Following osteopathic examination and giving proper importance to
lesions below the fourth dorsal vertebra, we must remember a special
significance to be attached to lesions of the =upper dorsal= in
relation to the eye.
Almost any author on nervous diseases or diagnosis will discuss this
center. Many of us have it not sufficiently impressed, hence I repeat
some known relations. The =ciliospinal= center consists of a nuclear
group of cells in the lateral horn of the last cervical and two upper
dorsal segments of the spinal cord. From this nucleus fibers pass to
the anterior division of the eighth cervical and first and second
dorsal nerves and become the white rami communicantes which are
efferent in their function. These fibers pass to the =inferior cervical
sympathetic ganglion=, thence upward with the sympathetic trunk through
the =middle= and =superior cervical sympathetic ganglia=, along the
carotid plexus to the vessels of the face and eye, to the glands of
that region, to the unstriped muscular fibers of the levator palpebræ
superioris and to the =dilator pupillae muscle=.
Any strong feeling or emotion (which of course is perceived and
interpreted by the brain cortex) will cause a dilatation of the pupil
of the eye. The cervical sympathetic being cut, dilatation does not
take place. The rami of the cervical, first and second dorsal cut, the
phenomenon stops. It is evident the ciliospinal center is under the
influence of a center or centers in the brain. Bing says “There is even
an idiomotor mydriasis, which may be brought about by a very vivid
mental conception of darkness.”
It has been noted that paralyzing lesions of the cervical sympathetic,
of the last cervical and two upper dorsal segments of the cord, and of
the anterior roots and rami communicantes of the same, will result in
myosis.
The efferent rami are also vasomotor, secretory and trophic. It must
necessarily follow that congestive and inflammatory conditions,
secretory perversion of the lachrymal, Meibomian, Zeissian and
perspiratory glands, and disturbance of the normal nutrition of any of
the orbital tissues may result from lesions of the lower cervical and
upper dorsal vertebræ.
Osteopathically we know that such a lesion may not be sufficient to
be paralytic in its effect, but stimulatory. In this case we may
note a pupil habitually too wide and more or less photophobia from a
superabundance of light. The unstriped muscle fibers in the levator
palpebræ superioris may be unduly contracted making an appearance of a
slightly bulging eyeball when it is only a wide open eye.
One who has eye strain from a refractive error, overuse of the eyes, or
unbalanced muscles will as a rule have tenderness at some spot in the
region of the =ciliospinal= center. A mechanical lesion at that part of
the spine may or may not exist in such conditions, but I believe the
soreness is there every time. This is one of the diagnostic points in
differentiating =headache= of eye strain from other conditions.
White rami are only in the dorsal region and to the second lumbar
and from the second, third and fourth sacral. It has been noted
that lesions of the cervical vertebræ do not have as profound
an effect upon the eyes as do lesions of the first three dorsal
vertebræ. The plausible explanation of that is that the cervical
vertebræ have no white rami from their corresponding nerves in the
bulbo-spino-sympathetic-ciliary arc as have the upper dorsal.
From all the foregoing statements one can readily contemplate the
intricate complexity of our osteopathic problems in relation to the
eye. Combine this logic of the lesions outlined and the ramifications
of the structures with their normal and perverted functions and combine
it with contributing causes, such as infection, exposure, irritants,
etc., and amidst the great diversity we reduce much miscellaneous,
unclassified material to a degree of simplicity. Many otherwise
unexplainable conditions become reasonably clear.
Dr. Louisa Burns under “The Experimental Demonstration of Osteopathic
Centers” has this to say:
“Somatic Reflexes”
“In the first series of experiments, the electrodes were placed upon
the nasal mucous membrane of animals under anesthesia. The muscles near
the third thoracic vertebra were at once strongly contracted....
“The electrodes were then placed upon the conjunctivæ. The muscles near
the second vertebra were then contracted. There were also slight and
inconstant contractions of the cervical muscles....
“The electrodes were placed upon the eye ball. The muscular
contractions were sometimes noted near the second thoracic vertebra,
but the reaction was not constant. The cervical muscles were scarcely
contracted at all.
“The electrodes were placed upon the outer surface of the eye lids.
The facial muscles were contracted very quickly and forcibly, but no
contraction of the muscles of the upper dorsal region were noted....
“The =superior cervical ganglion= was exposed to view, and the
electrodes placed upon it. The pupils became greatly dilated, the
conjunctivæ became lighter in color, and the mucous membranes of the
nose and throat were also lightened....
“The =Gasserian ganglion= was exposed to view. The ganglion was
stimulated directly. The upper thoracic muscles were very strongly
contracted, and the blood vessels in the area of the distribution of
the fifth nerve were immediately and strongly contracted. Some of the
sympathetic fibers are carried by way of the fifth nerve. In order to
exclude the effect of the direct stimulation of these fibers, the fifth
nerve was cut, and the central end was stimulated by the electrodes.
The muscles of the upper thoracic region were contracted, as before.
The vessels in the area of distribution of the fifth nerve were
contracted after latent period of a minute or so....
“The stimulation of the central end of the cut fifth nerve caused
strong muscular contractions in the upper thoracic region, and also
constriction of the vessels in the area of distribution of the fifth.
Direct stimulation of the superior cervical ganglion produced effects
identical with those produced before the mutilation.
“The spinal cord was cut above and below the superior cervical
ganglion. This cut was made from behind, and the sympathetic chain was
uninjured. The effects noted after both operations were the same, and
can be described as one.
“The stimulation of any cranial structure failed to cause reflex
contraction of the muscles in the upper dorsal or the cervical region.
“Stimulation of the cranial structures did not produce any vascular
changes except those which might be referred to the direct effects of
the electricity upon the vessel walls.
“Direct stimulation of the =superior cervical ganglion= produced the
effects noted before mutilation.
“Therefore the cervical portion of the spinal cord is an essential
element of the reflex arc by way of which sensory impulses from the
cranial structures are able to affect the condition of the upper
dorsal muscles, and also in the path by which these impulses are able
to affect the size of the blood vessels of the cranial structures
themselves....
“Mechanical stimulation of the tissues near the second thoracic spine
was followed by a contraction of the blood vessels of the cranial
mucous membranes and the conjunctivæ, by a dilatation of the pupils,
and an increased secretion of saliva. These effects were practically
invariable....
“The superior cervical ganglion was subjected to mechanical stimulation
by the manipulation of the tissues over it. In animals, this maneuver
was followed by dilatation of the pupils and by a contraction of the
cranial vessels, which was soon followed, if the stimulation continued,
by a dilatation which was rather persistent.
“After the =extirpation= of the =Gasserian ganglion= without the
injury of the sympathetic nerves, the mechanical stimulation of the
tissues near the second and third thoracic vertebræ caused the same
vaso-constriction and =pupilo-dilation= as was observed in the animal
before mutilation.
“After the destruction of the cervical portion of the sympathetic
chain, and after the extirpation of the Gasserian ganglion in most
animals, the mechanical stimulation of the tissues in the upper dorsal
region did not produce any perceptible effects....
“Mechanical stimulation of the tissues near the second and third
thoracic spines caused dilatation of the pupils and contraction of the
vessels of the cranial mucous membranes.
“Inhibition, or the maintenance of an artificial lesion, caused
dilatation of the vessels of the nasal mucous membranes and of the
conjunctivæ. The eye ball was also somewhat congested. The pupils were
dilated in this case also.”