When I took charge of the surgical work at Kirksville, osteopathy
was not used in post-surgical treatment. Post-operative vomiting was
treated medically, as were other post-operative conditions, including
pneumonia. Cases of a real major surgical nature rarely got an
osteopathic treatment.
The idea seemed to be that osteopathic post-operative treatment had to
be along the same lines as it would be for such an illness as lumbago,
brachial neuritis, or ordinary pneumonia, and other non-surgical
conditions where the patient could be placed for giving a treatment in
a position that was not permissible following an operation, as it would
work great harm to the wound.
It seemed to me that if osteopathy was effective in a case of ordinary
non-surgical pneumonia, it should certainly be good for a case of
pneumonia that was post-operative and that all we had to do to handle
the condition was to apply a new technique of treatment that could be
used on a patient who had a surgical wound. All we had to do was to so
manipulate the spine that we would get the results locally, and yet
handle it in such a manner as not to affect the wound.
Many laymen, and even some physicians of our own school, express
surprise at the suggestion that we do much osteopathic work in the
after care of surgical patients. But the fact is we have worked it out
so that now, except for pain, during the immediate after effects of
the operation drugs are absolutely not used in our hospital for any of
the post-operative complications. The opiate immediately following the
operation, is really a follow up of the anesthetic, and we use that as
rarely as possible. Needless to say, there are cases such as un-united
fractures, extensive adhesions, etc., where the emergency conditions
positively call for some relief of the pain for a short while, but that
is the only condition that we cannot control with mechanical treatment.
I am very glad that I had the confidence to give this an early trial
and a thorough trial, without being afraid to leave off the drugs.
The big field, however, where osteopathic treatment has won the most
impressive success and proved itself a most absolute specific, is in
the field of post-operative pneumonia with which I am proud to announce
a one hundred per cent. success for combined osteopathic treatment in
my fourteen years continuous surgical work. Not to have lost a single
case is partly due to luck. In other words, with any series of serious
cases, it is impossible but that there be some fatality finally.
Post-operative cases have one advantage along with their disadvantage.
While they have the shock of the operation to contend with, and the
weakened condition from the disease for which they were operated, still
except in extreme emergency they would not have been operated on unless
they had a good heart and good kidneys and a good blood pressure, so
that in cases in which we are most concerned in combatting pneumonia,
we usually start with a patient who has those organs in a healthy
condition.
=First Post-operative Pneumonia Cases Treated Osteopathically.=—At
the Chicago Convention in 1911, I reported the first post-operative
pneumonia cases that had been treated osteopathically. I believe at
that time that there had been only three cases. At that meeting I
mentioned the fact that some of the doctors and some of the internes
who treated those cases felt sure that they were not treating them
properly because they could not get away from the idea that pneumonia
needed strychnin and other drugs. One of these cases got well in three
days from the developed lobar pneumonia symptoms. The results were so
miraculous that the young man treating it began to doubt whether it
could have been pneumonia. He could not understand how he, a senior
student, could overcome this dreaded disease by merely working on the
spine. He could not believe that osteopathy, a science that he had been
able to learn himself, so easily could cure a condition that he had
thought must be almost necessarily fatal.
One of the weaknesses of osteopathy is the fact that there is no
mysticism about it. It is so simple that any person with ordinary
intelligence can learn to use it, and yet it is so simple that it takes
an unusual intelligence to be able to grasp the fact that it is the
therapeutic discovery of the age. Many, many times I have had young
internes and students cure genuine lobar pneumonia and do it with such
obvious ease that it caused them to wonder, in a way, if it really
could be pneumonia. It is bred in our very tissues to look for some
mysticism, something impossible to understand, something supernatural,
something connected with the Unknown associated with the treatment of
disease and accordingly it is just human nature to find it difficult
to believe, even when we see it, that a simple method of treatment can
actually effect a cure.
Real pneumonia, as we understand it, is a consolidation of the lung
tissues characterized by fibrosanguinous exudate into the pulmonary
tissues and spaces, associated with one or more particular germs as
exciting factors and proved by the physical tests and the character
of the expectoration. How many cases have been cured that had not
entered consolidation I do not know because up until the time of actual
consolidation there may be a question as to whether or not they would
have had pneumonia. I know that many cases with marked symptoms of
pneumonia have failed to develop under treatment or the case has been
aborted.
Pneumonia lacks a great deal of being a self limited disease. The
number of cases with beginning symptoms that fail to develop is too
great to be ascribed to coincidence. Of course I know that some of
these might have been only pleuritis, some only neuritis, etc. However,
in giving the statistics of pneumonia cures we will give only those in
which pneumonia developed and showed a hardening or consolidation of
the lung tissue. In these cases there can be no argument as to whether
there was pneumonia.
When we have an acute condition associated with the symptoms of
consolidation, we can hardly be confused as to the diagnosis. We may
make a mistake in our physical findings, but hardly after a little
experience, and certainly when we are sure of the physical findings
there will be no trouble in naming the disease.
=The Clinical Findings.=—Post-operative pneumonia is a little
different from the common pneumonia. It always comes on a little more
insidiously. One has to watch for post-operative pneumonia more closely
than he would for the attack that we may meet in ordinary practice.
A patient may have considerable pain from his wound, may have some
pain in the back from the position he is in; there may be headache,
and an upset feeling from ether; and the pain comes in the chest. All
these symptoms are forerunners of pneumonia, but the pain in the chest
is not noticed until it gets quite severe. In other words, there are
other things to annoy the patient as well as the attendant, and at
first, this condition does not cause complaint. A strong and healthy
individual who feels a pain in his pleura, which is the forerunner of
pneumonia, knows it at once, because that is the only distress he has.
His entire attention is attracted and he asks for a physician’s help.
But in the post-operative case, the physician has to keep a look out
in order to prevent a case from getting well under way before it is
recognized.
As an example of this I had a case of a man who was with a party
driving an automobile and they tried to cross the railroad track in
front of a train. This patient I speak of was one of the survivors. He
had a fracture of the femur, fracture of the skull, fracture of three
ribs, and otherwise more or less bruised up. Naturally the preliminary
work consisted in getting the ribs and legs attended to as well as
possible and looking out for cerebral hemorrhage or meningitis.
This patient developed consolidation in both lungs in spite of regular
treatment, and it precipitated on him very rapidly, partly masked by
the disturbed breathing from other sources of irritation. We put him on
hourly treatment, but after a few hours his condition from the injuries
and the pneumonia was such that his wife asked us not to treat him any
more. She put it this way, that she knew he would die in spite of all
that could be done and as long as he was going to die he might as well
die easy. Every time he was treated it had the effect of bringing him
out of his stupor, and he would complain, and she thought it would be a
kind act to let him slide off into the next world uncomplaining.
Pneumonia in a case of this sort cannot be handled with kid gloves if
we wish to save the patient. We must give firm, strong treatment. Light
treatment in this condition will do no good. Indeed light treatments in
any sort of pneumonia are of little avail. Many times I have changed
internes in a pneumonic case that was not responding and the results
were immediate. That is, the turn for the better was obvious from the
beginning of the good strong treatment.
The case above mentioned was treated a good part of each hour for
twelve hours. He had no strychnin, no oxygen, nothing but treatments,
but he got well and is now living, and aside from a limp has no
evidence of either his injury or his illness.
Some cases, in private practice, may get well on a treatment a day, but
I would hate to handle the kind of cases we get in that manner. I have
had severe cases, especially hemorrhagic cases, where the treatment was
almost continuous for hours preceding the crisis. Of course, after the
crisis we can ease up. On the other hand, it is not infrequent that
a few good strong early treatments, given at the beginning of a case
absolutely stop it. I have seen cases where a consolidation area of the
apex of the lower right lobe as large as the palm was easily outlined,
and this together with the clinical symptoms would be cleared up in two
or three days.
There is no possible medical method by which this can be done. Medical
authorities agree that under their treatment pneumonia runs an
unshortened course; in other words, a course in the individual case
that has not been affected by the medication. Medically, even where
the crisis occurs early, the consolidation persists for some time, but
I have seen it cleared up time and again under osteopathic treatment
in the length of time that could have been brought about only by
osteopathic treatment.
I have previously called attention to the fact that many of the medical
text books on physical diagnosis mention a point that is a very
practical and very plain demonstration of the efficiency of osteopathy
in pulmonary conditions. These books only mention this fact without
pointing any moral or drawing any conclusions. The point is this:
that frequently when a professor is having a class or a section of a
class examining a case of pneumonia, they will outline the size of the
consolidation at the beginning, the instructor marking it off when he
makes the first examination; then after the students have examined it,
by percussion, palpation, etc., possibly a dozen or twenty of them,
the later students will find that the area has shrunken perhaps an
inch. This fact has been frequently noted. It is said, indeed, that if
careful examination is made it will always be noted.