12/16/26 M. L. Richardson's paper, read before the
Osteopathic Society of the city of New York at the Waldorf
Astoria Hotel, December 16, 1926 [See GD's letter, Par. R3
below, mentioning the booklet:]
WHAT FINGER SURGERY IS, AND WHAT IT WILL DO
by M. L. Richardson, D.O., Norfolk, Va.
The nose with the paranasal sinuses and postnasal spaces
appears to me an area of unusual anatomical features and
of compelling clinical interest to all practitioners, for,
from the cradle to the grave, the nasopharyngeal district is
subjected to recurrent severe inflammatory reactions which
for frequency and violence have no parallel in any other
part of the body.
It is a district surrounded by highly important structures,
some of which are submucous, some separated only by thin
porous partitions, and some communicating by open passages.
Many of the anatomical features I have in mind are self
evident as soon as thought is turned to them. Some others
are perhaps not quite so generally known as their importance
deserves.
Although the nasal cavity is of considerable size its parts
are so arranged to provide broad surface area, that the open
spaces are mere slits and the apposing surfaces all but
touching. Into these narrow passages the nasal accessory
sinuses open all by small ostia. In the cases of the
sphenoid and mixillary sinuses the ostio are so placed that
these sinuses have no gravity drainage. The prominence of
the nose and its frail structure exposes it to early and
frequent injury. In fact its anterior septum is probably
dislocated from the pre-maxillary bones frequently in its
course through the birth canal, imposing deformity on these
narrow passages to complicate inflammatory reactions.
The mucous membrane lining of the nose and sinuses is very
closely applied to the periosteum, exposing the periosteum
and the bone to surface influence in a manner not paralleled
anywhere else in the body. This is significant, for bone
changes are a part of all chronic nasal pathology. Elsewhere
in the body the periosteum is covered by loose connective
tissues which acts as a barrier against considerable
inflammation in the surrounding tissues. The quantity and
distribution of the erectile tissues in different noses
varies considerably.
About the pharynx I would particularly mention that its back
wall is applied to the anterior surfaces of the first four
cervical vertebrae; of the presence here of the tonsillar
or lymphatic ring, extending from the pharyngeal tonsil
downward on either side to meet again at the lingual tonsil,
surrounding the postnasal and oral spaces, and the only place
in the body where lymphoid tissue comes to the surface and is
directly exposed. I believe the arrangement of this lymphoid
tissue is clinically and pathologically important. The ring
arrangement is constant. In some heads the lymphoid tissue
is quite limited to the ring; in others there is in addition
a vast amount spread generously over the pharyngeal wall,
inside and outside of this ring. The Eustachian tube opens
into the pharynx in the band of this tonsillar ring.
This vast labyrinth extending from the tip of the nose to the
spine behind, from the roof of the mouth to well above the
orbits and laterally to the malar bones, tympanic and mastoid
cavities, lined throughout by one continuous mucous membrane,
and holding the record over all parts of the body for the
frequency and severity of its inflammatory reactions, is by
itself of the highest clinical importance. This is magnified
many times by important structures lying (according to the
text books) outside of its boundaries, and yet separated from
its cavities and pathologies by such thin porous partitions,
that only by miracle can they escape serious insult - in
fact they do not escape.
All of the cranial nerves leave the base of the skull through
close fitting bony foramina. Of the first six some are
constantly, and the others sometimes, in contact with a sinus
wall, separated from its mucous membrane by a porous shell
of bone of paper thinness. That these nerves are accessible
to influence from nasal and sinus disease is established
clinically and experimentally.
The sphenoid sinus often extends laterally to completely
surround the optic foramina, and it is well established that
sphenoidal bone disease has gradually closed the foramina,
strangled the nerve and caused blindness.
The maxillary nerve is in contact with the wall of the same
sinus, and a drop of cocaine dropped into the sinus - not
injected submucously - is quickly absorbed through the thin
partition of bone and will completely paralyze the entire
nerve trunk. Like exposure of other cranial nerves and
ganglia could be adduced but time prohibits and these are
illustrative.
These nerve complications are greatly increased by the
situation submucous in the nasal wall of the sphenopalatine
or Meckel's ganglion. Sometimes only 2 mm and never more
than 9 mm under the surface membrane. And further by the
otic ganglion in the close apposition to the wall of the
Eustachian tube.
These ganglia with their cranial and sympathetic connections
link up the first six with the rest of the cranial nerves
and with the cervical sympathetics, establishing a network
involving the special senses of sight, hearing, taste and
smell; the sensation of the head, face and neck; the motor
impulses of expression, voice, deglutition, hearing, and
ocular accommodation; and the entire sympathetic system of
the head, neck and thorax. In no other part of the body is
such a network of nerves and ganglia so exposed to surface
influence.
The acute conditions of this distrcit first come to the
general practitioner as is proper and best. Your treatment
is superior to any therapy for shortening these inflammatory
reactions and prevening adhesive processes so likely to
result from long continual inflammation and which become
permanent points of sympathetic irritation, and mechanical
embarrassment to subsequent inflammations. Under your
care these cases usually make uneventful recoveries. The
inflammation subsides, discharges disappear, the breathway is
open and the patients are all right until another infection.
Somewhere along the line chronic processes start, we do not
know just where; in fact the relationship between the two,
acute and chronic, is not clearly established. We know quite
certainly that pathology starts in the soft tissues and later
involves the bone.
The chronic conditions are largely hypertrophies and
hyperplasias, of both the soft tissues and of the numerous
and extensive paper-thin body partitions which support
them. When once established we know also that these
chronic conditions run their course quite independent of the
inflammatory attacks. Between the coryzas or other attacks
when the inflammation, swelling and discharge have completely
cleared up, so far as the patient is aware, the deeper
chronic hyperplastic changes go on progressively.
This is an important point and knocks in the head at least
one popular notion. The freedom from abnormal nasal or
postnasal discharge is not a safe criterion of health in this
region. there are many conditions here called collectively
"catarrh" which have an excessive and modified discharge,
being surface or mucous membrane conditions they all excite
and modify the secretions. These conditions may, and often
do co-exist with deeper hyperplastic processes. And these
deeper conditions may, and often do exist without any
discharge of which the patient is aware.
Serious and disabling diseases here develop and progress in
patients who boast of never needing a handkerchief, who will
assure you that their breathway is always free and open, and
that they rarely have a head cold. A searching history will
usually reveal that they have had their share of these in
earlier life.
Local symptoms being wanting or minor in many of these
conditions, we are justified in ordering a complete
examination of the district in all cases which do or may
suggest involvement of the cranial nerves or ganglia or
sympathetic associations; including facial, cervical and
brachial neuritis and neuralgia. Tic douloureux, optic
neuritis and atrophy, headaches, especially the low grade
unending type, the sub-occipital type, migraine, vertigo,
head-noises, deafness, hay-fever - seasonal or perennial -
bronchial and hay-asthma.
Many bold and ingenious surgical procedures have been devised
and executed in this region for the relief of its many
conditions. I pertinently remind you that most of this
has been executed in the nasal cavities and its accessory
sinuses; that beyond being confined to the pharyngeal tonsil
(adenoids) and the palatine tonsils, the gross pathology of
the rest of pharaynx, the epipharynx, and the tubotympanic
areas, although intimately known, has practically escaped the
pansurgical age, and, as a matter of fact before the advent
of Finger Surgery had never met with treatment that was any
match for its pathology.
That the surgery of this region in competent hands has been
a boon to the occasional sufferer we cannot deny. That it
has been unsatisfactory, and even a complete failure, in
the vast majority of cases you bear witness to in your daily
practices. Especially is this true of nasal and paranasal
surgery, where the progressive hyperplastic conditions occur
and which gradually involve the cranial and sympathetic
systems with such disabling results. Even the leading
proponents of that system admit it is only palliative,
that it is not curative, that the deeper pathology is
inaccessible, that it is inoperable even if it were
accessible, that the best they can do is sacrifice parts by
removal to provide room for the remaining pathology to
develop outward and that the remaining pathology completely
ignores this surgical accommodation, will not back-up, and
disports itself after, just as before according to the laws
of pathology.
It is because of this and of other considerations about
to be mentioned that I ask your serious attention to
Finger Surgery.
Finger surgery is not the ju-jutsu of grabbing the world
by the throat and trying to choke a living out of it. In a
few words it is the application of lesion osteopathy to the
base of the cranium, to the twenty-four cranial nerves which
leave its base through close fitting bony foramina, which
twenty-four nerves with their ganglia and sympathetic
associations represents a vast part of the human physiology.
Carries lesion osteopathy, through its only avenue of
approach, to an important system of nerves whose trunks are
independent of, and remote from the spinal intervertebral
foramina, reaches them here directly whereas from the spine
they can be reached only reflexly.
The course pursued by pathology in this district is quite
different from that generally accepted for the spinal
district. Around the spine we are agreed that the pathology
of the lesion starts at or near the intervertebral foramina.
If this were so of the basal foramina of the skull the
cranial nerves would perhaps be hopelessly involved. It
is well established that head pathology begins as a surface
condition, penetrates deeper and deeper to finally involve
the basal foramina. Likely the earliest attacks upon
the cranial nerves is by absorbed toxins or products of
inflammation, next by the pressure of swollen parts, or by
inflammation, and lastly by the encroachment of hyperplastic
bone production.
The starting point in the surface elements is not so well
agreed upon. It is my opinion, based upon study and clinical
experience, that the lymphatic ring surrounding the post
nasal and oral cavities takes the primary and oft repeated
insults. That the varied clinical and pathological courses
from then on is determined somewhat by the arrangement of
this lymphoid tissue. I have reminded you that the ring
arrangement is constant, that in some heads, the lymphoid
tissue is limited to the ring, while in others there is
considerable lymphoid tissue widely diffused throughout the
pharynx both inside and outside of the ring, and that there
remain all gradations between these extremes.
From these anatomical variations it appears to me that in
those cases where the lymphoid tissue is limited to the ring,
future developments depend upon lymph stagnation, while in
those cases having considerable lymphoid masses beyond the
confines of this ring there is more low grade inflammation
of soft tissues with venous stagnation, that the district
is then flooded by a combination lymph and venous stasis. I
note but do not explain this. Every important structure in
the head drains through this lymphatic ring and the veins
adjacent to it.
Clearly then I recognize the lymphatic ring as the key to the
restoration of nose, throat and ear health. I attribute much
of the success of Finger Surgery to the fact that in the
majority of cases it can completely restore this ring
structurally and functionally. In the upper half of the ring
by the use of the fingers only, which by well regulated and
directed force will destroy hypertrophied tissues without
injury to the healthy, the devitalized tissue disappears,
leaving a clean healthy mucous membrane. It is very rare
that this is not completely successful in competent hands.
The rare exceptions in my experience are old adenoid masses
which have degenerated into a resistant fibrous mass, and a
few times I have found them seemingly cartilaginous - these
I have clipped with an adenotome and crushed the stump to
prevent scar formation.
Of course the complete ring must be restored at the same
time. The lower half comprises the palatine and lingual
tonsils. The palatine tonsils become chronically involved
because of peculiar anatomical relations. Wedged in between
the faucial pillars, and with its oral face partly covered by
a plica which may be anything from a mere linear suggestion
to a complete annular collar. Normally the tonsil is freely
movable in this muscular pocket, the actions of which in
swallowing express the contents of the crypts. Repeated
inflammations cause adhesions to form between the tonsil
and the plica and faucial pillars. It is no longer freely
movable, the crypts are blocked and the normal cleaning
motions no longer act. These adhesions can be severed, the
tonsil completely freed, and the cryptic matter aspirated
out. If kept clean and the adhesions prevented from
reforming until healing is complete, the tonsil will shrink
to normal size quickly or slowly depending on whether the
enlargement was lymphoedema, inflammatory, or hypertrophic.
After involution has taken place, the depth of the crypts has
shrunk to half or less and they become self draining - any
that do not can be incised and obliterated. Occasionally a
large plica, and particularly an annular one must be partly
trimmed away. I have treated very few tonsils that this
technique had not been completely successful with. One case
was examined by an old school specialist (out of curiosity)
two years later, while examing the patient for glasses, and
he informed the lady I had taken her tonsils out whether she
knew it or not.
While restoring to the structural integrity of the lymphatic
ring it is urgent that the lymphatic and venous drainage
be mechanically helped by manipulation of the main trunks
in the anterior neck and by stimulation of the cervical
sympathetics.
With the functions of the lymphatic ring reestablished by
lymphoedema congestion and swelling of everything above - the
nose, epipharynx and tubotympanic region - is much reduced
and Finger Surgery of the upper spaces thereby simplified.
Hypertrophied tissues in these parts is then destroyed again
by digital pressure which will not harm healthy tissue,
turbinates and septums which have been displaced by soft
tissue pathology or traumatic injury are adjusted, adhesions
severed, and the patency of the Eustachian tube restored,
ventilation and dranage to the paranasal spaces and middle
ear recovered and a gradual and permanent improvement to the
entire head results.
I have not cut a turbinate in three years and do not expect
to again. Acute polypi of the nasal chambers will vanish
under this treatment, the chronic polypi in my experience
must be snared or cut away. I have never found the
extirpation, or removal of the whole ethmoid region,
as practiced by old school rhinologists necessary.
The deep hyperplastic bone conditions which are so
disastrous, and which, as I have said, admittedly do not
yield to any medical or surgical procedure, I have watched
under Finger Surgery very carefully and I believe they are
yielding. I base my belief on clinical and experimental
evidence, rather than on microscopic tissue specimens. The
thin nasal bones are elastic and bend to moderate pressure
much as would a fresh piece of celluloid. When hyperplastic
changes have taken place they become as rigid and unyielding
as glass. I have many times seen this elasticity return
several months after clearing up the soft tissue pathology
of the nasopharyngeal district. One case particularly
astonished me. He was 77 years old when I operated for
catarrhal deafness and hay fever. In about a year a fair
amount of elasticity was palpable in the nasal septum and
turbinates, and has remained to this day - four years later.
I take this, and the experience in other cases to indicate
that with circulation, ventilation and drainage normalized,
the conditions on which hyperplastic processes feed are gone
and that the progress is not only stopped but that Nature by
involution has absorbed the excess bone salts. This to me
is the most convincing vindication of the osteopathic concept
that it has ever been my pleasure and privilege to witness.
Finger Surgery is a moderated surgery. For its successful
practice one must know his anatomy surgically, be equipped
to examine parts as thoroughly as up to date methods permit,
realize that he has made of his fingers surgical instruments
and that he must use them with the same care and precision as
he would the sharpest scalpel, and be surgically clean in all
operative and treatment procedures.
By its own nature it imposes certain limitations to its
practice and which are beyond individual control: A No.
10 finger should never enter a No. 5 nares or a No. 5 tube.
Even hands that are adaptable cannot reach digitally the
nasal attick, the paransal cells or the upper end of the
Eustachian tube, unless the Finger Surgery of the larger
and lower spaces, and which has corrected the grosser
pathologies, is supplemented in these higher and smaller
spaces by accurate and nontraumatic instrumental and
applicator technique its best efforts will give only
partial or negative results. It must also in occasional
instances have some support from minor surgical procedures.
In proper and qualified hands Finger Surgery is safe.
Can be depended upon to give results in the conditions
mentioned, results that are permanent. Without the danger
of hemorrhage, without the production of scar tissue which
so often is the source of new reflex disturbance, and without
the sacrifice of parts which are so essential to healthy
functioning of the nose, throat and ears.
Copyright 1926 by M.L. Richardson
5/20/31 EC's letter to [
4588]'s mother:
Mrs. [...]
.., N.J
My dear Mrs. [...]:
We are enclosing a copy of the reading which was obtained
this morning for your little son. The suggestion is given
that you put him under the supervision of a specialist along
a certain line. We do not wish to attempt to tell you what
individual you should take him to, but merely make the
suggestion that there is a specialist along this line in
Norfolk who is considered one of the best in the country.
I am sure he would "fill the bill" exactly, or he might be
able to refer you to someone in your locality who could give
these treatments. If you would like to communicate with him
direct, we would be glad to give you his name and address.
It would be very wonderful if you could bring him to Virginia
Beach as soon as school is out. I'm sure the climatic
conditions here would be excellent for him, and you could go
back and forth from the beach to Norfolk for the treatments
at very little expense.
Please let me hear from you. I assure you that my whole
desire is to be of service if at all possible. If there is
anything in the reading that you do not understand, don't
hesitate to write and ask.
With all good wishes, and with kindest personal regards, I am
Sincerely, EC:GD
5/23/31 GD's letter to Mother:
Dear Mrs. [...]
Here is a little booklet containing an article by the
specialist which Mr. Cayce mentioned in his letter to you the
other day [WHAT FINGER SURGERY WILL DO, by M. L. Richardson,
D.O., see Par. R1 above]. I has just come into my hands
and I am sending it on to you, thinking that you would be
interested in reading it.
Sincerely, [signed] Gladys Davis, Secretary to Mr. Cayce
6/10/31 Mother's letter to Dr. Richardson:
New York
Dr. M. L. Richardson
Bankers Trust Building
Norfolk, Va.
Dear Doctor,
I have been referred to you by Mr. Edgar Cayce of Virginia
Beach. As it would be impossible for me to take my boy to
Norfolk for treatments, I would appreciate it, if you would
recommend a specialist in New York City to me. One who gives
osteopathic treatments, and at the same time is capable of
giving other general treatment as needed.
My boy is nearly seven years old. He has had sinus trouble
for 4-1/2 years now, and this past winter he has developed
asthma.
Mr. Cayce has given him a psychic reading, which very
well describes his condition. He finds that my boy
needs adjustments in the cerebrospinal system, given
osteopathically by a specialist in the adjustments for
the sensory organisms.
6/10/31 Mother's letter to GD:
Miss Gladys Davis
c/o Mr. Cayce
Virginia Beach, Va.
Dear Miss Davis:
I am moving to the address, which I will give below, so will
you please change my address on your files.
I have obtained the name and address of the physician Mr.
Cayce recommends to me, through the little booklet you
recently sent me. I have written to him, asking him to refer
me to a physician in New York City, as I will be unable to
come to Norfolk.
I am very well pleased with the report of the reading, Mr.
Cayce gave my son. It describes his condition accurately.
Sincerely, Mrs. [...], ..., New York.
6/13/31 Dr. Richardson's letter to EC:
[Letterhead:] MIDDLE ATLANTIC STATES OSTEOPATHIC ASSOCIATION
(North Carolina, Virginia and the District of Columbia)
DEPARTMENT OF PUBLIC EDUCATION - Office of the Director: M.
L. Richardson, Bankers Trust Building, Norfolk, Va.
My dear Mr. Cayce
I have answered the enclosed as per the enclosed carbon which
is self explanatory. I appreciate your referring Mrs. [...]
[[
4588]'s mother] to me.
Always with the highest personal regards, I am
Sincerely yours, [signed] M. L. Richardson
6/22/31 EC's letter to [
4588]'s mother:
My dear Mrs. [...]
Your letter to Dr. Richardson was sent to me for answer.
I gather from it that you feel it would be impractical and
impossible for you to come to Norfolk, or to Virginia Beach.
Please understand, Mrs. [...], I am not trying to get
patients for any particular physician, unless it is where
the information has insisted that certain ones are better
qualified to do the job than any others. While your son's
reading suggested treatments by SUCH a specialist AS Dr.
Richardson, in other information it has been given many times
that this Dr. Richardson is the very best specialist in the
United States for the particular trouble described in your
son's reading. Therefore, I cannot help but feel that you
would be standing in your own light NOT to make some special
effort to have him under Dr. Richardson's care, for a while
at least. Even if he only started the treatment, it would
be worth while - and then he could better outline to someone
else just how it should be continued.
If it doesn't agree with your circumstances to do this, we
will be glad to give you a list of those in your vicinity
who are at least PARTIALLY, if not wholly, in sympathy with
the work. Some of them, however, are NOT the qualified
SPECIALISTS in this particular line, as Dr. Richardson is.
Please let us hear from you respecting this. Assuring you of
our desire to be of service whenever possible, and with all
good wishes, I am
Sincerely, Edgar Cayce EC:GD
Edgar Cayce Readings © 1971, 1993, 1994, 1995 by the Edgar Cayce Foundation