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K. Peratur, M.A., M.D.

Medical Instructor, University of Oklahoma School of Community Medicine

These are excellent means of making the feet still this Free E-Book is Presented As Is Without Guarantee or Warranty. Therefore, if your feet are cold and bloodless (which means that the blood is congested in other parts of the body), walk barefoot in the dewy grass, in a cool brook, on wet stone pavements or on the snow. The early morning dew upon the grass is especially beneficial; later in the day wet the grass or pavement with a hose. After barefoot walking, dry and rub the feet thoroughly and take a short, brisk walk in shoes and stockings. The "Kalte Guss" [cold water splashing] forms an important feature of the Kneipp system of water cure. Sprays or showers may be administered to the head, arms, chest, back, thighs, knees or wherever indicated, with a dipper, a sprinkler or a hose attached to the faucet or hydrant. Until you are accustomed to cold water, use water as cool as can be borne without discomfort. Directly from the warmth of the bed, or after sunbath and exercise have produced a pleasant glow, go to the bathroom, sit in the empty tub with the stopper in place, turn on the cold water, and as it flows into the tub, catch it in the hollow of the hands and wash first the limbs, then the abdomen, then chest and back. As long as there is a good reaction, the "cold rub" may be taken in an unheated bathroom even in cold weather. After the bath, dry the body quickly with a coarse towel and finish by rubbing with the hands until the skin is dry and smooth and you are aglow with the exercise, or expose the wet body to the fresh air before an open window and rub with the hands until dry and warm. The bath must be so conducted that it is followed by a feeling of this Free E-Book is Presented As Is Without Guarantee or Warranty. While persons with very strong constitutions may experience no ill effects, to those who are weak and do not react readily, the cold plunge might prove a severe shock and strain upon the system. When a bathtub is not available, take the morning cold rub in the following manner: Stand in an empty washtub. Pour into the vessel a few inches of water at natural temperature, as it comes from the faucet, and sit in the water until a good reaction takes place-that is, until the first sensation of cold is followed by a feeling of warmth. Dry with a coarse towel, rub and pat the skin with the hands, then, in order to establish good reaction, practice deep breathing for a few minutes, alternating with the internal massage described in a later chapter. Nothing more effectually stimulates the flow of blood to brain and scalp or promotes the elimination of waste matter and poisons from these parts than the head bath together with scalp massage. The Diagnosis from the Eye reveals the fact that glycerine, quinine, resorcin and other poisonous antiseptics and stimulants absorbed from scalp cures and hair tonics and deposited in the brain are in many cases the real cause of chronic headaches, neuralgia, this Free E-Book is Presented As Is Without Guarantee or Warranty. Cold water is an absolutely safe and at the same time a most effective means to promote the growth of hair, as many of our patients can testify. The country people in many parts of Europe, who are much closer and wiser observers of Nature and her ways than the conceited wise men of the schools, do their sowing and reaping in accordance with the phases of the moon. In order to insure vigorous growth, they sow and plant during the growing moon; but their cutting and reaping is done during the waning moon. Submerge forehead and eyes in a basin of water, open and close the lids under water from six to eight times; repeat a few times. Bend over a basin filled with water and with the hands dash the water into the open eyes. Fill a glass eye-cup (which can be bought in any drug store or department store) with water, bend the head forward this Free E-Book is Presented As Is Without Guarantee or Warranty. All such cases yield readily to our combination of natural methods of treatment, such as water applications, massage and special exercises, combined with the general Nature Cure regimen. In a large number of cases treated in our sanitarium, patients who had worn glasses for years were able to discard them. The effect of the air bath upon the organism is subject to the same Law of Action and Reaction which governs the effects of water applications. But if the temperature of air or water is this Free E-Book is Presented As Is Without Guarantee or Warranty. In order to react against the chilling effect of cold air or water, the nerve centers which control the circulation send the blood to the surface in large quantities, flushing the skin with warm, red, arterial blood. However, the custom of hiding the body under dense, heavy clothing, thus excluding it from the life- giving influence of air and light, together with the habit of warm bathing, has weakened and enervated the skin of the average individual until it has lost its tonicity and is no longer capable of fulfilling its natural functions. In the iris of the eye the atrophied condition of the skin is indicated by a heavy, dark rim, the so-called scurf rim. This, in turn, causes autointoxication and favors the development of all kinds of acute and chronic diseases. The black rim seen more or less distinctly in the outer rim of the iris in the eyes of the majority of people has been called the scurf rim, because it was found that this dark rim appears in the iris after the suppression of scurfy and other forms of skin eruptions and after the external or internal use of lotions, ointments and medicines containing mercury, zinc, iodine, arsenic or other poisons which suppress or destroy the life and activity of the skin.

The following breathing exercises are intended especially to develop greater lung capacity and to assist in forming the habit of breathing properly at all times. The different movements should be repeated from three to six times, according to endurance and the amount of time at disposal. Reverse the exe rcise, jerking the shoulders backward in similar manner while inhaling. Inhale, raising elbows sideways; exhale, bringing elbows down so as to strike the sides vigorously. Raise the body to original posture, reverse position of arms, and repeat the exercise. Lean back, inhaling, then bend forward, exhaling, touching the floor with both this Free E-Book is Presented As Is Without Guarantee or Warranty. Swing the right hand upward and backward, flinging the body to the left side, resting on the left hand and the left foot. Return to original position, repeat the exercise, flinging the body to the right side. Relax the muscles all over the body, then inhale deeply with the diaphragm only, raising the wall of the abdomen just below the ribs without elevating either the chest or the lower abdomen. Take about four seconds to inhale, then exhale in twice that length of time, contracting the abdomen below the ribs. Repeat these movements as long as you can hold the breath without straining, then breathe deeply and regularly for several minutes, this Free E-Book is Presented As Is Without Guarantee or Warranty. Leave them in this position for a few seconds, then raise them straight above the chest, and lower them slowly to the original position. Rhythmical Breathing It is a fact not generally known to us western people (our attention had to be called to it by the "Wise Men of the East"), that in this Free E-Book is Presented As Is Without Guarantee or Warranty. The breath entering through the right nostril creates positive electro-magnetic currents, which pass down the right side of the spine, while the breath entering through the left nostril sends negative electro- magnetic currents down the left side of the spine. These currents are transmitted by way of the nerve centers or ganglia of the sympathetic nervous system, which is situated alongside the spinal column, to all parts of the body. In the normal, rhythmical breath exhalation takes about twice the time of inhalation. The balancing of the electro-magnetic energies in the system depends to a large extent upon this rhythmical breathing, hence the importance of deep, unobstructed, rhythmic exhalation and inhalation. Now inhale through the right nostril and, reversing the pressure upon the this Free E-Book is Presented As Is Without Guarantee or Warranty. Alternate breathing may be practiced standing, sitting, or in the recumbent position. The spine should at all times be held straight and free, so that the flow of the electro-magnetic currents be not obstructed. While practicing the "alternate breath," fix your attention and concentrate your power of will upon what you axe trying to accomplish. As you inhale through the right nostril, will the magnetic currents to flow along the right side of the spine, and as you inhale through the left nostril, consciously direct the currents to the left side. The wise men of India knew that with the breath they absorbed not only the physical elements of the air, but life itself. Warning While the alternate breathing exercises are very valuable for overcoming obstructions in the air passages, for establishing the habit of rhythmic breathing and for refining and accelerating the vibratory activities on the physical and spiritual planes of being, they must be practiced with great caution. They are therefore especially dangerous to those who are already inclined to be physically and mentally negative and sensitive. The most dangerous of these methods are long extended fasting, raw food diet, that, is, a diet consisting of fruits, nuts, oils and raw vegetables and excluding the dalry products, "Yogi" breathing, and "sitting in the silence. By means of systematic exercise, combined with deep breathing, the liberation and distribution of electromagnetic energies in the system are also greatly promoted. Most persons who have to work hard physically are under the impression that they need not take special exercises. In nearly all kinds of physical labor only certain parts of the body are called into action and only certain sets of muscles exercised, while others remain inactive. They not only need breathing gymnastics and corrective movements mornings and evenings, but should take regular daily walks, no matter what the condition of the weather. Unless they do this faithfully, their circulation will become sluggish and their organs of elimination inactive.

Patients who have a head tilt can also provide you with clues as to where the problem may lie. For example, someone with a right superior oblique palsy may have a leftward tilt of the head. Treatment Treatment of the underlying disorder of sixth nerve palsy is indicated when significant and persistent. An isolated and presumed ischemic-related sixth nerve palsy can be observed for improvement for 1 to 3 months. However if these measures fail, surgery may be the only way to correct this problem. Binocular diplopia refers to double vision occurring from intrinsic problems in both eyes B. The key in evaluating diplopia is to start by determining if it is monocular or binocular [34. Which of the following indicates a more complicated underlying neurologic problem Urinary incontinence with seizure Confusion and lethargy after seizure Headache after the seizure Sixth nerve palsy after seizure [34. Various methods have been tried with limited success, and the patient still has diplopia. Surgery Eye patch Prisms Prednisone at a dose of 10 mg per day Botulinum toxin Answers [34. Seizures have not been reported to cause sixth nerve dysfunction and thus, its presence indicates a more complex situation. Younger patients with sixth nerve palsies more often have malignant etiologies, whereas older patients usually have more benign etiologies. Monocular diplopia results from intrinsic eye problems, including ocular muscles and neuromuscular junction. Incidence, associations, and evaluation of sixth nerve palsy using a population-based method. A review of 5-years experience in the use of botulinum toxin A in the treatment of sixth cranial nerve palsy at the Singapore National Eye Centre. She states she was well until approximately 3 days ago when she began to have right ear pain. Her physical examination shows a 68-year-old woman with obvious right facial paralysis involving her forehead and mouth. Her head and neck examination finds small blisters on an erythematous base in the right conchal bowl of the external ear. There are small blisters on an erythematous base in the right conchal bowl of the external ear. The examination of the ear canal is painful to her, but the tympanic membrane is intact. Most likely diagnosis: Herpes zoster oticus (Ramsay Hunt syndrome) Next diagnostic test step: Tzanck smear, audiogram, consider facial nerve electrodiagnostic studies and diagnostic imaging, if indicated Next therapeutic step: anti-herpes virus medication Analysis Objectives 1. Considerations this elderly woman has a history of chicken pox, blisters on her ear, hearing abnormalities, and unilateral facial paralysis. Her entire right facial muscles are affected, suggestive of a peripheral facial nerve palsy; a central defect usually spares the forehead. The Weber and Rinne tests are consistent with a sensorineural hearing loss rather than a conductive disorder. A diligent history and physical examination should be performed to exclude other possibilities such as central nervous system disorders, cholesteatomas, facial neuromas, and tumors of the parotid. Corticosteroid and antiviral therapy are recommended, with the probability of good recovery. Bell palsy: An idiopathic form of facial paralysis, thought to be caused by herpes simplex virus reactivation. The electromyographer looks for compound muscle action potentials, abnormal waves, or fibrillation potentials. An absence of motor unit potentials signifies severe damage or loss or nerve continuity. Fibrillation potentials are signs of a lack of facial nerve input, and are a particularly bad prognostic sign. Each side is stimulated at the stylomastoid foramen, and the responses from muscle groups are measured and compared.

One of these tests is called the alternate cover test and is performed by asking the patient to fixate on an object in each position of gaze. As the patient moves the eyes in each position, deviations in the eye as each one is alternately covered may be seen. The second test often used for evaluating binocular diplopia is the red lens test. In this test, a red lens is placed over an eye, most commonly the right eye, and the patient is asked to look at the nine positions of a cardinal gaze. The key to performing this test is to understand the following: (1) image separation will be greatest in the direction of the weak muscle and (2) the image that is the furthest away from the midline is a false image and corresponds to the eye with impaired motility. Evaluating other aspects of the cranial nerve examination will help determine where the diplopia is arising from. For example, ptosis or droopiness of the eyelid can suggest a third nerve problem. Postherpetic neuralgia: Neuropathic pain resulting from resolved herpes infection. Tzanck smear: A test that looks for intracytoplasmic particles due to viral infection. Clinical Approach Approach to Facial Paralysis Facial function can be characterized in many different ways. A distinction is made between paresis, which indicates weakness, but function is still present; and paralysis, which indicates total lack of function despite maximal effort. The American Academy of Otolaryngology has adopted a system for grading facial nerve function called the House-Brackmann score. The facial nerve emerges from the brainstem at the pons to traverse the cerebellopontine angle and then through the temporal bone. The bony course through the temporal bone is the longest course of any nerve through bone. It emerges at the stylomastoid foramen to pass through the substance of the parotid gland and divide into branches that innervate the various parts of the face. Additionally, the facial nerve contains general sensation to the ear canal and pinna, special sensation of taste from the anterior two-thirds of the tongue, and secretomotor function of parasympathetics to the submandibular gland, the lacrimal gland, and the nasal mucosa. Facial paralysis of central origin, that is, caused by stroke, is marked by forehead sparing. This is caused by the bilateral cortical connections to the facial nucleus in the brainstem. In such a circumstance, the examining physician should inquire about risk factors for stroke and look for other signs that might indicate a stroke. Facial paralysis associated with hearing loss and/or dizziness, vertigo, or imbalance suggests cerebellopontine angle and internal auditory canal disorders. In this circumstance, an audiogram might show a sensorineural type of hearing loss. Because the facial nerve passes through the middle ear and temporal bone, examination of the ear canal and tympanic membrane is of paramount importance. Acute bacterial otitis media produces a purulent middle ear effusion, which can often produce a spontaneous tympanic membrane perforation. In these cases, a preexisting history of otitis media is not always present, although the history and physical examination might indicate an upper respiratory tract infection or inflammation (as from allergic rhinitis). The physical examination will clearly show the abnormal findings in the middle ear. Acute otitis media is probably the most common cause of isolated facial paralysis in children. Cholesteatoma is a benign tumor of epithelial debris that is produced when the squamous layer of the eardrum is trapped and cannot exfoliate properly. The physical examination in cholesteatoma will show either cheesy epithelial debris in the ear canal or a pearly white tumor behind the ear drum.