CHAPTER VII
MISCELLANEOUS
CHAPTER VII
MISCELLANEOUS
MALNUTRITION
This condition may result from a lack of the proper amount of food and from unhygienic conditions. However, it is often found among the children who should be properly nourished, who have the very best of care and the most wholesome food. There is no definite standard by which to determine a case of malnutrition. The extreme cases are obvious, but a child may be simply underweight and still not be classed as a case of malnutrition. Up to eleven or twelve years of age a child is not usually considered properly nourished if he is 10% below the normal standard of weight for his age and height. If the food supply is insufficient in quantity or quality, if there are bad habits of eating, such as bolting the food, insufficient mastication, and irregular hours of eating, these should all receive proper attention. If, on the other hand, the supply of food is sufficient in quantity and quality, if all habits of eating are normal and there is malnutrition, it is because the food is either not properly digested or not properly assimilated, or both, and the child should receive prompt attention at the hands of a competent chiropractor.
Symptoms
The symptoms of malnutrition are very obvious and need no special mention here. Such children are usually irritable and fretful. They are of a nervous disposition and very active. They are usually very bright mentally and often excel in their school work. Children suffering with malnutrition are very susceptible to different incoördinations and may be sick a great deal.
Major Adjustment
In these cases, if the child is provided with food having sufficient nourishment, most excellent results will be obtained from chiropractic adjustments. A very careful analysis must be made in order to determine all the facts in the case for the major differs in different individuals. In some cases the major will be C.P. and K.P., in others S.P., K.P. and a lumbar, while in some cases Li.P. and Sp.P. may be involved.
INANITION
This is the term applied to the condition resulting from the lack of food assimilation, It affects principally young infants. It is characterized by a persistent loss of weight with more or less severe symptoms which may appear rather suddenly.
Symptoms
The infant’s pulse is weak and rapid and the temperature may be high. There is scanty urine, cold extremities and great muscular relaxation. The face presents a peculiar bluish gray color. There may be cyanosis. There is rapid irregular respiration. In the more severe cases there may be stupor, while in others the child is very restless and fretful. Pupils are contracted and the fontanel is sunken. The progress of the incoördination may be rapid and in very young infants death may occur quite suddenly. Breast feeding is very essential in these cases.
Major Adjustment
Inanition is really malnutrition in the young infant due to a lack of assimilation of nutrition. The major adjustment is C.P. or S.P. and K.P. In some cases Li.P. may be involved, while in others Spl.P. may enter into the combination.
MARASMUS
This condition is also called infantile atrophy and simple wasting. It is not very common and is usually found in institutions for infants. It affects infants who are unusually weak. It is said to result largely from improper food and feeding and also it is influenced by the surroundings. In these cases the methods of feeding and the character of food should be carefully investigated. If these are found satisfactory it will then be obvious that the food is not being properly digested. This calls for a careful analysis and adjusting of the child. In these cases the food can not be assimilated because it is not properly digested. There is a progressive and persistent loss in weight. The body temperature becomes subnormal, the lung expansion imperfect, emaciation very marked, the skin deeply wrinkled and the face and arms take on a very old appearance. The eyes appear very large, the temples and fontanels are sunken, and the abdomen becomes very prominent. The child is very susceptible to all forms of incoördinations and because of the extreme weakness may succumb quickly to any acute dis-ease. In some cases after the emaciation has become very marked there may be an unusual and sudden gain in weight due to a general edema. This condition may increase until all the tissues of the body become extremely water-logged. The large cavities, however, are very seldom affected. Infants under seven or eight months of age are likely to be affected by this edema.
Major Adjustment
These cases call for a combination major which consists of S.P. and K.P. and an Up.L.P. Excellent results will be attained in these cases if adjustments are given early enough in the stage of the incoördination. The patient is never too weak to be adjusted.
SCURVY
Scurvy is a condition resulting from faulty nutrition. It is characterized by a swelling of the joints, sometimes pseudoparalysis of the lower extremities and a spongy condition of the gums which have a tendency to bleed. There may be cachexia and anemia. This condition is supposed to result from a continuous diet lacking in the vitamin C.
Symptoms
Usually the first symptoms to appear are tenderness of the legs. This will be observed from the fact that the child cries when his legs are moved. Eventually this tenderness localizes about the knees and ankles and it is accompanied with swelling of these parts. The gums then become swollen and show a marked tendency to bleed. This swelling may produce pain sufficient to interfere with the child taking food. The child loses weight, becomes very fretful, and has a slight fever. There is a characteristic posture in which the hips are rotated outward, while there is a semi-flexion of the thighs and legs. The child will usually lie very quietly because any movement produces pain, especially in the legs. There is marked sub-periosteal hemorrhages which may be so great that the limbs will become twice their normal size. In severe cases epiphyseal separation is not uncommon. Scurvy is very often associated with rickets. However, it is affirmed that they are two separate conditions and not just different forms of the same condition.
Major Adjustment
This incoördination requires a combination major which will be found at C.P. or S.P. and K.P.
RICKETS
Rickets is also called rachitis and known by some as Barlow’s dis-ease. It is listed as a dis-ease of nutrition, although the most important anatomical changes which take place are those affecting the bones. This dis-ease is found among people of all classes. There is no race that is immune, yet some nationalities seem to suffer more frequently and severely than others. Negroes and Italians seem to be especially susceptible when placed in northern climates and congested quarters in northern cities. In general practice rickets is considered a rather uncommon incoördination, although in congested cities it will be found quite prevalent.
Symptoms
The first symptoms to appear are nocturnal restlessness and profuse sweating about the head during sleep. The restlessness is usually quite marked; the patient rolls and tosses a great deal, and almost constantly moves the head back and forth on the pillow. Because of the profuse sweating the child becomes very susceptible to colds, bronchitis and bronchial pneumonia. A case of rickets is rather easily recognized by the large head, the pigeon breast, beaded ribs, the deformities of the extremities, the swelling of the epiphyses of the wrists and ankles, and the prominent abdomen.
Deformities of the Head
Deformity of the head appears very early in the dis-ease and is due to the thickening of the cranial bones, producing the typical square head of rickets. This square head is known as caput quadratum. Numerous soft spots are formed in the cranial bones which when pressed upon give one the impression that he is feeling parchment. This is known as cranial tabies. The fontanels and sutures are very late in closing, sometimes as late as the third or fourth year. The large rachitic head must not be mistaken for hydrocephalus.
Deformities of the Thorax
The chest is deformed in such a way that the transverse diameter is decreased and the antero-posterior diameter is increased. This produces the typical pigeon breast. Such deformity is caused from the softening of the thoracic bones. Beading of the ribs is characteristic and is known as the rachitic rosary. These nodules are formed at the junction line of the costal cartilages and the ribs. While these nodules are always present, they are not always visible. The rachitic gurgle, which is a transverse depression extending from one side of the chest to the other and is about two inches broad, is also present.
Deformities of the Spine
The most characteristic deformity of the spine in rickets is a kyphosis usually involving the lower dorsal and the entire lumbar region, although lateral curvatures may appear. In a well defined case of rickets every bone in the body may be abnormally involved. The deformity of the spine results from a softening of the bones which give way under the weight of the trunk.
Deformities of the Extremities
A case of rickets usually presents characteristic curvatures of the bones. The long bones are, as a rule, involved symmetrically. Green stick fractures very often occur. In practically all cases of this dis-ease there is an arrested longitudinal growth in the bones. Because of this the height will often be very much less than that of the normal child. There is marked enlargement of the epiphyses at the wrists and ankles. The slight curvatures in the bones of the arms will be exaggerated when the child begins to creep and the curvatures in the legs will be increased when the child begins to stand and walk.
Deformities of the Abdomen
Due to the general motor minus condition of the abdominal muscles there is developed a condition known as pot belly. This enlargement is often exaggerated by intestinal indigestion and constipation. This constipation results from the motor minus condition which interferes with the vermicular movement of the intestinal tract.
Equation
The function that is primarily involved in rickets is nutrition, but this results in other functions being implicated. There is expansion minus especially in the development of the osseous tissue. The equation is N— with X—.
Major Adjustment
Most excellent results are obtained in rickets. It is very essential that the adjustments be given at the beginning before the deformities become marked. In the more chronic cases the incoördination will be checked by the adjustments and the patient will recover, but it will be obvious that the marked deformities such as genu varum, genu valgrum, enlargement of the wrist and deformities of the head can not be corrected in the chronic cases. The adjustment is At. or Ax., S.P. and K.P.
NEUROTIC CHILDREN
Neurotic symptoms may appear very early in infancy. They may be first noticed when the child is startled by sudden sounds or unusual sights. Ordinarily the infant, only a few weeks of age, will pay little or no attention to its surroundings. The neurotic infant, however, may be startled or badly frightened by its environment. Such infants are found to apparently fix their attention upon objects as early as the third or fourth week. If its attention is thus centered upon a person who should make a quick, unexpected move, the child often becomes terrified. In other cases the symptoms may manifest themselves in a muscular spasm, such as mild opisthotonos, and other conditions suggesting cerebral incoördination. In early infancy vomiting and diarrhea may be brought on by excitement. The vomiting takes place without nausea and may be excited either by food or water. This must be carefully distinguished from the spitting up of milk so characteristic in infancy. This is a perfectly normal process and seems to be Innate’s method of adaptation when the child has taken too much milk into the stomach. Vomiting in neurotic infants may even become so severe that it results in a loss of weight. The diarrhea occurs with no more apparent cause than the vomiting. If the stools are not too frequent the food will be well digested but the diarrhea may become so severe that the food passes through the intestinal tract undigested. This diarrhea may be very obstinate and then it results in serious malnutrition. As the child grows older the characteristic symptoms of infancy become less marked but the child continues to be extremely nervous, irritable and cross. This nervousness may be exaggerated by the surroundings. Such children usually have poor appetite and suffer from constipation. They are almost always poorly nourished and anemic. The pulse is usually more or less rapid and is generally affected by excitement. Such children are quite restless during sleep.
Neurotic children are often precocious but lack in concentration due to their restlessness. Headache is a very common symptom. There is a marked tendency toward habit, spasm and chorea.
Family
These conditions are classified in the spasms family.
Equation
The equation is not so well defined since the condition of nervousness is adaptative. Therefore the equation for the nervousness is I.A. If other symptoms appear the equation would depend upon the function involved.
Major Adjustment
It is maintained by most authorities that this nervousness is inherited, but it has been demonstrated clinically by Chiropractic that results are readily obtained by chiropractic adjustments. It is reasonable to assume that there are environmental conditions which might produce nervousness even in the small infant, but it is also recognized that if the child is normal he soon becomes accustomed to the peculiarities of the environment and pays little or no attention to them. Subluxations in the cervical region, usually atlas or axis, are found in these children. These subluxations may produce sufficient cord pressure to cause such symptoms as usually manifest themselves in malnutrition as so-called nervous indigestion and other symptoms which would indicate constitutional disorders. A very careful analysis reveals that the nervousness in some of these cases is adaptative to some other incoördination. If the nervousness is direct the major adjustment will be Up.C. with a possible combination of C.P. and K.P. If the nervousness is adaptative, then a very careful analysis must be made to determine the incoördination to which it is adaptative. The major then will be determined by the location and the family involved.
CONVULSIONS
A convulsion is a violent involuntary contraction of muscles which ordinarily contract only under direction of the will. It may be either clonic or tonic. A clonic convulsion consists of a spasm of the muscles with alternating contractions and relaxations while the tonic spasm consists in constant rigidity of the muscles involved. The contractions may be confined to certain muscles or sets of muscles as, for example, the muscles of the face, the trunk or the extremities. In some cases the muscles of the entire body are involved.
During the first eighteen months of life the child is more susceptible to convulsions than at a later age, although the condition is rather common during childhood. Convulsions accompany many incoördinations and are considered adaptative to some other condition. Therefore the first thing to consider in a case of this kind is the primary condition or the incoördination to which the convulsion is adaptative.
The more common conditions with which convulsions are associated are: Incoördinations involving the nervous system, such as cerebra-spinal conditions; rachitis; and organic and functional disorders. Any condition which produces an irritation of the nervous system may result in a convulsion of more or less violence. For this reason children are often subject to convulsions during dentition and disorders resulting in slight temperature. Cerebral tumors, abscesses of the brain, hydrocephalus and meningitis are examples of cerebral conditions in which convulsions are commonly found.
Subluxations in the upper cervical region are often produced at the time of birth which cause cord pressure, making the child susceptible to all conditions that would irritate the nervous system.
There may be K.P. subluxations interfering with the process of elimination resulting in an accumulation of poison within the body, or there may be other subluxations resulting in the production of toxines within the body and these will produce an irritation of the nervous system resulting in convulsions. Disturbances in digestion, affections of the respiratory tract, a sudden rise of temperature and incoördinations involving the gastro-intestinal tract are often responsible for convulsions. Convulsions are quite frequent at the onset of acute dis-eases such as whooping-cough, measles and mumps. They are often associated with enlargement of the thymus gland.
During the convulsion there may be loss of consciousness with tonic and clonic spasms in various degrees of severity. The urine may be voided and the bowels evacuated. In the very young infant a single attack may prove fatal, although this is rather unusual. When death occurs in this way it is most often due to asphyxia, or when the convulsions recur in rapid succession death will result from exhaustion.
The clinical picture is quite typical. Usually there is pallor of the face which may be followed quickly with a twitching of the facial muscles, and sometimes those of the hands and feet. In most cases the attack comes on without warning; the eyes become fixed and rolled backward; the twitching usually begins in the face and very soon the entire body is involved. The face is distorted by muscular contractions, the head is drawn backward and the neck is thrown forward; there may be frothing at the mouth. The pulse is irregular and weak, the respiration is shallow and feeble while there is cold perspiration of the forehead and it may also be on the body. The thumbs are turned into the palms and the hands are tightly closed. There is rhythmical convulsive movements consisting of alternating flexion and extension.
The attack usually lasts from a few minutes to half an hour and sometimes longer. The patient is left in a more or less state of exhaustion and the attack may be followed by stupor and coma. Very often convulsions in children over two years of age indicate the onset of some acute condition such as pneumonia or scarlet fever. However, convulsions may mean very little with small children that are extremely nervous. During the first few days of life they may be the result of temporary circulatory disturbances in the brain from prolonged pressure in difficult labor.
Family
All cases of convulsions are in the spasms family no matter with what other conditions they are associated. If there are other complications, and there usually are, the family for the complications will depend upon the functions involved.
Major Adjustment
When a chiropractor is called to see a child that is having convulsions he should make a very careful inquiry into the history of the case and try to find the associated incoördination. This is done for the purpose of determining the combination to be used. The major for location will be atlas or axis, while the combination will depend upon the associated condition. This may be K.P. or it may be S.P. or any other combination which would include the subluxation for condition.
Excellent results are obtained in cases of convulsions. The adjustment should be given as soon as possible. In many cases an adjustment of the atlas or axis will bring the child to consciousness and prevent a recurrence of the attack. The convulsion may be caused by an atlas subluxation with no accompanying condition. This is known as a direct convulsion and will respond very quickly to an adjustment.
NOCTURNAL ENURESIS
As early as the tenth or twelfth month of age the child may be trained to make known his desire to empty the bladder. However, with some children this may not be accomplished until two and a half years of age. If by the third year of age the child is unable to retain the urine for a normal length of time, it is evidence of some abnormality and should receive Chiropractic attention. The child is afflicted with what is known as enuresis, which may take place during the day or night, or both. If it occurs during the day, it is called diurnal; while if it takes place during the night, it is known as nocturnal. It is more likely to take place during the night, since it may be possible for the child to control the bladder during waking hours.
We are most concerned with the nocturnal enuresis, because this form causes the child more discomfort and it is more difficult to control than the diurnal.
We recognize nocturnal enuresis as an adaptative condition. That is, the emptying of the bladder is a perfectly natural process and will always take place under certain conditions. For example, if the sphincter muscle relaxes, the urine will be voided. In this event, we are not concerned in the voiding of the urine, but in the cause for the relaxation of muscle which prevented the bladder from retaining the urine. There are a number of conditions to which nocturnal enuresis is adaptative. The following are the most common:
Incoördinations involving the nervous system.
Highly acid urine.
Excessive quantity of urine.
Abnormalities and incoördinations of the bladder.
Irritation of the genital organs.
Incoördinations of the Nervous System
The incoördinations of the nervous system in which there may be nocturnal enuresis are those commonly found in extremely neurotic children, and children who are under-nourished and anemic. Chorea, neurasthenia and hysteria are examples of conditions in which nocturnal enuresis is very common. Nervous children are easily disturbed during sleep and are prone to dream, at such times the innate interpretation of the vibrations produced by the urine in the bladder reaches the educated mind and there is not sufficient reasoning of the conscious mind to enable the child to realize where he is or to prevent the following of the natural desire to urinate.
The inability of the child to control the bladder during acute illness must not be mistaken for habitual nocturnal enuresis; for this will be only temporary, and will disappear when the child recovers from the acute attack.
Highly Acid Urine
In some cases, the urine being highly acid, produces vibrations in the bladder which results in Innate Intelligence causing the sphincter muscle to relax, which results in the voiding of the urine. This is an adaptative action on the part of Innate to prevent the acidity of the urine from setting up an irritation in the bladder. If the urine remained in the bladder it would damage the tissues and call for an expenditure of energy for reparation; this is all prevented by getting the urine out of the bladder as soon as possible. The hyperacidity of the urine is the result of the lack of the expression of mental impulses in the body and should receive immediate attention, that the cause of the incoördination may be removed. When this is accomplished the nocturnal enuresis will cease.
Excessive Quantity of Urine
In some incoördinations there is abnormal thirst which results in the child drinking more water than is required for the normal bodily processes. The natural channel through which this excessive amount of water is excreted is through the kidneys. This results in the bladder being filled often, which necessitates the frequent passing of urine. The child might be able to control the bladder during waking hours and make his wants known; but in sleep, as the bladder becomes full, Innate would relax the sphincter muscle, which would allow the urine to escape in order to relieve the pressure. To overcome the nocturnal enuresis in a case of this kind, it is necessary to adjust for the cause of the excessive thirst; and when this is corrected, the bed wetting will cease.
Incoördinations of the Bladder
Abnormal conditions of the bladder will cause difficulty in retaining the urine for a normal length of time. An inflammation of the bladder is greatly exaggerated by the presence of urine, therefore an irritation would be set up which would result in a desire to empty the bladder. This would invariably result in nocturnal enuresis. An interference with the transmission of motor mental impulses to the sphincter muscle would be another cause for bed wetting. In this case, it would be impossible to retain the urine after a certain amount had passed into the bladder. This would result in enuresis, since there would be nothing to prevent the urine from passing freely from the bladder.
Irritation of the Genital Organs
In some cases there is an irritation of the genital organs resulting in the production of vibrations which, when the child is asleep, results in enuresis. This irritation may be produced by an adherent prepuce. Balanitis and phimosis are also quite common conditions. There may be an irritation of the rectum produced by pin-worms. Vaginal irritation may be the result of vulvovaginitis, or due to adherent clitoris.
Correction of the Condition
It is asserted by some that nocturnal enuresis in many cases is due largely to habit. We see no more reason for considering this condition a habit than for considering any other abnormal condition a habit. It is the result of interference with the transmission of mental impulses, and it is the duty of the chiropractor to find the condition to which nocturnal enuresis is adaptative and correct the cause of that condition.
Some parents have the idea that bed wetting is a habit, and the child should be punished in an effort to break him of the habit. This, however, is the wrong attitude and no good will be accomplished in this manner. Punishment will only tend to make the child nervous and the condition worse.
This condition yields so easily to Chiropractic adjustments that there is no reason for allowing a child to continue without relief from this most annoying condition. We have never seen a case that did not respond to adjustments after the proper analysis was obtained.
In analyzing a care of nocturnal enuresis it must not be taken for granted that the major is K.P., or even a lumbar. For this may not be true. A most thorough analysis should be made to determine the exact condition of the child. If the nervous system is involved, there will likely be found an atlas or axis subluxation. We have seen many cases that had been adjusted persistently at K.P. and a lumbar, but with no results, while an adjustment of the axis would get almost immediate results. This does not mean that every stubborn case will respond to an axis adjustment.
Scanty and highly colored urine, which has a tendency to scale and irritate the skin, usually indicates highly acid urine. In this case a careful analysis must be made to determine the cause of the acidity. The palpation will reveal a subluxation and most likely a hot box at C.P. and K.P. In many cases the child will be anemic, and in a general rundown condition; in this case the combination will be S.P. and K.P.; the combination may also include a lumbar.
In the cases involving the bladder, the major will be a lumbar vertebra. The combination will be determined by the local condition, which may necessitate the use of K.P. When there is an irritation of the genital organs or adjacent structures, the major will include a lower lumbar vertebra and may or may not require a K.P., the combination depending upon the character of the local condition.
From the foregoing it will be observed that the major for nocturnal enuresis varies, depending upon the condition to which it is adaptative. The major may include At., Ax., C.P., K.P., lumbar, or any combination of these or other subluxations. When the impingements are found, and the causative subluxations adjusted, complete results will be obtained—in every case.
OPHTHALMIA
This is an incoördination characterized by inflammation of the conjunctiva. It is also called purulent conjunctivitis. Medically these cases are supposed to be produced by gonorrhea, although in many of the milder forms the gonococcus is not present. This is evidence that the cause is not the gonococcus but that the germs, when present, are there because of the pathological condition of the tissues.
Symptoms
The eyelids are swollen, there is a copious, purulent discharge, and there may be ulceration of the eyelids.
Major Adjustment
The major for this condition is a combination major which includes a middle or upper cervical for the location and kidney place for elimination.
TETANUS IN INFANTS
This is a condition which is occasionally found in young infants and is the result of an infection usually of the umbilical wound. It is most prevalent where conditions are unsanitary. Tetanus is characterized by a tonic spasm of the muscles. It may affect all the muscles of the body or it may be limited to the muscles of the jaw, producing what is known as trismus or lockjaw.
Symptoms
The first symptom to appear may be the spasm in the masseter muscle which interferes with nursing the child. The muscle of the face and jaws appear firm and hot and the lips slightly protrude. Intervals will occur when the muscles will be completely relaxed. At first these paroxysms appear at intervals, between which the relaxation is complete; but later they become more frequent and the relaxations less marked until there is more or less of a continuous rigidity. This contraction grows more exaggerated until the entire body becomes rigid. The jaws become set and may be separated only slightly, if at all. There is a peculiar characteristic facial expression due to the contraction of the facial muscles. Swallowing becomes very difficult. There is a weak, rapid pulse. In the mild cases there is only a slight temperature, but in the more severe cases the temperature may become extremely high. The cry becomes weak and whining. The incoördination is of short duration. The child soon dies from exhaustion or from suffocation due to the rigidity of the respiratory muscles or it may be due to a spasm of the larynx. While tetanus is not a very common incoördination, the mortality is very high. Authorities place the fatality as high as 90% and even 95%.
Equation and Family
The equation is excretion minus (E-). The family is poison and contractures.
Major Adjustment
If these cases are adjusted at an early stage excellent results will be obtained. There is a combination major at At.P., C.P., and K.P.
PEMPHIGUS NEONATORUM
This is a rather unusual condition seldom found in general practice. It usually occurs as epidemics in institutions where large numbers of children are cared for. Outside of such institutions it is more common among children in unhygienic surroundings. It is characterized by an eruption of blebs containing a serous fluid.
Symptoms
These blebs appear about the third or fourth day and may be found upon any part of the body, but usually upon the exposed parts. They remain for a time and then rupture or dry up. There is no suppuration. As the blebs enlarge they sometimes coalesce, covering quite a large area. The epidermis is loosened by a serous exudate which occurs directly beneath it and separates it from the true skin. The case produces a very striking picture having the appearance of being extensively burned. After the blebs have ruptured the epidermis hangs in shreds, leaving a very bright red surface beneath. In this way there may be large areas of the body almost completely denuded of the epidermis. There may be a very slight temperature and slight restlessness. There is great depression and marked weakness. The symptoms at first appear rather slowly, later the dis-ease progresses very rapidly, death often occurring in from twenty-four to forty-eight hours. Pemphigus neonatorum should be distinguished from congenital syphilis. The liver and spleen are usually very greatly enlarged in syphilitic cases and there are usually other characteristic symptoms present, such as changes in the nails, mucous membrane and other parts.
Equation and Family
The general equation is excretion minus (E-). The condition is in the poison and fever families.
Major Adjustment
The major adjustment is C.P. and K.P.