Greenman s Principles of Manual

Medicine 5th Edition Destefano Do Lisa

A
Visit to download the full and correct content document:
https://ebookmeta.com/product/greenman-s-principles-of-manual-medicine-5th-editio
n-destefano-do-lisa-a/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Davidson’s Principles and Practice of Medicine, 24th

Edition Stuart Ralston

https://ebookmeta.com/product/davidsons-principles-and-practice-
of-medicine-24th-edition-stuart-ralston/

First Do No Harm 1st Edition Lisa Belkin

https://ebookmeta.com/product/first-do-no-harm-1st-edition-lisa-
belkin/

Palliative Medicine A Case Based Manual 4th Edition

https://ebookmeta.com/product/palliative-medicine-a-case-based-
manual-4th-edition/

Developing and Maintaining Practical Archives A How To

Do It Manual 3 (ePub) Edition Gregory S. Hunter

https://ebookmeta.com/product/developing-and-maintaining-
practical-archives-a-how-to-do-it-manual-3-epub-edition-gregory-
s-hunter/
The Academic Writer A Brief Rhetoric 5th Edition Lisa
Ede

https://ebookmeta.com/product/the-academic-writer-a-brief-
rhetoric-5th-edition-lisa-ede/

Principles of Virology 5th Edition Jane Flint

https://ebookmeta.com/product/principles-of-virology-5th-edition-
jane-flint/

Do or Die A Supplementary Manual on Individual Combat

Drexel Biddle

https://ebookmeta.com/product/do-or-die-a-supplementary-manual-
on-individual-combat-drexel-biddle/

Harrison s Principles of Internal Medicine 21st Edition

2022 Volume I II Joseph Loscalzo

https://ebookmeta.com/product/harrison-s-principles-of-internal-
medicine-21st-edition-2022-volume-i-ii-joseph-loscalzo/

Harrison's Principles of Internal Medicine 21st Edition

Loscalzo

https://ebookmeta.com/product/harrisons-principles-of-internal-
medicine-21st-edition-loscalzo/
GREENMAN’S PRINCIPLES OF
MANUAL MEDICINE
Fifth Edition

Lisa A. DeStefano, D.O.

Associate Professor and Chairperson
Department of Osteopathic Manipulative Medicine
College of Osteopathic Medicine
Michigan State University
East Lansing, Michigan
Acquisitions Editor: Matt Hauber
Product Development Editor: Greg Nicholl
Marketing Manager: Lisa Zoks
Production Project Manager: David Orzechowski
Design Coordinator: Teresa Mallon
Art Director: Jennifer Clements
Manufacturing Coordinator: Margie Orzech
Prepress Vendor: SPi Global

Fifth Edition

Copyright © 2017 Wolters Kluwer

Copyright © 2011 Lippincott Williams & Wilkins, a Wolters Kluwer business.

Copyright © 2003 Lippincott Williams & Wilkins. Copyright © 1996, 1984 Williams
& Wilkins.
All rights reserved. This book is protected by copyright. No part of this book may
be reproduced or transmitted in any form or by any means, including as
photocopies or scanned-in or other electronic copies, or utilized by any information
storage and retrieval system without written permission from the copyright owner,
except for brief quotations embodied in critical articles and reviews. Materials
appearing in this book prepared by individuals as part of their official duties as
U.S. government employees are not covered by the above-mentioned copyright.
To request permission, please contact Wolters Kluwer at Two Commerce Square,
2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or
via our website at lww.com (products and services).

987654321

Printed in China

Library of Congress Cataloging-in-Publication Data

DeStefano, Lisa A., author.
Greenman’s principles of manual medicine / Lisa A. DeStefano. — Fifth edition.
p. ; cm.
Principles of manual medicine
Includes bibliographical references and index.
ISBN 978-1-4511-9390-9
I. Title. II.Title: Principles of manual medicine.
[DNLM:1. Manipulation, Osteopathic.2. Manipulation, Orthopedic.3. Osteopathic
Medicine—methods.WB 940]
RM724
615.8'2—dc23
 2015035146

This work is provided “as is,” and the publisher disclaims any and all warranties,
express or implied, including any warranties as to accuracy, comprehensiveness, or
currency of the content of this work.

This work is no substitute for individual patient assessment based upon healthcare
professionals’ examination of each patient and consideration of, among other
things, age, weight, gender, current or prior medical conditions, medication
history, laboratory data and other factors unique to the patient. The publisher does
not provide medical advice or guidance and this work is merely a reference tool.
Healthcare professionals, and not the publisher, are solely responsible for the use
of this work including all medical judgments and for any resulting diagnosis and
treatments.

Given continuous, rapid advances in medical science and health information,

independent professional verification of medical diagnoses, indications, appropriate
pharmaceutical selections and dosages, and treatment options should be made
and healthcare professionals should consult a variety of sources. When prescribing
medication, healthcare professionals are advised to consult the product
information sheet (the manufacturer’s package insert) accompanying each drug to
verify, among other things, conditions of use, warnings and side effects and
identify any changes in dosage schedule or contraindications, particularly if the
medication to be administered is new, infrequently used or has a narrow
therapeutic range. To the maximum extent permitted under applicable law, no
responsibility is assumed by the publisher for any injury and/or damage to persons
or property, as a matter of products liability, negligence law or otherwise, or from
any reference to or use by any person of this work.

LWW.com
This edition is dedicated to Philip Erwin Greenman, DO, who passed
away on February 5, 2013, 20 days shy of his 85th birthday.
In 1952, Dr. Greenman earned his Doctor of Osteopathy degree
from the Philadelphia College of Osteopathy in Pennsylvania. He
then went on to complete an internship at Osteopathic Hospital of
Philadelphia and postdoctoral training in radiology and osteopathic
general practice. He was in private practice near Buffalo, New York,
from 1956 until 1972, before he was recruited to chair the
Department of Biomechanics by Myron S. Magen, DO, founding dean
of Michigan State University College of Osteopathic Medicine
(MSUCOM). He subsequently served as associate dean for academic
affairs and then senior associate dean. During his 60-year career, he
authored 4 books, 68 peer-reviewed medical journal articles, 10
book chapters, and 11 educational modules. He also served on the
editorial advisory board of 10 professional journals.
Dr. Greenman also led the Continuing Medical Education Manual
Medicine series. Faculty of the inaugural course, Principles of Manual
Medicine, included non-osteopaths John Bourdillion, MD, and John
Mennell, MD; then later Mark Bookhout, MS, PT, and Ed Isaacs, MD.
Dr. Greenman ultimately formed a diverse team of manual therapists
and thinkers who would cause many to rethink the conventional
wisdom of musculoskeletal pain syndromes. Committed to
challenging the status quo to address the patients’ needs, he sought
to connect the great minds that could go toe-to-toe with
conventional therapies for syndromes such as low back pain. Philip
E. Greenman, DO, was a standard-setter, an artist, an alchemist, a
heretic, and the most authentic wholehearted human being I have
ever had the privilege to meet.
Preface

This book was originally designed as course material used to support

the Continuing Medical Education courses offered through Michigan
State University College of Osteopathic Medicine. Since that time,
this publication has been used nationally and internationally in a
number of colleges of osteopathic medicine, chiropractic colleges,
schools of physical therapy, and schools of massage therapy. With an
energized commitment to making the text clinically focused; the fifth
edition of Greenman’s Principles of Manual Medicine continues to
help the learner look beyond the general application and pursue the
“how” and the “why” manual medicine techniques can improve
neuromusculoskeletal system function.
This edition has many new additions starting with my version of
Dr. Greemnan’s “walking around the temporal bone” diagnostic and
sutural approach to the head. Proven to make cranial treatment fun,
easy, and effective, this algorithm is invaluable. Cervical mobilization
with impulse has been rewritten for ease and consistency. These
techniques are simple and safe, defining them as such was greatly
needed. Finally, thanks to the expertise of Clarence Nicodemus, DO,
PhD, terminology for normal lumbosacral and sacroiliac motion has
been modified and clarified.
Basic science research continues to improve our understanding of
how ones musculoskeletal system is stabilized in three-dimensional
space. Fascial continuity continues to be a main focus, in particular
of the implications of myofascial force transformation. In this edition,
I added a chapter on clinical correlations of the upper quarter. This
chapter capitalizes on Frank Willard and Andry Vleemings’
conclusions as to the stabilizing roles of the specialized layers of the
thoracolumbar fascia beyond the trunk into the thorax, cervical
spine, and cranium. Call me genius or call me reckless, this is a
conceptual chapter that is genuinely meant to start a conversation.
Acknowledgments

Michigan State University College of Osteopathic Medicine has been

my home since matriculating in 1988; I would like to thank the staff
and faculty, present and past, for their tenacious pursuit of
excellence in osteopathic education. I would especially like to
acknowledge my colleagues in the Department of Osteopathic
Manipulative Medicine, Jennifer Gilmore, Jacob Rowan, Mark Gugel,
Sherman Gorbis, Jon Bruner, Matt Zatkin, Chris Pohlod, Catherine
Donahue, Peter Blakemore, Vincent Cipolla, William Pintal, and
Timothy Francisco; I am very fortunate to have such a great team. I
am particularly grateful to our Dean William Stampel, DO; thank you,
Bill, for all your continued support and leadership.
The Continuing Medical Education Program in Michigan State
University College of Osteopathic Medicine has been providing the
highest quality manual medicine education in the country for more
than 30 years. To be given the opportunity to participate as a faculty
member in this program is one of greatest joys in my career. Over
the years, I have learned from the very best students, faculty, and
staff; to you all, I owe a great deal of gratitude.
My greatest teachers in life have been my parents, Jim and
Joanne DeStefano. Thank you for providing me with all the tools
necessary to excel while allowing me the freedom to use them in a
fashion that is uniquely mine; I admire and love you both so very
much. I am especially appreciative to my husband Keith; thank you,
my love, for your enduring support and encouragement during this
adventure.
Contents

Preface
Acknowledgments
Reviewers

PART I PRINCIPLES AND CONCEPTS

1 Structural Diagnosis and Manipulative Medicine

History
2 Principles of Structural Diagnosis
3 Barrier Concepts in Structural Diagnosis
4 The Manipulative Prescription
5 Normal Vertebral Motion
6 Concepts of Vertebral Motion Dysfunction

PART II PRINCIPLES OF TECHNIQUE

7 Principles of Soft-Tissue and Other Peripheral

Stimulating Techniques
8 Principles of Muscle Energy Technique
9 Mobilization With and Without Impulse
Technique
10 Principles of Indirect Technique
11 Principles of Myofascial Release and Integrated
Neuromusculoskeletal Technique
PART III TECHNIQUE PROCEDURES

12 Cranial Technique
13 Cervical Spine Technique
14 Thoracic Spine Technique
15 Rib Cage Technique
16 Lumbar Spine Technique
17 Pelvic Girdle Dysfunction
18 Upper Extremity Technique
19 Lower Extremity Technique

PART IV CLINICAL INTEGRATION AND

CORRELATION

20 Common Clinical Problems of the Lower

Quarter
21 Common Clinical Problems of the Thorax,
Upper Quarter, and Neck
22 Adjunctive Diagnostic Procedures

Index
Reviewers

Rachel Johnson, DO
Associate Professor of Clinical Science
West Virginia School of Osteopathic Medicine
Lewisburg, West Virginia

Daniel Lee, DO
Family Medicine
Miami, Florida

Randy G. Litman, DO
Kentucky Osteopathic Medical Association
Pikeville College
Pikeville, Kentucky

Michael P. Rowane, DO, MS, FAAFP, FAAO

Associate Clinical Professor of Family Medicine and Psychiatry
Case Western Reserve University
Director of Medical Education
University Hospitals Regional Hospitals
Director of Osteopathic Medical Education
University Hospitals Case Medical Center
Cleveland, Ohio

Marc Sibella, DO
Clinical Instructor
School of Medicine
Tufts University
Boston, Massachusetts
 PART I

PRINCIPLES AND CONCEPTS

1 Structural Diagnosis and
Manipulative Medicine History

HISTORY
Manual medicine is as old as the science and art of medicine itself.
There is strong evidence of the use of manual medicine procedures
in ancient Thailand, as shown in statuary at least 4,000 years old.1
The ancient Egyptians practiced the use of the hands in the
treatment of injury and disease. Even Hippocrates, the father of
modern medicine, was known to use manual medicine procedures,
particularly traction and leverage techniques, in the treatment of
spinal deformity. The writings of such notable historical figures in
medicine as Galen, Celsus, and Oribasius refer to the use of
manipulative procedures.2 There is a void in the reported use of
manual medicine procedures corresponding to the approximate time
of the split of physicians and barber–surgeons. As physicians
became less involved in patient contact and as direct hands-on
patient care became the province of the barber–surgeons, the role of
manual medicine in the healing art seems to have declined. This
period also represents the time of the plagues, and perhaps
physicians were reticent to come in close personal contact with their
patients.
The 19th century found a renaissance of interest in this field.
Early in the 19th century, Dr. Edward Harrison, a 1784 graduate of
Edinburgh University, developed a sizable reputation in London
utilizing manual medicine procedures. Like many other proponents of
manual medicine in the 19th century, he became alienated from his
colleagues by his continued use of these procedures.3
 The 19th century was a popular period for “bonesetters” both in
England and in the United States. The work of Mr. Hutton, a skilled
and famous bonesetter, led such eminent physicians as James Paget
and Wharton Hood to report in such prestigious medical journals as
the British Medical Journal and Lancet that the medical community
should pay attention to the successes of the unorthodox
practitioners of bone setting.4 In the United States, the Sweet family
practiced skilled bone setting in the New England region of Rhode
Island and Connecticut. It has also been reported that some of the
descendants of the Sweet family emigrated west in the mid-19th
century.5 Sir Herbert Barker was a well-known British bonesetter
who practiced well into the first quarter of the 20th century and was
of such eminence that he was knighted by the crown.
The 19th century was also a time of turmoil and controversy in
medical practice. Medical history of the day was replete with many
unorthodox systems of healing. Two individuals who would
profoundly influence the field of manual medicine were products of
this period of medical turmoil. Andrew Taylor Still, MD, was a
medical physician trained in the preceptor fashion of the day, and
Daniel David Palmer was a grocer-turned- self-educated manipulative
practitioner.

Osteopathic Medicine
Still (1828 to 1917) first proposed his philosophy and practice of
osteopathy in 1874. His disenchantment with the medical practice of
the day led to his formulation of a new medical philosophy, which he
termed “osteopathic medicine.” He appeared to have been a great
synthesizer of medical thought and built his new philosophy on both
ancient medical truths and current medical successes, while being
most vocal in denouncing what he viewed as poor medical practice,
primarily the inappropriate use of medications then in use.6
Still’s strong position against the drug therapy of his day was not
well received by his medical colleagues and was certainly not
supported by contemporary osteopathic physicians. However, he was
not alone in expressing concern about the abuse of drug therapy. In
1861, Oliver Wendell Holmes said, “If all of the MATERIA MEDICA
were thrown into the oceans, it will be all the better for mankind,
and worse for the fishes.”7 Sir William Osler, one of Still’s
contemporaries, stated: “One of the first duties of the physician is to
educate the masses not to take medicine. Man has an inborn craving
for medicine. Heroic dosing for several generations has given his
tissues a thirst for drugs. The desire to take medicine is one feature
which distinguishes man, the animal, from his fellow creatures.”8
Still’s new philosophy of medicine in essence consisted of the
following:

1. The unity of the body.

2. The healing power of nature. He held that the body had within
itself all those things necessary for the maintenance of health
and recovery from disease. The role of the physician was to
enhance this capacity.
3. The somatic component of disease. He felt that the
musculoskeletal system was an integral part of the total body
and alterations within the musculoskeletal system affected total
body health and the ability of the body to recover from injury
and disease.
4. Structure–function interrelationship. The interrelationship of
structure and function had been espoused by Virchow early in
the 19th century,9 and Still applied this principle within his
concept of total body integration. He strongly felt that structure
governed function and that function influenced structure.
5. The use of manipulative therapy. This became an integral part of
Still’s philosophy because he believed that restoration of the
body’s maximal functional capacity would enhance the level of
wellness and assist in recovery from injury and disease.

It is unclear when and how Dr. Still added manipulation to his

philosophy of osteopathy. It was not until 1879, some 5 years after
his announcement of the development of osteopathy, that he
became known as the “lightning bonesetter.” There is no recorded
history that he met or knew the members of the Sweet family as
they migrated west. Still never wrote a book on manipulative
technique. His writings were extensive, but they focused on the
philosophy, principles, and practice of osteopathy.
Still’s attempt to interest his medical colleagues in these concepts
was rebuffed, particularly when he took them to Baker University in
Kansas. As he became more clinically successful, and nationally and
internationally well known, many individuals came to study with him
and learn the new science of osteopathy. This led to the
establishment in 1892 of the first college of osteopathic medicine at
Kirksville, Missouri. In 2014, there are 35 osteopathic training sites
(including five branch campuses) in the United States graduating
more than 4,500 students per year.10 Osteopathy in other parts of
the world, particularly in the United Kingdom and in the
commonwealth countries of Australia and New Zealand, is a school
of practice limited to structural diagnosis and manipulative therapy,
although strongly espousing some of the fundamental concepts and
principles of Still. Osteopathic medicine in the United States has
been from its inception, and continues to be, a total school of
medicine and surgery while retaining the basis of osteopathic
principles and concepts and continuing the use of structural
diagnosis and manipulative therapy in total patient care.

Chiropractic
Palmer (1845 to 1913) was, like Still, a product of the midwestern
portion of the United States in the mid-19century. Although not
schooled in medicine, he was known to practice as a magnetic
healer and became a self-educated manipulative therapist.
Controversy continues as to whether Palmer was ever a patient or
student of Still’s at Kirksville, Missouri, but it is known that Palmer
and Still met in Clinton, Iowa, early in the 20th century. Palmer
moved about the country a great deal and founded his first college
in 1896. The early colleges were at Davenport, Iowa, and at
Oklahoma City, Oklahoma.
Although Palmer is given credit for the origin of chiropractic, it
was his son Bartlett Joshua Palmer (1881 to 1961) who gave the
chiropractic profession its momentum. Palmer’s original concepts
were that the cause of disease was a variation in the expression of
normal neural function. He believed in the “innate intelligence” of
the brain and central nervous system and believed that alterations in
the spinal column (subluxations) altered neural function, causing
disease. Removal of the subluxation by chiropractic adjustment was
viewed to be the treatment. Chiropractic has never professed to be a
total school of medicine and does not teach surgery or the use of
medication beyond vitamins and simple analgesics. There remains a
split within the chiropractic profession between the “straights,” who
continue to espouse and adhere to the original concepts of Palmer,
and the “mixers,” who believe in a broadened scope of chiropractic
that includes other therapeutic interventions such as exercise,
physiotherapy, electrotherapy, diet, and vitamins.
In the mid-1970s, the Council on Chiropractic Education (CCE)
petitioned the U.S. Department of Education for recognition as the
accrediting agency for chiropractic education. The CCE was strongly
influenced by the colleges with a “mixer” orientation, which led to
increased educational requirements both before and during
chiropractic education. Chiropractic is practiced throughout the
world, but the vast majority of chiropractic training continues to be
in the United States. The late 1970s found increased recognition of
chiropractic in both Australia and New Zealand, and their registries
are participants in the health programs in these countries.11

MEDICAL MANIPULATORS
The 20th century has found renewed interest in manual medicine in
the traditional medical profession. In the first part of the 20th
century, James Mennell and Edgar Cyriax brought joint manipulation
recognition within the London medical community. John Mennell
continued the work of his father and contributed extensively to the
manual medicine literature and its teaching worldwide. As one of the
founding members of the North American Academy of Manipulative
Medicine (NAAMM), he was instrumental in opening the membership
in NAAMM to osteopathic physicians in 1977. He strongly advocated
the expanded role of appropriately trained physical therapists to
work with the medical profession in providing joint manipulation in
patient care.
James Cyriax is well known for his textbooks in the field and also
fostered the expanded education and scope of physical therapists.
He incorporated manual medicine procedures in the practice of
“orthopedic medicine” and founded the Society for Orthopedic
Medicine. In his later years, Cyriax came to believe that manipulation
restored function to derangements of the intervertebral discs and
spoke less and less about specific arthrodial joint effects. John
Bourdillon, a British-trained orthopedic surgeon, was first attracted
to manual medicine as a student at Oxford University. During his
training, he learned to perform manipulation while the patient was
under general anesthesia and subsequently used the same
techniques without anesthesia. He observed the successful results of
non–medically qualified manipulators and began a study of their
techniques. A lifelong student and teacher in the field, he published
five editions of a text, Spinal Manipulation. Subsequent to his death
in 1992, a sixth edition of Spinal Manipulation was published with
Edward Isaacs, MD, and Mark Bookhout, MS, PT, as coauthors.
The NAAMM merged with the American Association of
Orthopaedic Medicine in 1992 and continues to represent the United
States in the International Federation of Manual Medicine (FIMM).

PRACTICE OF MANUAL
MEDICINE
Manual medicine should not be viewed in isolation nor separate from
“regular medicine” and clearly is not the panacea for all ills of
humans. Manual medicine considers the functional capacity of the
human organism, and its practitioners are as interested in the
dynamic processes of disease as those who look at the disease
process from the static perspective of laboratory data, tissue
pathology, and the results of autopsy. Manual medicine focuses on
the musculoskeletal system, which constitutes more than 60% of the
human organism, and through which evaluation of the other organ
systems must be made. Structural diagnosis not only evaluates the
musculoskeletal system for its particular diseases and dysfunctions
but can also be used to evaluate the somatic manifestations of
disease and derangement of the internal viscera. Manipulative
procedures are used primarily to increase mobility in restricted areas
of musculoskeletal function and to reduce pain. Some practitioners
focus on the concept of pain relief, whereas others are more
interested in the influence of increased mobility in optimizing joint
stability and function of the musculoskeletal system. When
appropriately used, manipulative procedures can be clinically
effective in reducing pain within the musculoskeletal system, in
increasing the level of wellness of the patient, and in helping
patients with a myriad of disease processes.

GOAL OF MANIPULATION
In 1983, in Fischingen, Sweden, a 6-day workshop was held that
included approximately 35 experts in manual medicine from
throughout the world. They represented many different countries
and schools of manual medicine with considerable diversity in clinical
experience. The proceedings of this workshop represented the state
of the art of manual medicine of the day.12 That workshop reached a
consensus on the goal of manipulation: The goal of manipulation is
to restore maximal, pain-free movement of the musculoskeletal
system in postural balance.
 This definition is comprehensive but specific and is well worth
consideration by all students in the field.

ROLE OF THE
MUSCULOSKELETAL SYSTEM IN
HEALTH AND DISEASE
It is indeed unfortunate that much of the medical thinking and
teaching look at the musculoskeletal system only as the coat rack on
which the other organ systems are held and not as an organ system
that is susceptible to its own unique injuries and disease processes.
The field of manual medicine looks at the musculoskeletal system in
a much broader context, particularly as an integral and interrelated
part of the total human organism. Although most physicians would
accept the concept of integration of the total body including the
musculoskeletal system, specific and usable concepts of how that
integration occurs and its relationship in structural diagnosis and
manipulative therapy seem to be limited.
There are five basic concepts that this author has found useful.
Since the hand is an integral part of the practice of manual medicine
and includes five digits, it is easy to recall one concept for each digit
in the palpating hand. These concepts are as follows:

1. Holism
2. Neurologic control
3. Circulatory function
4. Energy expenditure
5. Self-regulation

Concept of Holism
The concept of holism has different meanings and usage by different
practitioners. In manual medicine, the concept emphasizes that the
musculoskeletal system deserves thoughtful and complete
evaluation, wherever and whenever the patient is seen, regardless of
the nature of the presenting complaint. It is just as inappropriate to
avoid evaluating the cardiovascular system in a patient presenting
with a primary musculoskeletal complaint as it is to avoid evaluation
of the musculoskeletal system in a patient presenting with acute
chest pain thought to be cardiac in origin. The concept is one of a
sick patient who needs to be evaluated. The musculoskeletal system
constitutes most of the human body, and alterations within it
influence the rest of the human organism; diseases within the
internal organs manifest themselves in alterations in the
musculoskeletal system, frequently in the form of pain. It is indeed
fortunate that holistic concepts have gained increasing popularity in
the medical community recently, but the concept expressed here is
one that speaks of the integration of the total human organism
rather than a summation of parts. We must all remember that our
role as health professionals is to treat patients and not to treat
disease.

Concept of Neural Control

The concept of neurologic control is based on the fact that humans
have the most highly developed and sophisticated nervous system in
the animal kingdom. All functions of the body are under some form
of control by the nervous system. A patient is constantly responding
to stimuli from the internal and external body environments through
complex mechanisms within the central and peripheral nervous
systems. As freshmen in medical school, we all studied the anatomy
and physiology of the nervous system. Let us briefly review a
segment of the spinal cord (Fig. 1.1). In this figure are depicted the
classic somatosomatic reflex pathways with afferent impulses coming
from the skin, muscle, joint, and tendon. Afferent stimuli from the
nociceptors, mechanoreceptors, and proprioceptors all feed in
through the dorsal root and ultimately synapse, either directly or
through a series of interneurons, with an anterior horn cell from
which an efferent fiber extends to the skeletal muscle. It is through
multiple permutations of this central reflex arc that we respond to
external stimuli, including injury, orient our bodies in space, and
accomplish many of the physical activities of daily living. This figure
also represents the classical viscerovisceral reflex arc wherein the
afferents from the visceral sensory system synapse, in the
intermediolateral cell column, with the sympathetic lateral chain
ganglion or collateral ganglia, which then terminate onto a
postganglionic motor fiber to the target end organ viscera. Note that
the skin viscera also receive efferent stimulation from the lateral
chain ganglion.

Figure 1.1 Cross section of spinal cord segment.

These sympathetic reflex pathways innervate the pilomotor activity

of the skin, the vasomotor tone of the vascular tree, and the
secretomotor activity of the sweat glands. Alteration in the
sympathetic nervous system activity to the skin viscera results in
palpatory changes that are identifiable by the structural diagnostic
means.13 Although this figure separates these two pathways, they
are in fact interrelated, so somatic afferents influence visceral
efferents and visceral afferents can manifest themselves in somatic
efferents. This figure represents the spinal cord in horizontal section,
and it must be recalled that ascending and descending pathways—
from spinal cord segment to spinal cord segment as well as from the
higher centers of the brain—are occurring as well.
Another neurologic concept worth recalling is that of the
autonomic nervous system (ANS). The ANS is made up of two
divisions, the parasympathetic and sympathetic. The
parasympathetic division includes cranial nerves III, VII, VIII, IX,
and X and the S2, S3, and S4 levels of the spinal cord. The largest
and most extensive nerve of the parasympathetic division is the
vagus. The vagus innervates all of the viscera from the root of the
neck to the midportion of the descending colon and all glands and
smooth muscle of these organs. The vagus nerve (Fig. 1.2) is the
primary driving force of the cardiovascular, pulmonary,
neuroimmune, endocrine, and gastrointestinal systems14,15 and has
an extensive distribution. Many pharmaceutical agents alter
parasympathetic nervous activity, particularly that of the vagus.
Figure 1.2 Autonomic nerve distribution.

The sympathetic division of the ANS (Fig. 1.2) is represented by

preganglionic neurons originating in the spinal cord from T1 to L3
and the lateral chain ganglion including the superior, middle, and
inferior cervical ganglia; the thoracolumbar ganglia from T1 to L3;
and the collateral ganglia. Sympathetic fibers innervate all of the
internal viscera as does the parasympathetic division but are
organized differently. The sympathetic division is organized
segmentally. It is interesting to note that all of the viscera above the
diaphragm receive their sympathetic innervation from preganglionic
fibers above T4 and T5, and all of the viscera below the diaphragm
receive their sympathetic innervation preganglionic fibers from below
T5. It is through this segmental organization that the relationships of
certain parts of the musculoskeletal system and certain internal
viscera are correlated. Remember that the musculoskeletal system
receives only sympathetic division innervation and receives no
parasympathetic innervation. Control of all glandular and vascular
activity in the musculoskeletal system is mediated through the
sympathetic division of the ANS.
Remember that all these reflex mechanisms are constantly under
the local and central modifying control of excitation and inhibition.
Conscious and subconscious control mechanisms from the brain
constantly modify activity throughout the nervous system,
responding to stimuli. The nervous system is intimately related to
another control system, the endocrine system, and it is useful to
think in terms of neuroendocrine control. Recent advances in the
knowledge of neurotransmitters, endorphins, enkephalins, and
materials such as substance P have enlightened us as to the detail of
many of the mechanisms previously not understood and have begun
to provide answers for some of the mechanisms through which
biomechanical alteration of the musculoskeletal system can alter
bodily function.16
Emphasis has been placed on the reflex and neural transmission
activities of the nervous system, but the nervous system has a
powerful trophic function as well. Highly complex protein and lipid
substances are transported antegrade and retrograde along neurons
and cross over the synapse of the neuron to the target end organ.17
Alteration in neurotrophin transmission can be detrimental to the
health of the target end organ.18–20

Circulatory Function
The third concept is that of circulatory function. The concept can be
simply described as the maintenance of an appropriate cellular
milieu for each cell of the body (Fig. 1.3). Picture a cell, a group of
cells making up a tissue, or a group of tissues making up an organ
resting in the middle of the “cellular milieu.” The cell is dependent
for its function, whatever its function is, upon the delivery of oxygen,
glucose, and all other substances necessary for its metabolism being
supplied by the arterial side of the circulation. The arterial system
has a powerful pump, the myocardium of the heart, to propel blood
forward. Cardiac pumping function is intimately controlled by the
central nervous system, particularly the ANS, through the cardiac
plexus. The vascular tree receives its vasomotor tone control
through the sympathetic division of the ANS. Anything that interferes
with sympathetic ANS outflow, segmentally mediated, can influence
vasomotor tone to a target end organ.21,22
Figure 1.3 The cellular milieu.

The arteries are also encased in the fascial compartments of the

body and are subject to compressive and torsional stress that can
interfere with the delivery of arterial blood flow to the target organ
or cell. Once the cell has received its nutrients and proceeded
through its normal metabolism, the end products must be removed.
The low-pressure circulatory systems, the venous and the lymphatic
systems, are responsible for the transport of metabolic waste
products. Both the venous and lymphatic systems are much thinner
walled than the arteries, and they lack the driving force of the
pumping action of the heart, depending instead on the
musculoskeletal system for their propelling action.23 The large
muscles of the extremities contribute greatly to this activity, but the
major pump of the low-pressure systems is the diaphragm (Fig. 1.4).
Figure 1.4 Thoracoabdominal diaphragm.

The diaphragm has an extensive attachment to the musculoskeletal

system, including the upper lumbar vertebra, the lower six ribs, the
xiphoid process of the sternum, and, through myofascial connections
with the lower extremities, the psoas and quadratus lumborum
muscles. The activity of the diaphragm modulates the negative
intrathoracic pressure that provides a sucking action on venous and
lymphatic return through the vena cava and the cisterna chyli.
Because of the extensive attachment of the diaphragm with the
musculoskeletal system and its innervation via the phrenic nerve
from the cervical spine, alterations in the musculoskeletal system at
a number of levels can alter diaphragmatic function and,
consequently, venous and lymphatic return. Accumulation of
metabolic end products in the cellular milieu interferes with the
health of the cell and its recovery from disease or injury. It should be
pointed out that the foramen for the inferior vena cava is at the apex
of the dome of the diaphragm. There is some evidence that
diaphragmatic excursion has a direct squeezing and propelling
activity on the inferior vena cava.24,25
Another circulatory concept related to musculoskeletal function
concerns the lymphatic system (Fig. 1.5) and the location where it
empties into the venous system. The lymph from the right side of
the head, right side of the neck, and right upper extremity enters
into the right subclavian vein at the thoracic aperture just behind the
anterior end of the first rib and the medial end of the clavicle. The
lymph from the rest of the body empties into the left subclavian vein
at the thoracic aperture behind the anterior extremity of the left first
rib and the medial end of the left clavicle. Alteration in the
biomechanics of the thoracic aperture, particularly its fascial
continuity, can affect the thin-walled lymph vessels as they empty
into the venous system. Maximal function of the musculoskeletal
system is an important factor in the efficiency of the circulatory
system and the maintenance of a normal cellular milieu throughout
the body.
Figure 1.5 Lymphatic system.

Energy Expenditure
The fourth concept is that of energy expenditure primarily through
the musculoskeletal system. The musculoskeletal system not only
constitutes more than 60% of the human organism but also is the
major expender of body energy. Any increase in activity of the
musculoskeletal system calls on the internal viscera to develop and
deliver energy to sustain that physical activity. The greater the
activity of the musculoskeletal system, the greater is the demand. If
dysfunction alters the efficiency of the musculoskeletal system, there
is an increase in demand for energy, not only for increased activity
but also for normal activity. If we have a patient with compromised
cardiovascular and pulmonary systems who has chronic congestive
heart failure, any increase in demand for energy delivery to the
musculoskeletal system can be detrimental. For example, a well-
compensated chronic congestive heart failure patient who happens
to sprain an ankle and attempts to continue normal activity might
well have a rapid deterioration of the compensation because of the
increased energy demand by the altered gait of the sprained ankle.
Obviously, it would make more sense to treat the altered
musculoskeletal system by attending to the ankle sprain than to
increase the dosage of medications controlling the congestive heart
failure. Restriction of one major joint in a lower extremity can
increase the energy expenditure of normal walking by as much as
40%,26 and if two major joints are restricted in the same extremity,
it can increase by as much as 300%.27 Multiple minor restrictions of
movement of the musculoskeletal system, particularly in the
maintenance of normal gait, can also have a detrimental effect on
total body function.28,29

Self-Regulation
The fifth concept is that of self-regulation. There are literally
thousands of self-regulating mechanisms operative within the body
at all times. These homeostatic mechanisms are essential for the
maintenance of health, and if altered by disease or injury, they need
to be restored. All physicians are dependent on these self-regulating
mechanisms within the patient for successful treatment. The goal of
the physician should be to enhance all of the body’s self-regulating
mechanisms to assist in the recovery from disease. Physicians should
not interfere with self-regulating mechanisms more than absolutely
necessary during the treatment process. All things that are done to
or placed within the human body alter these mechanisms in some
fashion. When any foreign substance is given to a patient, the
beneficial and detrimental potentials of the substance must be
considered. As modern pharmacology grows with evermore-potent
pharmacological effects, we must recognize the potential for
iatrogenic disease. Many patients are on multiple medications,
particularly in the hospital environment, and the actions and
interactions of each must be clearly understood to avoid iatrogenic
problems. Only physicians cause iatrogenic disease. Reportedly, the
incidence of serious adverse drug reactions in hospitalized patients is
6.7% and is considered one of the top ten leading causes of death in
the United States.30

THE MANIPULABLE LESION

Manual medicine deals with the identification of the manipulable
lesion and the appropriate use of a manual medicine procedure to
resolve the condition. The field of manual medicine has suffered
from multiple, divergent, and sometimes confusing definitions of the
entity amenable to manipulative intervention. It has been called the
“osteopathic lesion,” “chiropractic subluxation,” “joint blockage,” “loss
of joint play,” “joint dysfunction,” and other names. The acceptable
term for this entity is somatic dysfunction. It is defined as impaired
or altered function of related components of the somatic (body
framework) system; skeletal, arthrodial, and myofascial structures;
and related vascular, lymphatic, and neural elements.31 Notice that
the emphasis is on altered function of the musculoskeletal system
and not on a disease state or pain syndrome. Obviously, if a somatic
dysfunction is present that alters vascular, lymphatic, and neural
functions, a myriad of symptoms might well be present, including
painful conditions and disease entities. The diagnosis of somatic
dysfunction can accompany many other diagnoses or can be present
as an independent entity. The art of structural diagnosis is to define
the presence of somatic dysfunction(s) and determine any
significance to the patient’s complaint or disease process presenting
at the time. If significant, it should be treated by manual medicine
intervention just as other diagnostic findings might also need
appropriate treatment.

DIAGNOSTIC TRIAD FOR

SOMATIC DYSFUNCTION
The mnemonic ART can express the diagnostic criteria for
identification of somatic dysfunction.
“A” stands for asymmetry of related parts of the musculoskeletal
system, either structural or functional. Examples are altered shoulder
height, height of the iliac crest, and contour and function of the
thoracic cage, usually identified by palpation and observation.
“R” stands for range of motion of a joint, several joints, or region
of the musculoskeletal system. The range of motion could be
abnormal by being either increased (hypermobility) or restricted
(hypomobility). The usual finding in somatic dysfunction is restricted
mobility, identified by observation and palpation using both active
and passive patient cooperation.
“T” stands for tissue texture abnormality of the soft tissues of
the musculoskeletal system (skin, fascia, muscle, ligament, etc.).
Tissue texture abnormalities are identified by observation and a
number of different palpatory tests.
Some authors add one of two other letters to this mnemonic, “P”
or a second “T.” “P” stands for pain associated with other findings,
and “T” stands for tenderness on palpation of the area.32 Tenderness
is particularly diagnostic if localized to a ligament. A normal ligament
is not tender. A tender ligament is always abnormal. However, both
pain and tenderness are subjective findings instead of the objective
findings of asymmetry, altered range of motion, and tissue texture
abnormality. By the use of these criteria, one attempts to identify the
presence of somatic dysfunctions, their location, whether they are
acute or chronic, and particularly whether they are significant for the
state of the patient’s wellness or illness at that moment in time. In
addition to the diagnostic value, changes in these criteria can be of
prognostic value in monitoring the response of the patient, not only
to manipulative treatment directed toward the somatic dysfunction
but also to other therapeutic interventions.

Suggested Readings
Buerger AA, Greenman PE, eds. Empirical Approaches to the Validation of Spinal
Manipulation. Springfield, IL: Charles C. Thomas Publisher, 1985.
Buerger AA, Tobis JS. Approaches to the Validation of Manipulative Therapy.
Springfield, IL: Charles C. Thomas Publisher, 1977.
Cyriax J. Textbook of Orthopedic Medicine. Vol. 1. 7th Ed. East Sussex, UK:
Bailliere-Tindall, 1978.
Greenman PE. The osteopathic concept in the second century: Is it still germane
to specialty practice? J Am Osteopath Assoc 1976; 75:589–595.
Greenman PE, ed. Concepts and Mechanisms of Neuromuscular Functions. Berlin,
Germany: Springer-Verlag, 1984.
Greenman PE. Models and mechanisms of osteopathic manipulative medicine.
Osteopath Med News 1987;4(5):1–20.
Grieve GP. Common Vertebral Joint Problems. Edinburgh, UK: Churchill
Livingstone, 1981.
Hoag JM, Cole WV, Bradford SG. Osteopathic Medicine. New York, NY: McGraw-
Hill, 1969.
Maigne R. Orthopedic Medicine. Springfield, IL: Charles C. Thomas Publisher,
1972.
Maitland GD. Vertebral Manipulation. 4th Ed. Stoneham, MA: Butterworths, 1980.
Mennell JM. Back Pain. Boston, MA: Little, Brown and Company, 1960.
Mennell JM. Joint Pain. Boston, MA: Little, Brown and Company, 1964.
Northup GW, ed. Osteopathic Research: Growth and Development. Chicago, IL:
American Osteopathic Association, 1987.
Northup GW, Korr IM, Buzzell KA, et al. The Physiological Basis of Osteopathic
Medicine. New York, NY: Postgraduate Institute of Osteopathic Medicine and
Surgery, 1970.
Page LE. The Principles of Osteopathy. Kansas City, MO: American Academy of
Osteopathy, 1952.
Paris SA. Spinal manipulative therapy. Clin Orthop 1983;179:55–61.
Schiotz EH, Cyriax J. Manipulation Past and Present. London, UK: William
Heinemann Medical Books, 1975.
Schneider W, Dvorak J, Dvorak V, et al. Manual Medicine: Therapy. New York, NY:
Thieme Medical Publishers, 1988.
Stoddard A. Manual of Osteopathic Technique. London, UK: Hutchinson Medical
Publications, 1959.
Stoddard A. Manual of Osteopathic Practice. New York, NY: Harper & Row, 1969.
Ward RC, ed. Foundations for Osteopathic Medicine. Baltimore, MD: Lippincott
Williams & Wilkins, 1997.
Zink JG. Respiratory and circulatory care: The conceptual model. Osteopath Ann
1977;5:108–124.

References
1. Schiotz EH. Manipulation treatment of the spinal column from the medical-
historical viewpoint. Tidsskr Nor Laegeforn 1958;78:359–372, 429–438, 946–
950, 1003 [NIH Library Translation NIH 75-22C, 23C, 24C, 25C].
2. Lomax E. Manipulative therapy: A historical perspective from ancient times to
the modern era. In: Goldstein M, ed. The Research Status of Spinal
Manipulative Therapy. Bethesda, MD: National Institute of Neurological and
Communicative Disorders and Stroke, Monograph No. 15, 1975:11–17.
3. Weiner M-F, Silver JR. Edward Harrison and the treatment of spinal
deformities in the nineteenth century. J R Coll Physicians Edinb 2008;38:265–
271.
4. Hood W. On so-called “bone setting” its nature and results. Lancet
1871;1:336–338, 373–374, 441–443, 499–501.
5. Joy RJT. The natural bonesetters, with special reference to the Sweet family of
Rhode Island. Bull Hist Med 1965;28:416–441.
6. Hildreth AG. The Lengthening Shadow of Dr Andrew Taylor Still. Macon, MO:
Hildreth, 1938.
7. Gevitz N. The D.O.’s: Osteopathic Medicine in America. 2nd Ed. Baltimore,
MD: Johns Hopkins University Press, 2004.
 8. Osler W. Aequanimitas: With Other Addresses to Medical Students, Nurses
and Practitioners of Medicine. 2nd Ed. Philadelphia, PA: The Blakiston
Company, 1910.
9. Northup GW. Osteopathic Medicine: An American Reformation. 2nd Ed.
Chicago, IL: American Osteopathic Association, 1979.
10. The American Association of Colleges of Osteopathic Medicine. Trends in
Osteopathic Medical School Applicants, Enrollment and Graduates.
http://www.aacom.org/docs/default-source/data-and-trends/2014-trends-
COM-AEG-PDF.pdf?sfvrsn=26-
11. Haldeman S. Modern Developments in the Principles and Practice of
Chiropractic. East Norwalk, CT: Appleton-Century-Crofts, 1980.
12. Dvorak J, Dvorak V, Schneider W, eds. Manual Medicine 1984. Heidelberg,
Germany: Springer-Verlag, 1985.
13. Korr IM, ed. The Neurobiologic Mechanisms in Manipulative Therapy. New
York, NY: Plenum Publishing, 1978.
14. Verberne AJM, Saita M, Sartor DM. Chemical stimulation of vagal afferent
neurons and sympathetic vasomotor tone. Brain Res Rev 2003;41:288–305.
15. Brookes SJH, Spencer NJ, Costa M, et al. Extrinsic primary afferent signalling
in the gut. Nat Rev Gastroenterol Hepatol 2013;10(5):286–296.
16. Konttinen Y, Tiainen V-M, Gomez-Barrena E, et al. Innervation of the joint and
role of neuropeptides. Ann N Y Acad Sci 2006; 1069:149–154.
17. Altar CA, DiStefano PS. Neurotrophin trafficking by anterograde transport.
Trends Neurosci 1998;21(10):433–437.
18. Hagberg H, Mallerd C. Effect of inflammation on central nervous system
development and vulnerability. Curr Opin Neurol 2005; 18(2):117–123.
19. Aller MA, Arias JL, Sánchez-Patán F, et al. The inflammatory response: An
efficient way of life. Med Sci Monit 2006; 12(10):RA225–RA234.
20. Chao MV, Rajagopal R, Lee FS. Neurotrophin signalling in health and disease.
Clin Sci (Lond) 2006;110(2):167–173.
21. Tsuru H, Tanimitsu N, Hirai T. Role of perivascular sympathetic nerves and
regional differences in the features of sympathetic innervation of the vascular
system. Jpn J Pharmacol 2002;88:9–13.
22. Ter Laan M, van Dijk JMC, Elting JWJ, et al. Sympathetic regulation of cerebral
blood flow in humans: A review. Br J Anaesth 2013;111(3):361–367.
23. Gashev AA. Physiologic aspects of lymphatic contractile function: Current
perspectives. Ann N Y Acad Sci 2002;979:178–187.
24. Takata M, Robotham J. Effects of inspiratory diaphragmatic descent on inferior
vena caval venous return. J Appl Physiol 1992; 72(2):597–607.
25. Breslin JW. Mechanical forces and lymphatic transport. Microvasc Res
2014;96C:46–54. doi: 10.1016/j.mvr.2014.07.013.
26. Waters RL, Perry J, Conaty P, et al. The energy cost of walking with arthritis of
the hip and knee. Clin Orthop Relat Res 1987;214: 278–284.
27. Buzzell KA. The cost of human posture and locomotion. In: Northup GW, Korr
IM, Buzzell KA, et al., eds. The Physiological Basis of Osteopathic Medicine.
New York, NY: Postgraduate Institute of Osteopathic Medicine and Surgery,
1970:63–72.
28. Gussoni M, Margonato V, Ventura R, et al. Energy cost of walking with hip
joint impairment. Phys Ther 1990;70(5):295–301.
29. Sparling TL, Schmitt D, Miller CE, et al. Energy recovery in individuals with
knee osteoarthritis. Osteoarthritis Cartilage 2014;22(6):747–755.
30. Lazarou J, Pomeranz BH, Corey PN. Adverse drug reactions in hospitalized
patients. JAMA 1998;279(15):1200–1205.
31. Commission on Professional and Hospital Activities. Hospital Adaptation of the
International Classification of Disease. 2nd Ed. Ann Arbor, MI: Commission on
Professional and Hospital Activities, 1973.
32. DiGiovanna EL, Schiowitz S. An Osteopathic Approach to Diagnosis and
Treatment. Philadelphia, PA: JB Lippincott Co., 1991.
2 Principles of Structural
Diagnosis

Structural diagnosis in manual medicine is directed toward

evaluation of the musculoskeletal system with the goal of
identification of the presence and significance of somatic
dysfunction(s). It is a component part of the physical examination of
the total patient. Most of the evaluation of the internal viscera takes
place by evaluation of these structures through the musculoskeletal
system. Therefore, it is easy to examine the musculoskeletal system
while evaluating the internal viscera of the neck, chest, abdomen,
and pelvic regions. Structural diagnosis uses the traditional physical
diagnostic methods of observation, palpation, percussion, and
auscultation. Of these, observation and palpation are the most
useful. Structural diagnosis of the musculoskeletal system should
never be done in isolation and should always be done within the
context of a total history and physical evaluation of the patient. It
has been said that 90% of a physician’s decision making is from the
history and physical examination.
The diagnostic entity sought by structural diagnosis is somatic
dysfunction. The three classical diagnostic criteria for somatic
dysfunction can be identified with the mnemonic ART (see Chapter
1). Examples of asymmetry might be the height of each shoulder by
observation, height of iliac crest by palpation, and contour and
function of the thoracic cage by observation and palpation.
Asymmetry is usually discerned by observation and palpation.
Altered range of motion may be either restricted or increased
mobility. Restricted motion is the most common component of
somatic dysfunction. Range-of-motion abnormality is determined by
observation and palpation, using both active and passive patient
cooperation. Tissue texture abnormality (TTA) is ascertained by
observation and palpation. Percussion is also used in identifying
areas of altered tissue texture. A large number of descriptors are
used in the literature to express the quality of the abnormal feel of
the tissue. There are two primary tissue abnormalities that account
for palpable changes, namely muscle hypertonicity, secondary to
increased alpha motor neuron stimulation, and altered activity of the
“skin viscera,” the pilomotor, vasomotor, and secretomotor functions
that are under the control of the sympathetic division of the
autonomic nervous system.

HAND–EYE COORDINATION
In structural diagnosis, it is important for the physician to maximize
the coordinated use of the palpating hands and the observing eyes.
When using vision for observation, it is important to know which eye
is dominant so that it can be appropriately placed in relation to the
patient for accuracy in visual discrimination. Since most structural
diagnosis uses hand–eye coordination with the arms extended, it is
best to test for the dominant eye at arm’s-length distance (Fig. 2.1).
The test is as follows:
Figure 2.1 Test for dominant eye.

1. Extend both arms and form a small circle with the thumb and
index finger of each hand.
2. With both eyes open, sight through the circle formed by the
thumbs and fingers at an object at the other end of the room.
Make the circle as small as possible.
3. Without moving your head, close your left eye only. If the object
is still seen through the circle, you are right eye dominant. If the
object is no longer seen through the circle, you are left eye
dominant.
4. Repeat the procedure closing the right eye and note the
difference.

When looking for symmetry or asymmetry, it is important that

the dominant eye be located midway between the two anatomic
parts being observed and/or palpated. For example, when palpating
each acromial process to identify the level of the shoulders, the
dominant eye should be in the midsagittal plane of the patient,
equidistant from each palpating hand. In other words, the dominant
eye should be on the midline of the two anatomic parts being
compared. With a patient supine on the examining table, a right
eye–dominant examiner should stand on the right side of the patient
and a left eye–dominant examiner should stand on the left side of
the patient. Remember that the hands and eyes should be on the
same reference plane when one is attempting to determine if paired
anatomic parts are symmetrically placed. For example, when
evaluating the height of the shoulders by palpating the two acromial
processes and visualizing a level against the horizontal plane, the
eyes should be on the same horizontal plane as the palpating hands.
When palpating the two iliac crests to identify if they are level
against the horizontal plane, the eyes should be at the level of the
iliac crests in the same plane as the palpating hands. Whenever
possible, the eyes should be in the plane against which anatomic
landmarks are being compared for symmetry or asymmetry.
All physicians use palpation in physical examination of the
abdomen for masses, normal organs for size and position, point of
maximum impulse of the heart, tactile fremitus of the lungs, and
pulsations of the peripheral vessels. Palpation is also used to identify
masses, normal and abnormal lymph nodes, and other changes of
the tissues. In structural diagnosis, palpation requires serious
consideration and practice to develop high-level diagnostic skills.
Palpatory skills affect the following:

1. The ability to detect TTA

2. The ability to detect asymmetry of position, both visual and
tactile
3. The ability to detect differences of movement in total range,
quality of movement during the range, and quality of sensation
at the end of the range of movement
4. The ability to sense position in space of both the patient and
examiner
5. The ability to detect change in palpatory findings, both
improvement and worsening, over time
 It is important to develop coordinated and symmetric use of the
hands so that they may be linked with the visual sense. In
developing palpatory skills, one must be aware that different parts of
the hands are valuable for different tests. For example, the palms of
the hands are best suited for use in the stereognostic sense of
contour; the dorsum of the hands are more sensitive to temperature
variations; the finger pads are best for fine discrimination of textural
differences, finite skin contour, and so forth; and the tips of the
fingers, particularly the thumbs, are useful as pressure probes for
the assessment of differences in depth.
Three stages in the development and perception of palpatory
sense have been described: reception, transmission, and
interpretation. The proprioceptors and mechanoreceptors of the
hand receive stimulation from the tissues being palpated. This is the
reception phase. These impulses are then transmitted through the
peripheral and central nervous systems to the brain where they are
analyzed and interpreted. During the palpation process, care must
be exercised to ensure efficiency of reception, transmission, and
interpretation. Care must be taken of the examiner’s hands to
protect these sensitive diagnostic instruments. Avoidance of injury
abuse is essential; hands should be clean and nails an appropriate
length. During the palpation process, the operator should be relaxed
and comfortable to avoid extraneous interference with the
transmission of the palpatory impulse. To accurately assess and
interpret the palpatory findings, the examiner must concentrate on
the act of palpation, the tissue being palpated, and the response of
the palpating fingers and hands. Reduce all extraneous sensory
stimuli as much as possible. Probably, the most common mistake in
palpation is the lack of concentration by the examiner.
Tissue palpation can be further divided into light touch and deep
touch. In light touch, the amount of pressure is very slight and the
examiner attempts to assess tissue change both actively and
passively. By simply laying hands on the tissue passively, the
examiner is able to make tactile observation of the quality of the
tissues under the palpating hand. By moving the lightly applied hand
Another random document with
no related content on Scribd:
 HISTORICAL RECORD
OF THE

EIGHTY-SIXTH,
OR

THE ROYAL COUNTY DOWN REGIMENT

OF

F O O T.

The last twelve years of the eighteenth century form a

period, remarkable in the annals of Europe, for the efforts 1793
made to overthrow the governments of Christendom, and to
establish the destructive domination of atheism and democracy,
upon the ruins of institutions which had elevated the inhabitants of
this quarter of the globe to an height of knowledge, refinement,
wealth, and power, unknown in other parts of the earth. France was
the great theatre of commotion: there the war of hostile principles
produced the most sanguinary results;—the cry of “equality” was
raised,—the blood of princes, nobles, and citizens was shed, and
democracy appeared to triumph over the rights of society. In other
countries, republican principles were spreading to an alarming
extent; the sovereigns of Europe were forced to engage in war to
oppose the progress of destruction, and to Great Britain pertains the
honour of having persevered in this contest, for twenty years, when
the overthrow of that tyrannical power which sprung out of the
French revolution, was accomplished.
On the commencement of hostilities in 1793, the British army was
augmented: upwards of fifty regiments of foot were raised, and one
of the first corps embodied, on this occasion, was the regiment which
now bears the title of the Eighty-sixth, or the Royal County
Down Regiment.
This corps was raised by Major-General Cornelius Cuyler, who
had served with reputation in North America, and also in the West
Indies, where he had performed the duties of commander-in-chief; its
general rendezvous was at Shrewsbury, and its designation was
“General Cuyler’s Shropshire Volunteers;” but its ranks were
completed with men, principally from Yorkshire, Lancashire, and
Cheshire,—counties which have furnished many excellent soldiers.
Major-General Cuyler’s appointment was dated the 30th of October,
1793, and the royal warrants for raising recruits were issued on the
following day[1].
In February, 1794, the following officers were holding
commissions in the regiment:— 1794

Colonel, Major-General C. Cuyler.

Lieut.-Colonel, George Sladden.
Major, R. M. Dickens.
Captains. Lieutenants. Ensigns.
T. C. Hardy Thomas Neilson Willm. Murray
W. H. Digby Hugh Houstown Thos. Thornhill
Charles Byne W. S. Curry Thomas Symes
Edward Robinson Edward Barnes W. C. Williams
Alexander Campbell Thos. Pickering James Burke
Rowland Hill[2] Charles Dod Danl. McNeill
Robert Bell. Geo. Middlemore Edward Fox
Chas. E. Jolley Wm. St. Clair.
Captain-Lieutenant. Daniel Gavey
George Cuyler. Wm. Semple
J. C. Tuffnell.
Chaplain, Chas. Austen; Adjutant, Daniel Coleman;
Quarter-Master, Richard Jackson; Surgeon, Hugh Dean.
 From Shrewsbury, the regiment proceeded to Park-gate, where it
embarked, in April, for Ireland, and after landing at Cork, marched to
Kilkenny.
At this period the newly-raised corps were numbered, and this
regiment received the designation of the Eighty-sixth, or
Shropshire Volunteers.
On the 20th of June, 1794, Major-General Cuyler was appointed to
the Sixty-ninth Regiment, and was succeeded in the colonelcy of the
Eighty-sixth, by Lieutenant-General Russell Manners.
After remaining in Ireland ten weeks, the regiment embarked at
Cork, and was held in readiness for active service; but it landed at
Frome, in Somersetshire, in September, and proceeded from thence
to the Isle of Wight.
The regiment having been brought into a state of discipline
and efficiency, was selected to serve on board the fleet as 1795
marines; eight officers, and four hundred and fourteen non-
commissioned officers and soldiers, embarked in January, 1795, on
board the “Prince of Wales,” “Triumph,” “Brunswick,” and “Hector,”
line-of-battle ships, and in February, seven officers, and two hundred
and seventy-six non-commissioned officers and soldiers, embarked
on board the “Prince,” “Saturn,” and “Boyne.” The “Boyne” caught
fire at Spithead, and was destroyed, when the grenadier company of
the regiment lost its arms, accoutrements, and baggage.
Lieut.-General Russell Manners was removed to the Twenty-sixth
Light Dragoons, in March, 1795, and was succeeded by Major-
General William Grinfield, from Lieut.-Colonel in the Third Foot
Guards.
The head-quarters of the regiment were at Newport, in the Isle of
Wight, where they were inspected by His Royal Highness the Duke
of York, who expressed his approbation of their appearance; and in
October the establishment was augmented to one hundred rank and
file per company, its numbers being completed by drafts from the
118th and 121st Regiments; the men of the last-mentioned corps
were then recently liberated from French prison. In December, the
regiment was stationed at Portsmouth and Hilsea.
In the beginning of 1796, the establishment was augmented
to twelve companies,—the eleventh and twelfth being 1796
recruiting companies; and as the ships of war came into port, the
officers and soldiers of the Eighty-sixth landed and joined the
regiment; they had served in several engagements in which the
ships they were embarked in had taken part, during that eventful
period. In April, the regiment proceeded to Guildford, and in June it
returned to the Isle of Wight.
Meanwhile, Flanders and Holland had embraced the republican
principles of France, and the British government resolved to deprive
the Dutch of the settlement of the Cape of Good Hope; the Eighty-
sixth embarked for the Cape, where they landed on the 22nd of
September, six days after the Dutch governor had surrendered the
colony to the forces under General Sir Alured Clarke.
The regiment was stationed at the Cape of Good Hope
during the years 1797 and 1798, and received drafts from the 1797
1798
95th, and other corps. In February, 1799, it embarked for the
1799
East Indies, and landed, on the 10th of May, at Madras,
upwards of thirteen hundred strong,—a splendid body of men,
whose appearance excited much admiration.
The capture of Seringapatam had rendered the services of the
regiment at this station unnecessary, and after a month’s repose at
Madras, it embarked for Bombay, where it arrived on the 22nd of
July, and sent detachments by sea, under Major Bell, and Captain
James Richardson, to Tannah and Surat: these detachments
returned to Bombay, in December following.
From Bombay, three companies sailed, towards the end of
1800, for Ceylon, in the expectation of taking part in the 1800
1801
reduction of the Isle of France[3]; but orders had, in the
meantime, arrived for an army from India, to co-operate with a body
of troops from Europe, in the expulsion of the French “Army of the
East” from Egypt, and the detachment returned, in January, 1801, to
Bombay, where Major-General Baird assumed the command, and
the expedition sailed for the Red Sea.
It was originally designed, that the army from India should land at
Suez, a city of Egypt, situate at the head of the Red Sea, on the
borders of Arabia; and a small squadron under Admiral Blanquett,
having on board three companies of the Eighty-sixth (the
grenadier, light, and colonel’s companies) under Lieut.-Colonel
Lloyd, a detachment of Bombay artillery, a battalion of sepoys, with
other detachments, sailed some time before the main body of the
expedition, to attack Suez, and interrupt the formation of any
establishment there by the French. This small force left Bombay in
December 1800, arrived at Mocha in the middle of January 1801,
where the fleet remained two days to procure provisions, when it
sailed for Jedda, where one of the ships was lost on a bank. The
navigation of the Red Sea, from Jedda to Suez, proved particularly
difficult and tedious, on account of the want of a sufficient depth of
water, the fleet having to anchor daily, and take advantage of the
tides. On reaching Suez, the French had evacuated the place in
consequence of the arrival of the army from Europe, under General
Sir Ralph Abercromby, on the Mediterranean shores of Egypt, and
the success of the British arms near Alexandria, where Sir Ralph
Abercromby was killed.
The troops landed at Suez, and Lieut.-Colonel Lloyd, in reporting
his arrival, solicited permission to cross the Desert and share in the
dangers and honours of the army, which was advancing up the Nile,
and approaching Cairo, the modern capital of Egypt, which it was
expected the French would defend. Lieut.-General Hutchinson
acquiesced in Lieut.-Colonel Lloyd’s wishes, and preparations were
accordingly made to pass the Desert.
At six o’clock, on the evening of the 6th of June, the three
companies of the Eighty-sixth commenced their march, with only
three pints of water per man; the distance in a straight line, was only
fifty-eight miles; but the Arab Sheiks, furnished for guides by the
Vizier, and made responsible for the safe passage of the
detachment, represented that a detour of ten or twelve miles would
be necessary to prevent the French intercepting the detachment.
 After marching two hours over a hard sandy country, Captain
Cuyler, Lieutenant Morse, and Lieutenant Goodfellow, were taken so
ill as to be unable to proceed. At eleven the troops halted for two
hours, then resumed the march until seven in the morning, when
they again halted, having performed twenty-six miles of the journey.
The day became so intolerably hot, that Lieut.-Colonel Lloyd ordered
the tents to be pitched to shelter the men from the sun; but at ten
o’clock the guides stated it was necessary to march, as the camels
would be so debilitated by the heat, if they rested on the sand, as to
require water before they could move again; but if kept in motion
they would not be affected in so fatal a degree; adding, if the soldiers
slept, the camel drivers might steal the water, which they feared
would be found scarcely sufficient. The guides being responsible for
the safety of the detachment, Lieut.-Colonel Lloyd acceded to their
wishes; the tents were struck at eleven, and the march resumed; the
thermometer being at 109. Captain Cuyler soon fainted again, and
fell from his horse, and a camel and two men were left to attend him
and bring him forward. The men beginning to drop fast in the rear,
Lieut.-Colonel Lloyd halted about one o’clock, cut his own baggage
from the camels, which example was followed by all the officers, as
many men as could be carried were then mounted on the camels,
and the whole proceeded. At two o’clock a camseen, or south wind
began to blow, the thermometer rose to 116, and afterwards much
higher; the officers and soldiers were seized with dreadful
sensations:—some were affected with giddiness and loss of sight,
and others fell down gasping for breath, and calling for drink. At four
o’clock, Lieut.-Colonel Lloyd was forced to halt. The skins had been
cracked by the sun, and the water had become of a thick
consistence; the men who drank it were seized with vomiting and
violent pains. The officers had brought with them some Madeira
wine, which they divided among the soldiers; a proportion of spirits
were mixed with the remaining water, which was issued to the men,
accompanied with the warning, that every drop was in their own
possession, half the journey had not been performed, and on their
own prudence, in reserving a portion in their canteens, must depend
whether or not they should be enabled to accomplish the remainder
of the distance.
 Between six and seven o’clock the wind ceased; as the sun
declined, the air became more temperate, and the detachment being
a little refreshed, though still a languor pervaded the whole, the order
for marching was given at seven o’clock. Seventeen men, unable to
travel, were left on the ground, and camels were left to bring them
forward as soon as they could be moved.
During the march several officers and soldiers experienced an
extraordinary sensation of seeing horses, camels, and all kinds of
animals, moving with rapid transition before them, which false
perception their judgment could not correct. At eleven the
detachment halted; the night was excessively dark, and the officers
and soldiers were so exhausted, that unconquerable sleep seized
upon all.
At four o’clock the guides awoke Lieut.-Colonel Lloyd, and the
soldiers formed in order of march with difficulty, a heavy dew having
fallen upon them, and their limbs being benumbed with cold. The
march was, however, resumed; the south wind began to blow at the
same hour as on the preceding day, but the men were not affected in
the same severe degree; and by strenuous exertions the detachment
arrived at the springs of Elhanka, between four and five o’clock in the
evening of the same day, when the joy experienced by every one
was very great. By eight o’clock all the camels had come up, and the
men, who, from giddiness had fallen from their backs, joined during
the night. Eight of the seventeen men left behind, joined on the 9th of
June, and the other nine perished in the Desert.
No man had partaken of food after quitting Suez, as it would have
increased the thirst, and the rations of salt pork were thrown away on
the first morning. On arriving at the springs, the soldiers partook of
the water with caution; but two officers’ horses having broke loose
drank till they died on the spot. During the march of seventy miles,
no vegetation, bird, or beast, had been seen.
After halting at the springs of Elhanka until the evening of the 9th
of June, the detachment commenced its march in the dark, to
prevent being discovered by the enemy, and at eleven o’clock on the
following day, it joined the Turkish army, encamped at Chobra, under
the Grand Vizier; the British, under Lieut.-General Hutchinson, being
encamped on the other side of the river Nile. The Eighty-sixth
pitched their tents with Colonel Stuart’s division, which was with the
Vizier’s army; the soldiers had suffered the loss of their uniforms,
which had been burnt in consequence of the plague, and they had
been forced to abandon their knapsacks on the march; being very
fine men, their appearance excited great interest. On the 16th, the
three officers left behind on the march, joined; they had returned to
Suez, and afterwards passed the Desert with a caravan.
Advancing towards the metropolis of modern Egypt, the army
made preparations for investing that extensive fortress; but on the
22nd of June a flag of truce arrived from the French Commandant,
General Belliard, who agreed to surrender Cairo, on condition of
himself and garrison being sent back to France.
On the surrender of Cairo, the three companies of the Eighty-
sixth marched into the citadel, which the French had evacuated a
few hours previously. On the same day they took possession of Fort
Ibrahim.
In the mean time, the other three companies of the regiment which
had returned from Ceylon to join the expedition, had been delayed
by the difficult navigation of the Red Sea, and had landed at Cosseir,
from whence a march of above one hundred and twenty miles had to
be performed across the Desert to Kenna on the Nile. This distance
was divided into stages, stores were formed at several points, relays
of camels were placed to convey water, wells were found, and others
digged, and the march was performed by the army with much less
suffering than was experienced by the three companies under Lieut.-
Colonel Lloyd, in the passage of the Desert from Suez to the springs
of Elhanka. At the third stage, called Moilah, some soldiers of the
Eighty-sixth dug a well at the foot of a hill, under the direction of
Captain Middlemore, and found an excellent spring, for which they
received the thanks of the commander of the forces.
Arriving on the banks of the Nile, the troops embarked in boats
and proceeded down the river to the island of Rhonda, where they
encamped, while the forces from Europe were engaged in the siege
of Alexandria. At Rhonda the six companies of the Eighty-sixth
were united; four companies remaining in India.
In the beginning of September, Alexandria surrendered; Egypt was
thus delivered from the power of the French “Army of the East,”
and Europe saw the dawn of liberty in the horizon. The Eighty-sixth
received, in common with the other corps which served in this
enterprise, the approbation of their Sovereign, the thanks of
Parliament, and the royal authority to bear on their colours the
Sphynx, with the word “Egypt,” to commemorate the share taken by
the regiment in this splendid achievement.
To perpetuate the remembrance of the services rendered to the
Ottoman Empire, the Grand Seignor established an order of
knighthood, which he named the order of the Crescent, of which
the superior officers of the army and navy were constituted
members. The officers of the Eighty-sixth, and other corps, had
gold medals presented to them by the Grand Seignor, which they
were permitted by King George III., to accept and wear.
The object of the expedition having been accomplished, the
Eighty-sixth sailed up the Nile in boats, in order to return to India;
they arrived at El Hamed on the 14th of October, and on the 30th
proceeded to Gheeza, where they remained several months.
In April of this year, one of the four companies left in India,
proceeded from Bombay to Surat, a town situate on the south bank
of the river Taptee, in the province of Guzerat; and in November, two
companies sailed for Dieu in the same province.
The two companies at Dieu returned to Bombay in
February, 1802, and in March they sailed to Cambay, under 1802
the command of Captain Richardson, and joined the company from
Surat, which had arrived there a short time previously. They
encamped at Cambay, with part of the Seventy-fifth, five companies
of the Eighty-fourth, a battalion of native infantry, and some artillery,
under Colonel Sir William Clarke.
The jealousy of the native chiefs at the accession of territory
acquired by the British in India, often produced hostilities, and
circumstances occurred which occasioned a detachment of the
Eighty-sixth, under Lieutenant William Purcell Creagh, to take part
in an attempt to surprise the hostile fortress of Kareah, one hundred
and twenty miles from Cambay, on the night of the 17th of March.
The soldiers were advancing to storm the place with the greatest
gallantry, when their progress was arrested by a deep ditch, cut
through the rock a short time previously, and the Arabs in garrison
being numerous and prepared, opened a heavy fire. Lieutenant
Creagh was killed by a cannon ball, while in the act of leading the
soldiers to the attack; Lieutenant Lovell was also killed, and many
officers and soldiers were wounded; soon after day-break the troops
were obliged to retire.
In consequence of this repulse, the three companies of the
Eighty-sixth, with the other detachments encamped at Cambay,
were ordered to advance upon Kareah. The enemy having formed
for battle a short distance from the fort, with a numerous force, were
routed by the British on the 30th of April; and immediately afterwards
the town was captured, also some out-works, in one of which an
explosion took place, killing an officer and twenty-five soldiers.
The siege of the fort was commenced; but when the batteries
opened their fire, the garrison surrendered. The chief, Mulhar Rao,
was sent a prisoner to Bombay. After placing a garrison in the fort,
the troops marched for Surat, (170 miles,) where they arrived on the
12th of June, having captured Tarrapore, and other small places,
while on the march.
The six companies of the regiment in Egypt remained at Gheeza
until May, when they traversed the Desert to Suez, and from thence
to “Moses’ Well,” or the “Font of Moses,” on the Arabian side of the
Gulf of Suez. While at Gheeza they received two hundred and seven
volunteers from the Twentieth, Thirty-fifth, Forty-eighth, and Sixty-
third Regiments; Major Henry Torrens joined at that station.
While at Moses’ Well, several soldiers died of the plague, when
the men’s clothing, bedding, and tents were burnt, and the six
companies embarked for India; no other cases of the plague
occurring, the companies landed at Bombay on the 4th of July. In
November, the three companies arrived from the province of
Guzerat, and the regiment was once more united at Bombay.
The Eighty-sixth were only permitted to enjoy a short repose at
Bombay: the hostile demonstrations of some of the predatory states
composing the Mahratta power, rendering it necessary for the British
forces to be held in readiness for active operations, and assembled
on the verge of the British territory. The Mahratta states were united
by a sentiment of interest founded upon their common origin, civil
and religious usages, and habits of conquest and depredation; the
chiefs acted as independent sovereigns, but nominally
acknowledged the supreme authority of the Peishwah. They,
however, viewed with jealousy the treaties between the British and
the Peishwah, as tending to restrain their predatory habits, and
prevent their acquisition of power; and this acknowledged head of
the Mahratta states found his independence controlled, and the
existence of his government menaced by the violence and ambition
of his feudatory chieftains; at the same time he was unable to fulfil
his engagements with the British, the safety of whose possessions
was endangered. In consequence of these events, connected with
other causes, the Eighty-sixth left Bombay in the middle of
November, for the province of Guzerat, and landed at Cambay, from
whence they marched towards the hostile fortress of Baroda, in the
vicinity of which place they encamped, with several other corps, on
the 3rd of December. An enemy’s force was assembled to protect
the fortress, and on the 18th of December the British advanced,
leaving their tents standing, and engaged their opponents. During
the fight the garrison made a sally; but the English proved victorious,
routing their adversaries with great slaughter, and capturing a pair of
Arab colours and many prisoners.
During the night the erection of batteries commenced; on the 21st
of December the fire of the artillery was opened, and the flank
companies of the Eighty-sixth stormed an outwork, defended by
Arabs, who refused quarter, and were nearly all destroyed, very few
escaping. In four days the breach was practicable, and the storming
parties were ready; but the garrison surrendered. The Eighty-sixth
had seven men killed, and twenty-three wounded in these services.
Captain John Grant distinguished himself during the siege, and at
the storming of the outwork.
Towards the end of this year, the usurpations of Jeswunt Rao
Holkar, one of the Mahratta chiefs, forced the Peishwah to abandon
his capital, and to seek British aid, when a treaty was concluded with
him; and the refractory chiefs persisting in aggression, hostilities
were commenced to reinstate the deposed chieftain.
On the third of February, 1803, three companies of the
Eighty-sixth, under Captain James Richardson, were 1803
detached, with other forces, the whole commanded by Major
Holmes, of the Bombay army, in pursuit of the Mahratta chieftain,
Canojee Rao Guickwar, who had taken the field with a considerable
force.
While in quest of the enemy, the advance-guard of the Seventy-
fifth Regiment was suddenly attacked, when emerging from a defile,
on the 6th of February, and overpowered, with a loss of many men
and a gun. The three companies of the Eighty-sixth, being at the
head of the column of march, moved forward, encountered the
enemy, and, by a determined charge, routed the hostile forces,
chasing them across the bed of a river into the jungle, where they
dispersed, leaving their tents, baggage, camels, horses, and the
captured gun behind. The regiment lost very few men in this gallant
exploit.
On the same day five companies of the regiment, under Captain
Cuyler, marched from Baroda to reinforce Major Holmes’
detachment, leaving two companies behind under Captain Grant.
The Chief Canojee was at the head of a considerable force, but he
avoided an engagement, which occasioned many harassing
marches in endeavouring to come up with him. On the 25th of
February, a party of the Eighty-sixth was detached against the fort
of Kirrella, which was captured without experiencing serious
opposition.
On the 1st of March, when near Copperbund, information was
received that Canojee’s force was not far distant; and by
extraordinary exertions, the detachment came up with the hostile
bands, which were in full retreat. The Mahratta horse, attached to the
British detachment, did not act with spirit; but the Eighty-sixth,
though nearly exhausted with the march, made a gallant effort, and
encountered the enemy, who was in the act of passing the bed of a
river. The adverse bands being nearly all cavalry, and the British
nearly all infantry, the enemy escaped with little loss. The Eighty-
sixth had two men killed; Lieutenant Alexander Grant, and a few
men wounded.
The forces of Canojee Rao Guickwar having been, in a great
measure, dispersed, the Eighty-sixth were allowed a short period
of repose; and these districts were annexed to the British
possessions in India.
Operations having commenced for the restoration of the
Peishwah, the Eighty-sixth were stationed a short time in Guzerat,
where a force was detained to afford security to that valuable and
important province, and also a reserve disposable for active
operations. The regiment formed part of the disposable force
stationed in front of Brodera, the residence of the Guickwar, and to
the northward of the Nerbudda river.
In May, the regiment advanced and pitched its tents before the
fortress of Keira, belonging to one of Doulat Rao Scindia’s chiefs,
where some native infantry and battering guns also arrived; but the
garrison surrendered without waiting for a breach having been made
in the works.
From Keira the regiment marched to Nerriade, where it was joined
by two companies left at Baroda under Captain Grant; but the rains
setting in, the operations were suspended.
Information having been received that a body of the enemy was
levying contributions about thirty miles from the quarters of the
regiment, Captain Grant performed a forced march with four
companies and some sepoys, and making a night attack with great
success, killed and took prisoners many of the enemy, and captured
some horses, &c. Lieutenant Procter and a few men of the regiment
were wounded on this occasion.
 A body of Canojee’s troops threatening to cross the river about
fifteen miles above Baroach, and plunder the country, four hundred
rank and file of the regiment, with a battalion of sepoys, and four
guns, under Captain James Richardson, advanced, on the 14th of
July, during the heavy rains, in search of the enemy. The gun-
bullocks failed, and the country being inundated by the rains, the
soldiers had to drag the guns, up to their waists in water; but by
extraordinary efforts they arrived at the bank of the river on the 16th
of July, and attacking a number of Canojee’s troops which had
crossed the stream, routed them, and forced them into the water,
where many lost their lives, the river being full and rapid.
The river having fallen considerably during the night, the soldiers
passed the stream on the following day, under cover of the fire of the
guns, and assaulting the breast-works of the main body of Canojee’s
legions, carried them at the point of the bayonet, and pursued the
routed enemy two miles with great slaughter. A body of Arabs
disdaining to seek their safety in flight, fought with great desperation
until overpowered.
Captain Richardson and Lieutenant Lanphier distinguished
themselves on this occasion; and the enterprise being accomplished
with the loss of a few men killed and wounded, the troops returned to
Baroda.
In pursuance of the plan suggested to the Governor-General by
Major-General Hon. Arthur Wellesley, five hundred men of the
Eighty-sixth, a small detachment of the Sixty-fifth, a proportion of
European artillery, and a battalion of Sepoys, advanced, under
Lieut.-Colonel Woodington, to besiege the strong fortress of
Baroach. On the 23rd of August, this small body of troops encamped
on the bank of the river within a few miles of the fortress, expecting
the arrival of the battering train in boats. The baggage of the
regiment was this day attacked by a numerous body of the enemy’s
horse, when nearly every soldier and follower was killed or wounded,
and the baggage captured and plundered.
A schooner and gun-boat having arrived with cannon and
ammunition, the troops advanced on the 25th of August, and arriving
within two miles of the fortress, discovered a numerous body of
hostile cavalry, infantry, and Arabs, in order of battle on the plain.
These opponents were speedily routed with the loss of their flag and
a number of killed and wounded; and the armament soon afterwards
attacked, and carried, the pettah with great gallantry; Ensign
D’Aguilar distinguished himself on this occasion.
The siege of the fort was commenced, and a breach was reported
practicable; at one o’clock on the 29th of August, the storming
parties assembled in the streets under the command of Major
Cuyler; the bayonets were firmly fixed by the introduction of a piece
of cotton cloth, to prevent the Arab swordsmen disengaging them,
and the soldiers proceeded quietly to their post behind the battery. At
three the signal to attack was fired, and the forlorn hope, consisting
of Serjeant John Moore and twelve soldiers of the Eighty-sixth,
sprang forward; a hundred soldiers of the Eighty-sixth, and a
hundred Sepoy grenadiers, under Captain Richardson, rushed
towards the breach, followed by three hundred men under Major
Cuyler, and a reserve of two hundred under Captain Bethune.
Passing the ditch knee-deep in mud, and climbing the long steep
and difficult ascent to the breach, the soldiers encountered the Arab
and Scindian defenders, who made a desperate resistance. Hand to
hand the combatants strove for mastery, and amidst the clash of
steel and turmoil of deadly contest, many feats of valour were
performed. Captain Maclaurin, who evinced great ardour, was
wounded and made prisoner, but he was rescued from the Arabs, by
Private John Brierly. Captain Richardson and Captain Grant
signalized themselves, and Serjeant Bills was conspicuous for the
heroic courage with which he fought. At length British valour proved
triumphant, and the breach was won, when the Eighty-sixth
crowned the rampart, the Scindian colours were pulled down, and
the British standard planted in their place, by Serjeant Moore.
Having overpowered all resistance at the breach, Captain
Richardson’s party swept the works to the Cuttoopore gate; Major
Cuyler led his detachment at a running pace to the Jaraseer gate,
and firing upon the Scindians and Arabs who were escaping by that
avenue, wounded one of the elephants in the passage. The Arabs
threw down their matchlocks, drew their creesis, and rushing upon
their assailants with deadly fury, refused to give or receive quarter.
The contest was of short duration; British discipline and prowess
were again victorious; two hundred Arab horsemen and foot lay on
the ground, and the Eighty-sixth stood triumphant on the scene of
conflict. Among the trophies of the day, were fifteen stand of
Scindian and Arab colours, which were sent to head-quarters,
excepting two, retained by the Eighty-sixth regiment, as trophies of
the valour displayed by the corps on this occasion.
Thus was captured a fortress of great importance to the
commercial interests of Britain, with a territory yielding a
considerable revenue, which were added to the British dominions. In
his public despatch, Lieut.-Colonel Woodington highly commended
the conduct of Major Cuyler and Captain Richardson, and added,
—“The whole of the officers and men employed on this service have
conducted themselves so much to my satisfaction, that I cannot
express myself too strongly in their commendation.”
The Governor-General in Council, also, signified in general orders,
—“his particular approbation of the valour and judgment manifested
by Major Cuyler, of His Majesty’s Eighty-sixth regiment, throughout
the service at Baroach, and in commanding the storm of the fort, and
by Captain Richardson of the same corps, leading the assault. His
Excellency in Council, also, observes with particular satisfaction the
conduct of Captain Cliffe, of the Engineers of Bombay. To all the
officers and troops, European and Native, employed on this
honorable occasion, His Excellency in Council signifies his high
commendation.”
Serjeant Bills was rewarded with the appointment of serjeant-
major; Serjeant Moore received a donation of five hundred rupees
from the Government for his gallantry, and Private Brierly was
promoted corporal, and afterwards serjeant.
The loss of the regiment was Captain William Semple, killed in the
breaching battery on the 25th of August—an excellent officer, whose
fall was much regretted; also two serjeants and ten rank and file
killed; Major Cuyler, Captain Richardson, Captain Maclaurin, and
twenty-three rank and file wounded.
From Baroach the regiment proceeded to Baroda, from whence
five hundred rank and file of the Eighty-sixth, a battalion of Sepoys,
some irregular horse, and a battering train, marched to attack the fort
of Powanghur, situated on a stupendous rock of extraordinary height
and of difficult ascent. Arriving before this place on the 14th of
September, and the garrison refusing to surrender, the walls were
battered until the 17th, when orders were issued to prepare to attack
the lower fort by storm. The garrison was intimidated by the
knowledge of the fact, that if they defended the breach, their
communication with the fort on the top of the mountain would be cut
off, and their escape rendered impossible; they therefore
surrendered. Thus a fort of great strength by nature and art fell into
the hands of the British.
The district of Champaneer, the only territory remaining to Scindia,
in the province of Guzerat, had thus been reduced, and annexed to
the British dominions. Lieut.-Colonel Murray, of the Eighty-fourth
regiment, assumed the command of the troops at Baroda, and
advanced towards Scindia’s territories, in the province of Malwa, in
quest of Holkar’s forces, but it was found impossible to bring the
armed bands of that chieftain to action. On the 18th of October the
city and fortress of Godera was taken possession of, the enemy
retiring as the British approached. At this place information was
received of the victory of Assaye, gained by the troops under Major-
General the Hon. Arthur Wellesley, on the 23rd of September, which
was followed by the submission of two of the hostile chiefs, Scindia
and the Rajah of Berar, leaving Holkar, Canojee, and some minor
chiefs in the field.
Leaving Godera, the troops took possession of Balinsanere in the
beginning of November; and advanced towards Lunawarrah. On the
march, the rearguard, consisting of five companies of Sepoys, and
some native cavalry, was suddenly attacked, while passing through
an extensive jungle, by a numerous body of the enemy in ambush.
 The hostile bands did not venture to attack the Europeans of the
advance-guard, nor the column, but rushed with great fury upon the
native troops in the rear, occasioning the loss of many Sepoys and
camp followers, with some baggage, before assistance could arrive
from the column. The Eighty-sixth had several men killed and
wounded on this occasion.
Lunawarrah was evacuated by the enemy, and Dhowd was taken,
about six weeks afterwards, with little opposition.
In this part of the country, the Eighty-sixth, and other corps, with
Lieut.-Colonel Murray, remained about two months[4], watching
Holkar, who had power to concentrate an overwhelming force, which
rendered vigilance particularly necessary.
On the death of Lieut.-General Grinfield, King George III.
conferred the colonelcy of the regiment on Lieut.-General Sir 1804
James Henry Craig, K.B., from the Forty-sixth Foot, by commission
dated the 5th of January, 1804.
From Dhowd, the Eighty-sixth, and other corps under Lieut.-
Colonel Murray, retired to Godera, and from thence to Jerode, in
order to obtain supplies, and protect the province of Guzerat. At this
period a dreadful famine raged in the Deccan, and other parts of the
country hitherto the seat of war.
After three weeks’ repose at Jerode, the Eighty-sixth, Sixty-fifth,
Sepoys and native cavalry, advanced once more into the province of
Malwa, under Lieut.-Colonel Murray, and arrived at Dhowd on the
12th of June, having lost many men from the excessive heat. On the
march Major Stuart, of the Sixty-fifth, died and was buried, (9th
June,) under the colours of the Eighty-sixth, on which day twenty-
one men of the Sixty-fifth, and eleven of the Eighty-sixth, died from
the effects of the hot winds.
From Dhowd, the troops advanced to Ongein, the capital of
Scindia, from whence the Eighty-sixth, three battalions of Sepoys,
a train of artillery, and a body of Scindia’s cavalry, were immediately
pushed on to Indore, the capital of Holkar’s dominions, where they
arrived on the 14th of August; the city having been evacuated on the
previous evening.
From Indore, the flank companies of the regiment, and a battalion
of Sepoys, advanced with scaling ladders, under Captain
Richardson, twenty miles, to surprise a fort, which was reported to
be full of troops and provisions; but when the soldiers scaled the
walls, they found the place empty; the enemy having fled a few
hours previously.
Having penetrated so far beyond the boundaries of Guzerat, the
troops under Lieut.-Colonel Murray found their communication with
that country cut off, and Holkar threatening to enter and lay waste
the province; their supplies were nearly exhausted; they were in a
territory devastated by famine and disease; the rainy season was
approaching, and a small force, under Lieut.-Colonel Monson, sent
by General Lord Lake to effect a junction with Lieut.-Col. Murray, was
pursued by Holkar’s numerous legions, and forced to make a
precipitate flight, abandoning its cannon and baggage. Under these
circumstances, a sudden advance was made, of two marches, to
deceive the enemy, and on the third march the troops faced about
and retreated. The rain set in with such violence as to destroy the
tents;—the artillery and baggage oxen and camels died in great
numbers;—much of the baggage was abandoned;—the soldiers had
to drag the guns through the cotton-grounds waist-deep in water;—
no cover or shelter for officers or soldiers;—the inhabitants dying in
great numbers from famine;—the European soldiers dying also from
excessive fatigue, the inclemency of the weather and privation;—the
native troops and followers also perishing in great numbers: such
were the distressing circumstances under which this retrograde
movement was executed, but, by the perseverance of the
Europeans, the guns were preserved, and the troops arrived at
Ongein, where the Sixty-fifth, Eighty-sixth, and artillery, were
accommodated with a building in the fort. This force had been
reduced by its sufferings, from six to three thousand men.
Exertions were made to re-equip this diminished force for the field,
and orders being received to advance, it was again in motion in the
middle of October, advancing in the direction of Kota and
Rhampoorae, and capturing, on the route, the hill fort of Inglehur by
escalade, also several other small forts.
The army of Holkar was routed and dispersed by the troops under
General Lord Lake; but the war was protracted by the defection of
the Rajah of Bhurtpore, and the Eighty-sixth were destined to
transfer their services to the rajah’s dominions.
Reinforcements having arrived from Bombay, Major-General
Jones assumed the command, and marched towards the city 1805
of Bhurtpore, the capital of the hostile rajah’s territory[5]. After a long
and harassing march, the troops approached that fortress on the
10th of February, 1805, when a large body of hostile horsemen
surrounded the column and impeded its movements across a level
country. Half the force was employed in protecting the baggage, and
the guns were repeatedly unlimbered, to keep the adverse cavalry at
a distance. On the following day, Major-General Jones’s division
joined the army before Bhurtpore, and was inspected by Lord Lake,
who expressed his satisfaction at the bearing of the troops. The
soldiers of the Sixty-fifth and Eighty-sixth presented a motley
appearance: their worn-out uniforms were patched with various
colours, or replaced by red cotton jackets; many of the men wore
sandals in the place of shoes, and turbans instead of hats; but
beneath this outward war-worn appearance, the innate courage of
Britons still glowed.
The siege of Bhurtpore had unfortunately been undertaken without
a battering train of sufficient weight, and necessary to insure the
reduction of so strong a fortress; the siege was, however,
persevered in. At three o’clock, on the 20th of February, two hundred
and fifty men of the Eighty-sixth, and two companies of Sepoys,
commanded by Captain Grant, of the Eighty-sixth, stormed an out-
work, covering one of the principal gates, with the bayonet, driving
the Arabs, who fought with their usual determination, into the city,
and capturing eleven brass guns; in which service Lieutenants
Lanphier and D’Aguilar distinguished themselves, the former
receiving a spear wound in the neck. As the Arabs fled to the gate,
Captain Grant followed, in the hope of being able to enter with them,
but he found it closed, and, after destroying the fugitives, who were