
 less frequently in the cerebellum, still less commonly in the 
 pons and medulla, and very rarely on the convexity of the 
 brain, in which case they are known as meningeal hemorrhage.
 
 DISEASES OF NERVOUS SYSTEM 489 
 
 Symptoms. — In some cases there may be prodromal symp- 
 toms, while in other cases the attack occurs without the 
 slightest warning. When prodromal symptoms arc present, 
 they include headache, vertigo, irritability, and numbness in 
 the extremities of one side. In a typical case of apoplexy the 
 patient falls suddenly, there is a marked mental confusion, 
 but not necessarily loss of consciousness in a simple case. 
 There is more or less paralysis on the one side. In a more 
 severe attack the patient falls after having lost consciousness 
 completely ; there is sterterous breathing, the face is flushed, 
 the eyes are congested, the eyelids closed, and there is pro- 
 fuse perspiration of the entire body. In cases which end in 
 death, the temperature soon becomes subnormal. In other 
 cases, where death does not occur at once, the temperature 
 gradually rises until it reaches 107 or 108 just before death. 
 In those cases which terminate favorably, the temperature 
 drops gradually to normal. 
 
 After a more or less prolonged period, the patient partially 
 regains the use of the limbs, and is able to walk about, al- 
 though the limbs are stifif, and the joints are painful and 
 swollen. The reflexes are exaggerated on the affected side, 
 but there is no muscular atrophy. If muscular atrophy does 
 take place, as occurs sometimes, it is an indication that a 
 secondary lesion has occurred in the spinal cord. The 
 mentality is slowly and incompletely restored. 
 
 Treatment. — When the patient is seen immediately after 
 the occurrence of the hemorrhage, his clothing should be 
 loosened, and he should be placed in a horizontal position, 
 with the head slightly raised. An ice bag should be applied 
 to the head and a hot pack to the feet. Adjust the 1st and 2nd 
 cervical vertebrae. Concussion of the 1st, 2nd and 7th cerv- 
 ical vertebrae. Later on the patient should be given hot 
 baths ; during the time that he is in the bath, cold compresses 
 should be applied to the head. The various sequelae to 
 apoplexy should be treated by proper adjustment and massage, 
 and passive movements. 
 
 Headache 
 
 Etiology. — Headache is a symptom rather than a disease, 
 and the cause should be looked for in everv case. Among the
 
 490 SPINAL ADJUSTMENT 
 
 more common causes of pain in the head may be mentioned 
 migraine, neuralgia and neuritis. Remote causes of pain in the 
 head are anemia, hemorrhage, Bright's disease, constitutional 
 diseases, infectious diseases, intoxication, neuroses, fatigue, 
 impure air, acclimation, reflex or referred pain from other parts 
 of the body, and organic diseases of the nervous system. 
 
 Symptoms. — The character of the headache is of great 
 assistance in determining the cause thereof. Thus in neu- 
 ralgia the pain is sharp, lancinating and paroxysmal ; in mi- 
 graine or hemicrania, the headache is pulsating or throbbing, 
 paroxysmal and unilateral ; in gastro-intestinal diseases and 
 infectious fevers, the headache is dull, heavy and general, and 
 is increased by shaking the head ; in neurasthenia the head- 
 ache is binding or pressing ; in anemia and rheumatism the 
 headache is a hot and burning pain ; in epilepsy and hysteria 
 the pain is sharp and boring. The location of the pain in the 
 head is also of value, in determining the producing cause. 
 Thus a headache caused by anemia is usually frontal ; head- 
 aches due to hysteria afifect the vertex ; neurasthenic head- 
 aches usually afifect the vertex, and sometimes are described 
 as a tight-band about the head ; headaches due to catarrh of 
 the nose and throat begin at the root of the nose, and extend 
 directly backward to the occiput, and are greatly increased 
 by coughing and bending forward ; headaches due to ocular 
 defects are frontal or occipal ; headaches due to constipation 
 or indigestion are frontal and orbital, and are made worse by 
 sudden movements of the head ; in headaches due to pelvic 
 disorders, the pain is experienced chiefly on the top of the 
 head, and in the occipital region. 
 
 Treatment. — Primary attention should be directed towards 
 relief of the cause of the headache. Attention should next be 
 directed toward the relief of the headache itself, and this can 
 be accomplished in nearly all cases by adjustment of the 1st 
 and 4th cervical vertebrae. Accessory methods of treatment 
 should be applied as indicated. 
 
 Diseases of the Spinal Cord 
 
 Acute Anterior Poliomyelitis (Infantile Paralysis) 
 
 Etiology. — This disease is seen most commonly in chil- 
 dren between the ages of one and three years. It occurs most
 
 DISEASES OF NERVOUS SYSTEM 491 
 
 commonly in the summer months. Frequently it follows a 
 prolonged diarrhea, or some of the exanthemata. Its con- 
 tagious nature seems to indicate that it is of an infectious 
 character, although the exact nature of the producing organ- 
 ism has not as yet been determined. Spinal adjustment is 
 exceedingly beneficial in these cases, and acute subluxations 
 may therefore justly be considered as predisposing causes. 
 
 Pathology. — The anterior horns of the spinal cord of the 
 affected segments are congested, and small hemorrhages into 
 the gray matter of the cord are found. Various degrees of 
 parenchymatous degeneration are present. The ganglion cells 
 are swollen, granular, and their processes are indistinctly seen 
 under the microscope. In post-mortem examinations made 
 some years after the occurrence of the disease, it is seen that 
 the anterior horn is shrunken, and the ganglion cells are 
 replaced by fibrous tissue. 
 
 Symptoms. — The onset is usually very sudden, the child 
 going to bed apparently in perfect health, and being found 
 the next morning with some of the extremities paralyzed • 
 Often the disease is initiated by convulsions, and a high fever 
 follows, which is of short duration. The lower limbs are 
 paralyzed more often than the upper. At first for a few hours 
 or days there is extreme pain in the affected limbs, but this 
 subsides. In a week or two most of the paralyzed muscles 
 recover, leaving other groups more or less permanently af- 
 fected, depending upon the degree of destruction of the gang- 
 lion cells in the cord. Any group of muscles may thus remain 
 affected, but the perinei muscles of the lower extremities are 
 most often paralyzed. No sensory disorders are present, but 
 the reflexes are lost. The parts which remain paralyzed soon 
 evidence trophic disturbances, as noted by the atrophy of 
 the muscles, the coldness of the surface, and the poor circula- 
 tion. In many cases the atrophy of the muscles becomes 
 extreme, and as a result of this, various deformities occur. 
 As the child grows older, the paralyzed limb, if left untreated, 
 does not develop as does the healthy one, and the bones are 
 shorter and smaller in the affected limb than in the healthy 
 one. 
 
 Treatment. — A careful and searching spinal analysis must 
 be made, paying especial attention to the segments which
 
 492 SPINAL ADJUSTMENT 
 
 govern the paralyzed muscles. Subluxations should be ad- 
 justed every other day, and if treatment is persisted in, it 
 will be followed by almost complete recovery, in all cases, and 
 total cure in most cases. Valuable accessory measures are 
 the galvanic current, and massage of the affected limb. The 
 diet, hygiene, and the general health of the patient must be 
 carefully attended to. 
 
 Locomotor Ataxia (Tabes Dorsalis') 
 
 Etiology. — Locomotor ataxia is a degeneration of the pos- 
 terior column and posterior nerve roots of the spinal cord, 
 and is considered in every case to be due to syphilis. Con- 
 tributing causes such as alcoholism, exposure, hardship, and 
 injuries have some influence in its production. 
 
 Pathology. — The disease process affects both the central 
 and the peripheral nervous system. The principal lesions are 
 located in the sensory tract of the spinal column and in the 
 ganglia and roots of the posterior columns of the cord. The 
 • optic nerve is especially affected, and this is considered due 
 to the fact that the optic nerve is really an extension of the 
 cerebral substance. The morbid changes generally commence 
 in the dorso-lumbar portion of the cord, and are most marked 
 in that region. 
 
 Symptoms. — Symptomatically the disease is divided into 
 two stages : First, the prodromal stage ; second, the ataxic 
 stage. The symptoms of the prodromal stage are divided into 
 the subjective symptoms and the objective symptoms. 
 
 The subjective symptoms which are characteristic of the 
 prodromal stage are lightning pains in different parts of 
 the body, especially the lower limbs. Following the pain, 
 abnormalitis of sensation appear, which may consist of itch- 
 ing, numbness, or a sensation in the feet as though the patient 
 were walking on a thick pad of cotton. The most character- 
 istic disturbance of sensation, however, is the girdle sensa- 
 tion, which is a feeling of constriction about the waist as 
 though a tight band were drawn around it. There is a feeling 
 of weakness or uncertainty in the lower limbs. Slight blad- 
 der and sexual disturbances are present. Any of the follow- 
 ing ocular disturbances may be present : Squint, double-vision, 
 or impaired vision ; optic atrophy commences early in the
 
 DISEASES OF NERVOUS SYSTEM 493 
 
 disease in many cases, and is the first thing to draw the 
 patient's attefition to his condition. 
 
 Objective symptoms which are present in the prodromal 
 stage are Romberg's sign, which is a symptom of incoordina- 
 tion, and is shown by swaying of the patient on standing with 
 the eyes closed. The Argyll-Robertson pupil is present. The 
 knee-reflex is lost. Sensibility to temperature and pain 
 is diminished. The space sense is interfered with, the 
 muscle sense is retained, and the sense of touch is not greatly 
 affected. 
 
 The ataxic stage is characterized chiefly by the presence 
 of motor symptoms, which are not due to involvment of the 
 motor tract of the cord, but are due to incoordination. The 
 characteristic symptom is the ataxic gait. Incoordination of 
 the muscles becomes more and more marked, and the sensa- 
 tion of posture and position of the limbs entirely disappears. 
 Crises of pain occur in all cases, the gastric crises being 
 diagnostic. Disturbances in micturition and defecation and 
 loss of sexual power may occur early or late in the disease. 
 The patient's condition is finally terminated by paralysis, or 
 death is a result of an intercurrent affection, most commonly 
 pneumonia. 
 
 Treatment. — Adjust the 1st and 2nd cervical vertebrae, 
 the upper dorsal, and the lumbar vertebrae. A careful spinal 
 analysis should be made in every case, to determine the exist- 
 ence of subluxations, and these may vary in their occurrence. 
 Concuss the 11th dorsal certebra. Apply pressure for about 
 one minute upon those nerves which supply afifected parts, 
 for the relief of the various forms of crises. In the ataxic 
 stage, traction from two to five minutes every day is a val- 
 uable measure. In all cases, the patient should be confined 
 to bed for a long period of time. He should be removed from 
 all excitement, mental exertion, and wotry. By all means, as 
 a well regulated diet, attention to the eliminative organs, and 
 general hygienic measures, the health of the patient should 
 be improved as much as possible. Massage and systematic 
 exercises are very beneficial, and should be applied in all 
 cases. During the ataxic stage the patient should practice 
 exercises which will restore the power of coordination. Many 
 methods of doing this are used, and the operator may use
 
 494 SPINAL ADJUSTMENT 
 
 any system or method which seems suitable to the particular 
 case which he is treating. Cold packs along the spine are 
 very beneficial. The galvanic current should be applied along 
 the spine, and the faradic current to the wasting muscles. 
 Otherwise the treatment is symptomatic. 
 
 Acute Myelitis (Transverse Myelitis) 
 
 Etiology. — Inflammation of the substance of the spinal 
 cord may be due to exposure to cold and wet, injuries of the 
 vertebrae or subluxation thereof ; or it may occur as a sequel 
 to puerperal fever, typhoid fever, syphilis, rheumatism, erup- 
 tive fevers, and intoxications. It may also be a sequel to 
 congestion of the spinal cord, or spinal meningitis. 
 
 Pathology. — The inflammation of the spinal cord may 
 affect the gray or the white substance; it may be limited to 
 certain sections of the cord, or affect the entire cord. The 
 progress of the inflammation may be in an upward direction, 
 or downward, or transversely. The nerve structures of the 
 cord undergo fatty degeneration, and softening of the cord 
 may occur. 
 
 Symptoms. — The disease usually commences very sudden- 
 ly with a chill, and rapid rise in temperature, and changes in 
 motor and sensory function. The back is exceedingly sensi- 
 tive, there is paresthesia of the limbs, or even complete anes- 
 thesia. The girdle sensation, namely, a feeling as though a 
 tight band were drawn about the waist, is a characteristic 
 symptom of this condition. As early as the first day, paralysis 
 of the lower limbs, and the bladder and bowels occurs. The 
 knee-jerk is absent, as are all the other reflexes of the lower 
 extremities. The muscles atrophy, and the temperature of 
 the affected limbs is lowered. During the acute course of the 
 disease, symptoms common to all acute disorders, such as 
 gastrointestinal disorders, irregularity of the heart, dyspnea, 
 and difficult swallowing are present. Bed-sores are prone 
 to develop. The urine is alkaline in reaction and cystitis 
 finally develops. 
 
 Treatment. — The patient should be placed in bed, and ab- 
 solute rest enforced. Hot magnesium sulphate compresses 
 should be applied along the spine. The patient should be 
 sponged several times a day, followed by an alcohol rub, and
 
 DISEASES OE NERVOUS SYSTEM 495 
 
 the liberal use of talcum, to prevent the formation of bed- 
 sores. In cases where the urine is retained, the catheter 
 should be used. Nerve pressure along the spine is very useful 
 to relieve the tenderness. Later on electricity and massage 
 may be used. A careful spinal analysis should be made, and 
 subluxated vertebrae should be corrected as found. 
 
 Bulbar Paralysis 
 
 Etiology. — Bulbar paralysis is a gradually increasing paral- 
 ysis of both sides of the tongue, lips, palate, pharynx and 
 larynx, due to a degeneration of certain nuclei in the medulla 
 oblongata. The cause of the degeneration is an injury in the 
 upper part of the neck, whereby the atlas and axis are dis- 
 placed. In the young adult, however, such a displacement 
 will not produce bulbar paralysis, since the disease is seldom 
 seen before the 40th year of life. Contributing causes are 
 syphilis, gout and rheumatism. 
 
 Symptoms. — The disease commences very slowly, the first 
 symptoms being difficulty in speech, owing to the lack of 
 control of the movements of the tongue ; this becomes more 
 and more pronounced, until finally the tongue is completely 
 paralyzed. From here the paralysis extends to the muscles 
 of the pharynx and the soft palate, causing dysphagia. Next 
 the orbicularis oris becomes paralyzed, and prevents the 
 closing of the lips. Finally the muscles of the larynx are 
 paralyzed and speech is completely lost. As the paralysis 
 of the lips and tongue becomes progressively more pro- 
 nounced, atrophy of the muscles sets in. As the degenerative 
 processes in the medulla increase, the nucleus of the vagus 
 nerve becomes affected, and cardiac and respiratory disturb- 
 ances develop. The inability of the patient to swallow 
 and thus obtain nourishment, together with the deficient 
 respiratory activity, causes marked impairment of the health. 
 
 In addition to the chronic form just described, there are 
 two other varieties, one caused by hemorrhage of the medulla, 
 and the other by an inflammatory condition. Their symptoms 
 are the same as those of the chronic form, but their onset is 
 acute. 
 
 Treatment. — Adjust the upper cervical vertebrae. Elec-
 
 496 SPINAL ADJUSTMENT 
 
 tricity and massage are also useful. Otherwise the treatment 
 is symptomatic. 
 
 Amyotrophic Lateral Sclerosis (Primary Lateral Sclerosis; Spasmodic 
 
 Tabes Dorsalis) 
 
 Etiology. — This disease, which is a degenerative process 
 in the lateral columns of the spinal cord, is seen chiefly in 
 men between the ages of 30 and 50 years. The exact mode 
 of production of this condition is not known, but it is prob- 
 ably due to a want of proper innervation of the affected seg- 
 ments of the spinal cord themselves, as a result of which the 
 metabolic processes in the cord are deranged. 
 
 Pathology. — The morbid process is limited usually to the 
 lateral columns of the spinal cord, and the anterior horns are 
 the ones affected. There is gradual wasting or degeneration 
 of the ganglion cells, and an infiltration of fibrous connective 
 tissue occurs, sclerosis of the lateral column of the cord finally 
 developing. 
 
 Symptoms. — The disease commences very gradually, and 
 almost at the same time in both the upper and lower extremi- 
 ties. There is first a sensation of weakness and weight in the 
 limbs ; this is followed by spasms of the muscles of the limbs, 
 with stiffness. These spasms become more pronounced as 
 the disease progresses. The knee reflex is greatly exagger- 
 ated, and rectus clonus and ankle clonus are present. Sensation 
 is undisturbed, and the bladder and rectum are not affected. 
 
 Treatment. — Adjustments should be made wherever indi- 
 cated after a careful spinal analysis has been made. Warm 
 baths daily should be given. Massage is also of great value. 
 The patient should refrain from all mental and physical 
 work, and the general health should be improved in every 
 possible way. 
 
 Progressive Muscular Atrophy (Wasting Palsy) 
 
 Etiology. — Combined wasting and paralysis of certain sets 
 of muscles is seen most commonly in men between the ages 
 of 30 and 50 years. Its occurrence is contributed to chiefly 
 by syphilis, lead poisoning, acute infectious diseases and 
 exposure. 
 
 Pathology. — There is atrophy and degeneration of the
 
 DISEASES OF NERVOUS SYSTEM 497 
 
 anterior columns of the spinal cord, and a degeneration of the 
 ganglion cells. There is a wasting of the muscular tissue 
 and a replacement thereof by fibrous connective tissue. This 
 continues until the muscle is converted into a fibrous band 
 containing a large number of fat cells. 
 
 Symptoms. — The disease commences very insidiously. 
 There are first fine contractions of the muscles, which are 
 very sensitive and respond to such slight stimulation as a 
 draught of air. The disease process is usually confined to 
 one or a number of groups of muscles, most commonly those 
 of the upper extremities. The first noticeable symptom is a 
 gradual wasting of the muscle, which is accompanied by in- 
 creasing weakness of those muscles, together with paresthe- 
 sia, pallor and coldness of the skin over them. The atrophy 
 of the muscles is so extreme that the bones remain practically 
 uncovered except by skin. V^arious forms of the disease are 
 recognized, depending upon the particular group of muscles 
 which is affected. 
 
 Treatment. — Alake adjustments in those segments from 
 which the affected groups of muscles derive their innervation. 
 Electricity and massage are both of value in these cases. Hot 
 baths, followed by brisk friction for about ten minutes are 
 also useful adjuncts in the treatment. Rest and attention 
 to the general health are measures which should not be 
 overlooked. 
 
 Ataxic Paraplegia 
 
 Etiology. — Chronic degeneration of the lateral and poste- 
 rior columns of the spinal cord occurs principally in persons 
 of advanced age, whose life has been one of hardships. 
 Among the contributing causes may be mentioned syphilis, 
 heredity, anemia, and various forms of intoxications. 
 
 Pathology. — There is a sclerosis of the posterior and 
 lateral columns of the spinal cord similar to that which occurs 
 in tabes dorsalis, except that the lesions are limited princi- 
 pally to the dorsal portion of the spinal cord, rather than 
 to the dorso-lumbar section. 
 
 Symptoms. — The disease commences very gradually, the 
 first symptom noted being a loss of power in the lower ex- 
 tremities, together with pain and stiffness. Ataxia is present
 
 498 SPINAL ADJUSTMENT 
 
 as shown by the swaying when the patient stands with the 
 feet close together, and the tendency to fall when he stands 
 with the eyes closed. The knee-jerk is increased. Spasms 
 of the lower limbs occur. There are no shooting pains nor 
 eye symptoms, nor is sensation impaired, as is the case in 
 locomotor ataxia. Incontinence of urine and feces is, however, 
 frequently noticed. 
 
 Treatment. — The treatment of this affection is, in general, 
 the same as that given in the case of locomotor ataxia, and 
 amyotrophic lateral sclerosis. 
 
 Hereditary Ataxia (Friedrich's Ataxia) 
 
 Etiology. — This disease affects persons during the first 20 
 years of life, and is seen most commonly in families, which 
 indicates that it is hereditary. 
 
 Patholog}\ — There is defective development of the spinal 
 cord, since post-mortem examinations show the cord to be 
 smaller than normal. There is a degeneration and atrophy, 
 together with disappearance of the ganglia in the posterior 
 columns of the spinal cord. 
 
 Symptoms. — The characteristic symptoms of this condi- 
 tion are ataxia, and paraplegia, which produce an uncertain 
 gait. The speech is scanning and uncertain. Vision is im- 
 paired. Reflexes are unchanged or diminished. Sensory 
 symptoms are never present. Scoliosis and deformities of 
 the feet are often noticed. 
 
 Treatment. — The treatment given for locomotor ataxia 
 is applicable in this disease. 
 
 Multiple Sclerosis (Cerebro-Spinal Sclerosis; Disseminated Sclerosis) 
 
 Etiology. — This disease is seen between the ages of 15 
 and 40 years, and is due to injuries. Sometimes it follows 
 acute infectious diseases, and has also been accompanied by 
 a previous history of syphilis, tuberculosis and malaria. 
 
 Pathology. — Spots of sclerosis are found throughout the 
 extent of the brain and spinal cord. These spots vary in 
 size from a pinhead to a nut, and consist of degenerated nerve 
 tissue and connective tissue. Pressure of the nodules upon 
 the nerve structures of cord result in degeneration thereof.
 
 DISEASES OF NERVOUS SYSTEM 499 
 
 Symptoms. — The condition develops slowly, and the symp- 
 toms indicate the location of the lesion. Characteristic 
 symptoms are impaired vision and nystagmus, speech dis- 
 turbances, headache, vertigo, and epileptiform seizures. Later 
 a tremor of the extremities appears, the reflexes are exagger- 
 ated, and stiffness and contracture of the limbs develop. 
 Later the gait becomes spastic, and finally complete paralysis 
 occurs, the legs remaining extended and rigid. 
 
 Treatment. — Make adjustments in those segments which 
 control the parts affected. Useful adjunct measures are 
 electricity, massage, and systematic exercises. 
 
 Syringomyelia 
 
 Etiology. — The characteristic feature of this disease is the 
 occurrence of cavities in the substance of the spinal cord, the 
 exact mode of production of which is not definitely known. 
 The affection is seen during the first half of life, and follows 
 injuries of the cord most frequently. 
 
 Pathology. — The morbid lesions are confined principally 
 to the cervical portion of the spinal cord. The production of 
 the cavities has been explained in two ways. The first theory 
 is that there is faulty development of the central canal of 
 the cord, in which there is only a partial closure of the pri- 
 mary central canal of the cord in the embryo. The second 
 theory is that the cavities are produced by the degeneration 
 and absorption of gliomatous substance in the substance of 
 the cord. 
 
 Symptoms. — The disease commences very slowly, the first 
 symptom usually being a diminution or absence of the pain 
 and temperature sense, while the touch sense is intact. When 
 the anterior columns of the cord are affected, atrophy of the 
 muscles occurs, and most commonly affects the muscles of 
 the arms and shoulders, being generally bilateral. The at- 
 rophy of the muscles is accompanied by weakness, and wiien 
 the weakness affects the muscles of the spinal column, scoli- 
 osis follows. In like manner the skin is affected by trophic 
 changes, which may progress to gangrene. 
 
 Treatment. — Make adjustments as indicated by the spinal 
 analysis. Attention to the general health and treatments of 
 symptoms as they arise, are required.
 
 500 - SPINAL ADJUSTMENT 
 
 Caisson Disease 
 
 Etiology. — This condition is seen in individuals who work 
 under increased atmospheric pressure, such as divers, and 
 those engaged in the construction of tunnels, subways, and 
 the foundations of large buildings. 
 
 Symptoms. — The symptoms generally occur when the in- 
 dividual returns to the surface atmosphere, and include head- 
 ache, dizziness, ringing of the ears, and mild prostration. The 
 more severe symptoms which may follow are various forms 
 of paralysis, loss of sensation, and epileptiform seizures. 
 
 Treatment. — The essential treatment is prevention, and 
 consists in persons engaged in work of this nature to return 
 to the surface gradually, so as to accustom themselves to the 
 change in the atmospheric pressure. Sequelae should be 
 treated as they arise, the treatment consisting principally of 
 adjustments, massage and hydro-therapy. 
 
 Diseases of the Peripheral Nervous System 
 Simple Neuritis 
 
 Etiology. — The primary and predisposing cause of inflam- 
 mation of the nerve trunks is impingement of the nerves by 
 a subluxated vertebra. Among the principal contributing 
 or exciting causes may be mentioned injuries, exposure to 
 cold and wet, alcoholism, gout, rheumatism, syphilis, 
 lead-poisoning, and infectious diseases. 
 
 Symptoms. — The characteristic symptom of this affection 
 is intense pain and tenderness along the cords of the nerve 
 and its main branches ; the pain resembles that of a toothache, 
 and is increased by movement or by pressure. If the nerve, 
 in addition to being sensory, is a motor nerve, contraction and 
 spasms of the muscles occur, followed by partial paralysis. 
 The muscular and temperature sense are very little impaired, 
 but the touch and pain sense are decidedly afifected. At times 
 degeneration of the nerve trunk follows, and in such cases 
 there is atrophy and degeneration of the muscles supplied by 
 this nerve. 
 
 Treatment. — Make adjustments in the segments which 
 control the aiTected parts, and subluxations will always be 
 found affecting the nerve. Accessory treatment consists in
 
 DISEASES OF NERVOUS SYSTEM 501 
 
 placing the part at rest, and after the acute symptoms have 
 subsided, electrical treatments should be given to further 
 stimulate the nerve, and to repair the tonicity of the affected 
 muscle. 
 
 Multiple Neuritis 
 
 Etiology. — Inflammation of a number of nerves may be 
 caused by a great variety of poisons, chief of which are alco- 
 hol, lead and arsenic, and mercury. It also accompanies 
 nearly all the acute infectious diseases. Frequently it is seen 
 in syphilis, diabetes, rheumatism, gout, and chorea. It is seen 
 in w^omen much more commonly than in men, and occurs 
 between the ages of 30 and 50. 
 
 Symptoms. — The disease usually commences slowly, and 
 runs a chronic course. The characteristic symptoms of mul- 
 tiple neuritis due to lead poisoning are the fact that it occurs 
 in chronic lead poisoning, and that the symptoms of this con- 
 dition, namely a blue line on the gums, anemia, and lead 
 colic are present. The radial nerve is principally affected, and 
 wrist-drop is a constant symptom. No sensory disturbances 
 are present. 
 
 The characteristic symptoms of multiple neuritis, due to 
 alcoholic poisoning are the facts that there is always a his- 
 tory of chronic alcoholism : in this form the neuritis is very 
 generally distributed over the body ; the result of the affection 
 in the lower extremities are foot-drop, ataxia, uncertain gait, 
 paralysis of the muscles, tenderness of the calf muscles. The 
 disease is not so severe in the upper as in the lower extremi- 
 ties, both of which are, however, affected in every case. 
 Tenderness of the nerve and nerve pain are present, and occur 
 before paralysis develops. All forms of sensory disturbances 
 are present. The reflexes are absent in the paralyzed mus- 
 cle, and edema of the ankles very often occurs. IMental dis- 
 orders frequently accompany this form of multiple neuritis. 
 
 The characteristic symptoms of multiple neuritis due to 
 arsenic poisoning are marked gastro-intestinal disturbances 
 for some time preceding the actual occurrence of the inflam- 
 mation of the nerves. As in alcoholic neuritis, the legs are 
 more affected than the arms, though to a greater degree. 
 Various disturbances of sensation, atrophy and paralysis, and 
 pain are present.
 
 502 SPINAL ADJUSTMENT 
 
 Treatment. — In all cases attention should first be directed 
 to the relief of the exciting cause. Absolute rest in bed is 
 necessary and the afifected limb should be wrapped in hot 
 compresses. The diet should be nourishing and non-stimulat- 
 ing. Adjustment should be made in those segments control- 
 ling the afifected parts. After the acute symptoms have 
 subsided, electricity and massage and passive exercises should 
 be used. 
 
 Neuralgia 
 
 Etiology. — The primary and predisposing cause of neu- 
 ralgia is a subluxation of a vertebra which produces an im- 
 pingement of the nerve transmitted through the correspond- 
 ing intervertebral foramen. The contributing or secondary 
 causes are exposure to cold and damp, injuries of the nerve 
 trunks, reflex disturbances, mental overwork and anxiety. 
 The condition frequently accompanies syphilis, rheumatism, 
 gout, intoxications, anemia, and malaria. It is seen ordinarily 
 in adult life, more frequently in women than in men, and 
 heredity seems to have some influence in its production. 
 
 Symptoms.— There are a number of varieties of neuralgia 
 which are classified according to their location. The most 
 common forms of these local neuralgias are the following: 
 
 Trigeminal Neuralgia, or Tic douloureux, is a neuralgia 
 of the 5th cranial nerve, and is one of the most severe and 
 obstinate of all neuralgias. Pains are intense and darting, 
 and unilateral. Paroxysms usually last for a few minutes, 
 followed by partial remissions. There are convulsive twitch- 
 ing of the muscles of the side of the face afifected. There is 
 tenderness at the supra-orbital and infra-orbital foramina, and 
 along the course of the nerve. 
 
 Cervico-occipital Neuralgia consists of a sharp, spasmodic 
 pain, which may be unilateral of bilateral, and extends from 
 the top of the head down the neck as far as the clavicle, and 
 then forward and upward to the sides of the face. The skin 
 over the afifected area may be very sensitive, contractions of 
 the cervical muscles may occur. In many of these cases a 
 clicking sound in the back of the neck is complained of. 
 
 Cervico-brachial Neuralgia is a lancinating or burning 
 pain, and tenderness along the nerves forming the cervical
 
 DISEASES OF NERVOUS SYSTEM 503 
 
 and lirachial plexuses. There is numbness and weakness of 
 the shoulder, arm, scapula and breast. 
 
 Intercostal Neuralgia is a paroxysmal pain occurring most 
 commonly in the 5th and 6th intercostal nerves. The condi-* 
 tion is distinguished from pleurisy by the three characteristic 
 points of tenderness, namely, at the exit of the nerve from 
 the spinal foramen, at the greatest covexity of the rib, and 
 at the sterno-costal articulation. This form of neuralgia is 
 frequently accompanied by herpes zoster, or shingles. 
 
 Lumbo-Abdominal Neuralgia, is a paroxysmal pain of a 
 lancinating character along the inner side of the thigh, the 
 hip and the scrotum. 
 
 Sciatica is a paroxysmal lancinating pain along the thigh, 
 calf, ankle and heel. 
 
 Coccygodynia is a paroxysmal, boring pain experienced 
 during walking and sitting alike, and felt over the end of the 
 spine. It is a result commonly of perineal laceration or pelvic 
 diseases. 
 
 Tarsalgia is a variety of neuralgia which afifects the soles 
 of the feet, and is seen in those who are obliged to be on their 
 feet a great deal of the time. It is frequently accompanied 
 by flatfoot. 
 
 Treatment. — The treatment of neuralgia consists in adjust- 
 ment of the vertebrae corresponding to those spinal segments 
 which control the afifected parts, or from which the nerves 
 are derived. Accessory methods of treatment are the applica- 
 tion of hot compresses, or dry heat. In all cases the occur- 
 rence of contributing causes should be carefully investigated, 
 and corrections made as indicated. The general health should 
 be given careful attention. Suitable diet, baths, and exercises 
 should be prescribed. 
 
 Facial Paralysis (Bell's Palsy) 
 
 Etiology. — Paralysis of the 7th cranial nerve is caused by 
 exposure to cold, disease or injury of the middle ear, disease 
 of the nucleus of the 7th nerve, or in the cortex or base of 
 the brain ; also by rheumatism, syphilis, and infectious 
 diseases. 
 
 Symptoms. — The characteristic symptoms of paralysis of 
 the facial muscles are want of expression, all wrinkles being
 
 504 SPINAL ADJUSTMENT 
 
 smoothed out, and the mouth is drooped, and drawn toward 
 the unaffected side. The eye-lids do not cover the eye-balls 
 entirely; the patient is unable to whistle, to show the teeth, 
 or to inflate the cheek of the paralyzed side. The mouth is 
 dry, due to a diminution in the quantity of saliva, and there 
 is disturbance of the sense of taste of the anterior two-thirds 
 of the paralyzed side of the tongue. In some cases hearing 
 is hyper-acute. No sensory disturbances are present. 
 
 Treatment. — Adjust the 1st and 4th cervical and the upper 
 dorsal vertebrae. In the acute stages of the affection the 
 bowels should be kept open and free action of the skin main- 
 tained by daily hot baths. Later, when the acute symptoms 
 have subsided, electricity and massage are useful. 
 
 General Nervous Diseases 
 Epilepsy 
 
 Etiology. — In nearly all cases of epilepsy a pronounced 
 neurotic family history may be obtained. The disease is seen 
 most commonly during the first half of life, and commences 
 ordinarily between the ages of 10 and 20 years. The most 
 common exciting causes are any form of peripheral irritation ; 
 thickening or adhesions of the meninges, mental worry, 
 anxiety, fear and depression, syphilis, and uterine diseases. 
 Frequently the condition can be traced to an injury, and sub- 
 luxation of the vertebrae may be the cause in some cases, as 
 attested to by the fact that adjustments sometimes relieve 
 the condition. In all cases of epilepsy constipation is a 
 constant feature and may be an important predisposing cause. 
 
 Symptoms. — Epilepsy is classed in two forms : Petit Mai, 
 in which the disease is very mild, and Grand Mai, in which 
 the attacks are severe. 
 
 The attack comes on suddenly and without forewarning, 
 the patient falling where he stands, and being unable to make 
 any efforts to protect himself. Sometimes a characteristic 
 cry is uttered before the patient falls. Convulsions then occur, 
 which at first are tonic and later become clonic. During the 
 attacks there may be frothing of the mouth, due to the forci- 
 ble passage of air through the narrow opening between the 
 teeth, and the tongue may be bitten. The convulsions con-
 
 DISEASES OF NERVOUS SYSTEM 505 
 
 tiniie for several minutes, and are followed by unconscious- 
 ness. During the stage of coma the face becomes cyanotic, 
 and turned to one side. The pupils are dilated, and do not 
 react. The pulse is increased in frequency; the respiration 
 is first diminished and then becomes snoring; the temperature 
 is slightly raised. 
 
 Treatment. — Every case of epilepsy should be carefully 
 studied w^ith a view to determining the exact cause. Some 
 cases respond to spinal adjustment, a complete cure result- 
 ing; others are only improved, while still others are not af- 
 fected at all. In those cases in which the disease is due to 
 some peripheral irritation, correction of this exciting cause 
 will help. A careful spinal analysis should be made in every 
 instance, and the subluxations which are found should be 
 corrected. Adjustment of the atlas and axis, the 4th cervical 
 and the upper dorsal and upper lumbar vertebrae are espe- 
 cially indicated. Rectal dilatation has also been recommended 
 in these cases. The general health should receive attention, 
 and proper diet of a non-stimulating character prescribed. 
 The hot magnesium sulphate baths daily are also beneficial 
 measures during the intervals between the paroxysms. If 
 the patient is seen during an attack, the clothing should be 
 loosened, an object should be placed between the teeth to 
 prevent biting of the tongue, and he should be left in a 
 comfortable position. 
 
 Hysteria 
 
 Etiology. — This disease is best defined by IMobius as be- 
 ing "A state in which ideas control the body, to produce mor- 
 bid changes in its function" (Osier). It is a condition peculiar 
 to our present civilization, and is seen in young girls, unmar- 
 ried women, widows, and childless married women. Mani- 
 festations are seen most commonly during menstruation, and 
 during the menopause. Exciting causes are powerful emo- 
 tions, especially those of a painful nature, such as fear, sorrow, 
 etc. Predisposing causes are faulty innervation due to a 
 multiplicity of spinal lesions, in connection with injuries, 
 infectious fevers, mercury, tobacco, and all forms of toxic 
 irritants. 
 
 Symptoms. — The disease is seen in two forms : Hysteria
 
 506 '^" SPINAL ADJUSTMENT 
 
 minor and hysteria major. Hysteria minor generally attacks 
 girls or young women who are of an emotional nature. The 
 first symptoms which manifest themselves are a morbid 
 sensitiveness, inability to control the emotions, great depres- 
 sion of mind, nervousness, etc. The patient becomes alarmed 
 at trifles, and as a rule there are headaches, and pains along 
 the spine. There may also be attacks of vomiting, and some- 
 times the hysteria is so severe as almost to amount to actual 
 delirium. In aggravated cases and when the patient is of 
 an intensely emotional nature, there may be present a mental 
 condition in which the patient says and does things of which 
 afterwards there is no consciousness. The "cries" emitted 
 during the hysterial crises are sufficient to distinguish it from 
 neurasthenia or mere nervousness. Unless properly treated, 
 this minor form of the malady may be perpetuated and de- 
 velop into the major form. Between the paroxysms of hys- 
 teria major, there are present contractures, paralysis, tremors 
 and anesthesia, as well as a disturbance in the mental func- 
 tions. There are also attacks of vomiting, severe pains, 
 hysterical coughing, sneezing, and labored respiration. The 
 patient loses all control of the emotions, and laughs and cries 
 excessively and without any reason. Very frequently there 
 are paroxysms of anger, with great excitation, and accompany- 
 ing these manifestations there is a feeling as if there were 
 some substance in the throat producing a feeling of squeez- 
 ing or compression (Globus Hystericus). An excessive 
 discharge of urine follows the crisis. Convulsions occur only 
 in the major form of hysteria; it is really epileptical in nature, 
 as its name implies (hystero-epileptic). These attacks are 
 quite severe, and manifest themselves as follows : The patient 
 suddenly falls, and the legs and arms are thrown about in 
 a wild, irregular manner ; the head is rolled from side to side ; 
 the body is rolled from side to side, and in very severe attacks 
 the patient flexes the fingers and extends the feet ; there are 
 also abnormal conditions of the eyeballs and the eyes are gen- 
 erally closed. During the seizure the patient may bite the 
 lips, but does not, as in true epilepsy, bite the tongue, nor 
 do herself any serious injury during the attacks. The at- 
 tacks may last from half an hour to several hours. In some 
 cases of hysterical convulsions there may be merely a shaking
 
 DISEASES OF NERVOUS SYSTEM 507 
 
 of the body, as in a chill ; in others, the attacks may manifest 
 themselves in a rigidity and rhythmical swaying of the body, 
 movements of the arms, and incoherent noises. During these 
 attacks the patient is, in a great measure, conscious of her 
 surroundings, and very often can be beneficially acted upon 
 by suggestions from those around. In the case of children, 
 the attacks are often accompanied by peculiar noises,, the 
 patient imitating the bark of a dog, and similar sounds. 
 
 Besides these motorial symptoms, there are also sensory 
 symptoms, such as hyperesthesia of the skin and the mucous 
 membranes, and also disturbances in the organs of special 
 sense. The permanent optic disturbances of hysteria are loss 
 of color sense, which is either entirely lost or at least greatly 
 impaired ; the vision is also impaired, and in some cases eye- 
 sight is totally lost. The hearing is also afifected ; in some 
 cases hearing by aerial conduction may be normal, while 
 hearing by bone conduction may be greatly impaired or en- 
 tirely lost. There may also result abnormalities in the sense 
 of taste and also in that of smell. Although true neuralgia 
 is not often associated with hysteria, yet hyperesthesia and 
 different kinds of pains are of common occurrence. In 
 women the most prominent hyperesthetic points are over the 
 region of the ovaries, and in men on the corresponding area 
 (the scrotum). The motor symptoms which are associated 
 with hysteria are contractures, tremors, paralyses, and choreic 
 and ataxic movements. These paralyses may be either hemi- 
 plegic, monoplegic, or paraplegic. Hemiplegia, associated 
 with hysteria, can be easily distinguished from the hemiplegia 
 due to organic disease, by the gait of the patient. In true 
 hemiplegia, or that form which is the result of organic dis- 
 ease, the patient invariably swings his leg, while in the 
 hysterical he drags the afifected leg after him. Hysterical 
 hemiplegia is usually accompanied by anesthesia of the af- 
 fected region. Paraplegia is not uncommon among the 
 permanent effects of hysteria, and may or may not be accom- 
 panied by pain of a very severe nature. Permanent 
 disturbances of the sphincters is not common, and when it 
 does occur, can generally be traced to some other complicated 
 conditions. There is another peculiar condition of frequent 
 occurrence in the interparoxysmal stage of hysteria, and
 
 508 SPINAL ADJUSTMENT 
 
 which is known as amyosthenia, or a temporary loss of power 
 in the arm or leg. It is not confined to a single group of 
 muscles, but affects the entire member. 
 
 Treatment. — Adjust the atlas, axis, upper dorsal and lum- 
 bar vertebrae. A cold douche to the abdomen or spine will 
 frequently terminate a paroxysm. Further than this nothing 
 need be done for the hysterical attack. The treatment of 
 patients, suffering from hysteria must be confined in the first 
 place to an attempt to discover the cause of the condition. 
 It is very often difficult to do this, and hypnotism has been 
 suggested as a means of eliciting the desired information. 
 Suggestive therapeutics are probably the best method in cases 
 of this kind, although their effects are usually temporary only. 
 Daily tepid baths are useful not only for their effect in im- 
 proving the general health, but also for their sedative affect. 
 Attention to diet, exercise, and general hygienic measures is 
 necessary. 
 
 Neurasthenia 
 
 Etiology. — In every case of neurasthenia a great diversity 
 of spinal lesions are constantly present. Contributing causes 
 are a neurotic temperament, overwork, both mental and 
 physical, sexual excesses, and chronic diseases. Heredity 
 plays an important part in the production of this condition, 
 and excessive use of alcohol and tobacco also are a 
 contributing cause. 
 
 Symptoms. — The characteristic symptoms of true neu- 
 rasthenia are insomnia, general weakness, restlessness, inabil- 
 ity to concentrate the mind, or do physical work of any kind, 
 increase of the sense of pain, headaches, and expression of 
 anxiety on the face, imaginary ailments of all kinds, and 
 exaggerated reflexes. 
 
 Treatment. — A careful spinal analysis should be made, and 
 all subluxations found should be corrected. Special attention 
 should be paid to the 1st, 2nd and 4th cervical, and the 4th 
 and 6th dorsal, and the 2nd lumbar vertebrae. Adjunct meas- 
 ures consist chiefly in procuring for the patient a change in 
 surroundings, rest, good diet, and attention to the mental 
 condition. Much can be accomplished by attention to the 
 last mentioned condition through suggestion to the patient
 
 DISEASES OF NERVOUS SYSTEM 509 
 
 of the Heedlessness of their fears, and encouraging them. The 
 causes which have brought on the condition should be re- 
 moved. Rectal dilatation and daily tepid baths are very 
 beneficial in this condition. Electricity and massage are also 
 very useful measures. 
 
 Chorea (St. Vitus' Dance) 
 
 Etiolog}^ — Chorea is seen most commonly in children, 
 and girls are afifected more often than boys. The primary 
 and predisposing cause in the large proportion of cases is a 
 lowering of the general vitality, due to spinal lesions. Con- 
 tributing causes are fright, overstudy, lack of fresh air and 
 exercise, auto-intoxication, and sometimes following infection. 
 
 Symptoms. — The characteristic symptoms of chorea are 
 involuntary, jerky, spasmodic irregular movements, of vari- 
 ous groups of muscles, usually affecting the arm first. The 
 muscular twitchings in the face and tongue give rise to a 
 great variety of facial grimaces. The overactivity of the mus- 
 cles finally renders them weak and partially paralyzed. The 
 memory is affected; there is irritability, and violent temper 
 may be shown at times. Diseases of the heart, especially 
 valvular lesions and endocarditis are common in this affection. 
 
 Treatment. — The first essential in the treatment consists 
 in removing the cause whenever it can be found. If the child 
 is in a poor state of general health, measures should be taken 
 towards improving the health. The bowels should be regu- 
 lated by exercise and massage, a generous diet should be pre- 
 scribed, and the child should be kept in the fresh air as much 
 as possible. In all cases the heart should receive careful at- 
 tention, and unless it is affected, the child should be encour- 
 aged to take a great deal of exercise. Cold sponging every 
 morning and evening is also a very useful measure in this 
 condition. Rectal dilatation has been used with good success 
 in the treatment of chorea also. The classical treatment of 
 this condition is adjustment of the 1st cervical, the 3rd and 
 6th dorsal, and the lumbar vertebrae. Other subluxations 
 may, however, exist, and a careful spinal analysis should be 
 made in all cases. In a large percentage of cases, spinal 
 adjustment alone is effective in curing this condition in a very 
 short time.
 
 510 SPINAL ADJUSTMENT 
 
 Tetany 
 
 Etiology. — This disease is primarily due to aggravated 
 subluxations, such as those produced by traumatism. Con- 
 tributing causes are chiefly an insufficient function of the 
 parathyroid gland, emotion, hysteria, and following some of 
 the infectious fevers. It is seen most commonly in young 
 adults of a nervous temperament, and in children suffering 
 from rickets. 
 
 Symptoms. — The characteristic symptoms of this affection 
 are spasmodic contractions of the muscles, closely resembling 
 epilepsy, during which the hands are strongly flexed, the arms 
 are drawn upward, with the elbows flexed, and the legs mark- 
 edly extended. These paroxysms last from a few minutes 
 to a number of hours. They may occur once an hour, or an 
 entire day may intervene between them. 
 
 Treatment. — A careful spinal analysis should be made, 
 and subluxations corrected wherever found, paying especial 
 attention to the segments controlling the regions which are 
 affected by the spasmodic contraction. The general health 
 of the patient should receive careful attention. Cold com- 
 presses to the spine, several times a day, are a useful adjunct 
 measure. 
 
 Paralysis Agitans (Shaking Palsy) 
 
 Etiolog}^ — This disease is seen most commonly in women, 
 after the age of 50. 
 
 Symptoms. — The onset is gradual, and the first symptom 
 noted is a tremor in one of the hands, especially the right one, 
 following which the arm and leg of the same side are affected. 
 The limbs of the other side then become affected in the same 
 order, and the tremor finally becomes general. The tremor 
 is a slow, rythmic oscillating movement, and the attitude of 
 the hand has been compared to pill-rolling. There is a gen- 
 eral rigidity of the muscles which is shown by the stolid, 
 mask-like expression of the face, and by the peculiar gait, 
 which results from the stiffening of the muscles of the entire 
 body, so that the trunk is bent forward, and the body moves 
 slowly, as though composed of one piece. The sensations 
 are not disturbed, as a result, although there may be 
 sensations of heat and burning at times.
 
 DISEASES OF NERVOUS SYSTEM 511 
 
 Treatment. — Adjustments should be made in those seg- 
 ments from which the innervation of the parts affected is 
 derived. Spinal traction is also a very useful measure in 
 these cases. Attention to the general health is necessary and 
 mental and physical exertion should be prohibited. 
 
 Occupation Neuroses 
 
 Etiolog}^ — Pain and cramps of certain groups of muscles 
 as a result of over-use, are seen most commonly in persons 
 of a neurotic history. The most common example is Writer's 
 cramp. 
 
 Symptoms. — There is first a stiffness of the affected mus- 
 cles, followed by a feeling of weight and weakness, and lastly 
 the development of spasmodic cramps and contraction. There 
 may be paresis and atrophy of the muscles late in the 
 condition. 
 
 Treatment. — In all these cases the affection soon produces 
 reflex subluxations in those segments from which its inner- 
 vation is derived, and subluxations should be corrected. The 
 affected members should be placed at rest, and general rest 
 of the patient is also advisable. During this time he should 
 be placed upon a liquid diet, and attention given to the neu- 
 rotic element of the case. Later, friction, massage, electricity 
 and passive movements are useful measures of treatment. 
 
 Mental Diseases 
 
 For a description of mental diseases, the reader is referred 
 to works on Psychiatry. Few of these diseases are amenable 
 to treatment of any kind, although there are cases reported 
 in which adjustments relieved mental aberration, but whether 
 it was a true insanity or not is questionable. There are also 
 cases on record, in which rectal dilatation was eff'ective in 
 restoring normal mentality. It must be remembered that 
 certain cases of insanity tend toward a spontaneous cure, and 
 whether anything that was done for their relief proved eff'ec- 
 tive or not, is consequently open to question. In the author's 
 opinion, a true, well-developed case of insanity is incurable. 
 There is, however, in this, a fertile field for valuable research 
 work, and it is to be hoped that the future will bring to light 
 positive evidence of restoration of the mental faculties by 
 spinal adjustments.
 
 CHAPTER X 
 
 Diseases of the Blood and Ductless Glands 
 
 Diseases of the Blood 
 Anemia 
 
 Etiology. — The primary cause of this disease is disturbed 
 innervation of the blood-forming organs, as a result of spinal 
 lesions which are reflexly produced through various predis- 
 posing causes, among which may be mentioned the following : 
 Hemorrhage, discharges, imperfect nutrition, excessive nurs- 
 ing, chronic intestinal catarrh, wasting diseases, unhygienic 
 surroundings, deficient food, excessive mental and physical 
 work, and pregnancy. 
 
 Pathology. — The blood is light in color, owing to the re- 
 duction in the amount of hemoglobin and in the number of 
 red corpuscles. It is also considered by some that coagulation 
 is slow. 
 
 Symptoms. — The characteristic symptom of secondary 
 anemia is the proportion of decrease in the number of red 
 corpuscles to the diminution in the amount of hemoglobin. 
 Other symptoms present are pallor of the skin and mucous 
 membranes ; malaise ; loss of flesh and strength ; headache ; 
 irritability, vertigo, fainting, hysteria, and convulsive attacks ; 
 anorexia, nausea and vomiting ; constipation or diarrhea ; low 
 blood pressure ; rapid heart action ; rapid respiration and 
 dyspnea ; edema of the ankles ; cold hands and feet ; rapid and 
 feeble pulse. 
 
 Treatment. — The first essential in the treatment of secon- 
 dary anemia is the removal of the cause. In connection 
 therewith a nutritious diet, exercise, fresh air, and sunlight, 
 and rest should be prescribed. Make adjustments as indi- 
 cated in the 5th dorsal region, for stimulation of the blood- 
 forming organs, and concussion of the 10th dorsal vertebra 
 for the same reason. Treat the cause which may be present 
 in each individual case, and attend to the symptoms as they 
 arise. 
 
 512
 
 DISEASES OF BLOOD AND DUCTLESS GLANDS 513 
 
 Chlorosis (Green Sickness) 
 
 Etiology. — The primary cause of this disease is subluxa- 
 tions, which interfere with the conduction of the nerve 
 impulses necessary to the functional activity of the blood- 
 forming organs. Contributing causes are overwork, impure 
 air, improper food, puberty, female sex, menstrual disorders, 
 heredity, change of climate, and constipation. 
 
 Pathology. — The decrease in the number of red blood 
 corpuscles is very slight, but there is a decided decrease in 
 the amount of hemoglobin. There is very little loss in weight. 
 No morbid changes in the bone marrow, lymphatic glands, 
 or spleen are present. 
 
 Symptoms. — The characteristic symptom of this condition 
 is a greenish yellow tint of the skin. Other symptoms pres- 
 ent are edema of the ankles and eyelids, palpitation of the 
 heart, faintness, ringing in the ears, murmurs in connection 
 with the heart sounds, dyspnea, cold hands and feet, digestive 
 disturbances, headache, and menstrual disorders. 
 
 Treatment. — Adjust the 1st cervical and the middle dorsal 
 vertebrae. Make any other adjustments which may be indi- 
 cated after a careful spinal analysis has been made. Hygienic 
 measures are an essential in the treatment of this condition. 
 The bowels, kidneys and skin should be kept well regulated. 
 Concussion of the 10th thoracic vertebra. Rectal dilatation. 
 Well regulated exercises. Careful attention to the diet, which 
 should be highly nutritious. Beyond this the treatment should 
 be directed to the correction of any causes, and symptoms 
 should be taken care of as they arise. 
 
 Pernicious Anemia 
 
 Etiology. — The primary cause of this disease is a profound 
 disturbance in the innervation of the blood-forming organs, 
 especially the bone-marrow. Among the predisposing causes 
 may be mentioned syphilis, pregnancy, mental worry and 
 anxiety. 
 
 Pathology. — The blood is thin, pale and scanty. The red 
 corpuscles are diminished in number and in the quality of 
 their hemoglobin, and show changes in their form. There 
 is no increase in the white cells. The bone marrow is mark-
 
 514 SPINAL ADJUSTMENT 
 
 edly changed in character. Various organs and muscles 
 degenerate. There is not much emaciation, but there is 
 present extreme weakness. 
 
 The leading symptoms are a slow onset, with pallor of the 
 skin, dyspnea on exertion, increasing weakness, edema of 
 the ankles or eyes, palpitation of the heart, a soft, feeble pulse, 
 hemic murmurs, and finally prostration and stupor develop. 
 The number of red blood corpuscles is increasingly dimin- 
 ished, but there is not a corresponding diminution in the 
 amount of hemoglobin. The size, and shape of the red blood 
 corpuscles is very much changed, and macrocytes. poikilo- 
 cytes, megalocytes. and microcytes are present, together with 
 a diminution in the number of leucocytes. 
 
 Treatment. — A careful spinal analysis should be made, 
 and adjustments given as indicated. Rest in bed is indicated 
 in all cases. Fresh air, nutritious food, salt baths and other 
 hygienic measures should be employed. 
 
 Leukemia 
 
 Etiology. — The cause of this disease is rather uncertain, 
 but it is due primarily to a grave functional disturbance in 
 the blood-forming organs, the underlying basis of which is a 
 marked derangement of the nervous system. 
 
 Pathology. — The disease occurs in two forms, first lym- 
 phatic leukemia ; second, spleno-medullary, or myelogenous 
 leukemia. In both cases the white corpuscles are greatly in- 
 creased in number. In the lymphatic form the lymph glands 
 are moderately enlarged. In spleno-medullary leukemia the 
 spleen and liver are increased in size in over half the cases, 
 and the bone marrow is changed. 
 
 In the spleno-medullary form of leukemia the red cells 
 are greatly decreased in number, while the white corpuscles 
 are markedly increased, the myelocytes being in excess of all 
 other forms of white corpuscles combined. In the lymphatic 
 form, however, the myelocytes are diminished in number, 
 while the lymphocytes constitute nearly 90 per cent of the 
 total number of leucocytes present. 
 
 Symptoms. — In the lymphatic form the glands are en- 
 larged ; in the spleno-medullary form the spleen is markedly 
 increased in size. In most varieties the disease commences
 
 DISEASES OF BLOOD AND DUCTLESS GLANDS 515 
 
 gradually, and the symptoms are similar to those of pernicious 
 anemia. 
 
 Treatment. — The same as that of pernicious anemia. 
 
 Hodgkin's Disease (Pseudo-Leukemia) 
 
 Etiology. — No definite cause of this disease is known. It 
 is very likely due to a deep-seated disturbance in the 
 sympathetic nervous system. 
 
 Pathology. — "A hyperplasia of the lymph glands interfer- 
 ing more or less with their function. The enlargement may 
 be confined to one isolated gland, or a number may be af- 
 fected in different portions of the body, or a number in one 
 location may be simultaneously afifected, causing a tumor 
 varying in size from an tgg to an orange, or even larger. The 
 spleen and liver are involved in two-thirds of the cases. The 
 marrow of the long bones may be converted into a rich lym- 
 phoid tissue." (Osier.) ''The red blood corpuscles are de- 
 creased in number, and altered in size and shape ; the white 
 blood corpuscles may be slightly increased in number, but 
 there is no approximation to anything like true leukemia." 
 (Hughes.) 
 
 Symptoms.— The disease commences very gradually, the 
 first symptom noticed being an enlargement of the lymph 
 glands in the neck, after which all the glands in the body 
 become afifected. Anemia then develops, and becomes pro- 
 gressively worse. The symptoms of leukemia then follow. 
 The number of leucocytes is very little increased. 
 
 Treatment.- — ^The treatment is the same as that of 
 pernicious anemia. 
 
 Addison's Disease 
 
 Etiology. — This disease occurs most commonly in men 
 from the ages of 30 to 50 years. It is due to some destructive 
 process in the suprarenal glands, which acts by virtue of a 
 disturbance in the integrity of the gland, induced by faulty 
 innervation. 
 
 Pathology. — The most common destructive process in the 
 gland which occurs when their innervation is withdrawn, is 
 tuberculosis ; inflammation, atrophy or malignant disease may 
 also be contributing causes. Sometimes no destructive lesion
 
 516 SPINAL ADJUSTMENT 
 
 of the suprarenal capsule is present, but the disease is 
 occasioned by pressure upon the semilunar ganglion. 
 
 Symptoms. — The disease commences very slowly, with 
 a feeling of malaise, gastrointestinal disorders, dyspnea, pal- 
 pitation of the heart, and dizziness. The skin first becomes 
 pale, and finally changes to a bronze color. Similar changes 
 in the color occur on the mucous membrane of the mouth. 
 
 Treatment. — Adjust the 4th cervical and the 9th dorsal 
 vertebrae. Otherwise the treatment is symptomatic. 
 
 Goitre 
 
 Etiology. — The primary cause of this disease is a sublux- 
 ation in the cervical region of the spinal column, which, by 
 impinging the nerves that supply the thyroid gland, cause 
 changes in its functional activity, and organic integrity. 
 
 Pathology. — The enlargement of the thyroid gland which 
 is present may be either parenchymatous, interstitial, cystic 
 or vascular. 
 
 Symptoms. — There is a gradual enlargement of one of the 
 lobes, or both the lobes and isthmus of the thyroid gland. The 
 enlargement is painless. No symptoms are present unless the 
 growth is large enough to cause pressure symptoms, by en- 
 croaching upon the trachea, or by pressing upon vessels and 
 nerves. 
 
 Treatment. — Adjust the 4th, 5th and 6th cervical vertebrae, 
 according to the findings elicited upon a careful spinal analy- 
 sis. Massage of the gland is sometimes useful, while in 
 other cases it seems to cause an increase in the size of the 
 gland. Hot magnesium sulphate compresses over the gland 
 have proven of value in some cases. Another valuable ad- 
 junct measure of treatment is the Violet ray. Electrical treat- 
 ments are also of value in such cases. 
 
 Exophthalmic Goitre 
 
 Etiology. — This disease is due primarily to a perverted 
 function, namely excessive activity of the thyroid gland, which 
 is induced by an irritable condition of the nerves which supply 
 the thyroid gland, as a result of impingement by subluxated 
 vertebrae in the mid-cervical region. It is seen more com-
 
 DISEASES OF BLOOD AND DUCTLESS GLANDS 517 
 
 monly in women than in men, and is caused often by anemia 
 and strong- mental emotions. 
 
 Symptoms. — The characteristic symptoms of this disease 
 are exophthalmos, a fibrillary tremor of the hand, tachycardia, 
 and enlargement of the thyroid gland. The disease com- 
 mences insiduously, and runs a chronic course, or it may be 
 acute. Widening of the angle between the eyelids is present, 
 and is known as Stellwag's sign. When the eyeball is turned 
 down and the upper lid does not follow it, exophthalmos is in- 
 dicated, and this is known as Graefe's sign. Among other 
 symptoms present may be mentioned profuse perspiration, 
 pigmentation of the skin, gastro-intestinal disturlpances, 
 anemia, glycosuria, albuminuria and mental depression. 
 
 Treatment. — Adjust the 4th, 5th or 6th cervical vertebra, 
 as indicated by the spinal analysis. These adjustments are 
 made for their direct effect upon the innervation of the thyroid 
 gland itself; in addition thereto, adjust the 4th dorsal vertebra 
 for its effect upon the heart. Concussion over the 7th cervical 
 to increase the force of the heart action, and of the 2nd dorsal 
 vertebra to inhibit and regulate its action. Much is claimed 
 for Epsom salt baths, and these should be given a thorough 
 trial. Electricity is useful in some cases. General hygienic 
 measures should be enforced. 
 
 Myxedema 
 
 Etiology. — This disease occurs in two forms. (1) Cretin- 
 ism, which is a congenital absence of the thyroid gland ; 
 (2) Myxedema of adults, which is atrophy of the gland fol- 
 lowing withdrawal of its nerve supply. The disease develops 
 about middle life and is more common in women than in men. 
 It may follow total extirpation of the thyroid gland, in which 
 case it is known as Operative Myxedema. 
 
 Pathology. — The lesion characteristic of myxedema is 
 atrophy of the thyroid gland which is sometimes more evident 
 in one lobe than in the other. 
 
 Symptoms. — In the myxedema of adults the disease com- 
 mences gradually ; the countenance is expressionless, the lips 
 are thick, the nostrils are wide and large. The hair is dry; 
 mentality is deficient; temperature is subnormal. In cretin- 
 ism the symptoms are noticeable after the child is about six
 
 518 SPINAL ADJUSTMENT 
 
 months old, when it becomes apparent that its growth and 
 mentality are stunted. Other characteristic features are the 
 dry skin, large tongue, and the hair is thin. "About the sec- 
 ond year the face is large, bloated and waxy appearing; eye- 
 lids puffy; nose depressed and flat; teeth decay; abdomen 
 swollen ; legs short ; muscular weakness ; and large pads of 
 fat in the supra-clavicular region. Idiocy is the rule. Those 
 that survive youth, grow up dwarfed with short limbs, and 
 enormous enlargement of the articulation." (Kohberger). 
 
 Treatment. — Make the same adjustments as for exoph- 
 thalmic goitre. Warm climate. Consultation is advisable in 
 these cases.
 
 CHAPTER XI 
 
 Diseases of the Genito-Urinary System 
 Congestion of the Kidneys 
 
 Etiology. — Passive congestion of the kidneys is produced 
 by heart and hmg diseases and by pressure upon the renal 
 veins as in pregnancy, dropsy and abdominal tumors. Active 
 congestion of the kidneys is seen in the first stages of 
 nephritis, or after the taking of irritating drugs. Both forms 
 of congestion, no matter what the direct causes may be, are 
 superinduced by faulty innervation, as a result of a subluxa- 
 tion producing impingement upon those nerves which supply 
 the kidneys. 
 
 Pathology. — The kidneys are enlarged, and in passive con- 
 gestion they are of a blue color, while in active congestion, 
 their color is red. A catarrhal condition of the tubules is pres- 
 ent, together with proliferation of the connective tissue of the 
 parenchyma of the kidney, causing it to become hardened and 
 contracted. 
 
 Symptoms. — In passive congestion the alterations of the 
 kidney are overshadowed by the heart and lung symptoms, 
 but later it becomes evident that the kidneys are affected when 
 ascites is present, and the urine becomes very much diminished 
 in amount, contains albumin, and is high colored. In the 
 active form of congestion of the kidneys, there is pain in the 
 lumbar region, which extends towards the front, and follows 
 the course of the ureters into the testes. The bladder is very 
 irritable, the urine scanty, and may contain blood, casts, fibrin 
 and albumin. There is a constant desire to urinate, but usually 
 no pain accompanies the act of urination. Constitutional 
 symptoms, such as a general feeling of discomfort, nausea and 
 vomiting, and headache are present. 
 
 Treatment. — Adjust the 10th dorsal vertebra, and any 
 others which may be found subluxated. Concussion of the 
 7th cervical vertebra. As soon as the diagnosis has been made, 
 the patient should be put in bed, a liquid diet prescribed, and 
 
 519
 
 520 SPINAL ADJUSTMENT 
 
 the bowels cleansed by an enema. The cause should then be 
 ascertained and treatment directed toward its removal. Rectal 
 dilatation by stimulating the circulation is very useful espe- 
 cially in the passive form of congestion, in which there is too 
 little blood in the arteries, and too much blood in the veins. 
 Concussion of the 7th cervical and the 2nd dorsal vertebrae 
 will stimulate the heart action, and thus- also assist in over- 
 coming the passive congestion. 
 
 Acute Parenchymatous Nephritis (Acute Bright's Disease) 
 
 Etiology. — The most common causes of acute Bright's 
 disease are exposure to cold and wet, infectious diseases, and 
 the use of irritant drugs, which are eliminated by the kidneys. 
 It also occurs in connection with some skin diseases, and acute 
 infectious fevers. These conditions all cause more or less 
 irritability of the kidneys, as a result of which reflex subluxa- 
 tions are produced in the segments which control the kid- 
 neys, namely the 10th thoracic, and as a result of these spinal 
 lesions, the conduction of impulses to the kidneys are inter- 
 fered with, and functional and organic derangements ensue. 
 It is, however, frequently due to direct injuries of the back, 
 which induce a subluxation about the 10th thoracic vertebra, 
 and which later predispose to Bright's disease. 
 
 Pathology. — The kidneys are increased in size, congested, 
 and of a very red color. Later on the tubules become engorged 
 with epithelial cells, blood corpuscles and fibrin. The capsule 
 of the kidney is very loose. If proper treatment is instituted, 
 and the case terminates favorably, the organ returns to its 
 normal size, the congestion disappears, and the tubules regain 
 their normal state. 
 
 Symptoms. — The disease usually commences suddenly, 
 with a chill. Dropsy, dyspnea, and prostration then develop. 
 There is usually a moderate rise in temperature. Gastro-in- 
 testinal symptoms later develop. Pain may be present in the 
 lumbar region, although this is not a constant feature. There 
 is an almost constant desire to urinate. The pulse is tense, 
 full and rapid, and the skin is harsh and dry. In cases which 
 follow scarlet fever, anemia and prostration are extreme. 
 Symptoms of uremia may develop. The urine is scanty, 
 smoky and of a high specific gravity. Albumin, together with
 
 DISEASES OF GENITO-URINARY SYSTEM 521 
 
 hyaline, g^ranular, epithelial and blood casts are present. 
 Phosphates, chlorides and urea are decreased in amount. 
 
 Treatment. — Adjust the 10th to 12th thoracic vertebrae. 
 The patient should be placed in bed, and remain there until all 
 symptoms have disappeared. Hot Epsom salt packs should be 
 applied over the region of the kidneys. The diet is very im- 
 portant, and during the height of the disease should consist of 
 milk only. The patient should drink large amounts of water. 
 The bowels should be kept open by the use of enemas. Free 
 perspiration should be induced daily by the use of a hot pack. 
 
 Chronic Parenchymatous Nephritis (Chronic Bright's Disease; Large 
 
 White Kidney) 
 
 Etiology. — The primary cause of this disease is subluxa- 
 tion of the 10th to the 12th thoracic vertebrae, which inter- 
 feres with the conduction of nerve impulses to the kidneys, 
 and induces organic changes therein. The disease may follow 
 the acute form, in which case it is the result of reflex subluxa- 
 tions, which occur during the course of the acute variety. 
 This form of chronic Bright's disease is seen most commonly 
 in men before the age of 40. Contributing causes are constant 
 exposure to wet and cold, excessive use of alcohol, various 
 forms of intoxication, syphilis, diseases of the liver, and tuber- 
 culosis. 
 
 Pathology. — The kidney is increased to twice its normal 
 size, and of a white or yellowish color. The tubules are thick- 
 ened and dilated, and engorged with epithelial cells, debris 
 and casts. The medullary portion of the kidney is thickened 
 as a result of the increase in the amount of connective tissue, 
 and as the disease progresses, this connective tissue has a 
 tendency to become contracted, and finally the kidney becomes 
 reduced in size, and its surface is irregular. 
 
 Symptoms. — The disease commences very gradually, and 
 its onset is characterized by malaise, anemia, gastro-intestinal 
 disorders, edema of the eye-lids, especially in the morning. 
 difficult breathing and palpitation of the heart. Later symp- 
 toms are severe headache, dizziness, failing vision, nausea and 
 vomiting, and general dropsy. Enlargement of the heart and 
 high blood pressure are common symptoms. Symptoms of 
 uremia may develop at any time during the course of the
 
 522 SPINAL ADJUSTMENT 
 
 disease. Irritability of the bladder is an early and constant 
 symptom. The enormous loss of albumin, together with the 
 gastro-intestinal disturbances, result in a marked amemia. 
 The urine is scanty, highly colored, and contains albumin and 
 granular, hyaline and fatty casts. Later the amount of urine 
 may become increased. All the normal constituents of the 
 urine are diminished in amount, and one point of particular 
 importance is the fact that the greater the diminution of the 
 amount of chlorides becomes, the greater is the amount of 
 albumin present, and the more unfavorable the prognosis be- 
 comes. Dangerous complications arise during the course of 
 the disease, chief among which are uremia, pneumonia, en- 
 largement of the heart, apoplexy, and edema of the lungs. 
 
 Treatment. — Adjust the 10th to 12th dorsal vertebrae. The 
 next most important measure in the therapy of this disease is 
 attention to the diet, since an unsuitable diet may produce a 
 great deal of harm. The diet must be so selected as to keep 
 up the body weight, or even to increase it. At the same time 
 it must make as little demands upon the renal activity as pos- 
 sible, and be free from any substance which could possibly 
 cause an irritation of the kidneys. The patient must be 
 guarded against taking cold, since this may bring on an acute 
 attack. He should keep his feet well protected, and wear 
 woolen underwear, with the addition of a flannel band about 
 the loins. Residence in a warm climate is preferable. Mod- 
 erate exercise in the open air is advisable, but should not be 
 excessive. Overwork and mental worry, anxiety, etc., should 
 be avoided. The bowels should be kept open at all times. 
 Hot baths followed by a light sweat are useful, since they 
 keep up the skin secretions. If aterio-sclerosis is present, care 
 must be exercised in giving the baths. To harden the skin 
 against undue sensitiveness to sudden changes in temperature, 
 Semola suggests a dry rub down each day. 
 
 Chronic Interstitial Nephritis (Chronic Bright's Disease; Small Red 
 
 Kidney) 
 
 Etiology. — The primary cause of this affection is the fail- 
 ure of proper innervation of the kidney. That withdrawal of 
 innervation may produce interstitial nephritis is proven by 
 the fact that changes in the renal ganglionic centers may also
 
 DISEASES OF GENITO-URINARY SYSTEM 523 
 
 cause this disease. It is seen most commonly in men between 
 the ages of 40 and 60 years. It may also occur secondarily to 
 chronic parenchymatous nephritis. Among the conditions 
 which predispose to the contraction of this disease are alco- 
 holism, syphilis, mental worry, grief or anxiety, chronic lead 
 poisoning, gout, chronic gonorrhea, or cystitis, liver diseases, 
 and passive congestion, as a result of heart disease. 
 
 Pathology. — There is first of all an inflammation of the 
 intervening connective tissue of the kidney, which is of a 
 chronic form, and results in hardening and contraction of the 
 organ. The kidneys are very much diminished in size ; their 
 surface is granular, and covered by numerous small cysts, and 
 the capsule is very adherent. The cortex of the kidney is 
 atrophied. The interstitial tissue of the kidney is converted 
 into fibrous tissue. The arteries are very much sclerosed. 
 The glomeruli are degenerated and atrophied ; the tubules are 
 degenerated and converted into thread-like capillaries. 
 
 Symptoms. — The disease commences so insidiously that 
 often it is not recognized until serious symptoms appear. For 
 some time previously the heart and vessels have been affected. 
 The characteristic symptoms of the disease are frequent mic- 
 turition of large amounts of a pale, highly acid urine, of low 
 specific gravity, and containing a very small amount of albu- 
 min, which may, however, not be evident for weeks at a time 
 Sometimes epithelial cells and granular and hyaline casts are 
 present. Progressive anemia is a common symptom of the 
 disorder, and there is great weakness and loss of flesh and 
 strength. Dyspnea is a common symptom. There is no 
 dropsy, but a little edema of the eyelids. Vision is impaired. 
 Albuminuric retinitis is present. High blood pressure is a 
 constant feature, and heart action is very forcible, owing to 
 the hypertrophy of the heart, which is generally present. 
 Other symptoms are headache, dizziness and palpitation of 
 the heart. Uremia may develop at any time during the course 
 of the disease, and is shown by excessive digestive disturb- 
 ances, headache, dizziness, drowsiness, convulsions, or apo- 
 plectic attacks. 
 
 Treatment. — Adjust the 10th to the 12th dorsal vertebrae. 
 In general the treatment is the same as that of the chronic 
 parenchymatous form of Bright's Disease.
 
 524 SPINAL ADJUSTMENT 
 
 Uremia 
 
 Etiology. — This is a group of symptoms rather than a 
 specific disease, and the cause is the absorption by the blood 
 of excrementitious matter which should be excreted by the 
 urine. The resulting intoxication is manifested by a group of 
 extreme nervous phenomena. It is seen during the course of 
 acute or chronic Bright's disease. 
 
 Symptoms. — Uremia exists in two forms, the acute and 
 chronic. In the acute form of uremia the onset may be slow 
 or sudden. The common symptoms present are headache, 
 which is usually in the occipital region, and extends down the 
 back of the neck, nausea and vomiting, dyspnea, vertigo, in- 
 somnia, or stupor, and convulsions. The convulsions may be- 
 come more and more severe, and the patient finally passes 
 into a comatose condition. The common symptoms of chronic 
 uremia are similar to those of acute uremia, but less severe. 
 There is constant headache and dyspnea, nausea and vomiting, 
 insomnia, cramps in the calves, and itching of the skin. Con- 
 vulsions or twitchings of the muscles occur at times. The 
 urine is diminished in amount, contains large amounts of 
 albumin, and a diminished amount of urea. The blood con- 
 tains a large amount of urea. 
 
 Treatment. — The chronic form of uremia is treated in the 
 same manner as chronic Bright's disease. In acute uremia 
 adjust the 1st and 2nd cervical, and the 6th and 10th dorsal 
 vertebrae. Free perspiration should be induced by the use 
 of hot magnesium sulphate baths. Free action of the kidneys 
 is stimulated by the application of hot compresses over the 
 region of the kidneys, and enemas of normal salt solution. 
 
 Amyloid Kidney (Waxy Kidney) 
 
 Etiology. — Waxy degeneration of the kidneys is seen in 
 chronic suppuration, lead poisoning, gout, and leukemia. It 
 often follows chronic parenchymatous nephritis. It is seen 
 in connection with waxy degeneration of the spleen and liver. 
 
 Pathology. — The kidneys are enlarged and hard, and have 
 a peculiar waxy appearance, which, on being treated with a 
 solution of iodine, change to a deep mahogany red color. 
 Lesions showing chronic nephritis are also present. 
 
 Symptoms. — The previous personal history of the patient
 
 DISEASES OF GEN ITO-URl NARY SYSTEM 525 
 
 must be taken into consideration, and it must be determined 
 whether or not there is an associated enlargement of the liver 
 and spleen. Dropsy and diarrhea, together with uremic symp- 
 toms, and high blood pressure, are present in connection with 
 a profound cachexia. The urine is increased in amount, of a 
 low specific gravity, and a pale color. Albumin is present, 
 together with hyaline, s^ranular and fatty casts. 
 
 Treatment. — The treatment is the same as that of chronic 
 interstitial nephritis. In addition to this the underlying cause 
 must in all cases be attended to. 
 
 Movable Kidney (Floating Kidney) 
 
 Etiology. — The primary cause of this condition is an inter- 
 ference with the nerve supply of the supports of the kidney, 
 as a result of which the tissues about the kidney become so 
 lax and atrophic that the kidney is permitted to leave its 
 normal location, and float about in the abdomen. This con- 
 dition is seen most commonly in women, and important con- 
 tributing causes are relaxation of the abdominal wall, wearing 
 of tight corsets, trauma, increased weight of the kidneys, 
 rapid emaciation, and pressure upon the kidney by tumors 
 adjacent to it. 
 
 Symptoms. — In some cases the patient is unaware of the 
 condition, and should then not be told of it, for the tendency 
 to neurasthenia in those who are aware of their condition is 
 very great. The most important symptoms are a heavy pain 
 in the abdomen, increased by standing or walking. Various 
 reflex disturbances such as neuralgic pains, irritability of the 
 bladder and palpitation may be present. At times the ureters 
 and renal vessels may become twisted, and paroxysms of 
 agonizing pain, known as Dietl's crises occur. 
 
 Treatment. — Adjust the 6th and 10th dorsal vertebrae, and 
 any other subluxations which may be found after a careful 
 spinal analysis has been made. In addition to this the gen- 
 eral health should be improved by the use of suitable diet, 
 well directed exercises, and hygienic measures. Sometimes 
 the condition is relieved by lying on the back for an hour or 
 two each day, while in other cases relief is obtained by wear- 
 ing a suitable support or binder, to keep the kidney in its 
 proper position. When the paroxysms due to the twisting of
 
 526 SPINAL ADJUSTMENT 
 
 the ureters occur, the patient should be placed in bed, and hot 
 applications over the lumbar region are indicated. Usually, 
 however, the adjustments alone will suffice to produce a cure, 
 by restoring the normal tonicity to the supports of the kidney, 
 through restoration of their nerve supply. 
 
 Hydronephrosis 
 
 Etiology. — This is a cystic condition of the kidney, which 
 is due to an obstruction of the ureter, by twisting, calculus, or 
 tumors. As a result of the obstruction of the ureter, the 
 urinary secretion is retained in the kidneys. 
 
 Pathology. — The pelvis of the kidney is first dilated by the 
 accumulating fluid and as its amount increases, pressure of 
 the fluid upon the parenchyma produces gradual atrophy of 
 the kidney structure, until the whole kidney is converted into 
 a sac containing fluid. 
 
 Symptoms. — As soon as the amount of fluid becomes large, 
 a soft, fluctuating tumor appears in the lumbar region. This 
 tumor is the cystic kidney, and contains a serous fluid, con- 
 taining uric acid and urea. The tumor is painless on palpa- 
 tion, and dullness is elicited upon percussion over it. 
 
 Treatment.— Adjust the 6th and 10th dorsal vertebrae, 
 and if the condition is acute, it may be further relieved by the 
 application of hot compresses of magnesium sulphate solution. 
 In chronic cases the treatment is usually surgical. 
 
 Nephrolithiasis (Renal Calculi, Kidney Stone, Gravel) 
 
 Etiology. — The primary cause of this disease is a disturb- 
 ance of the innervation to the kidneys as a result of which the 
 urinary secretion is changed, and the salts of the urine are 
 permitted to deposit, and form either gravel, which is like fine 
 sand, or to deposit around a previously existing nucleus, to 
 form a stone. The nucleus may be a dried particle of mucus 
 or blood, or consist of the same material as the surrounding 
 stone. The disease occurs most commonly in men between 
 the ages of 40 and 50 years. 
 
 Symptoms. — No signs of this condition may be present 
 until a stone becomes lodged in one of the ureters, when an 
 attack of renal colic takes place. This is shown chiefly by 
 severe pain in the lumbar region, which radiates along the
 
 DISEASES OF GEXITO-URIXARY SYSTEM 527 
 
 ureters to the testicles. Each attack of colic is accompanied 
 by nausea and vomiting, subnormal temperature, faintness, 
 pallor of the face, and irritability of the bladder. Upon the 
 stone passing into the bladder, the symptoms disappear. The 
 amount of urine is diminished, on account of the obstruction 
 of the ureter, and the urine which is voided, contains small 
 amounts of blood. Should the condition be present on both 
 sides, namely both ureters obstructed, uremia will develop. 
 Between the attacks of renal colic there is always a certain 
 amount of pain and soreness over the kidneys, and the urine 
 is stained wath blood. In addition to the presence of blood 
 the urine also contains albumin and hyaline casts, and its 
 specific gravity is high. 
 
 Treatment. — Adjust the 10th to 12th thoracic vertebrae. 
 During the attack of renal colic, the patient should be placed 
 in a hot bath. Hot compresses should be applied to the lum- 
 bar region, and large amounts of hot water should be drunk. 
 During the interval between attacks the patient should drink 
 freely of alkaline mineral water. Meat should be very spar- 
 ingly used or not at all, and the diet should consist principally 
 of milk and vegetables. If the stone is large or if numerous 
 stones are present, and impair the kidney or ureters so as to 
 threaten life, surgical measures are indicated. 
 
 Pyelitis (Pyelo-Nephritis; Suppurative Nephritis) 
 
 Etiology. — The primary cause of this disease is a lack of 
 resistance of the kidney structure to the invasion of bacteria, 
 caused by faulty innervation of the organ. A catarrhal con- 
 dition of the pelvis of the kidney usually precedes the in- 
 vasion of pus. Predisposing causes are exposure to cold and 
 wet, inflammation of the bladder, long use of irritating drugs, 
 rheumatism, infectious diseases, and kidney stones. 
 
 Pathology. — There is a catarrhal or suppurative inflamma- 
 tion of the pelvis of the kidney and ureters. Pus is formed 
 constantly, and escapes with the urine, when there is no ob- 
 struction of the ureters ; if, however, this outflow is prevented, 
 it accumulates in the kidneys, and gives rise to the disease 
 known as Pyelonephrosis. Pressure of the accumulated pus 
 causes an atrophy of the kidney structure. This is followed 
 by the formation of pus which is constantly accumulating.
 
 528 SPINAL ADJUSTMENT 
 
 and if no obstruction of the ureter is present, it escapes with 
 the urine. If, however, its outflow is impeded, it accumulates 
 in the pelvis of the kidney, and the pressure which it produces 
 upon the parenchyma of the kidney causes the latter to 
 atrophy, and the kidney finally becomes converted into a sac 
 filled with pus, in other words, an abscess. The kidney is now 
 in the same condition as in hydronephrosis, except that the 
 fluid, instead of being water, is pus. 
 
 Symptoms. — The characteristic symptoms of this condi- 
 tion are pain and tenderness on deep pressure over the kid- 
 neys. The symptoms common to septic infection in any part 
 of the body, namely alternate fever and chills, occur. The 
 urine is cloudy and of an acid reaction, and contains mucous, 
 pus and red blood corpuscles. If the affection becomes 
 chronic, anemia, progressive loss of flesh and strength, and 
 finally cachexia develop. 
 
 Treatment. — In mild cases adjustment of the 10th to 12th 
 thoracic vertebrae may be sufficient to overcome the condi- 
 tion. In addition to this the patient should remain in bed, 
 and drink large amounts of alkaline mineral water, and the 
 diet should be light and nutritious, and non-irritating. Hot 
 compresses over the kidneys are very beneficial. In chronic 
 cases, when an abscess has developed, surgical measures are 
 necessary. 
 
 Cystitis (Catarrh of the Bladder) 
 
 Etiology. — Catarrh of the bladder is seen in two forms, 
 the acute and the chronic. In both cases the primary cause 
 of the aiifection is an interference with the innervation of the 
 organ. This lack of innervation renders the bladder susceptible 
 to the invasion of the contributing causes, chief of which are 
 the infectious fevers, presence of foreign bodies in the blad- 
 der, the extension of a suppurative inflammation to the blad- 
 der from the kidneys or from the urethra, traumatism, and 
 the retention of urine in the bladder for long periods of time. 
 The chronic form may be engrafted upon the acute variety, 
 or the integrity of its mucous lining may be impaired, by 
 withdrawal of its innervation, when the addition of such 
 causes as calculi, retention of urine, large prostate gland or 
 urethral stricture, gout, and chronic Bright's disease are present.
 
 DISEASES OF GENITO-URINARY SYSTEM 529 
 
 Pathology. — Acute cystitis commences with congestion of 
 the mucous membrane during the course of which small blood 
 vessels may rupture and cause minute hemorrhages. If the 
 inflammation is extreme, it may end in ulceration. 
 
 In chronic cystitis the bladder wall is thickened, its mucous 
 lining is gray and covered with large amounts of muco- 
 purulent material. 
 
 Symptoms. — Acute cystitis commences very suddenly with 
 a chill, slight fever, a feeling of malaise, insomnia and loss of 
 appetite. There is frequent urination, which is accompanied 
 by intense pain. Pain over the bladder, in the inguinal region, 
 and along the course of the urethra, is present. The urine 
 is cloudy, of an alkaline reaction, and contains red blood cells, 
 pus, and epithelium. 
 
 Chronic cystitis commences slowly, and is characterized 
 by a dull pain over the bladder and frequent voiding of small 
 amounts of urine. The urine is alkaline in reaction, and con- 
 tains large quantities of pus. If an ulcerative process is pres- 
 ent, intense pain over the bladder, presence of blood in the 
 urine, and loss of flesh and strength will be noted. In all 
 cases the symptoms of the contributing cause are present. 
 
 Treatment. — Adjust the 11th dorsal and the 1st and 5th 
 lumbar vertebrae. Adjust also for the relief of the causative 
 factors. Concussion over the 9th dorsal and the 5th lumbar 
 vertebrae is indicated. Rectal dilatation is a valuable measure 
 in these cases. In addition to this treatment, the patient 
 should, in all acute cases, be confined in bed, and placed on a 
 milk diet. Hot magnesium sulphate compresses should be 
 applied over the bladder. Large amounts of alkaline mineral 
 water should be drunk to dilute the urine as much as possible. 
 The bowels should be daily cleansed with a high rectal enema 
 of normal salt solution. All highly seasoned and irritating 
 foods should be avoided. 
 
 Hypertrophy of the Prostrate 
 
 Etiology. — The primary cause of enlargement of the 
 prostate gland is interference with the conduction of normal 
 nerve impulses to the organ. It is seen most commonly in 
 men about the age of 60, and among the important contributing 
 causes may be mentioned sedentary occupation, cystitis, slug-
 
 530 SPINAL ADJUSTMENT 
 
 gish circulation, a foreign body in the bladder, stricture of the 
 urethra, numerous previous attacks of gonorrhea, excessive use 
 of diuretic drugs, and alcoholic liquors, exposure to cold, gout, 
 and rheumatism, traumatism, and habitual straining at stool. 
 
 Pathology. — The prostate gland is enlarged, hard and in- 
 durated. The enlargement is uniform, and the isthmus and 
 two lateral lobes of the gland can be distinctly felt as three 
 separate tumors. 
 
 Symptoms. — These are not apparent until the hypertrophy 
 has existed for some time. The enlargement is not painful of 
 itself, and pain is not present until there is mechanical inter- 
 ference w^ith the function of urination. Incontinence of urine 
 at night is a common symptom. A muco-purulent urethral 
 discharge is present. The patient is very irritable ; there are 
 alternating chills and fevers, digestive disturbances, loss of 
 flesh and strength. 
 
 Treatment. — Adjust the 12th dorsal and the 3rd and 5th 
 lumbar vertebrae. Concussion of the 9th to 12th dorsal ver- 
 tebrae. Massage of the gland is a very useful adjunct meas- 
 ure. The application of hot compresses over the seat of the 
 prostate glands is also beneficial. 
 
 Enuresis (Bed-Wetting) 
 
 Etiology. — The primary cause of this condition is a de- 
 rangement of the functional activity of the bladder, due to 
 faulty innervation or an irritable condition of the micturition 
 centers. It may also be produced reflexly from some irrita- 
 tion of the genito-urinary system, and is seen most commonly 
 in persons of a nervous temperament, who are suffering from 
 anemia and faulty nutrition. It also occurs in diseases of the 
 central nervous system. 
 
 Symptoms. — The characteristic symptom is unconscious 
 voiding of urine. This occurs especially at night, and may 
 take place every night, or only at intervals. 
 
 Treatment. — Adjust the 11th dorsal and the 1st and 5th 
 lumbar vertebrae. Concussion of the 9th dorsal and the 5th 
 lumbar vertebrae. The bowels should be regulated. The 
 evening meal should be light and no liquids should be taken 
 after 5 o'clock. Look for lesions in the genito-urinary system, 
 which may reflexly induce the condition, such as phimosis.
 
 CHAPTER XII 
 
 Diseases of the Eye and Ear 
 
 The reader will note that not all diseases of the eye and 
 ear are given. This is so for the reason that so many of these 
 diseases are obviously in the realm of the specialist in eye 
 and ear diseases and only those which we know respond to 
 treatment by spinal adjustments are therefore given. 
 
 Lachrymation 
 
 This condition is a symptom rather than a disease, and is 
 characterized, as its name implies, by an excessive flow of 
 tears, occasioned by irritation of the eye and its appendages, 
 as a result of which the secretion of the lachrymal glands is 
 increased. This is produced by an overstimulation of the 
 aflferent nerves, which reflexly excite the efferent nerves to 
 over-activity, with the resulting increase in the functional 
 activity of the lachrymal gland. The treatment consists in 
 adjustment of the 4th cervical and upper dorsal vertebrae. 
 
 Amblyopia 
 
 By this term is meant a defect in vision which is not due 
 to a lesion of the eyeball or error of refraction. When the 
 defective vision is due to causes other than those mentioned, 
 it may be corrected by adjustment of the 4th cervical and the 
 1st, 3rd and 5th dorsal vertebrae, together with removal of 
 the cause which may be present. 
 
 Strabismus (Squint) 
 
 This is a condition in which the lines of sight do not meet 
 at the objective point. The vision of the affected eye is very 
 often defective. Selected cases of strabismus or squint, may 
 be corrected by adjustment of the 4th cervical, and the 1st, 
 3rd and 5th dorsal vertebrae. When the condition is due to* 
 disuse, as is true in some cases, the better eye should be cov- 
 ered, and the affected eye used exclusively for a time. 
 
 531
 
 532 SPINAL ADJUSTMENT 
 
 Cataract 
 
 A cataract is an opacity of the lens of the eye, or its en- 
 velope. In some cases surgical measures are the only means 
 of relief. In other cases, however, adjustment of the 4th cer- 
 vical, and the 1st, 3rd and 5th dorsal vertebrae, together with 
 concussion of the 1st, 4th and 7th cervical vertebrae, have been 
 productive of good results in these cases. Important adjunct 
 measures of treatment are rectal dilatation, magnesium 
 sulphate baths, and compresses over the affected side, and the 
 local use of normal salt solution. 
 
 Stye 
 
 This is a circumscribed, acute inflammation of the tissues 
 about the glands of the margin of the eyelid, which frequently 
 terminates in suppuration. Styes very often occur in crops, 
 and are seen in young adults, being produced most commonly 
 by gastro-intestinal disorders. In the treatment of styes 
 adjust the 4th. cervical and the 1st, 3rd and 5th dorsal verte- 
 brae. If the case is seen early, cold compresses over the eye 
 may serve to abort a stye. Attention should be given to 
 the gastro-intestinal system. 
 
 Ptosis 
 
 This is a drooping of the upper eye-lids, due to paralysis, 
 or faulty development of the levator palpebrae muscle. It 
 may exist in any degree, and be sufficient to entirely cover 
 the eye. It may be congenital, in which case it is bilateral, 
 and is due to faulty development of the levator palpebrae 
 muscle, and accompanies congenital defects. The acquired 
 form is generally unilateral, and is caused by paralysis of a 
 branch of the 3rd nerve that innervates the levator palpebrae. 
 The treatment of this condition should consist of adjustment 
 of the 4th cervical, and the 1st, 3rd and 5th dorsal vertebrae. 
 Electricity may also be used to directly stimulate the muscle. 
 
 Mydriasis and Myosis 
 
 Mydriasis is the term used to designate dilatation of the 
 pupil, while myosis designates contraction of the pupils. 
 • Mydriasis may be due to paralysis of the nerves which pro- 
 duce contraction of the pupil, namely the third cranial nerve, 
 or to stimulation of the sympathetic fibers, which normally
 
 DISEASES OF THE EYE AND EAR 533 
 
 dilate the pupil. In myosis the opposite is true, namely, there 
 is stimulation of the 3rd cranial nerve, and paralysis of the 
 sympathetic nerve fibers. This condition very often responds 
 readily to adjustments of the 3rd to 5th cervical vertebrae, 
 and the 1st, 3rd and 5th dorsal vertebrae. 
 
 Retinitis 
 
 There are various forms of inflammation of the retina, 
 namely simple retinitis, albuminuric retinitis, syphilitic re- 
 tinitis, diabetic retinitis, and hemorrhagic retinitis. Some 
 cases are amenable to treatment, while others are not, and a 
 guarded prognosis is therefore to be given in every case. 
 The treatment consists in adjustment of the 4th cervical and 
 the 1st, 3rd and 5th thoracic vertebrae. The eye should be 
 protected from the light, and should not be used. The con- 
 tributing causes should be corrected. 
 
 Optic Neuritis 
 
 Inflammation of the optic nerve often results from exten- 
 sion of an inflammation in the brain, or may be produced by 
 tumors of the brain. It also frequently accompanies anemia, 
 arteriosclerosis, rheumatism, Bright's disease, syphilis, and 
 infectious diseases. Treatment consists in adjustment of the 
 4th cervical and the 1st, 3rd and 5th dorsal vertebrae. Atten- 
 tion should also be given to the cause of the condition. Hot 
 baths and compresses over the afifected eye are useful 
 measures. 
 
 Ear-ache 
 
 Ear-ache is a symptom of nearly all abnormal conditions 
 of the auditory apparatus, and w^hile some of these diseases 
 are not always amenable to spinal adjustment, the pain in 
 the ear is greatly reduced by correction of subluxations in 
 the upper cervical and upper thoracic region. Adjust the 1st 
 and 2nd and 6th cervicals, and the 1st, 3rd and 5th dorsal 
 vertebrae. A valuable accessory method of treatment is the 
 application of hot compresses over the ear. 
 
 Tinnitus Aurium 
 
 A ringing, roaring or hissing sound in the ear proceeds 
 from many causes. One of the most common being a gen-
 
 534 SPINAL ADJUSTMENT 
 
 eral neurasthenic condition. Congestion, sunstroke, alcohol- 
 ism, and arteriosclerosis, are also responsible for this disorder. 
 Should the noises be synchronous with the beat of the heart 
 and of a pulsating character, and further, should they be sus- 
 pended by pressing on the carotid arteries, they are in all 
 probability due to aneurysm, inflammatory congestion, or 
 paralysis of the vaso-motor nerves. Continual rushing, pul- 
 sating, knocking noises are likely caused by inflammatory 
 conditions in the labyrinth. Bubbling, gurgling, singing or 
 shell-like roaring, indicates fluid exudations or catarrh of the 
 Eustachian tube. A dry, roaring and ringing sound is due to 
 catarrh of the middle ear, or insufificient nerve-supply to the 
 tympanum. Many such cases are relieved by adjustment of 
 the upper cervical vertebrae, and the 1st, 3rd and 5th dorsal 
 vertebrae. In all cases the cause as mentioned should be 
 
 corrected. 
 
 Deafness 
 
 Deafness may be due either to a disease of the auditory 
 apparatus, or to a lesion affecting the integrity of the auditory 
 nerve. To distinguish between them, a vibrating tuning fork 
 should be placed upon the head, and if the vibrations are 
 heard, it is an indication that the lesion producing the deaf- 
 ness is located in the auditory apparatus ; if the vibrations are 
 not heard, it is evidence that the lesion is of the auditory 
 nerve. Deafness is produced by a great variety of causes, 
 and each individual case should be carefully studied, with a 
 view to determining the exact nature and location of the con- 
 tributing cause. In many of these cases adjustment of the 
 upper cervical and upper dorsal vertebrae, supplemented by 
 treatment directed to the relief of the causative factors, are 
 productive of good results. 
 
 Otitis Externa 
 
 Inflammation of the external auditory meatus may be 
 either acute or chronic, and afifect the greater part of, if not 
 the entire lining of the external ear. It is due primarily to 
 faulty innervation of the parts, as a result of which its resis- 
 tance is rendered feeble, and it becomes susceptible to the in- 
 vasion of various forms of bacteria. The condition com- 
 mences with an itching sensation in the external auditory
 
 DISEASES OF THE EYE AND EAR 535 
 
 meatus ; severe radiating pain then follows, which is aggra- 
 vated by lying upon the affected side, or by movements of 
 the jaws. Ringing of the ears and deafness may occur. Treat- 
 ment of this affection consists in adjustment of the upper 
 cervical and upper dorsal vertebrae. Hot compresses over 
 the ear are useful accessories in the treatment. 
 
 Otitis Media 
 
 Inflammation of the middle ear may occur either acutely 
 or chronically. In either case, but more especially in the 
 chronic form, the disorder is due to faulty innervation of the 
 middle ear. Contributing causes of the acute variety are the* 
 extension of an inflammatory process from the nose, sudden 
 changes in temperature, and constitutional debility. The 
 primary cause of the chronic form is faulty innervation which 
 is due to reflex subluxations which were produced during 
 the course of the acute form. Contributing causes are exces- 
 sive use of alcohol and tobacco, and a prolongation of the 
 contributing causes of the acute form. The condition is com- 
 monly manifested by partial deafness, ringing of the ears, 
 and pain. These symptoms increase in severity, and fre- 
 quently pus forms in the middle ear, and systemic disturb- 
 ances then become marked. The treatment of many of these 
 affections should be left to the specialist, but many of these 
 cases, if taken early, are relieved by adjustment of the upper 
 cervical and upper dorsal vertebrae. Causative factors should, 
 in all cases, be corrected. 
 
 Vertigo 
 
 Dizziness may be due to a great variety of causes, but 
 is essentially produced by a disturbance of the cochlear part 
 of the auditory nerve. Auditory Vertigo is due to disease of 
 the labyrinth, and is frequently accompanied by nausea and 
 sometimes syncope ; this form of vertigo is known also as 
 Menier's disease, and is accompanied by deafness and tinni- 
 tus. A history of syphilis, gout or injury may also be pres- 
 ent. Vertigo may also be produced reflexly from stomach 
 disorders. Anything which interferes with the continuous 
 flow of nerve-impulses from the eye, the joints, the viscera, 
 or the ear, will interfere with the relation of the body to ex- 
 ternal objects, and will produce vertigo. No matter what
 
 536 SPINAL ADJUSTMENT 
 
 the varying symptoms may be, the cause is in all cases the 
 same, namely, an interference with the nicely balanced co- 
 relation of the different parts of the body, the function of 
 which is to maintain the consciousness of equilibrium. When 
 the nerve impulses are in any way interfered with, the result 
 is disharmony. Such a disturbance of normal vibrations can 
 also be produced by mechanical causes, as the movements of 
 cars, ships, or whirling rapidly around. In such cases the 
 symptoms will disappear immediately upon removal of the 
 promoting cause, since in such cases the vibrations are at 
 once restored. In the treatment of this affection, the correc- 
 tion of the cause is the first consideration. In all cases 
 adjustment of the upper cervical, lower dorsal and upper 
 lumbar vertebrae should be made. 
 
 Impacted Cerumen 
 
 By this term is meant the collection in the external audi- 
 tory meatus, of an increased amount of ear-wax, mixed with 
 debris, and rendered dry and hard. The essential symptoms 
 are similar to obstruction of the auditory meatus, by any 
 foreign body. So long as the plug of wax does not impinge 
 against the drum membrane, no symptoms may be present. 
 If the collection of wax is sufficient to occlude the meatus, 
 tinnitus, partial deafness, pain, and a sense of fullness in the 
 meatus, are the leading symptoms. A condition of malaise, 
 reflex cough, and nausea and vomiting sometimes occur. 
 Treatment consists in removal of the collection of wax by 
 syringing the ear with a warm solution of sodium bicarbon- 
 ate. Adjust the upper cervical and the 1st, 3rd and 5th dorsal 
 vertebrae. 
 
 Inflammation of the Eustachian Tube 
 
 The primary cause of this affection is a low grade of re- 
 sistance of the Eustachian tube, induced by faulty innervation. 
 The most common contributing causes are extension of an 
 inflammation from the nose or throat ; various other abnor- 
 malities of the naso-pharynx ; and a general debilitated condi- 
 tion. Treatment should first of all be directed toward the 
 removal of the exciting cause. Following this, or in connec- 
 tion therewith, adjust the upper cervical and the noper dorsal 
 vertebrae.
 
 CHAPTER XIII 
 
 Gynecological Diseases 
 
 Some gynecological affections are so manifestly in the 
 realm of the specialist in Diseases of Women, that they will 
 not be referred to here. Only such as are amenable to spinal 
 adjustment and local therapy will be discussed. 
 
 Vulvitis 
 
 Etiology. — Simple vulvitis is contributed to by lack of 
 cleanliness, irritation, and the presence of foreign bodies, all 
 of which reflexly excite the production of subluxations in 
 the upper lumbar region, as a result of which the inflammatory 
 process may become chronic. 
 
 Symptoms. — The affected parts are red, swollen, con- 
 gested, and painful. The mucous membrane covering the 
 part is dry, and later becomes covered with a mucous secre- 
 tion, and desquamation of large areas of the mucous membrane 
 may occur. 
 
 Treatment. — The prime consideration is cleanliness, and 
 the parts should be washed several times a day with normal 
 salt solution. Adjust the 1st to 3rd lumbar vertebrae. If 
 the case has advanced, the use of astringents locally, may be 
 necessary. 
 
 Pruritus Vulvae 
 
 Etiology. — This condition is due to anything which pro- 
 duces a congestion of the parts, such as pregnancy and tu- 
 mors. It is also due to uncleanliness, and to the irritating 
 effects of discharges from the upper part of the genital tract. 
 
 Vaginitis 
 
 Etiology. — The predisposing cause of inflammation of the 
 vagina is a general impairment of the health, due to faulty 
 innervation. Other predisposing causes are any conditions 
 which produce congestion of the pelvis, as tumors and preg- 
 nancy. The exciting causes are various forms of local 
 
 537
 
 538 SPINAL ADJUSTMENT 
 
 irritation, such as discharges from the uterus, and mechanical 
 irritation. 
 
 Symptoms. — Characteristic symptoms of this condition 
 are burning pain and itching about the opening of the vagina, 
 and heavy sensations in the vagina itself, accompanied by 
 frequent desire to micturate. There is a large amount of a 
 greenish or yellowish discharge, containing a small amount 
 of blood, and consisting of mucus or muco-pus. There is 
 also a dragging pain in the back and pelvis. In chronic cases 
 the symptoms are very similar, though not so marked. In 
 every case a microscopical examination should be made of 
 the discharge, to determine the presence of gonorrhea. 
 
 Treatment. — Adjust the 1st and 3rd lumbar vertebrae. 
 The patient should refrain from moving about for several 
 days. The diet should be liquid, chiefly. Douches of warm 
 salt solution should be used. 
 
 Dysmenorrhea 
 
 Etiology. — There are several forms of dysmenorrhea, the 
 most common of which are membranous, mechanical, 
 congestive, neuralgic, and ovarian. 
 
 Membranous Dysmenorrhea is painful menstruation due 
 to the expulsion of membranes and clots from the uterus. 
 Mechanical dysmenorrhea is painful menstruation due to ob- 
 structions in the cervix, the os uteri, or the vagina. Conges- 
 tive dysmenorrhea is caused by any condition which causes 
 an inflammation of the pelvic organs or cellular tissue. Neu- 
 ralgic dysmenorrhea is seen most commonly in women of a 
 nervous temperament. Ovarian dysmenorrhea is due to 
 coincident ovarian disease. 
 
 Symptoms. — In membranous dysmenorrhea the pain com- 
 mences a short time before the onset of menstruation, and in- 
 creases until the membrane is expelled. These pains are 
 cramp-like in character, are due to contractions of the uterus, 
 and the os is dilated. A profuse flow often accompanies this 
 form of dysmenorrhea. 
 
 In mechanical dysmenorrhea the pains are still more 
 cramp-like, often approaching those experienced in miscar- 
 riage. The obstruction to the free outflow of blood causes an 
 accumulation thereof in the uterus and its presence induces
 
 GYNECOLOGICAL DISEASES 539 
 
 the contractions of the womb. This is the form of dysmenor- 
 rhea which is seen so commonly in young women suffering 
 from anteflexion of the uterus. Following one pregnancy this 
 form of dysmenorrhea usually ceases, since the ante-flexion 
 is corrected by the tendency to retroversion, which always 
 follows pregnancy. 
 
 Congestive dysmenorrhea is accompanied by intense pain 
 in the pelvis throughout the menstrual period, with a slight 
 diminution in its severity when relieved by a temporarily 
 free flow. Systemic disturbances are present, and may 
 sometimes be extreme. 
 
 Neuralgic dysmenorrhea is characterized by pain which 
 is marked just before and for the first few hours during the 
 menstrual flow. The pain is situated in the pelvis and extends 
 around to the lumbar region. It is a steady, sharp pain, and 
 not cramp-like, as that in the other forms of dysmenorrhea. 
 There are no signs of inflammation, and the flow is steady, 
 and contains no clots. 
 
 In ovarian dysmenorrhea the pain is always present be- 
 fore the onset of the flow although it may commence several 
 days before it. The pain is experienced in the pelvis, and 
 is referred down the thigh, and the mammary glands may be- 
 come sensitive. There is often extreme nervousness and 
 sometimes hysteria. 
 
 Treatment. — In all cases adjust the 1st and 3rd lumbar 
 vertebrae. In congestive dysmenorrhea, concuss the spinous 
 process of the 7th cervical vertebra. In membranous and me- 
 chanical dysmenorrhea, pressure applied upon the nerves be- 
 tween the 2nd and 3rd lumbar vertebrae often serves to 
 stimulate the flow. The cause should be ascertained in every 
 case, and treated accordingly. Hot compresses should be 
 applied over the lower part of the abdomen ; hot sitz-baths 
 should be taken, and hot vaginal douches should be given. A 
 rectal enema is sometimes beneficial. IMeasures should be 
 taken to improve the general state of health. 
 
 Menorrhagia and Metrorrhagia 
 
 Etiology. — Menorrhagia is an abnormally profuse men- 
 strual discharge. IVIetrorrhagia is a flow of blood from the 
 uterus at times other than the menstrual period. These con-
 
 540 SPINAL ADJUSTMENT 
 
 ditions are, in reality, symptoms rather than diseases, per se. 
 The most common causes not in direct relation with the 
 uterus itself, are hemophilia, extra-uterine pregnancy, dis- 
 eases of the ovaries and tubes, and diseases of the heart, liver 
 and kidneys. Uterine disorders which may cause these symp- 
 toms are subinvolution, malignant disease, endometritis, and 
 perimetritis, incomplete abortion, and polypi. 
 
 Treatment. — Adjust the 1st and 3rd lumbar vertebrae. 
 Concussion of the 1st, 2nd and 3rd lumbar vertebrae. In all 
 cases the cause should be ascertained, and proper treatment 
 instituted. Vaginal douches of water, as hot as can be borne, 
 are beneficial. Sometimes it becomes necessary to pack the 
 
 vagina. 
 
 Amenorrhea 
 
 Etiology. — Absence of the menstrual flow may be normally 
 caused by pregnancy; it is also normally present in lactation 
 and during the menopause. Abnormal amenorrhea is caused 
 chiefly by exposure to cold and wet, mental or physical shocks, 
 sorrow, etc., accompanying various diseases, stenosis of the 
 cervix, obesity, infantile uterus, a vicarious flow, and anything 
 which makes great demands upon the nervous system. 
 
 Symptoms. — The symptoms present are usually referable 
 to the primary cause of the condition. 
 
 Treatment. — Adjust the 1st and 3rd lumbar vertebrae. 
 
 Pressure upon the nerves betwen the 2nd and 3rd lumbar 
 
 vertebrae. Hot compresses over the abdomen; hot vaginal 
 
 douches ; and warm sitz baths. In all cases, treatment should 
 
 be directed toward the relief of the primary cause of the 
 
 condition. 
 
 Leucorrhea 
 
 Etiology. — A whitish mucous, or muco-purulent discharge 
 is seen in prolapse of the uterus, retrodisplacement, carcinoma 
 of the uterus, and anteflexion. 
 
 Treatment. — Leucorrhea being a symptom rather than a 
 disease, per se, the primary cause thereof should be corrected. 
 In all cases adjust the 1st and 3rd lumbar vertebrae. Hot 
 douches of normal salt solution are beneficial. 
 
 Anteflexion 
 Etiology. — A bending forward of the body of the uterus 
 upon the cervix is seen most commonly in those who have
 
 GYNECOLOGICAL DISEASES 541 
 
 not borne children. The tendency of pregnancy is to result 
 in retroversion, which tendency invariably corrects a previous 
 anteflexion. The uterus being normally in a slightly ante- 
 flexed condition, accentuation of this position is more readily 
 brought about than is retroversion. Among the causes which 
 directly operate to produce the forward position of the 
 uterus may be mentioned inflammation and consequent short- 
 ening of the sacro-uterine ligaments, which draw the cervix 
 upward and backward, and thus throw the fundus forward ; 
 anything which causes an increase in the weight of the uterus, 
 will, according to its location, induce malposition of the womb, 
 and thus this condition may also induce anteflexion ; adhesions 
 between the uterus and the abdominal wall, as a result of 
 perimetritis or peritonitis, may also draw the body of the 
 uterus forward, and flex it upon the cervix. 
 
 Symptoms. — The characteristic symptoms of this condi- 
 tion are sterility, dysmenorrhea, menorrhagia, leucorrhea, 
 and symptoms referable to the exciting cause of the condition. 
 
 Treatment. — Adjust the 1st and 3rd lumbar vertebrae. 
 Concussion of the 1st, 2nd, and 3rd lumbar vertebrae. When 
 adhesions are present, binding the uterus in its abnormal 
 position, manipulations are necessary to replace it in its prop- 
 er position. This is accomplished by raising the fundus with 
 two or three fingers placed in the vagina, and at the same 
 time drawing the cervix forward. This method either finally 
 breaks the adhesions, or stretches them ; the use of tampons 
 placed behind the cervix will serve to hold it in place. If 
 the anteflexion is due to inflammation of the uterus, hot saline 
 douches should be given twice daily. In all cases the bowels 
 should be carefully regulated. In every case the cause should 
 be ascertained, and treatment directed toward its removal. 
 It goes without saying that surgical measures are sometimes 
 
 indicated. 
 
 Anteversion 
 
 Etiology. — In this condition the uterus is directed for- 
 ward, and the normal bend is obliterated. As a result of this 
 the cervix is higher than normal, and is directed backward 
 toward the posterior wall of the vagina, or toward the hollow 
 of the sacrum. Probably the most common predisposing cause 
 of this condition is a relaxation of the uterine ligaments, ac-
 
 542 SPINAL ADJUSTMENT 
 
 companied by general muscular relaxation throughout the 
 body. The most common contributing or exciting causes 
 are subinvolution of the uterus following abortion ; any in- 
 crease in the weight of the uterus, as congestion, hyper- 
 trophy, or tumors ; weakness of the other supports of the 
 uterus, as laceration of the perineum and prolapse of the 
 vagina ; ill-fitting corsets. 
 
 Symptoms. — The characteristic symptoms of this condi- 
 tion are sterility, dysmenorrhea, cystitis, frequent urination, 
 rectal tenesmus, and the symptoms of the exciting cause of 
 the condition. 
 
 Treatment. — The treatment of anteversion is the same as 
 that of anteflexion. 
 
 Retroflexion 
 
 Etiology. — The primary and predisposing cause of this con- 
 dition is a weakness of the uterine ligaments due to an 
 interference with their normal nerve-impulses, which maintain 
 them in a state of constant contraction. The most common 
 contributing and exciting causes are anything which increases 
 the weight of the uterus, as pregnancy, hypertrophy, tumors, 
 and subinvolution ; adhesions between the uterus and sacrum, 
 or those resulting from pelvic peritonitis; mechanical meas- 
 ures, such as falls, blows, pressure of tumors from the anterior 
 aspect, and a long period of time spent in the dorsal position, 
 following confinement ; laceration of the perineum. 
 
 Symptoms. — There is a continuous, dull, heavy pain in 
 the lower part of the back, and radiating down the thighs. 
 Headache is a constant symptom of this condition, the pain 
 being situated most commonly at the vertex or in the occipi- 
 tal region. Symptoms referable to the uterus itself are steril- 
 ity, or repeated abortions, dysmenorrhea, menorrhagia and 
 leucorrhea. Constipation is an almost constant symptom, 
 ribbon-like stools being a characteristic of this condition, and 
 tenesmus occurring after defecation. Cystitis may be present 
 and partial incontinence of urine is a common symptom. 
 After a time many nervous symptoms develop, such as 
 hysteria, melancholia, neurasthenia and other functional 
 neuroses. 
 
 Treatment. — Adjust the 1st and 3rd lumbar vertebrae.
 
 GYNECOLOGICAL DISEASES 543 
 
 Concussion of the 1st, 2nd and 3rd lumbar vertebrae. An 
 accessory measure which often meets with success is the 
 assuming by the patient of the knee-chest position for 30 
 minutes every morning and evening. When adhesions are 
 present, replacement of the uterus in its normal position may 
 be necessary by means of manipulation. Following the 
 manipulations, the introduction of a tampon to maintain the 
 uterus in its normal position, is advisable. 
 
 Prolapse of the Uterus 
 
 Etiology. — This is a downward displacement of the uterus, 
 which is primarily due to the relaxation of its ligaments con- 
 sequent on improper innervation thereof, in addition to which 
 chronic constipation, general weakness, overwork and a large 
 number of poorly-conducted labors are also common pre- 
 disposing causes. The most common exciting or direct causes 
 are anything which increases the weight of the uterus, such 
 as pregnancy, hypertrophy and tumors ; loss of the supports 
 of the uterus, such as laceration of the perineum, weakness 
 of the abdominal muscles, an extremely large pelvis, and poor 
 tonicity of the vaginal vvalls ; downward displacement of the 
 uterus by pressure from above, as tight-lacing, tumors in 
 the abdomen, dropsy, coughing, or straining at stool ; condi- 
 tions which produce a pulling downward of the uterus from 
 below, as prolapse of the bladder, rectum or vagina. 
 
 Symptoms. — The characteristic symptoms of this condi- 
 tion are a dragging, bearing-down weight in the pelvis, pain 
 in the lower part of the back and radiating down the thighs, 
 vertical or occipital headaches, constipation, irritability of the 
 bladder, tenesmus, and various nervous symptoms, such as 
 hysteria, and neurasthenia. Various degrees of prolapse of 
 the uterus may occur ; first, the cervix may rest on the pelvic 
 floor ; second, it may protrude at the vaginal orifice ; third, the 
 entire uterus may escape through the vaginal orifice. Accom- 
 panying this condition there may be a protrusion or prolapse 
 of the posterior wall of the vagina, namely rectocele, or of the 
 anterior wall of the vagina, namely cystocele. 
 
 Treatment. — The first indication is to replace the uterus, 
 which should be done by having the patient assume the knee- 
 chest position. In cases which have not existed for too long
 
 544 SPINAL ADJUSTMENT 
 
 a period, several weeks' rest in bed, with the vagina packed 
 with cotton daily, together with adjustment of the 1st and 
 3rd lumbar vertebrae, and concussion of the 1st, 2nd and 3rd 
 lumbar vertebrae, may produce excellent results. In advanced 
 cases, however, surgical measures are sometimes necessary. 
 
 Acute Endometritis 
 
 Etiology. — Inflammation of the mucous lining of the 
 uterus may afifect the entire organ or any part of it, and is 
 primarily due to an interference with the proper innervation 
 of the organ. The most contributing causes are exposure 
 to cold and wet just before or during menstruation, dysmenor- 
 rhea, septic infection, and extension upward of an inflamma- 
 tion in the vagina, and chronic exhausting diseases, espe- 
 cially tuberculosis and Bright's disease, and accompanying 
 long, continued fevers. 
 
 Symptoms. — The first symptom of this disease is a heavy 
 sensation and pain in the pelvis together with pain in the 
 back, loins, and thighs. There is mild fever. The bladder 
 and rectum are both irritable and frequent micturition and 
 diarrhea are present. The discharge appears early in the 
 condition and is at first thin and watery, which indicates that 
 the entire uterus is afTected, but later, as the inflammation 
 subsides in the fundus, and becomes limited more particularly 
 to the cervix, the discharge becomes thick and albuminous. 
 In many cases various disorders of menstruation develop. If 
 the cause is a gonococcus infection, all the above symptoms 
 are intensified, and the discharge is of a yellowish-green color. 
 
 Treatment. — The first indication is absolute rest in bed. 
 Adjustment of the 1st and 3rd lumbar vertebrae, and concus- 
 sion over the 1st, 2nd and 3rd lumbar vertebrae. Hot com- 
 presses should be applied over the hypogastric region. A 
 liquid diet should be prescribed. Hot saline douches should 
 be given twice a day. Gonorrheal and septic endometritis 
 require medicinal treatment. 
 
 Chronic Endometritis 
 
 Etiology. — Various forms of this condition are found, the 
 primary cause of which is, in all cases, faulty innervation of 
 the mucous lining of the uterus, as a result of which its ton-
 
 GYNECOLOGICAL DISEASES 545 
 
 icity is impaired. In such cases it is simply a continuation 
 of the acute form, or results from an untreated chronic vagin- 
 itis. Other direct causes of chronic endometritis are improp- 
 erly conducted labors, miscarriage, subinvolution, insufficient 
 rest following confinement, exposure to cold and wet at the 
 time of menstruation, a large number of pregnancies, anemia, 
 insufficient rest after confinement, and subinvolution of the 
 uterus. 
 
 Symptoms. — There is a heavy, dull pain in the lumbar 
 region, and extending down the thighs. This pain is increased 
 by the upright position, in which case pains may be experi- 
 enced also in various other parts of the body. A frequent 
 accompaniment is hemorrhage, either at the time of men- 
 struation, or between the menstrual periods. When the con- 
 dition is due to anemia, amenorrhea may result. Vertigo and 
 frontal headache are common symptoms. A leucorrheal dis- 
 charge is a constant feature of this condition, and when due 
 to disease of the cervix, the discharge is thick and gelatinous, 
 while when it is from the body of the uterus it is thin and 
 watery. If the condition is due to sepsis or to gonorrhea the 
 discharge is yellowish or greenish. Gastro-intestinal and 
 nervous disorders are common in this condition. 
 
 Treatment. — The first consideration in the treatment 
 should be measures directed toward the improvement of the 
 general health, and prolonged rest. Adjust the 1st and 3rd 
 lumbar vertebrae. Concussion of the 1st, 2nd and 3rd lumbar 
 vertebrae. Hot douches of normal salt solution should be 
 given two or three times a day. 
 
 Acute Metritis 
 
 Etiology. — Inflammation of the muscular coat of the uterus 
 is primarily due to a low grade of resistance, which renders 
 it susceptible to the invasion of the contributing causes which 
 are in most instances of an infectious nature. Such causes 
 may be gonorrheal. The infection may also be due to re- 
 tained clots, or pieces of the placenta, or to the use of un- 
 clean hands or instruments. It also follows exposure to cold 
 and wet during the menstrual period. It is sometimes an ac- 
 companiment of acute infectious diseases, and is also seen in 
 tuberculosis and Bright's disease. Aletritis, never occurs in-
 
 546 ~ SPINAL ADJUSTMENT 
 
 depeiidently, but generally is the result of extension from an 
 inflammation of the endometrium, or the peritoneum. 
 
 Symptoms. — The disease usually commences suddenly, 
 with a chill. This is followed by a rapid rise in temperature, 
 and an increase in the pulse rate. There are nausea and 
 vomiting, and frequent urination and diarrhea. Pain is a 
 constant feature, and is experienced in the hypogastric 
 region over the uterus, and also in the lumbar region and 
 iliac region. The uterus is soft and enlarged. Hemorrhages 
 frequently occur. 
 
 Treatment. — Absolute rest in bed, and if the case is seen 
 early, cold compresses over the uterus, while if seen later, 
 hot applications are the first considerations in the treatment. 
 Adjustments of the 1st and 3rd lumbar vertebrae, and con- 
 cussion of the 1st, 2nd and 3rd lumbar vertebrae. An enema 
 should be given every day. After the initial stage has been 
 passed over, hot douches of normal salt solution should be 
 given several times a day. If the condition is due to reten- 
 tion of particles of placenta or clots, removal thereof by 
 surgical means may be necessary. 
 
 Chronic Metritis 
 
 Etiology. — The cause of chronic metritis is a prolonga- 
 tion of the causes of the acute form, when left untreated. 
 
 Symptoms. — The characteristic symptoms of chronic 
 metritis are a constant heavy pain in the hypogastric, lumbar 
 and sacral regions, and extending down the thighs. Vertigo 
 and occipital headache are constant symptoms of this condi- 
 tion. Painful and profuse menstruation occur, and at other 
 than the menstrual time there is a leucorrheal discharge. 
 Frequent micturition and diarrhea, owing to irritability of 
 the bladder and rectum, are common symptoms. Various 
 nervous diseases, such as hysteria and neurasthenia, frequent- 
 ly are noticed. There is either complete sterility, or if preg- 
 nancy occurs, abortions are the rule. During the acute stages 
 of the affection the uterus is enlarged and tender, but later 
 It becomes reduced in size owing to replacement of muscular 
 tissues by fibrous connective tissue. Displacements of the 
 uterus are commonly seen. 
 
 Treatment. — Adjust the 1st and 3rd lumbar vertebrae, and
 
 GYNECOLOGICAL DISEASES 547 
 
 concuss the 1st, 2nd and 3rd lumbar vertebrae. General mas- 
 sage and attention to diet are important measures in this 
 condition. The bowels should be kept well regulated by 
 means of enemas and abdominal massage. Daily douches of 
 hot saline solution are valuable measures. The general 
 health of the patient should be improved in every possible 
 way. Rest in bed during the menstrual period is a good 
 
 procedure. 
 
 Salpingitis 
 
 Etiology. — Inflammation of the mucous lining of the Fal- 
 lopian tubes is most commonly due to gonorrhea. It also fol- 
 lows septic endometritis. Frequently it occurs following 
 excessive exercises, or exposure to cold and wet during the 
 menstrual period. 
 
 Symptoms. — The disease occurs in two forms, acute and 
 chronic. During the acute period of the disease there is mild 
 fever, and an acute, heavy pain on the affected side, which 
 is increased by standing or walking. If a tube contains 
 pus the usual symptoms of sepsis are present, and the patient 
 lies on the back, with the thighs flexed upon the abdomen. 
 The characteristic symptoms of the chronic form are pain in 
 the lower part of the abdomen on the side of the affected 
 tube, which is increased by exertion of any kind. Sterility 
 is a common symptom of this condition. Dysmenorrhea and 
 profuse menstruation and repeated attacks of inflammation 
 of the pelvic peritoneum are common symptoms. If a bi- 
 manual examination be made, the enlarged tube can be felt, 
 and it will also be noted that the uterus is generally 
 posteriorly displaced. 
 
 Treatment. — In simple catarrhal salpingitis the patient 
 should remain in bed for some time. Adjust the 1st and 3rd 
 lumbar vertebrae. If the case is seen early, cold compresses 
 on the affected side may serve to abort the inflammation. 
 Later hot applications are more useful, together with hot 
 saline douches, and sitz baths every day. In some cases 
 surgical measures are necessary. 
 
 Congestion of the Ovaries 
 
 Etiology. — The primary and predisposing cause of this 
 condition is faulty innervation of the ovaries, whereby the
 
 548 SPINAL ADJUSTMENT 
 
 blood supply therein is increased. Contributing causes are 
 chiefly overwork, especially in young girls at school, together 
 with lack of sufficient exercise and fresh air. 
 
 Symptoms. — The most characteristic symptom of this af- 
 fection is pain in the pelvic region for several days preceding 
 the menstrual period. This pain gradually diminishes, as 
 menstruation becomes established, and finally disappears al- 
 together. The patient is weak and chlorosis is usually 
 present. 
 
 Treatment. — Adjust the 3rd lumbar vertebra. Concussion 
 of the 1st, 2nd and 3rd lumbar vertebrae. The patient should 
 be given a sponge bath every morning, followed by a brisk 
 rub. Candies, and pastries, and highly seasoned foods should 
 be forbidden, and a liberal diet of plain food prescribed. Often 
 it is necessary to remove these patients from school work for 
 some time, and enforce rest and an outdoor life. 
 
 Acute Oophoritis 
 
 Etiology. — Inflammation of the ovaries is due to a great 
 variety of causes, chief among which are extension of an 
 inflammation or infection from the uterus or tubes, such as 
 endometritis, salpingitis, gonorrhea, or septic infection ; dis- 
 turbances of menstruation ; also occurs in the acute eruptive 
 fevers, tuberculosis, and various intoxications. 
 
 Symptoms. — The characteristic sign of this infection is an 
 acute, sharp pain over the iliac region of the afifected side, 
 and radiating down the back and thighs. Accompanying 
 this there is marked tenderness over the inflamed ovaries. 
 Alternating chills and fever, and a rapid pulse are present. 
 
 Treatment. — Adjust the 3rd lumbar vertebra and concuss 
 over the 1st, 2nd and 3rd lumbar vertebrae. The patient 
 should be confined in bed, and an ice-bag should be applied 
 on the affected side, if the condition is seen early, while later 
 on hot applications are more beneficial. The bowels should 
 be cleansed by an enema, and a liquid diet should be 
 prescribed. 
 
 Chronic Oophoritis 
 
 Etiology. — The cause of this condition is faulty innerva- 
 tion of the ovary, due to the continuance of the spinal
 
 GYNECOLOGICAL DISEASES 549 
 
 lesions which were reflexly induced during the course of the 
 acute form, and left uncorrected. Chronic inflammation 
 of the ovary also accompanies amenorrhea and various 
 unnatural acts, in respect to the sexual organs. 
 
 Symptoms. — The characteristic symptoms of this affection 
 are a continuous dragging pain over the affected ovary, and 
 radiating back to the lumbar region, along the spine, and 
 down the thighs. Headache is a constant symptom of this 
 affection. Rectal and vesical irritation are present, and pain 
 is experienced on urination and defecation. If both ovaries 
 are diseased, sterility results. Various forms of neuroses 
 develop, especially hysteria. The menstrual flow is profuse, 
 amounting sometimes to an actual hemorrhage. 
 
 Treatment. — Adjust the 3rd lumbar vertebra, and concuss 
 over the 1st, 2nd and 3rd lumbar vertebrae. During the 
 menstrual period the patient should remain in bed. Hot saline 
 douches should be given twice a day ; the bowels should be 
 regulated by means of enemas. Vaginal massage should be 
 used to prevent adhesion of the ovaries to surrounding 
 structures. Electricity is useful in this condition also. 
 
 Pelvic Peritonitis 
 
 Etiology. — Inflammation of the pelvic peritoneum and cel- 
 lular tissue is commonly a result of an inflammation of the 
 uterus, tubes and ovaries, and most usually a septic inflam- 
 mation of the tubes. Other causes are gonorrhea, and direct 
 septic infection, from unclean hands, instruments, etc. 
 
 Symptoms. — Pelvic peritonitis may be either acute or 
 chronic. In the acute form the onset is sudden, with a chill 
 and pain and tenderness over the hypogastric region. The 
 patient lies in the dorsal position, with the thighs flexed on 
 the abdomen to relieve as much as possible the muscular ten- 
 sion, and thus the pain. The abdomen is distended and 
 tympanitic; there is constipation, irritability of the bladder, 
 and sometimes nausea and vomiting. 
 
 The symptoms of the chronic form of pelvic peritonitis 
 are a dull, aching, dragging pain in the pelvic region, dis- 
 orders of menstruation, leucorrhea, and irritability of the 
 bladder and rectum. 
 
 Treatment. — Adjust the lower dorsal and upper lumbar
 
 550 SPINAL ADJUSTMENT 
 
 vertebrae. Concussion should also be used over the same 
 vertebrae. In acute cases rest in bed is essential, and if the 
 case is seen early, cold applications over the abdomen are 
 useful. Later on, however, hot compresses should be used. 
 A liquid diet should be prescribed, and the bowels cleansed 
 by an enema each day. The chronic form is treated chiefly 
 by adjustments, concussions and massage, together with 
 attention to the general health of the patient.
 
 / 
 
 CHAPTER XIV 
 
 Diseases and Injuries of the Spine and Deformities 
 Scoliosis 
 
 Etiology. — The principal causes of lateral curvature of the 
 spinal column are the following: Rickets in young children 
 may frequently cause a lateral curvature on account of the 
 softened condition of the bones. Occasionally the condition 
 may be congenital, as a result of faulty development of the 
 vertebrae ; frequently it is caused by carrying infants on the 
 one arm and in the same position at all times; other anatom- 
 ical deformities, such as shortness of one leg, dislocation of 
 the hips, genu valgum, contraction of one side of the chest 
 as a result of empyema, and a long standing torticollis ; if 
 the lateral curvature is due to shortening of one of the legs, 
 the pelvis is tilted downward on the side of the shorter limb. 
 and results in a lateral curvature in the lumbar region, with 
 its convexity toward the shortened extremity ; at the same 
 time a compensatory curve forms in the dorsal region in 
 the opposite direction. When the curvature is due to empy- 
 ema, it is located primarily in the dorsal region, with its 
 concavity towards the affected side of the chest. In torti- 
 collis the curve is situated in the cervical region, and a com- 
 pensatory curve follows in the dorsal region. Another fre- 
 quent cause of lateral curvature is standing or sitting in an 
 incorrect position, namely, throwing the weight chiefly on 
 one leg when standing, or leaning constantly to one side 
 while sitting. Another frequent cause of lateral curvature is 
 a depraved systemic condition which is present so frequently 
 about the age of puberty, as a result of rapid growth of the 
 individual, combined with improper food, poor hygienic sur- 
 roundings, or overwork. This deformity of the spine is also 
 seen in young women suffering from chlorosis and amenor- 
 . rhea, whose occupation requires them to do a great deal of 
 lifting. 
 
 Symptoms and Signs. — The nature and extent of the de- 
 
 551
 
 552 SPINAL ADJUSTMENT 
 
 formity varies considerably in different cases. The most coni- 
 mon condition is the presence of two curves, one of which 
 is primary, and is due to the cause of the affection, while the 
 other is a compensatory curve, formed for the purpose of 
 maintaining the upright axis of the body. The form which is 
 usually seen is a curvature in the dorsal region with the 
 convexity toward the right side, and a compensatory curve, 
 in the opposite direction, in the lumbar region. In connection 
 with the lateral displacement of the vertebrae there is present 
 rotation of the vertebrae in the affected region. This rota- 
 tion is toward the side of convexity of the curve. As a direct 
 consequence of this rotation, the spinous processes of the 
 vertebrae are directed away from the convexity, and conse- 
 quently minimize the apparent extent of the deformity. Other 
 portions of the body also participate in the deformity. The 
 ribs on the side towards which the convexity of the curve is 
 directed are separated from each other, and are more promi- 
 nent on that side, as a result of the rotation of the vertebrae. 
 At the same time the ribs on the affected side are depressed^ 
 and the front of the chest consequently is flat. On the oppo- 
 site side the ribs are pressed toward each other, the scapulae 
 are displaced in the same direction that the thoracic wall is, 
 and consequently the shoulder on the side of the convexity 
 of the curve is raised while that on the other side is lowered. 
 On the side toward which the curve is directed, the hip is 
 lower, and sunken in, while on the opposite side the hip is 
 raised and thrown out. The erector spinae muscle on the 
 side of the concavity of the curve stands out very prominent- 
 ly, and the transverse processes on this side are also plainly 
 seen in many cases. In the early stages of the condition the 
 spine may be made to appear perfectly straight by extension 
 of the trunk ; as the condition progresses, however, ankylosis 
 slowly develops, and the curve becomes fixed. 
 
 Treatment. — The first requisite in the treatment of these 
 cases is the determination of the cause, and measures directed 
 towards removal thereof. If, for example, it is found that the 
 condition is due to general debility, the patient's health must 
 be improved by means of a nutritious diet, well regulated 
 exercises, baths, and massage. If the condition is due to 
 faulty habits of standing or sitting, these must be corrected.
 
 INJURIES OF SPINE AND DEFORMITIES 553 
 
 Again, if it is clue to shortening of one of the limbs, 
 it will be necessary to wear a high-heeled boot until the 
 manipulations of the spine and adjustments have restored it 
 to its normal position. 
 
 Kyphosis 
 
 Etiology. — An increase of the dorsal convexity of the 
 spine is very frequently associated with a marked increase 
 in the lumbar curve, so that lordosis is present, which is a 
 compensatory curve. 
 
 This condition is seen frequently in various diseases of the 
 spinal column, especially tuberculosis, syphilis and cancer. 
 It also follows fractures of the spine. It is seen frequently 
 in children, under the age of five years, and is in such cases 
 a result of rickets. In youthful persons, up to the age of 
 eighteen, it is commonly known as round-shoulders, and is 
 brought about by a continuous habit of bending forward, as 
 in reading or writing. Different occupations predispose to 
 this form of deformity, such as those which necessitate the 
 carrying of heavy loads, or work which requires constant 
 stooping forward. In the aged it is a compensatory curve 
 to prevent the complete closure of the intervertebral fora- 
 mina, the vertical diameter of which is markedly diminished, 
 by the compression of the intervertebral discs. 
 
 Symptoms. — The symptoms of this condition have been 
 described in the chapter dealing with the various forms of 
 subluxation, and the reader is referred to that chapter. 
 
 Treatment. — In many cases ankylosis of the vertebrae has 
 taken place, and in such it is not advisable to attempt to break 
 the ankylosis. This is especially true if the spinal deformity 
 is a result of tuberculosis. In many of these cases the focus 
 of tuberculosis is still present, though not active, and attempts 
 at breaking the ankylosis very often produce a reaction of 
 inflammation and again light up an active tuberculosis. In 
 the aged, a kyphotic curve is really physiological, and should 
 not be interfered with. When due to various occupations, its 
 occurrence has been so gradual, and the curves of the spine 
 have adapted themselves to the changed position, and it is 
 therefore inadvisable to attempt to change them. Where 
 ankylosis has not occurred, it is possible to do a great deal 
 toward the correction of this deformity by means of exten-
 
 554 SPINAL ADJUSTMENT 
 
 sion. At the same time individual subluxations should be 
 corrected as indicated. In some cases surgical measures are 
 indicated. 
 
 Round Shoulders 
 
 Etiology. — This condition is seen most commonly in 
 young girls who have grown very rapidly, and developed 
 early. It is usually brought about by faulty habits of stand- 
 ing or sitting, while defective vision and adenoids may also 
 be producing factors. The spine becomes bent forward in 
 the lower cervical and upper dorsal region, while the 
 shoulders are also thrown forward and the chest is narrowed. 
 
 Treatment. — The first essential in the treatment is to as- 
 certain the cause of the condition and correct it. The general 
 health must receive attention, and plenty of fresh air and a 
 good, nourishing diet must be provided. Girls aflfected in 
 this way should never exercise to excess, and should spend 
 several hours a day in the dorsal position ; at night they 
 should lie on the back with a pillow placed beneath the curve. 
 The muscles of the back should be strengthened by means of 
 electricity, massage and well-directed exercises. Extension 
 is a very good adjunct measure in these cases. 
 
 Lordosis 
 
 Etiology. — Lordosis is seen most commonly in the lumbar 
 region of the spine. It is commonly a compensation curve 
 in cases of kyphosis. It is very often due to congenital dis- 
 location of the hip, or to diseases of the hip-joint. A physi- 
 ological lordosis occurs in pregnancy ; large fibroid tumors 
 of the uterus also occasion this curve, owing to the necessity 
 of the patient throwing backward the upper part of the spine, 
 in order to maintain the center of gravity of the body. A 
 similar condition is produced in the same way in individuals 
 with a large, pendulous abdomen. 
 
 Treatment. — The measures outlined under scoliosis apply 
 in general to this condition also, various forms of manipulation 
 being essential in the treatment. 
 
 Spondylolisthesis 
 Etiology. — This is a deformity in which the lumbar group 
 of vertebrae are displaced forward and downward upon the 
 sacrum. Most commonly the 5th lumbar alone is thus dis-
 
 INJURIES OF SPINE AND DEFORMITIES 555 
 
 placed, which, in reality, constitutes a true anterior subluxa- 
 tion of this vertebra. When, however, the term "Spondy- 
 lolisthesis" is used, it is meant to imply that the entire group 
 of lumbar vertebrae are displaced anteriorly and downward. 
 The condition is most commonly produced by the carrying of 
 heavy loads upon the shoulders, which fact explains the man- 
 ner of correction of an anterior displacement of the 5th lumbar 
 vertebra, by the Bohemian shoulder-thrust method. The in- 
 creased weight of the uterus during pregnancy may also 
 produce this deformity. 
 
 Symptoms. — There is a diminution in the height of the 
 individual, and a depression is present above the sacrum, 
 while at the same time the lumbar group of vertebrae are 
 seen displaced anteriorly. Weakness of the lower part of the 
 back, and neuralgic or rheumatic pains are present. 
 
 Treatment. — The classical treatment of this affection is 
 
 by spinal adjustment. When only the 5th lumbar vertebra 
 
 is afifected, a thrust upon the sacrum towards the feet may 
 
 alone suffice to correct it. Sometimes an adjustment of 
 
 the 4th lumbar vertebra in the direction of the head is also 
 
 necessary. In connection with this treatment, traction 
 
 and prolonged rest may also be of assistance in obstinate 
 
 cases. 
 
 Sprains of the Spine 
 
 Etiology. — Sprains of the spine are exceedingly common 
 injuries, and are responsible for a great number of the sub- 
 luxations, which subsequently are followed by a train of dis- 
 eases and disorders, whose nature depends upon the region 
 of the spine afifected. They are produced by any sudden or 
 unlooked-for movements, such as falls, jars, twists, and other 
 movements. The cervical and lumbar regions of the spine 
 are most apt to be afifected by sprains. In some cases no 
 actual subluxations are produced, and the injury is simply 
 ligamentous at the commencement, but later on spinal lesions 
 are produced, as a result of the contraction of the ligaments 
 on one side. 
 
 Symptoms. — The characteristic symptoms are those of 
 subluxation, namely, displacement of a vertebra, contraction 
 of the ligaments, local heat, tenderness of the nerve, and 
 possibly thickening of the nerve trunk. There may also be
 
 556 SPINAL ADJUSTMENT 
 
 evidences of trauma, and especially bruising of the surface, 
 and swelling of the soft tissues. Sprains of the spine may be 
 very simple, or they may be extremely severe ; thus merely 
 the muscles and the interspinous ligaments may be involved, 
 and no further disorders follow. On the other hand the liga- 
 menta subflava may be torn and the spinal canal laid open, 
 in which case grave symptoms will follow by reason of the 
 blood finding its way into the spinal canal, and producing 
 pressure upon the cord. In persons of a tuberculous diathe- 
 sis, Pott's disease may develop. Sprains of the cervical por- 
 tion of the spine are usually a result of violent blows upon the 
 head, and as a result of rupture of the intertransverse liga- 
 ment, marked displacement of the vertebrae may be occa- 
 sioned, and is sometimes so severe as to resemble an actual 
 dislocation. The head and neck are held perfectly rigid, and 
 the patient is unable to move the head in any direction. 
 Sprains in the lumbar region of the spine are seen very fre- 
 quently in railway injuries, and are also a result of over- 
 lifting. In these cases the back is held rigid, and the patieht 
 is unable to turn or bend forward or stoop without 
 experiencing severe pain. 
 
 Treatment. — If the patient is seen early after the injury 
 has occurred, absolute rest is indicated and hot applications 
 should be used over the afTected parts of the back. As soon 
 as inflammation has subsided, and the pain has diminished, 
 spinal adjustments should be used as indicated. This should 
 be followed by the use of massage. In aggravated sprains 
 which involve the cord, cold compresses should be used con- 
 stantly, and the patient placed in a prone position. In all 
 cases adjustment should be made as soon as possible after 
 the occurrence of the injury. 
 
 Dislocations of the Spine 
 
 Etiology .^ — A dislocation of the spine is a complete sepa- 
 ration of its articular processes, and all its contiguous sur- 
 faces. It differs from a subluxation in this, namely, that in 
 the latter there is only a partial displacement of the contigu- 
 ous surfaces. Many dislocations are accompanied by frac- 
 ture ; in the cervical region, however, a pure dislocation can 
 occur without being associated with a fracture. The reason
 
 INJURIES OF SPINE AND DEFORMITIES 55/ 
 
 that dislocations may occur in the cervical region without 
 fracture is due to the shape and placement of the articular 
 processes, which in this region are flat, and slope backward 
 and forward, and look upward and downward, so that it 
 is easily possible for one to slip over the other. In the dor- 
 sal region, and lumbar region, however, complete dislocation 
 without fracture is scarcely possible, for the reason that in 
 the dorsal region the surfaces of the articular processes are 
 nearly vertical and look forward and backward ; in the lumbar 
 region they are also placed vertically, and are directed 
 inward and outward respectively, and fit into each other very 
 accurately. 
 
 Since a pure dislocation is seen most commonly only in 
 the cervical region, dislocations of the dorsal and lumbar 
 region will not be considered here, but will be described under 
 the consideration of fractures of the spine. A dislocation 
 may be located in any part of the cervical region ; thus, the 
 atlas may be displaced from the occipital bone, and if com- 
 plete, death results at once. A dislocation between the atlas 
 and axis is the common cause of death in hanging, and also 
 occurs following blows on the neck ; in nearly all these cases 
 the transverse ligament is torn, or the odontoid process is 
 fractured, death resulting from compression of the medulla. 
 Any of the other five cervical vertebrae may be displaced 
 from each other, most commonly the 5th and 6th. It is 
 usually produced by violent bending backward of the head 
 and neck, in connection with rotation, in which case the injury 
 to the surrounding soft parts is very extensive. 
 
 Dislocation of this kind may involve either one side of 
 the aflfected vertebrae, or it may be bi-lateral. 
 
 Symptoms. — In a unilateral dislocation the head is turned 
 away from the dislocated side, and is held rigid, and no 
 symptoms of injury of the cord are present. The consequent 
 pressure of the margins of the intervertebral foramina upon 
 the nerves, produces prickling sensations, and neuralgic pain 
 along the course of the nerves. The spinous processes of the 
 affected vertebrae are displaced to one side, and the trans- 
 verse processes are similarly affected. If the condition is not 
 corrected at once, it becomes permanent and various disorders 
 ensue, depending upon the location of the dislocation.
 
 558 SPINAL ADJUSTMENT 
 
 In a bi-lateral dislocation there are always present symp- 
 toms of pressure upon the cord, such as paraplegia. 
 
 Treatment. — In severe cases the patient should be anaes- 
 thetized in order to produce complete relaxation of the sur- 
 rounding ligaments. The dislocation is then corrected by 
 the characteristic chiropractic thrust. 
 
 Fractures of the Spine 
 
 Etiology. — Fractures of the spine are a result of direct 
 or indirect violence. They are of two kinds, complete and 
 incomplete. Complete fractures are usually associated with 
 dislocation, and are often referred to as fracture-dislocations. 
 
 Complete fractures may be produced by direct or indirect 
 violence. The lesions produced may be of various kinds : 
 Any portion of the body of the vertebra may be fractured, or 
 the injury may involve any of the processes of the vertebra. 
 The lower fragment is usually fixed, while the upper frag- 
 ment is movable and is forced forward over the lower. In 
 nearly all cases the spinal cord is seriously injured by being 
 crushed. In some cases, however, the injury consists merely 
 in a puncturing of the meninges by a splinter of bone, or it 
 may consist in a hemorrhage of the meninges. 
 
 Incomplete fractures are of various kinds, and are usually 
 due to direct violence. Fracture of the spinous processes 
 occurs most commonly in the lower cervical and in the dorsal 
 regions of the spine. In the cervical region the upper cervical 
 spinous processes are very short, while in the lumbar region 
 they are also short and in addition to this fact, are very 
 strong. Fracture of the laminae is not unusual; if both lam- 
 inae are fractured there is a forward displacement of the up- 
 per fragment and a crushing injury of the spinal cord en- 
 sues. If only one lamina is fractured, the cord is usually left 
 uninjured, and the signs of the fracture are indistinct. Frac- 
 ture of the transverse processes alone is an uncommon injury. 
 Fractures of the bodies of the vertebrae when incomplete, 
 are accompanied by no displacement of the fractured portion, 
 and little after effects result. 
 
 Symptoms. — The signs of a complete fracture are pain. 
 swelling, deformity, crepitation, shock and paraplegia. The 
 signs of incomplete fracture are pain, swelling, increased mo-
 
 INJURIES OF SPINE AND DEFORMITIES 559 
 
 bility, and sometimes crepitation, together with mal-alignment 
 of the spinous processes in some instances. 
 
 Treatment. — The treatment of a complete fracture con- 
 sists first of all in placing the patient on a hard bed, which 
 is perfectly level. When the patient is seen immediately 
 after the injury has occurred, the greatest care should be ex- 
 ercised in moving him so as not to aggravate the displace- 
 ment of the fractured portions. Severe shock should be 
 treated by the use of warm application's and stimulants. When 
 the reaction of inflammation and the severe pain have some- 
 what subsided, a careful analysis of the spine should be made. 
 In some cases an adjustment under an anesthetic will suffice 
 to replace the fractured fragments. Following this complete 
 rest in bed should be had for a long period of time, during 
 which careful attention should be given to the condition of the 
 skin, bowels and bladder. The tendency toward bed-sores is 
 marked, and everything should be done to harden the skin, 
 and thus prevent their occurrence. The bladder is very often 
 paralyzed, and the urine must be withdrawn by means of a 
 catheter. The bowels have a tendency toward constipation 
 and daily enemata are necessary. 
 
 The treatment of incomplete fractures consists chiefly in 
 keeping the patient at rest for a prolonged period, during 
 which time union of the fractured portions take place. 
 
 Tuberculosis of the Spine (Pott's Disease) 
 
 Etiology. — Tuberculosis of the spine is caused primarily 
 by a low grade of resistance, due to faulty innervation, by 
 reason of which the individual is predisposed to the con- 
 tributing causes of the disease, which are infection by tubercle 
 bacilli. Usually the actual occurrence of the disease process 
 dates from the time of an injury; this injury may not be 
 sufficient to occasion any trouble at the time, and no symp- 
 toms may develop until six months to a year after the occur- 
 rence of the traumatism. Tuberculosis of the spine is seen 
 most commonly in children, but may occur at any age. It 
 may afifect any portion of the spinal column, though the lower 
 dorsal region is most commonly involved. 
 
 Pathology. — The disease process commences in the bodies 
 of the vertebrae, and spreads to neighboring vertebrae either
 
 560 SPINAL ADJUSTMENT 
 
 along the under surface of the anterior common ligaments, or 
 by way of the intervertebral discs. When the process ex- 
 tends along the anterior common ligaments many vertebrae 
 may be afifected, and the deformity which results is in the 
 nature of a kyphosis. When the process extends along the 
 intervertebral discs, it is not so extensive, fewer vertebrae 
 are involved, and an angular deformity results. The active 
 process is finally terminated by the bodies of the vertebrae 
 collapsing and becoming ankylosed, resulting in a deformed 
 and immovable condition of the involved portion of the spine. 
 
 Symptoms. — The characteristic symptoms of Pott's disease 
 are pain, which is continuous, and of two kinds : First, a 
 local pain which is experienced at the site of the lesion and 
 is of a boring nature ; second, referred pain, which is felt at 
 the terminals of the spinal nerves which are impinged as they 
 emerge through the intervertebral foramina. Spinal rigidity 
 is a constant symptom of Pott's disease, and in the early stages 
 is due to the muscular contraction, which accompanies the 
 local inflammation. In all cases deformities result, as above 
 described, the patient's stature is much diminished, the 
 sternum is thrown forward, the upper ten ribs are approxi- 
 mated so that the intercostal spaces are practically obliterated, 
 while the lower two ribs are in their normal position, and a 
 horizontal groove is thus formed on a line with the 10th rib. 
 The most serious efifects of tuberculous disease is abscess 
 formation. The abcess is not felt until it has reached a con- 
 siderable size and has burrowed for some distance into sur- 
 rounding structures and parts. 
 
 Treatment. — The treatment of Pott's disease consists in 
 complete immobilization of the spine, together with the ap- 
 plication of a mechanical support, which has for its object the 
 removal of the weight of the body from the affected portion 
 of the spine. For the technique of the various methods of 
 immobilizing the spine, the reader is referred to text-books 
 on surgery. 
 
 Syphilitic Disease of the Spine 
 
 Symptoms. — Syphilis of the spine occurs in the tertiary 
 stage of syphilis, and consists in the deposition of gummata 
 on the bodies of the vertebrae beneath the periosteum. The 
 general symptoms are similar to those of tuberculosis of the
 
 INJURIES OF SPIxNE AND DEFORMITIES -561 
 
 spine. The lesion occurs most commonly in the cervical 
 region of the spine. 
 
 Treatment. — The treatment consists in the use of elimina- 
 tive measures, rest, and the application of a spinal support. 
 
 Rheumatic Spondylitis 
 
 Etiology. — This condition is the same as that occurring in 
 any portion of the body affected by rheumatism. The liga- 
 ments and muscles of the spine are usually afifected, although 
 the intervertebral discs may also be the seat of rheumatic in- 
 flammation. It is most commonly noted in the cervical region. 
 
 Symptoms. — The movements of the head and neck are 
 much impaired, and lateral deflection of the neck, such as 
 occurs in torticollis, is often present. In cases which are left 
 untreated, ankylosis finally develops. 
 
 Treatment. — The treatment is the same as that for rheu- 
 matism in any portion of the body. 
 
 Osteoarthritis of the Spine 
 
 Symptoms. — Osteoarthritis may afifect the entire vertebral 
 column, and ankylosis usually occurs. In most cases kyphosis 
 develops, and intense pain is present due to the pressure of 
 the bony outgrowths upon the nerve roots. The condition 
 may remain confined to the spine or may extend to othei 
 portions of the body. 
 
 Treatment. — The treatment of osteoarthritis of the spine 
 
 is the same as that of the disease in other portions of the 
 
 body. 
 
 Acute Osteomyelitis of the Spine 
 
 Etiology. — The primary and predisposing cause of this 
 afifection is a low-grade of resistance due to faulty innerva- 
 tion. The direct cause is an infection with pus-producing 
 organisms, in the face of this low resistance. 
 
 Symptoms. — The characteristic symptoms of osteomyelitis 
 of the spine are pain of an intense and boring character in the 
 afifected portions of the spine and radiating over the back ; 
 alternating chills and fever; early in the course of the disease 
 abscesses develop, which may burrow into the spinal canal, 
 which is a common complication. 
 
 Treatment.— The treatment of this aifection is limited to 
 surgical measures.
 
 562 SPINAL ADJUSTMENT 
 
 Genu Valgum (Knock-knee) 
 
 Etiology. — There are two varieties of this deformity: 
 First, that form which is seen in young children, and which 
 is due to rickets; second, that form which is seen in individ- 
 uals under the age of 20 years, and which is due to general 
 debility, and in addition is brought about by the carrying of 
 heavy weights, being seen especially in nurse-maids, janitors, 
 etc. 
 
 Symptoms. — The thighs approach each other until the 
 knees touch, while the patellae look forward, and at the same 
 time the legs are in a state of fixed abduction. One or both 
 limbs may be affected, although if the condition is due to 
 general causes, both limbs are usually affected. 
 
 Treatment. — In children suffering from rickets the treat- 
 ment is confined principally towards the correction of that 
 disease. For this purpose plenty of fresh air, hygenic meas- 
 ures, and a nourishing diet are indicated. At the commence- 
 ment of the treatment the patient should be confined to bed, 
 and massage, passive movements, and manipulation used in 
 order to straighten the limb. At the same time general ad- 
 justments should be given. When the deformity has existed 
 for a long time, or is very marked, various corrective ap- 
 pliances or even surgical measures are necessary to produce 
 a cure. 
 
 Talipes (Club-foot) 
 
 Etiology. — This deformity may be either congenital or 
 acquired. 
 
 The congenital form may result from faulty development 
 of the bones of the foot or leg, or from a deficiency in the 
 amount of the amniotic fluid, as a result of which the feet are 
 held in one position. This form is often hereditary and is 
 seen in several members of one family. 
 
 The acquired form is frequently due to infantile paralysis, 
 contraction of muscles following burns or infection, long con- 
 tinued spasm of the muscles, shortening of the leg from hip 
 or knee disease, the habit of standing with the foot in an 
 awkward position, and diseases of the main peripheral nerves. 
 
 Symptoms. — Four main forms of Talipes are commonly 
 seen: First, Talipes Varus, in which the front half of the
 
 INJURIES OF SPINE AND DEFORMITIES 563 
 
 foot is adducted, while its inner side is elevated, the patient 
 thus walking on the outer side. Second, Talipes Valgus, in 
 which the front half of the foot is adducted and turned out, 
 so that the patient walks on the inner side of the foot. Third, 
 Talipes Equinus, in which the heel is drawn up, so that the 
 patient walks on the toes. Fourth, Talipes Calcaneus, in 
 which the toes are raised from the ground, and the patient. 
 walks on the heel. Various combinations of these forms may- 
 be seen. 
 
 Treatment. — In the congenital variety treatment should 
 be commenced as soon after birth of the child as possible. 
 The foot must be manipulated daily into a good position, in 
 addition to which forcible attempts should be made at cor- 
 rection. The muscles of the foot and leg should be massaged 
 thoroughly, and the faradic current should be used. Later 
 on mechanical appliances and the use of surgical measures 
 are often necessary. When the condition is due to infantile 
 paralysis, general adjustments, massage, and electrical treat- 
 ments are the proper measures to be used. The other form 
 should be corrected by manipulation, massage, electricity and 
 adjustments, and those cases which will not respond to this 
 method of treatment should be referred to the surgeon. 
 
 Flat-foot 
 
 Etiology. — This deformity is seen chiefly in young adults 
 whose occupation requires them to spend long hours standing 
 on the feet. It is also a result of a general muscular relaxa- 
 tion and loss of tone which follows debilitating diseases. It 
 is seen more commonly in long than in short feet, and it seems 
 to be a natural condition among some of the negro races. 
 
 Symptoms. — In the early stages of the condition the 
 patient complains of weakness and fatigue along the inner 
 side of the foot or ankle. Later on the gait becomes shuffling 
 and marked pain is present over the entire foot. The sole of 
 the foot is flat, and in advanced cases is in contact with the 
 floor throughout its entire extent. A diagnosis of the con- 
 dition can readily be made by having the patient stand on a 
 piece of smoked paper, and obtaining the imprint of the foot. 
 
 Treatment. — In the early stages, before the deformity has 
 become fixed, the first consideration is rest of the affected
 
 564 SPINAL ADJUSTMENT 
 
 feet. This permits the exhausted and over-strained ligaments 
 and muscles to regain their normal strength and tonicity. At 
 the same time the parts should be thoroughly massaged and 
 manipulated, in order to build up the arch of the foot again. 
 Exercises should be used, the best of which consist in having 
 the patient raise himself on the toes, and move up and down 
 20 times without permitting the heels to strike the floor. 
 This should be done every morning and has for its object the 
 strengthening of the plantar muscles. In addition to these 
 measures of treatment, adjustments in the lumbar region 
 often prove wonderfully successful. The patient should wear 
 proper shoes, and if necessary, an arch should be inserted to 
 support the foot. If the deformity is fixed, surgical measures 
 may be necessary to forcibly correct it. 
 
 Torticollis 
 
 Etiology. — Torticollis or Wry-neck is a deformity due 
 primarily to a contraction of the sterno-mastoid and trapezius 
 muscles of one side, as a result of irritation of the nerves 
 which control them. It is secondarily due to exposure tc 
 cold, rheumatism, and hysteria. 
 
 Symptoms. — The affected side of the head is drawn down 
 toward the shoulder, and at the same time the face is turned 
 away therefrom. The cervical portion of the vertebral column 
 is scoliotic, with the concavity of the curve directed toward 
 the afifected side. Coincidently with this, a compensation 
 curve forms in the dorsal region, which is chiefly for the pur- 
 pose of maintaining the eyes at the same level. Later on 
 the muscles of the affected side of the face and neck become 
 atrophied. 
 
 Treatment. — Adjust the cervical vertebrae. Massage and 
 electricity are useful adjunct measures in these cases. 
 
 Diseases of the Joints 
 
 For a detailed discussion of the various diseases of the 
 joints, the reader is referred to text-books on surgery. It 
 may, however, be mentioned in this connection, that spinal 
 adjustment is often extremely successful in the treatment of 
 various joint affections, and should in all cases be given a 
 thorough trial.
 
 CHAPTER XV 
 
 Diseases of the Skin 
 
 Many of these cases belong to the specialist, and should 
 be referred to a dermatologist. There are a number of 
 dermatoses however, which respond to methods of therapy 
 other than the use of drugs and these can be successfully 
 managed by the general practitioner. 
 
 In the consideration of this subject it will be necessary to 
 confine ourselves to generalities since it is obviously im- 
 possible in a work of this nature to give a detailed description 
 of each disease. Skin diseases have been so minutely classified 
 and so variously named that skill in diagnosis of each individ- 
 ual disease can be acquired only by long experience. 
 
 The treatment of these diseases is identical in many cases, 
 and varies with the nature of the local lesions, the acuteness 
 or chronicity of the condition, and whether systemic or local 
 in origin ; symptomatic therapy is often indicated. 
 
 Etiology. — Diseases of the skin are due to a great variety 
 of causes, the most important of which is subluxation of the 
 vertebrae by which the innervation of the skin is made de- 
 ficient. As a result of this, it sufifers nutritional disturbances, 
 its functional activity is impaired, and the low grade of re- 
 sistance which is thereby induced, renders it susceptible to 
 the invasion of the contributing causes, which are as follows: 
 
 The contributing or exciting causes of skin diseases are 
 of two classes: First, internal; second, external. 
 
 The internal causes of dermatoses are, first, drugs, foods, 
 bacteria, and infections. Second, various neuroses, reflex 
 nervous derangements and emotional disorders. Third, nu- 
 tritional disturbances. 
 
 The external causes of skin diseases are chemical, thermal, 
 mechanical, and parasitic. 
 
 Other predisposing causes to various dermatoses in addi- 
 tion to general impairment of the health as a result of subluxa- 
 
 565
 
 566 SPINAL ADJUSTMENT 
 
 tions are, first, age; second, sex; third, nationality or race; 
 fourth, climate and seasons; fifth, occupation and mode of 
 living; sixth, susceptibility, predisposition, diathesis, or 
 idiosyncracies of the individual. 
 
 Symptoms and Diagnosis. — "Extent of surface involved — 
 In making the general inspection, attention must also be paid 
 to the amount of surface involved and to the localities occupied 
 by the eruption. In addition to the illustration just given, it 
 should be recalled that exanthemas usually cover the whole 
 body; that the early syphilids are w^idely distributed; that 
 acne is seated upon the face and shoulders ; that psoriasis is 
 likely to be symmetrically disposed ; and that tinea versicolor 
 is found on the trunk, xanthoma on the lids, lupus and 
 epithelioma generally on the face, and lupus erythematosus 
 on the nose and cheeks. 
 
 Arrangement of Lesions. — It is important to know whether 
 the lesions occupy one or both sides of the body, and whether 
 they possess any special arrangement. For example, in zoster 
 the eruption is unilateral and the eruptive elements follow the 
 course of cutaneous nerves, displaying clusters of vesicles on 
 a red base. In ringworm the lesions afifect a ringed arrange- 
 ment, and extend at the periphery while clearing in the center. 
 This disposition is also to be noted in psoriasis and in some 
 syphilids; herpes iris is annular. Moreover the eruption in 
 syphilis is often grouped — a feature also to be observed in 
 dermatitis herpetiformis ; but the first-mentioned afifection 
 presents no marked subjective symptoms, whereas in the 
 latter there are intolerable itching and burning. 
 
 Color. — The color of an eruption is often at least an 
 auxiliary aid to diagnosis. The brownish-red or ham color 
 of some syphilids differs from the underlying brighter red of 
 psoriasis, and it also may be said that the thick greenish 
 crusts of syphilis are fairly characteristic. The favus cups 
 are sulphur-yellow ; the patches of tmea versicolor are of a 
 fawn-tint; keloidal tumors are pinkish; and the new growths 
 of xanthoma are buflf-colored. In the same way the shade of 
 color presented by an inflammation of the skin will measur- 
 ably indicate its acute or chronic character. 
 
 Touch. — The affected skin should also be pinched up be- 
 tween the fingers, or in order to get as accurate an idea as
 
 DISEASES OF THE SKIN 567 
 
 possible of the amount of infiltration present, the special 
 tissues involved, the temperature, the presence or absence of 
 fluctuation, etc. An account of the symptoms revealed by the 
 educated touch will often determine whether a disease is 
 superficial or deep-seated, and thus eliminate whole groups 
 of disorders from the field of discussion. 
 
 Odor. — The odors arising from certain diseases of the 
 skin are at times helps to their diagnosis. Favus has a pecu- 
 liar mouse-nest smell ; syphilitic ulceration emits a nauseating 
 stench that is suggestive ; while the smell of gangrene is well 
 recognized. 
 
 Acute or Chronic. — The objective aspect of the disease is 
 indicated by these terms rather than the time occupied in its 
 development, the latter point receiving notice more particu- 
 larly when the previous history of the case is under inquiry. 
 For example, an eczema may have an acute appearance 
 although a long time in existence, while a syphilid may be of 
 recent origin yet lack all evidence of acuteness. Any changes 
 that may have occurred, such as crusting, scarring and the 
 like, should be carefully noted, and the extending or outer 
 margin of a patch should be especially observed, as often in 
 this way we may detect the primary lesions (e. g., in lupus) 
 of an eruption that has been disguised by complications of 
 treatment. 
 
 Individual Lesions. — It so happens that diseases of the 
 skin, whatever may be their cause or nature, impress them- 
 selves upon the integument by certain elementary forms called 
 primary lesions, which have been justly termed the alphabet 
 of dermatology ; and there are also to be observed certain 
 other manifestations that are partly the sequels of the initial 
 processes or are the efifect upon them of traumatism — these 
 are termed secondary lesions. The primary lesions consist 
 of macules, papules, vesicles, blebs, pustules, tubercles, wheals 
 and tumors. 
 
 Macules are discolored patches of skin, of variable shape 
 and size, without elevation or depression. 
 
 Papules are circumscribed solid elevations of the skin, 
 varying in size from that of a pinhead to that of a pea. 
 
 Vesicles are pinhead-sized to a pea-sized circumscribed 
 elevations of the epidermis, containing clear or opaque fluid.
 
 568 SPINAL ADJUSTMENT 
 
 Blebs are round or irregular shaped pea-sized to egg-sized 
 elevations of the epidermis, containing clear or opaque fluid. 
 
 Pustules are circumscribed, flat, or accuminate elevations 
 of the epidermis, containing pus. 
 
 Wheals are edematous, circumscribed, irregular, pinkish 
 elevations of the skin, transitory in character. 
 
 Tubercles are circumscribed, solid, deep-seated elevations 
 of the skin, attaining or exceeding the size of a pea. 
 
 Tumors are variously sized and shaped prominences, hav- 
 ing their seat in the coTium or subcutaneous tissue. 
 
 The secondary lesions comprise scales, crusts, excoriations, 
 fissures, ulcers, scars, and stains. 
 
 Scales are dry epidermal exfoliations shed from the sur- 
 face of the skin. 
 
 Crusts are brownish or yellowish masses of dried exuda- 
 tion. 
 
 Excoriations are epidermal denudations, usually the result 
 of local traumatism. 
 
 Fissures are linear cracks or wounds in the epidermis or 
 corium due to disease or injury. 
 
 Ulcers are round or irregular losses of tissue involving 
 the skin and subcutaneous tissue. 
 
 Scars are connective tissue new formations occupying the 
 region of former losses of tissue. 
 
 Stains are discolorations of the skin left after the disap- 
 pearance of cutaneous lesions. 
 
 While it is absolutely necessary for one desiring a knowl- 
 edge of dermatology to know thoroughly these pathologic 
 processes, it is not claimed that the recognition of a primary 
 or secondary lesion will immediately give a clue to the diag- 
 nosis ; for it is well known that these lesions are due to the 
 most varied morbid states, and that the same kind of lesions 
 will often be found in very dissimilar diseases. If, however, 
 the type of the lesion has been determined, at least the field 
 of investigation has been considerably narrowed. For in- 
 stance, it is of decided advantage to be aware that in herpes 
 zoster there are vesicles and not tubercles ; that in a disorder 
 presenting macules we have not to deal with pemphigus or 
 acute urticaria, for these afifections are characterized by an 
 entirely different order of lesions. The same reasoning holds
 
 DISEASES OF THE SKIN 569 
 
 good, in a measure, for secondary lesions, such as crusts, 
 ulcers, scars, scales, etc. 
 
 Macules occur in chloasma, eczema, erysipelas, roseola, 
 rubeola, scarlatina, rotheln, erythema, ephelis, leukoderma, 
 melanoderma, tinea versicolor, syphilis, xanthoma, purpura, 
 naevus pigmentosus, and morphea. When a large portion 
 or the entire skin is involved by change of color, it is known 
 as a discoloration ; such, for example, as is seen in Addison's 
 disease, leprosy, and argyria. 
 
 Papules are observed in acne, milium, comedo, eczema, 
 lichen, prurigo, in certain kinds of purpura and urticaria and 
 in variola, keratosis pilaris, ichthyosis, and miliaria papulosa. 
 The eruptions of measles and rotheln are really maculopapular 
 in character. In syphilis the papule is often surmounted by a 
 scale. 
 
 Tubercles are found in connection with syphilis, leprosy, 
 parasitic sycosis, acne, molluscum epitheliale, and lupus. 
 
 Tumors exist in carcinoma, sarcoma, syphilis, elephantia- 
 sis, angioma, keloid, lipoma, fibroma, and erythema nodosum. 
 
 Vesicles are present in eczema, herpes, vaccinia, sudamen, 
 miliaria, varicella, dermatitis, dysidrosis, scabies ; vesicopus- 
 tules are observed in impetigo contagiosa, the vesicular 
 syphilid, etc. 
 
 Blebs occur in pemphigus, hydroa, erysipelas, herpes iris, 
 leprosy, syphilis and dermatitis. 
 
 Pustules are encountered in acne, variola, ecthyma, equinia, 
 impetigo, scabies, syphilis, sycosis, dermatitis, and pustula 
 maligna. 
 
 Wheals are found in connection with irritable states of 
 the skin, such as occur from the bites of insects and most 
 typically in urticaria, and also in some degree with purpura 
 and erythema multiforme. 
 
 Scales are observed in psoriasis, eczema, pityriasis rubra, 
 exfoliative dermatitis, scarlet fever, measles, seborrhea, the 
 vegetable parasitic afifections, and ichthyosis. 
 
 . Crusts are to be found in eczema, syphilis, scabies, 
 ecthyma, scrofuloderma, leprosy, impetigo, carcinoma, sebor- 
 rhea, herpes zoster, and sycosis. 
 
 Fissures occur in eczema, psoriasis, syphilis, ichthyosis, 
 verruca.
 
 570 SPINAL ADJUSTMENT 
 
 Excoriations are to be seen in prtiriginous disorders, such 
 as eczema, pruritis, pediculosis, scabies, etc. 
 
 Ulcers appear as sequels to the lesions of syphilis, lupus, 
 boils, carbuncles, eczema, herpes zoster, scrofulo-derma, 
 epithelioma, sarcoma. 
 
 Scars come in the wake of ulcerative skin-diseases ; e. g., 
 lupus vulgaris, syphilis and lupus erythematosus. 
 
 Having now closely observed all that the eye, the touch, 
 the sense of smell, etc., can reveal — in other words, having 
 made, free from preconceived notions, a thorough study of 
 the objective symptoms present — we are better prepared to 
 ascertain the general history of the case, to obtain an account 
 of the patient's own sensations, and, finally, to make use of 
 the various collateral methods of diagnosis that science has 
 placed at our disposal. 
 
 Locality. — Many diseases have distinct predilections for 
 special localities. Psoriasis elects the scalp and the extensor 
 surfaces of the elbows and knees. Eczema may occur any- 
 where, but prefers the flexor surfaces. The excoriations of 
 pediculosis corporis are seen across the shoulder-blades and 
 around the waist. Acne attacks the face and chest. The 
 lesions of scabies are quite constantly present on the webs 
 and sides of the fingers, the flexor surfaces of the wrists, the 
 anterior and posterior axillary folds, the nipples, the umbilicus, 
 the penis, the buttocks, the inner sides of the thighs and legs, 
 and the toes (in infants). The face is always exempt, except 
 in infants. Erythema multiforme attacks the face, the neck, 
 and the back of the hands and feet. Erythema nodosum is 
 usually situated on the anterior surfaces of the tibias. The 
 proneness of common afifections to attack special localities 
 is indicated in the following list : 
 
 Scalp — Eczema, ringworm, pediculosis capitis, favus, 
 seborrhea, alopecia areata. 
 
 Face — Acne, eczema, lupus vulgaris, lupus erythematosus, 
 syphilis, impetigo, sycosis. 
 
 Chest — Tinea versicolor, seborrheic eczema, macukr 
 syphiloderm, acne. 
 
 Shoulders and Back — Acne, carbuncle, pediculosis corporis. 
 
 Buttocks — Furuncles, scabies, congenital syphilis, eczema 
 intertrigo.
 
 DISEASES OF THE SKIN 571 
 
 Genitals — Eczema, pruritus, herpes simplex, scabies, 
 syphilis. 
 
 Lower extremities — Purpura, ecthyma, eczema rubrum, 
 erythema nodosum. 
 
 Age, Sex and Social Condition. — Some diseases of the skin 
 are more prone to attack children than adults, and vice versa. 
 Epithelioma usually appears first in middle or advanced life, 
 while lupus vulgaris nearly always dates from childhood. 
 Neither acne nor tinea versicolor is common in children, but 
 ringworm of the scalp shows a predilection for that age and 
 usually spares the adult. Ichthyosis is practically congenital. 
 Lupus erythematosus is more frequent in women, and 
 epithelioma of the lower lip is generally an affection of the 
 male. V i 
 
 A knowledge of the occupation is sometimes a help in 
 diagnosis. Bakers, grocers, bricklayers, plasterers, and bar- 
 keepers suffer from eczema, and artisans who handle chemicals 
 and other irritants exhibit various grades of dermatitis. 
 Hostlers may contract glanders, and wool-sorters become in- 
 fected with anthrax. Pediculosis is more common in the poor 
 and unclean than in the upper classes of society. 
 
 Antecedent History. — The past history of the case will in- 
 form us as to former attacks of cutaneous or other diseases ; 
 and if the information is judiciously elicited, may throw much 
 light on the present condition. This is of prime importance, 
 especially in syphilis. 
 
 General Symptoms.- — The general symptoms of the patient 
 must not be neglected. His facial expression, his gait, the 
 color of his skin and conjunctivas, the state of the tongue, 
 stomach, and bowels, etc.. must be thoroughly investigated. 
 The thermometer will show the body temperature, and micro- 
 scopic and chemic investigation will determine the condition 
 of the blood and urinary secretion, thus proving or disprov- 
 ing the existence of diabetes, nephritis, and malaria, each of 
 which may be potent factors in the etiology. 
 
 Microscope. — Aside from the employrpent of the micro- 
 scope in the conditions just mentioned, this instrument is an 
 invaluable aid in dermatologic practice. With it the char- 
 acter of tumors may be determined and information furnished 
 as to the nature of obscure pathologic processes. It is of
 
 572 SPINAL ADJUSTMENT 
 
 especial utility in recognizing the presence of fungi or of 
 animal parasites, and in the investigation of the rapidly ex- 
 tending class of bacillary diseases. 
 
 Drug and Feigned Eruptions. — The ingestion of various 
 drugs produces in many persons diverse lesions of the skin, 
 and a careful inquiry should always be made in that direction. 
 The same observation may be applied in regard to certain 
 foods : e. g., urticarial and erythematous rashes are often due 
 to the eating of strawberries or buckwheat, and eczemas are 
 sometimes at least indirectly connected with the free eating of 
 oatmeal. Many plants set up severe dermatitis, and heat and 
 cold and the X-rays are also responsible for similar condi- 
 tions. The physician should also be fully aware that feigned 
 or artificial eruptions are not infrequently produced upon 
 themselves by hysterics and malingerers. 
 
 Subjective Symptoms. — The merely subjective symptoms 
 of a patient are not of paramount importance in diagnosis ; 
 still, one must not put aside as of no importance the state- 
 ments of intelligent persons in matters relating to their own 
 experiences of pain, itching, burning, or other sensations. 
 Very often such statements may be verified by the condition 
 of the integument itself; for example, if itching is severe, the 
 presence of scratch marks will testify to its existence." (Gould 
 and Pyle.) 
 
 Treatment. — The treatment of skin diseases is divided into 
 two kinds, the internal and the external. The first requisite 
 in the treatment is the determination of the exact contributing 
 cause of the condition, and then using measures directed 
 toward its removal. The general practitioner is usually called 
 upon to treat such skin diseases as are due to auto-intoxica- 
 tion, disorders of digestion, and disturbances of metabolism. 
 It is therefore these conditions which should, in all cases, be^ 
 corrected. The first essential in treating skin diseases of this 
 kind, is spinal adjustment. In all cases adjustments of the 
 6th and 10th dorsal, and the 2nd lumbar vertebrae should be 
 made; in addition to this, adjustments of the vertebrae pro- 
 ducing an impingement upon the nerve governing the afifected 
 part of the body, should be made. Of the accessory external 
 methods the most generally useful are the magnesium sulphate 
 baths, and magnesium sulphate compresses to the local area
 
 DISEASES OF THE SKIN 5/3 
 
 affected. In connection with this the hygiene should be cor- 
 rected, suitable exercises should be prescribed, and the patient 
 should be in the fresh air and sun-light as much as possible. 
 Internal accessory methods consist in a regulation of diet, 
 attention to the bowels, and the internal use of mineral waters. 
 Many cases of skin disease require the care of a specialist, and 
 consultation with a dermatologist is advisable in most in- 
 stances.
 
 INDEX 
 
 Abdncens, nerve, Tz • 
 Adams position, 289 
 Addison's disease, 515 
 Adjunct measures, whj^ used, 387 
 Adjustment, Spinal, 315 
 
 and adjunct measures, 387 
 
 of cervical vertebrae, 322 
 
 of dorsal vertebrae, 341 
 
 of lumbar vertebrae, 365 
 
 practice of, 383 
 Alcoholism, 417 
 Alimentary tract, tuberculosis of, 
 
 407 
 Amblyopia, 531 
 Amenorrhea, 540 
 Amyotrophic lateral sclerosis, 496 
 Analysis, spinal, 279 
 Anatomical basis of chiropractic, 15 
 Anchylostomiasis, 413 
 Anemia, 512 
 
 pernicious, 513 
 Aneurysm, 454 
 Angina pectoris, 450 
 Anteflexion, 540 
 Anterior subluxation, 271 
 
 diagnostic signs of, 300 
 
 holds for correction of, 378. 379, 
 381 
 Anteversion, 541 
 Aortic plexus, anatomy of, 58 
 Appendicitis, 472 
 Arrythmia, 452 
 Arsenic poisoning, 419 
 Arteriosclerosis, 453 
 Arthritis deformans, 422 
 Ascariasis, 413 
 Ascites, 483 
 Asthma, 435 
 Ataxia, hereditary, 498 
 Atlas, palpation of, 309 
 Atrophy, progressive muscular, 496 
 Auditory nerve, "JZ 
 Automatism, 84 
 Axis, palpation of, 309 
 
 Bilateral digito-transverse hold, 358 
 Bilateral pisiform-transverse hold, 
 
 347. 365 
 Bilious fever, 410 
 
 Bladder, innervation of, 157 
 
 catarrh of, 528 
 
 tuberculosis of, 408 
 Blood and ductless glands, diseases 
 of, 512 
 
 Addison's disease, 515 
 
 Anemia, 512 
 pernicious, 513 
 chlorosis, 513 
 
 Goiter, 516 
 
 Leukemia, 514 
 
 Myxedema, 517 
 
 Pseudo-Leukemia, 515 
 Bloody flux, 400 
 Bradicardia, 452 
 Brain, The, 62 
 
 Anemia of, 488 
 
 Congestion of, 487 
 
 Diseases of, 485 
 
 Hemorrhage of, 488 
 
 Innervation of, 117 
 Bright's disease, acute, 520 
 
 chronic, 521, 522 
 Bronchial tubes, diseases of, 433 
 Bronchitis, acute, 433 
 
 chronic, 434 
 Bronchopneumonia, 437 
 Bulbar paralysis, 495 
 
 Caisson disease, 500 
 Calcaneo-pisiform-transverse hold, 
 
 353 
 
 Calcaneo-spinous hold, 359 
 
 Cancrum oris, 457 
 
 Canker, 456 
 
 Cardiac plexus, 54 
 
 Cataract, 532 
 
 Catarrh, acute nasal, 429 
 chronic nasal, 430 
 
 Causes of subluxations, external, 179 
 Age as a cause of, 185 
 Exhaustion as a cause of, 186 
 Habits as a cause of, 181 
 Lijuries as a cause of, 181 
 Occupation as a cause of, 180 
 
 Causes of subluxation, internal, 188 
 
 Celiac plexus. The. 57 
 
 Cerebral, anemia, 488 
 
 Cerebral congestion, 487 
 
 ?/D
 
 576 
 
 INDEX 
 
 Cerebral hemorrhage, 488 
 Cerebro-spinal nervous system, 62 
 Cerebrum, diseases of, 485 
 
 innervation of. 117 
 Cerumen, impacted, 536 
 Cervical vertebrae, 215 
 
 adjustment of, 322 
 
 palpation of, 309 
 Chart, spinal analysis, 313 
 Chemicals and drugs, effect of, on 
 
 nerves, 168 
 Chicken-pox, 393 
 Chloral habit, 419 
 Chlorosis, 513 
 Cholelithiasis, 479 
 Cholera morbus, 469 
 Chorea, 509 
 Circulatory system, diseases of, 442 
 
 Aneurysm, 454 
 
 Angina pectoris, 450 
 
 Arrythmia, 452 
 
 Arteriosclerosis, 453 
 
 Bradicardia, 452 
 
 Cardiac hypertrophy, 448 
 
 Cardiac dilatation, 449 
 
 Endocarditis, acute, 445 
 chronic, 446 
 
 Fatty heart, 450 
 
 Myocarditis, acute, 444 
 chronic, 443 
 
 Palpitation of the heart, 451 
 
 Pericarditis, acute, 442 
 chronic, 443 
 
 Tachycardia, 453 
 
 Varicose veins, 455 
 Club-foot, 562 
 Cocaine habit, 418 
 Colic, intestinal, 471 
 Colitis, mucous, 472 
 Compound subluxations, 277 
 Compression subluxations, 265 
 
 diagnostic signs of, 300 
 
 holds for correction of, 378, 379, 
 381. 
 Conduction process, The. 40 
 Connection between sympathetic and 
 
 cerebro-spinal nerves. 65 
 Connection between sympathetic sys- 
 tem and cranial nerves, 67 
 Constipation, 467 
 Constitutional diseases, 421 
 
 Arthritis deformans, 422 
 
 Diabetes insipidus, 427 
 
 Diabetes mellitus, 426 
 
 Gout, 424 
 
 Hemophilia, 426 
 
 Obesity, 427 
 
 Rheumatism, chronic articular, 421 
 muscular, 421 
 
 Rheumatoid arthritis, 422 
 
 Rickets, 424 
 
 Scurvy, 425 
 Consumption, 402 
 Contact points, 321 
 Coryza, 429 
 Cranial nerves, 62, 67 
 
 function of, 90 
 
 how influenced by adjustment, 11 
 
 abducens, jt, 
 
 auditory, y2> 
 
 facial, 72> 
 
 glosso-pharyngeal, J2> 
 
 hypoglossal, 74 
 
 motor oculi, 72 
 
 olfactory, y2 
 
 optic, y2 
 
 pneumogastric, "Ji 
 
 spinal accessory, 74 
 
 trigeminal, 7:^ 
 
 trochlear, 72 
 Cranial and spinal reflexes, 190 
 Cranial reflexes, 190 
 Crossed bilateral pisiform - trans- 
 verse hold, 346 
 Crossed thumb-transverse hold, 346 
 Croup, 431 
 
 Curves of the spine, 216 
 Cystitis, 528 
 
 Deafness, 534 
 Deformities, 562 
 
 Club-foot, 562 
 
 Flat-foot, 563 
 
 Genu valgum, 562 
 
 Knock-knee, 562 
 
 Talipes, 562 
 
 Torticollis, 564 
 Diabetes insipidus, 427 
 Diabetes mellitus, 426 
 Diagnosis, spinal, 248 
 
 in abdominal affections, 248 
 
 value of, 249 
 Diaphragm, innervation of, 143 
 Diarrhea, 468 
 
 Diffusion of outgoing impulses, 194 
 Digestive system, diseases of, 456 
 
 Appendicitis, 472 
 
 Ascites, 483 
 
 Cancrum oris, 457 
 
 Canker, 456 
 
 Cholera morbus, 469 
 
 Constipation, 467 
 
 Diarrhea, 468 
 
 Dropsy, 483 
 
 Enteritis, acute, 465 
 chronic, 465 
 
 Enteroptosis, 471 
 
 Gall stones, 479 
 
 Gastric carcinoma, 462 
 
 Gastric dilatation, 460
 
 INDEX 
 
 577 
 
 Gastric neuroses, 463 
 Gastric ulcer, 461 
 Gastritis, acute, 458 
 
 cliroiiic, 459 
 Indigestion, intestinal, 466 
 Intestinal colic, 471 
 
 olistruction, 470 
 Jaundice, 478 
 Liver, abscess of, 476 
 
 cancer of, 477 
 
 congestion of, 473 
 
 cysts of, 476 
 
 fatty, 474 
 
 waxy, 475 _ 
 Mucous colitis, 472 
 Pancreas, cancer of, 481 
 
 cysts of, 482 
 Pancreatic calculi, 482 
 Pancreatitis, acute, 480 
 
 chronic, 481 
 Peritonitis, 482 
 Stomatitis, aphthous, 456 
 
 catarrhal, 456 
 
 gangrenous, 457 
 
 mercurial, 458 
 
 parasitic, 458 
 
 ulcerative, 457 
 Yellow atrophy, acute, 478 
 Diphtheria, 410 
 Dorsal position, 291 
 Dropsy, 483 
 Dysentery, 400 
 Dysmenorrhea, 538 
 
 Ear, diseases of, 533 
 
 Ear-ache, 533 
 
 Deafness, 534 
 
 Impacted cerumen, 526 
 
 Innervation of, 121 
 
 Otitis externa, 534 
 media, 535 
 
 Tinnitus aurium, 533 
 
 Vertigo, 535 
 Effects of vertebral subluxations, 
 local, 199 
 
 on afferent spinal nerve, 2co 
 
 on arteries, 201 
 
 on circulation, 2og 
 
 on cranial nerve functions, 211 
 
 on efferent spinal nerve, 200 
 
 on existing action, 207 
 
 on gray rami communicantes, 20 1 
 
 on lymphatics, 202 
 
 on metabolism, 208 
 
 on movement and sensibility, 203 
 
 on nutrition, 205 
 
 on organs, 209 
 
 on reflex action, 210 
 
 on resistance, 203 
 
 on secretion and excretion, 206 
 
 on temperature, 207 
 
 on veins, 202 
 
 on white rami communicantes, 
 200 
 Efferent action of nerves, 56 
 Eighth cervical nerve, parts in- 
 fluenced by, 253 
 Eighth thoracic nerve, parts in- 
 fluenced by, 253 
 Eleventh thoracic nerve, parts in- 
 fluenced by, 254 
 Endocarditis, acute, 445 
 
 chronic, 446 
 Endometritis, acute, 544 
 
 chronic, 544 
 Enteritis, acute, 465 
 
 chronic, 465 
 Enteroptosis, 471 
 Enuresis, 530 
 Epilepsy, 504 
 Erect position, 291 
 Erysipelas, 399 , 
 
 Etiology of disease, 8 
 Exit of spinal nerves in respect to 
 
 spines, 223 
 Extremes of temperature on nerves. 
 
 167 
 Eye, diseases of, 531 
 
 amblyopia, 531 
 
 cataract, 532 
 
 lachrymation, 531 
 
 mydriasis and myosis, 532 
 
 optic neuritis, 533 
 
 ptosis, 532 
 
 retinitis, 533 
 
 squint, 531 
 
 strabismus, 531 
 Eye, innervation of, 119 
 
 Facial nerve, 'j^i 
 
 Fallopian tubes, innervation of, 157 
 
 Tuberculosis of, 408 
 Fatigue of nerves, 165 
 Fifth cervical nerve, parts influence 1 
 
 by, 251 
 Fifth lumbar nerve, parts influenced 
 
 by, 254 
 Fifth thoracic nerve, parts influenced 
 
 by, 253 
 Filariasis, 414 
 First cervical nerve, parts influenced 
 
 by. 251 
 First lumbar nerve, parts influenced 
 
 by, 254 
 First sacral nerve, parts influenced 
 
 by, 254 
 First thoracic nerve, parts influenced 
 
 by, 253 
 Fourth cervical nerve, parts in- 
 fluenced by, 251
 
 578 
 
 INDEX 
 
 Fourth lumbar nerve, parts in- 
 fluenced by, 254 
 
 Fourth sacral nerve, parts influenced 
 by, 255 
 
 Fourth thoracic nerve, parts in- 
 fluenced by, 253 
 
 Flat-foot, 563 
 
 Food poisons, 420 . 
 
 Friedreich's disease, 498 
 
 Fronto-transverse hold, 328 
 
 Gall stones, 479 
 Gangliated cords. The, 10 
 Gastric plexus. The, 57 
 Gastritis, acute, 458 
 
 chronic, 459 
 Genito-urinary system, diseases of, 
 
 519 
 
 Cystitis, 528 
 
 Enuresis, 530 
 
 Floating kidney, 525 
 
 Hydronephrosis, 526 
 
 Kidneys, congestion of, 519 
 
 Movable kidney, 525 
 
 Nephritis, acute parenchymatous, 
 520 
 
 chronic interstitial, 522 
 chronic parenchymatous, 521 
 
 Nephrolithiasis, 526 
 
 Prostate, hypertrophy of, 529 
 
 Pyelitis, 527 
 
 Uremia, 524 
 
 Waxy kidney, 524 
 Genito-urinary tract, tuberculosis of, 
 
 407 
 Genu-deltoid hold, zil 
 Genu-spinous hold, 371 
 Genu valgum, 562 
 German measles, 396 
 Glosso-pharyngeal nerve, T>i 
 Goitre, 516 
 
 exophthalmic, 516 
 Gout, 424 
 
 Gray rami communicantes, 64 
 Gynecological diseases, 537 
 
 Amenorrhea, 540 
 
 Anteflexion, 540 
 
 Anteversion, 540 
 
 Dysmenorrhea, 538 
 
 Endometritis, acute, 544 
 chronic, 544 
 
 Leucorrhea, 540 
 
 Menorrhagia and metrorrhagia, 
 539 
 
 Metritis, acute, 545 
 chronic, 546 
 
 Oophoritis, acute, 548 
 chronic, 548 
 
 Ovaries, congestion of, 547 
 
 Peritonitis, pelvic, 549 
 
 Prolapsus uteri, 543 
 Pruritus vulvae, 537 
 Retroflexion, 542 
 Salpingitis, 547 
 Vaginitis, 537 
 Vulvitis, 537 
 
 Hay fever, 434 
 Headache, 489 
 Hearing, 82 
 Heart, fatty, 450 
 Heart, diseases of, 442 
 
 Dilatation of, 449 
 
 Hypertrophy of, 448 
 
 Palpitation of, 451 
 
 Valvular disease of, 446 
 Heart, innervation of, 135 
 Hemophilia, 426 
 Hepatic plexus, 57 
 Hereditary ataxia, 498 
 Hodgkin's disease, 515 
 Holds 
 
 Bilateral digito-transverse, 358 
 
 Bilateral pisiform-transverse, 347, 
 365 
 
 Calcaneo-pisiform-transverse, 353 
 
 Calcaneo-spinous, 359 
 
 Crossed bilateral pisiform-trans- 
 verse, 346 
 
 Crossed thumb-transverse, 346 
 
 Fronto-transverse, 328 
 
 Genu-deltoid, ZT] 
 
 Genu-spinous, 371 
 
 Ilio-deltoid, 371 
 
 Ilio-spinous, 365 
 
 Infra-iliac, 370 
 
 Malar-transverse, 329 
 
 Mandibulo-spinous, 359 
 
 Occipito-mandibular A, 335 
 
 Occipito-mandibular B, 335 
 
 Occipito-mandibular C, 335 
 
 Pisiform-spinous, 352, 370 
 
 Pisiform-transverse, 328 
 
 Recoil, The, 364 
 
 Sacro-spinous, 363 
 
 Supra-iliac, 370 
 
 Supra-sacral, 370 
 
 Temporo-centrum, 334 
 
 T. M. or thumb movement, 329, 
 
 Temporo-occipital, 340 
 Temporo-transverse, 322 
 Thumb-transverse, 341, 365 
 Thoracic extension I, 363 
 Thoracic extension H, 364 
 Ulno-spinous, 353, 365 
 Unilateral pisiform-transverse, 
 
 353, 370 
 Unilateral pisiform-transverse, 
 
 anterior, 329
 
 INDEX 
 
 579 
 
 Hydronephrosis, 526 
 Hydrothorax, 441 
 Hypogastric plexus, 59 
 Hypoglossal nerve, 74 
 Hysteria, 505 
 
 Ilio-deltoid hold, 271 
 Ilio-spinous hold, 365 
 Indigestion, intestinal, 466 
 Infantile paralysis, 490 
 Infectious diseases, 390 
 
 Bloody flux, 400 
 
 Chicken-pox, 393 
 
 Diphtheria, 410 
 
 Dysentery, 400 
 
 Erysipelas, 399 
 
 German measles, 396 
 
 Influenza, 398 
 
 Intermittent fever, 409 
 
 Lagrippe, 398 
 
 Malaria, 409 
 
 Measles, 395 
 
 Mumps, 396 
 
 Parotitis, epidemic, 396 
 
 Pellagra, 412 
 
 Pertussis, 397 
 
 Relapsing fever, 408 
 
 Remittent fever, 410 
 
 Rheumatism, acute articular, 399 
 
 Rubella, 396 
 
 Scarlet fever, 394 
 
 Small-pox, 392 
 
 Tuberculosis, 401 
 
 Typhoid fever, 390 
 
 Varicella, 393 
 
 Whooping cough, 397 
 Inferior cervical ganglion, 51 
 Inferior hemorrhoidal plexus, 59 
 Influenza, 398 
 Infra-iliac hold, 370 
 Inhibition and augmentation, 85, 8' 
 Innervation, iii 
 
 of bladder, 157 
 
 of brain, 117 
 
 of diaphragm, 143 
 
 of ear, 121 
 
 of eye, 119 
 
 of face and neck, 115 
 
 of heart, 135 
 
 of kidneys, 153 
 
 of large intestine, 149 
 
 of larynx, 127 
 
 of liver, 145 
 
 of lungs, 139 
 
 of mammary gland, 135 
 
 of nose, 123 
 
 of organs of abdomen, 143 
 
 of organs of pelvis, 157 
 
 of organs of thorax, 135 
 
 of ovaries, 159 
 
 of pancreas, 145 
 
 of penis, 161 
 
 of peritoneum, 143 
 
 of pharynx, 125 
 
 of prostate gland, 159 
 
 of scalp, 113 
 
 of small intestine, 151 
 
 of spleen, 145 
 
 of stomach, 147 
 
 of structures of cranium, face and 
 neck. III 
 
 of suprarenal capsules, 155 
 
 of teeth and oral cavity, 131 
 
 of testicles, 161 
 
 of thyroid gland, 131 
 
 of tongue, 129 
 
 of tonsils, 127 
 
 of uterus, 157 
 
 of vagina, 161 
 Intermittent fever, 409 
 Intervertebral discs, function of, 21 
 Intervertebral foramen, boundaries 
 of. 5 
 
 calibre of, 6 
 
 contents of, 12 
 
 measurements of, 12 
 Intoxications, The, 417 
 
 Alcoholism, 417 
 
 Arsenic poisoning, 419 
 
 Chloral habit, 419 
 
 Cocaine habit, 418 
 
 Food poisons, 420 
 
 Lead poisoning, 419 
 
 Morphine habit, 418 
 Intestines, diseases of, 465 
 
 innervation of, 149, 151 
 Irritability of nerves, 41 
 
 Jaundicf, 478 
 
 Joints, diseases of, 564 
 
 Kidneys, congestion of, 519 
 
 floating, 525 
 
 innervation of, 153 
 
 waxy, 524 
 Knock-knee, 562 
 Kyphosis, 553 
 Kyphotic subluxation, 260 
 
 diagnostic signs of, 302 
 
 holds for correction of, 378, 379, 
 382 
 
 Lachrymation, 531 
 La Grippe, 398 
 Laryngitis, acute, 430 
 
 chronic, 430 
 
 edematous, 431 
 
 spasmodic, 431 
 Larynx, diseases of, 430 
 
 innervation of, 127 
 
 tuberculosis of, 407
 
 580 
 
 INDEX 
 
 Lateral subluxation, 269 
 
 diagnostic signs of, 301 
 
 holds for correction of, 378, 379, 
 380 
 Lead poisoning, 419 
 Leucorrhea, 540 
 Leukemia, 514 
 Ligaments of the spinal column, 16 
 
 reflex influence upon, 17 
 Liver, diseases of, 473 
 
 Abscess of, 476 
 
 Cancer of, 477 
 
 Congestion of, 473 
 
 Cysts of, 476 
 
 Fatty, 474 
 
 Linervation of, 145 
 
 Waxy, 475 
 Local effects of vertebral subluxa- 
 tions, 199 
 
 on afferent spinal nerve, 200 
 
 on arteries, 201 
 
 on efferent spinal nerve. 200 
 
 on gray rami communicantes, 201 
 
 on lymphatics, 202 
 
 on veins, 202 
 
 on white rami communicantes, 200 
 Locomotor ataxia, 492 
 Lordosis, 554 
 Lordotic subluxation. 262 
 
 diagnostic signs of, 302 
 
 holds for correction of, 378, 379, 
 382 
 Lumbar portion of gangliated cord, 
 
 53 
 Lumbar vertebrae, 216 
 
 palpation of, 313 
 Lungs, diseases of, 435 
 
 congestion of, 435 
 
 edema of, 436 
 
 hemorrhage of, 436 
 
 innervation of, 139 
 
 tuberculosis of, 401 
 
 Malalignment of vertebrae, 163. 171 
 as a sign of vertebral subluxa- 
 tions, 240 
 
 ?^Ialaria, 409 
 
 Malar-transverse hold, 329 
 
 Malnutrition of nerves, 166 
 
 Mammary gland, innervation of, 
 135 
 
 Mandibulo-spinous hold, 359 
 
 Measles. 395 
 
 Mechanical conditions, influence of, 
 on nerves. 169 
 
 Meningitis, 485 
 
 Menorrhagia and metrorrhagia, 539 
 
 Mental diseases, 511 
 
 Metritis, acute, 545 
 chronic, 546 
 
 Middle cervical ganglion, 51 
 ^lorphine habit, 418 
 Motor function of nerves, 86 
 Motor oculi nerve, 72 
 Mouth, diseases of, 456 
 
 innervation of, 131 
 Movements of the spine, 217 
 Mucous colitis, 472 
 Mumps, 396 
 Muscular sense, 80 
 Mydriasis and myosis, 532 
 Myelitis, acute, 494 
 Myocarditis, acute, 444 
 
 chronic, 443 
 Myxedema, 517 
 
 Nasal catarrh, acute, 429 
 
 chronic, 430 
 Nephritis, acute parenchymatous, 520 
 
 chronic interstitial, 522 
 
 chronic parenchymatous, 521 
 Nephrolithiasis, 526 
 Nerve function, abnormal, 163 
 
 causes of, 164 
 Nerve-impulse, 40 
 
 origin of, 75 
 Nerves, effect of blood-supply upon, 
 
 43 
 effect of lymphatics upon, 44 
 effect of pressure upon, 42 
 function of, 39, 75, 86 
 irritability of, 41 
 Nervous system, diseases of. 485 
 Amyotrophic lateral sclerosis, 456 
 Bulbar paralysis, 495 
 Caisson disease, 500 
 Cerebral anemia, 488 
 
 congestion, 487 
 
 hemorrhage, 488 
 Chorea. 509 
 Epilepsy, 504 
 Facial paralysis, 503 
 Headache, 489 
 Hysteria, 505 
 Locomotor ataxia, 492 
 Meningitis, 485 
 Mental diseases, 511 
 IMultiple sclerosis, 498 
 Myelitis, acute, 494 
 Neuralgia, 502 
 Neurasthenia, 508 
 Neuritis, multiple, 501 
 
 simple, 500 
 Occupation neuroses, 511 
 Paralysis agitans, 510 
 Paraplegia, ataxic. 497 
 Poliomyelitis, acute anterior, 490 
 Progressive muscular atrophy, 496 
 Syringomyelia, 499 
 Tabes dorsalis, 492
 
 INDEX 
 
 581 
 
 Tetany, 510 
 
 Wasting palsy, 496 
 Neuralgia, 502 
 Neurasthenia, 508 
 Neuritis, multiple, 501 
 
 optic, 533 
 
 simple, 500 
 Ninth thoracic nerve, parts in- 
 fluenced by, 253 
 Nose, diseases of, 429 
 
 innervation of, 123 
 
 Obesity, 427 
 
 Obstruction, intestinal, 470 
 Occipito-mandibular hold A, 335 
 Occipito-mandibular hold B, 335 
 Occipito-mandibular hold C, 335 
 Occupation neuroses, 511 
 Olfactory nerve, 72 
 Oophoritis, acute, 548 
 
 chronic, 548 
 Opposition to theory of chiro- 
 practic, 15 
 Optic nerve, 72 
 Optic neuritis, 533 
 Origin of chiropractic, i 
 Osteopathy and chiropractic, 3 
 Otitis externa, 534 
 
 media, 535 
 Outgoing impulses, diffusion of, 194 
 Ovaries, congestion of, 547 
 
 innervation of, 159 
 
 Pain as a symptom of subluxation, 
 13, 243 
 
 sense of, 80 
 Palpation of various vertebrae, 303 
 Pancreas, cancer of, 481 
 
 cysts of, 482 
 
 diseases of, 480 
 
 innervation of, 145 
 Pancreatic calculi, 482 
 Pancreatitis, acute, 480 
 
 chronic, 481 
 Paralysis agitans, 510 
 
 facial, 503 
 Paraplegia, ataxic, 497 
 Parasitic diseases, 413 
 
 Anchylostomiasis, 413 
 
 Ascariasis, 413 
 
 F'ilariasis, 414 
 
 Tapeworms, 415 
 
 Trichinosis, 416 
 Parotitis, epidemic, 396 
 Pellagra, 412 
 Pelvic plexus, 59 
 
 portion of gangliated cord. 53 
 Pericarditis, acute, 442 
 
 chronic, 443 
 
 Peritoneum, diseases of, 482 
 
 innervation of, 143 
 Peritonitis, acute general, 482 
 Peritonitis, pelvic, 549 
 Pertussis, 397 
 
 Pharynx, innervation of, 125 
 Phrenic plexus, 56 
 Phthisis, 402, 404 
 
 chronic, 404 
 
 fibroid, 405 
 
 pneumonic, 402 
 Physiological basis of chiropractic, 
 
 39 
 Pisiform-spinous hold, 352, 370 
 Pisiform-transverse hold, 328 
 Pleura, diseases of, 438 
 Pleurisy, 438 
 Pneumogastric nerve, "JZ 
 Pneumonia, lobar, 437 
 Pneumothorax, 440 
 Poise as a requisite to the thrust, 
 
 317 
 Poliomyelitis, acute anterior, 490 
 Position of the patient, 289 
 
 of the vertebrae, 219 
 Positions 
 
 Adams, 289 
 
 dorsal, 291 
 
 erect, 291 
 
 prone, 291 
 Posterior subluxation, 273 
 
 diagnostic signs of, 300 
 
 holds for correction of, 378, 379, 
 381 
 Prolapsus uteri, 543 
 Prone position. 291 
 Prostate gland, hypertrophy of, 529 
 
 innervation of, 159 
 
 tuberculosis of, 408 
 Prostatic plexus, 59 
 Pruritus vulvae, 537 
 Pseudo-leukemia, 515 
 Ptosis, 532 
 Pyelitis, 527 
 
 Recoil, The, 364 
 Reflex act. The, 191 
 Reflex action, 83 
 Reflex cycle. 188 
 
 Reflex production of vertebral sub- 
 luxations, 195 
 Reflexes, cranial. IQC 
 
 cranial and spinal, 190 
 
 spinal, 189 
 
 spinal and cranial, 190 
 Regional classification of holds, 37S 
 Relapsing fever, 408 
 Remittent fever, 410 
 Renal plexus, 57
 
 582 
 
 INDEX 
 
 Respiratory system, diseases of, 429 
 Asthma, 435 
 Bronchitis, acute, 433 
 
 chronic, 434 
 Bronchopneumonia, 437 
 Hay fever, 434 
 Hydrothorax, 441 
 Laryngitis, acute, 430 
 chronic, 430 
 edematous, 431 
 spasmodic, 431 
 Lobar pneumonia, 437 
 Nasal catarrh, acute, 429 
 
 chronic, 430 
 Pleurisy, 438 
 Pneumothorax, 440 
 Pulmonary congestion, 435 
 edema, 436 
 hemorrhage, 436 
 Tonsillitis, 432 
 Retinitis, 533 
 
 Retroflexion of uterus, 542 
 Rheumatism, acute articular, 399 
 chronic articular, 421 
 muscular, 421 
 Rheumatoid arthritis, 422 
 
 spondylitis, 561 
 Rickets, 424 
 Round shoulders, 554 
 Rotary subluxation, 274 
 diagnostic signs of, 301 
 holds for correction of, 378, 379, 
 380 
 Rubella, 396 
 
 Sacro-spinous hold, 363 
 Salpingitis, 547 
 Scarlet Fever, 394 
 Sclerosis, multiple, 498 
 Scoliosis, 551 
 Scoliotic subluxation, 264 
 diagnostic signs of, 302 
 holds for correction of, 378, 379, 
 382 
 Second cervical nerve, parts in- 
 fluenced by, 251 
 Second lumbar nerve, parts in- 
 fluenced by, 254 
 Second sacral nerve, parts influenced 
 
 by, 255 
 Second thoracic nerve, parts in- 
 fluenced by, 253 
 Secretory function of nerves, 88 
 Segmental localization, 225 
 Sensations, Ti 
 common, 78 
 subjective, 80 
 Seventh cervical nerve, parts in- 
 fluenced by, 253 ' 
 
 Seventh thoracic nerve, parts in- 
 fluenced by, 253 
 Sight, 82 
 Signs of vertebral subluxations, 239, 
 
 279 
 Sixth cervical nerve, parts influenced 
 
 by, 251 
 Sixth thoracic nerve, parts influenced 
 
 by, 253 
 Skin, diseases of, 565 
 Small-pox, 392 
 Smell, sense of, 82 
 Solar plexus, 55 
 Spermatic plexus, 57 
 Spinal accessory nerve, 74 
 Spinal adjustment, general consid- 
 erations of, 315 
 
 practice of, 383 
 Spinal analysis, 279 
 Spinal analysis chart, method of 
 
 using, 313 
 Spinal and cranial reflexes, 190 
 
 diseases of, 490 
 Spinal cord, 62 
 Spinal nerve, 9, 62 
 
 anterior root of, 63 
 
 attachment of to cord, 221 
 
 exit of in respect to spinous 
 processes, 223 
 
 posterior root of, 63 
 Spinal reflexes, 189 
 Spinal segments, 225 
 Spinal symptomatology, 239 
 Spine, The, 213 
 
 dislocations of, 556 
 
 fracture of, 558 
 
 injuries and diseases of, 551 
 
 kyphosis, 551 
 
 lordosis, 554 
 
 movements of, 217 
 
 normal curves of, 216 
 
 osteoarthritis of, 561 
 
 osteomyelitis of, 561 
 
 rheumatoid spondylitis, 561 
 
 round shoulders, 554 
 
 scoliosis, 551 
 
 spondylolisthesis, 5=^:1 
 
 sprains of, 555 
 
 syphilitic disease of, 560 
 
 tuberculosis of, 559 
 Spinous process, palpation of, 285 
 Splenic plexus, 58 
 Spondylolisthesis, 554 
 Spontaneity as a requisite to the 
 
 thrust, 317 
 Spontaneous adjustment, 175 - 
 Spleen, innervation of, 145 
 Squint, 531 
 Stomach, cancer of, 462 
 
 dilatation of, 460
 
 INDEX 
 
 583 
 
 diseases of, 485 
 innervation of, 147 
 neuroses of, 463 
 ulcer of, 461 
 Stomatitis, aphthous, 456 
 catarrhal, 456 
 gangrenous, 457 
 mercurial, 458 
 parasitic, 458 
 ulcerative, 457 
 Strabismus, 531 
 Stye, 532 
 
 Subluxations, vertebral, 163, 171 
 anatomical changes as a sign of, 
 
 247,. 284 
 and disease, 383 
 anterior, 271 
 caused of , external, 179 
 
 age, 185 
 
 exhaustion, 186 
 
 habits, 181 
 
 injuries, 181 
 
 occupation, 180 
 causes of, internal, 188 
 compound, 277 
 compression, 265 
 contraction of ligaments of spine 
 
 as a sign of, 241, 282 
 demonstration of, on cadaver, 27 
 diagnosis of, 293 
 diagnostic signs of each form of, 
 
 300 
 diminished mobility of back as a 
 
 sign of, 242, 283 
 effect of, on circulation, 209 
 
 on cranial nerve functions, 211 
 
 on existing action, 207 
 
 on metabolism, 208 
 
 on movement and sensibility, 
 203 
 
 on nerve function, 203 
 
 on nutrition, 205 
 
 on organs, 209 
 
 on reflex action, 210 
 
 on resistance, 203 
 
 on secretion and excretion, 206 
 
 on temperature, 207 
 forms of, 260 
 functional disturbances as a sign 
 
 of, 244, 281 
 inspection in the diagnosis of, 293 
 kyphotic, 260 
 lateral, 269 
 local effects of, 199 
 
 on afferent spinal nerve, 200 
 
 on arteries, 201 
 
 on efferent spinal nerve, 200 
 
 on gray rami communicantes, 
 201 
 
 on lymphatics, 202 
 on veins, 202 
 
 on white rami communicantes, 
 200 
 
 local zone of increased tempera- 
 ture as a sign of, 246 
 
 lordotic, 262 
 
 malalignment of vertebrae as a 
 sign of, 240, 285 
 
 nature of, 173 
 
 pain as a symptom of, 243, 280 
 
 palpation in the diagnosis of, 295 
 
 posterior, 273 
 
 physical explanation of, 258 
 
 production of, 18 
 
 vertical posture in, 22 
 
 reflex production of, 195 
 
 region of spine where found, 276, 
 
 rotary, 274 
 
 scoliotic, 264 
 
 results of, general, 175 
 
 supero-inferior, 267 
 
 temperature variations as a sign 
 
 of, 281 
 tenderness as a symptom of, 244. 
 
 280 
 thickening of nerve trunks as a 
 sign of, 247, 280 
 Sunstroke, 420 
 Superior cervical ganglion, n, 49, 
 
 68 
 Superior mesenteric plexus, 58 
 Supero-inferior subluxation, 267 
 diagnostic signs of, 301 
 holds for correction of, 378, 379, 
 380 
 Suprarenal capsules, innervation of, 
 
 155 
 Suprarenal plexus, 57 
 Supra-iliac hold, 370 
 Supra-sacral hold, 370 
 Sympathetic nervous system, anat- 
 omy of, 10, 47 
 physiology of, 93 
 influence on circulation, loi 
 on excretion, 104 
 on heat production, 97 
 on metabolism, 100 
 on movement and sensibility, 
 
 94 
 on nutrition, 95 
 on other existing action, 106 
 on organs, 109 
 on reflex actions, 108 
 on secretional, 103 
 on special senses, 106 
 Symptomatology, spinal, 239 
 Syringomyelia, 497
 
 584 
 
 INDEX 
 
 Tabes dorsalis, 492 
 
 Tachycardia, 453 
 
 Talipes, 562 
 
 Tapeworms, 415 
 
 Taste, sense of, 81 
 
 Teeth, innervation of, 131 
 
 Temperature sense, 79 
 
 Temporo-centrum hold, 334 
 
 Temporo-occipital hold, 340 
 
 Temporo-transverse hold, 322 
 
 Tenderness as a symptom of sub- 
 luxation, 244 
 
 Tenth thoracic nerve, parts influ- 
 enced by, 254 
 
 Testes, innervation of, 161 
 tuberculosis of, 408 
 
 Tetany, 510 
 
 Theoretical basis of chiropractic, 5 
 
 Third cervical nerve, parts influ- 
 enced by, 251 
 
 Third lumbar nerve, parts influ- 
 enced by, 254 
 
 Third sacral nerve, parts influenced 
 . by, 255 
 
 Third thoracic nerve, parts influ- 
 enced by, 253 
 
 Thoracic extension hold I, 363 
 
 Thoracic extension hold II, 364 
 
 Thoracic portion of gangliated cord. 
 
 52 . 
 Thoracic vertebrae, 215 
 
 palpation of, 311 
 Thrust, proper application of the, 
 316 
 
 mode of delivery, 319 
 Thumb-transverse hold, 341, 365 
 Thyroid gland, innervation of, 131 
 Tinnitus aurium, 533 
 T. M. hold, 329, 358 
 Tongue, innervation of, 129 
 Tonsillitis, 432 
 Tonsils, innervation of, 127 
 Torticollis, 564 
 Touch, sense of, 79 
 Transverse processes, malalignment 
 of, 285 
 
 palpation of, 287 
 Traumatism of nerves, 167 
 Trichinosis, 416 
 Trigeminal nerve, jz 
 
 Trochlear nerve, ^2 
 
 Trophic function of nerves, 88 
 
 Tuberculosis, 401 
 
 acute miliary, 402 
 
 of alimentary tract, 407 
 
 of Fallopian tubes, 408 
 
 of genito-urinary tract, 407 
 
 of larynx, 407 
 
 of prostate gland, 408 
 
 of testes, 408 
 
 of ureter and bladder, 408 
 
 pulmonary, 402. 404 
 
 treatment of, 406 
 Twelfth thoracic nerve, parts influ- 
 enced by, 254 
 Typhoid fever, 390 
 
 Ulno-spinous hold, 353, 365 
 Unilateral pisiform-transverse an- 
 terior hold, 329 
 Unilateral pisiform-transverse hold, 
 
 353, 370 
 Uremia, 524 
 Ureter, innervation of, 153 
 
 tuberculosis of, 408 
 Uterus, diseases of, 538 
 
 innervation of, 157 
 
 prolapse of, 543 
 
 Vagina, innervation of, 161 
 Vaginal plexus, 60 
 Vaginitis, 537 
 Varicella, 393 
 Varicose veins, 455 
 Vertebrae, cervical, 215 
 
 lumbar, 216 
 
 palpation of, 303 
 
 position of, 219 
 
 thoracic, 215 
 Vertebral column, 213 
 
 normal curves of, 216 
 
 normal movements of, 217 
 Vertigo, 535 
 Vesical plexus, 59 
 Vulvitis, 537 
 
 White rami communicantes, 64 
 Whooping cough, 397 
 
 Yellow atrophy, acute, 478
 
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