Management Information Systems

Managing the Digital Firm 14th Edition

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Management Information Systems Managing the Digital Firm 14th Edition Laudon Test Bank

Management Information Systems, 14e (Laudon)

Chapter 2 Global E-Business and Collaboration

1) A business process in the ________ function is producing bills of material.

A) finance and accounting
B) human resources
C) manufacturing and production
D) research and development
E) sales and marketing
Answer: C
Page Ref: 44
Difficulty: Easy
AACSB: Reflective thinking
CASE: Content
LO: 2.1: What are business processes? How are they related to information systems?

2) An example of a cross-functional business process is

A) identifying customers.
B) transporting the product.
C) creating a new product.
D) assembling a product.
E) paying creditors.
Answer: C
Page Ref: 44
Difficulty: Moderate
AACSB: Analytical thinking
CASE: Analysis
LO: 2.1: What are business processes? How are they related to information systems?

3) Identifying customers is a business process handled by the human resources function.

Answer: FALSE
Page Ref: 44
Difficulty: Moderate
AACSB: Information technology
CASE: Content
LO: 2.1: What are business processes? How are they related to information systems?

4) One example of a business process is shipping a product to a customer.

Answer: TRUE
Page Ref: 44
Difficulty: Moderate
AACSB: Analytical thinking
CASE: Evaluation
LO: 2.1: What are business processes? How are they related to information systems?

1
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5) A(n) ________ is a set of logically related activities for accomplishing a specific business
result.
Answer: business process
Page Ref: 43
Difficulty: Easy
AACSB: Reflective thinking
CASE: Content
LO: 2.1: What are business processes? How are they related to information systems?

6) What is the connection between organizations, information systems, and business processes?
Answer: Business processes refer to the manner in which work activities are organized,
coordinated, and focused to produce a specific business result. They also represent unique ways
in which organizations coordinate work, information, and knowledge and the ways in which
management chooses to coordinate work. Managers need to pay attention to business processes
because they determine how well the organization can execute, and thus are a potential source
for strategic success or failures. Although each of the major business functions has its own set of
business processes, many other business processes are cross functional. Information systems can
help organizations achieve great efficiencies by automating parts of these processes or by
helping organizations rethink and streamline them. Firms can become more flexible and efficient
by coordinating and integrating their business processes to improve management of resources
and customer service.
Page Ref: 43-45
Difficulty: Moderate
AACSB: Analytical thinking
CASE: Synthesis
LO: 2.1: What are business processes? How are they related to information systems?

7) What are cross-functional business processes? Give an example.

Answer: Cross-functional processes are those that require input, cooperation, or coordination
between the major business functions in an organization. For instance, when a salesman takes an
order, the major business functions of planning, production, inventory control, shipping,
accounting, and customer relations will all be involved before the order is completed.
Page Ref: 44-45
Difficulty: Easy
AACSB: Analytical thinking
CASE: Analysis
LO: 2.1: What are business processes? How are they related to information systems?

2
Copyright © 2016 Pearson Education, Inc.
8) Your aunt has asked you for your suggestions to make her business, a local sandwich shop,
more efficient. Describe at least three types of business processes that a sandwich shop has. Can
any be better coordinated through the use of information systems?
Answer: The business processes of a sandwich shop would include: Taking orders, making
sandwiches, selling to the customer, ordering supplies, opening the store, closing the store,
cleaning the store, paying employees, hiring employees, paying creditors and vendors, creating
financial statements, paying taxes, managing cash.
Many of these processes could be helped by better information systems, specifically those that
require recorded data, such as any financial processes (payments, cash management, taxes,
salaries) and information gathered from and distributed to employees.
Page Ref: 43-45
Difficulty: Moderate
AACSB: Analytical thinking
CASE: Synthesis
LO: 2.1: What are business processes? How are they related to information systems?

9) The ________ function is responsible for identifying customers.

A) finance and accounting
B) human resources
C) manufacturing and production
D) sales and marketing
E) distribution and logistics
Answer: D
Page Ref: 44
Difficulty: Easy
AACSB: Reflective thinking
CASE: Content
LO: 2.2: How do systems serve the different management groups in a business and how do
systems that link the enterprise improve organizational performance?

10) If your main supplier was late in delivering goods, which type of system would you use to
update your production schedule?
A) ESS
B) TPS
C) MIS
D) DSS
Answer: B
Page Ref: 46
Difficulty: Moderate
AACSB: Analytical thinking
CASE: Analysis
LO: 2.2: How do systems serve the different management groups in a business and how do
systems that link the enterprise improve organizational performance?

3
Copyright © 2016 Pearson Education, Inc.
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easily corrected by changing the position of the child occasionally. These
variations should not be mistaken for actual deformities of the head.

THORAX

The average chest measurement of the child at birth is from thirteen to

thirteen and four-tenths inches; thus it is seen that at birth the
circumference of the chest is about a half inch less than that of the head.
The circumference of the abdomen is about equal to that of the chest.
The transverse diameter is practically the same as that of the antero-
posterior, but as time goes on and the child develops, the transverse
diameter increases more rapidly until about ten years of age when the
shape of the thorax becomes about the same as that of the adult. The
diameter of the chest increases at the rate of about one inch per year until
the average of thirty inches is reached at about the age of fifteen. During
childhood the thorax should be carefully observed for deformities.
Subluxations in the upper dorsal region may result in faulty postures,
which in turn will result in various deformities of the thorax. If this
faulty posture is not corrected and the child is permitted to grow into
adult life with the deformity, it can readily be seen that such deformity
will become permanent. In such cases the dorsal subluxation should be
adjusted early in life to overcome the faulty posture. Innate will then take
care of this temporary deviation from the normal shape of the thorax.
Deformities of the thorax often indicate Pott’s dis-ease, curvatures of the
spine, rickets, emphysema, empyema and cardiac disturbances. In such
cases a very careful analysis should be made and the subluxations
adjusted to remove the cause of the condition to which the deformity is
adaptative.

ABDOMEN

The abdomen of the infant is very large in comparison with its

proportion in later childhood. Up to about two years of age the
circumference is the same as that of the chest, after which the chest
develops more rapidly and the abdomen gradually assumes the
proportions of the adult. However, the abdomen remains proportionately
large up to the age of puberty. Unless this fact is recognized by the
practitioner, he may suspect an abnormal enlargement of the abdomen.
There are conditions in which an enlargement of the abdomen is typical,
such as in various intestinal disorders and especially in rickets. In rickets
the abdomen becomes gradually extended and is known as pot belly, but
with this there will be other symptoms of the dis-ease. If the abdomen
seems abnormally large the chiropractor should carefully analyze the
child to determine whether this is the result of some incoördination or
whether it is simply an idiosyncrasy of the child.

WALKING

The age at which children are able to sit alone, stand and walk, varies
greatly. Some infants walk as early as the tenth month, while others are
as late as the eighteenth month. The average age at which children are
able to walk alone is from thirteen to fifteen months. Other things being
equal, the age at which a child walks has little significance. The first
voluntarily directed movements of the child occur at about four months
of age, sometimes a little earlier, when the child begins to make an effort
to grasp objects which he sees about him.
At about four or five months of age the average child is able to hold
the head erect when the body is properly supported. Between the seventh
and eighth month the muscles have developed sufficiently for the child
to sit erect by himself for a few minutes at a time. From this on, the child
develops the sense of equilibrium very rapidly. Not later than nine
months of age the child will indicate a tendency to stand and to bear the
weight upon the feet. He may even be able to stand with a little
assistance; then, in a very short time, if placed upon the floor he will
show a tendency to pull himself up by a chair and stand alone. This is
soon followed by the first steps and by the thirteenth month the child is
walking alone freely.
Mechanical devices intended to assist the child in learning to walk are
of little value and may be an actual detriment. If the child is normal, has
the proper care and a reasonable environment, Nature will put him on his
feet at the earliest possible moment without injury to the delicate
structures of the body. If the child is extremely backward in learning to
walk a careful analysis should be made to determine the reason. Rickets
is a very common cause for backwardness in children, not only in
walking but in other functions as well. If a child is backward in learning
to walk he should not be urged, but the reason for this backwardness
should be sought out and the cause adjusted.
CHAPTER II
DENTITION
 CHAPTER II
DENTITION
The age at which the child begins to cut teeth varies greatly in the
different individuals with no apparent reason. There are twenty
deciduous or milk teeth and they make their appearance in the following
order and at an average time as shown in the data. From six to eight
months of age the lower central incisors appear. The four upper incisors
do not appear until from the seventh to the tenth month; then the two
lower lateral incisors and four anterior molars come through between the
tenth and fourteenth month. From a year and a half to two years of age
the four canines put in their appearance, and from two years to two and a
half the four posterior molars. This completes the set. By the time a child
is one year of age he should have six teeth; at the age of one and a half
years, twelve teeth; at two years, sixteen teeth; and by the time he is two
and a half years of age he should have the entire set of twenty. The table
below gives the order in which the deciduous teeth appear and the
approximate time when they may be expected. This time is subject to
great variation. This variation does not necessarily indicate an
abnormality. In some children the teeth appear much earlier than in
others. The appearance of the first teeth may be as late as the tenth
month in perfectly healthy children. However, if the delay is too great
attention should be given the child.

6 to 8 months of age ..... the two lower central incisors.

7 to10 ” ” ” ..... the four upper incisors.
10 to14 ” ” ” ..... two lateral incisors, four anterior molars.
16 to24 ” ” ” ..... four canines.
22 to30 ” ” ” ..... the four posterior molars.

Normal children cut their teeth without any very severe symptoms. If
the child is below normal, or if there are meric zones in which the
structures are not receiving a sufficient amount of mental impulses,
symptoms will be produced.
 At the time of dentition many incoördinations may appear, not because
the process of cutting the teeth produces these conditions, but because
the process requires a great expenditure of internal energy to produce the
eruption of the teeth, hence at such times the forces of the body are very
heavily drawn upon. The force that might be used in bringing about
adaptation to other conditions must be used in this process. If the child is
normal the growth of the teeth will produce no more symptoms than the
growth of the nails. During the time teeth are coming through the gums
there may be increased salivation and drooling and a tendency for the
child to chew on the fingers. Irritability and restlessness at night are very
frequent symptoms. It is quite common to have gastro-intestinal
disturbances and especially diarrhea.
In delicate and neurotic children all symptoms may be greatly
exaggerated and may become alarming. There may be fever and acute
indigestion. Diarrhea may become very severe and the child show
marked decrease in weight as a result. If the child is having difficulty
cutting the teeth it is evident that Innate Intelligence is unable to get the
forces to the periphery. In this case the child should have immediate
chiropractic attention. It is not uncommon for a temperature to run
during the time just before the teeth come through the gums. In such
cases a very careful analysis should be made and the child adjusted
regularly until the symptoms have disappeared.
In the majority of cases when there is incoördination during the
process of dentition it will be found upon careful analysis that there are
conditions responsible for the symptoms other than difficult dentition
and they are only exaggerated by the dentition.
After the teeth have made their appearance care should be taken that
they are kept clean. This may be accomplished by washing the teeth and
mouth.
The eruption of the permanent teeth causes no great disturbance and
there are usually no symptoms connected with their appearance other
than a little discomfort locally. The appearance of the first permanent
teeth do not disturb any of the temporary teeth, since they develop just
posterior to them. These are the six-year-old molars. Following these we
find the incisors displacing the incisors of the temporary teeth. Then
comes the bicuspids taking the place of the temporary molars. These are
followed by the canines which displace the canines of the temporary set.
The next to appear are the second and third molars which occupy a place
back of the canines where room has been made by the development of
the jaw.
The following table is given to enable the student to get at a glance an
idea of the approximate age that the different permanent teeth make their
appearance.

year of
6th ..... First molars just posterior to the temporary molars.
age
7th ” ” ” ..... First incisors displacing the former incisors.
8th ” ” ” ..... Lateral incisors displacing the first lateral incisors.
9th ” ” ” ..... Bicuspids displacing the temporary molars.
11th ” ” ” ..... Canines displacing the canines of the temporary set.
..... Second molars appearing posterior to the first
14th ” ” ”
permanent molars.
to 21st ..... Third molars or wisdom teeth posterior to second
18th
year permanent molars.

Hygiene of the Teeth

It should be remembered that these are the teeth that must serve the
child during his entire life and therefore should receive the best of
attention. Want of cleanliness is without doubt responsible for much of
the trouble with the teeth of children. This is especially true among the
poorer class of people and those who do not appreciate the value of
proper personal hygiene. Even before there are any teeth the infant’s
mouth should be washed and properly cleansed, and attention should be
given the teeth as soon as they appear. The child should be taught early
in life that it is very essential that the teeth be washed and cleaned
regularly. Before the child is old enough to do this the nurse or attendant
should do it for him. Food permitted to remain between the teeth will
soon decompose in the temperature of the mouth, therefore care should
be exercised that all particles of food be removed as soon as possible.
Decomposing food has a very destructive effect upon the teeth and tends
to destroy the enamel due to the chemical reaction. When there are no
subluxations Innate will bring about an adaptation as far as possible, but
it is impossible to change the reaction of a chemical without neutralizing
it. Undoubtedly Innate does this in many instances, but it should not be
necessary for Innate to do this extra work when the filth may be removed
educationally.
Lack of cleanliness is entirely too prevalent among some classes of
people and it will be found that children who have not had the proper
care of the teeth will suffer more or less with dental caries. The common
belief that many conditions and incoördinations are caused from the teeth
has been proven erroneous by Chiropractic, but the chiropractor should
recognize the necessity for the proper care of the teeth and when they are
in need of attention the patient should be sent to a dentist. Poor teeth
interferes with mastication and prevents the food being properly
prepared for gastric digestion. Severe nervous symptoms may arise from
toothache.
It must be remembered that proper hygienic methods alone are not
sufficient to preserve the teeth in perfect condition. The teeth may be
kept strictly clean and yet they decay, as a result of subluxations causing
interference with the transmission of mental impulses. If the teeth are
decaying the child should be given a thorough analysis and the
subluxations should be adjusted. However, the chiropractor does not take
the place of the dentist. The child should be taken periodically to the
dentist to have the teeth examined and any defects attended to; likewise
he should be taken regularly to the chiropractor to have his subluxations
adjusted.

Adjustments during Dentition

Most excellent results may be obtained in difficult dentition from

chiropractic adjustments. The major for the local condition is M.C.P., but
if there are accompanying conditions such as diarrhea or indigestion, the
combination will include the zones that may be involved. If there are
gastric symptoms then we will include an S.P.; if the intestinal tract is
involved then it will be necessary to adjust a lumbar. There are some
cases that require adjustments at K.P. During dentition the child should
be taken to the chiropractor for an analysis and should receive
adjustments to keep him in a healthful condition. Certainly it is much
better to have the child in perfect health during the time the teeth are
appearing for under the most favorable conditions the cutting of the teeth
is very trying on the child. The idea that cutting the teeth is responsible
for many abnormal symptoms in children is very old, but it is now
generally conceded that the eruption of the teeth in the healthy child will
cause no disturbance in his health.
 CHAPTER III
ANALYZING INFANTS
 CHAPTER III
ANALYZING INFANTS
One of the most baffling situations the chiropractor meets is in caring
for sick babies. There are several reasons for this: The baby can give no
assistance in the way of subjective symptoms. It is difficult to nerve trace
with any degree of satisfaction and assurance of accuracy; it is even very
difficult to keep the child still for palpation. Therefore, it becomes
necessary to rely largely upon the objective symptoms and the palpation,
with what verification may be obtained from nerve tracing and the
spinograph. However, there is no class of patients in which the results
are so gratifying as with the babies and small children, for they respond
to adjustments more readily than does the adult.
There is no time in the practice of the chiropractor when he needs to
have better self-control than when he is taking care of infants. There is
great need of every faculty that is employed in the analyzing and
adjusting, especially if the child is seriously ill. Usually the parents are
more or less excited and worried and are likely to keep urging the
chiropractor to do something and thus unduly influence him unless he is
accustomed to such cases. If the child is in pain and crying it is likely to
get on the nerve of every one present and this will tend to make the
chiropractor nervous. He must be careful that these things do not
influence him to act too hastily before he has had time to make a careful
analysis.

History of the Case

Great care must of necessity be exercised in taking the analysis of the

baby and of the small child. A very careful history should be taken. This,
of course, must be obtained from the parents or nurse. This history
should include such points as whether birth was instrumental or natural,
whether it was premature or full term, whether there were any
peculiarities of respiration at birth, whether there have been any
convulsions and what sickness, if any, the child has suffered with.
Inquiry should be made relative to the condition of the bowels and
kidneys, how the child sleeps, and if there is a tendency to cry out during
sleep. If the child refuses to nurse or nurses with difficulty it may
indicate an incoördination of the mouth or the throat.
Objective Symptoms

In view of the fact that the child can give no aid in the way of
subjective symptoms, it is necessary for the chiropractor to make most
careful observations and substitute, as far as possible, the objective
symptoms for the subjective ones. About the first thing we see when we
begin the analysis is the baby’s face. It may reveal valuable information.
A very careful study should be made of the facial expression and the
condition of the eyes. In the face we take into consideration the color. We
should look for pallor, cyanosis and jaundice; we notice whether there is
perspiration, whether the face is cold and clammy or warm and moist;
also we observe the expression as to the muscular condition, since there
may be muscular spasms which will produce grimace. This is either the
result of pain some place in the body or an abnormal action of the facial
muscles. There may be a pinched expression or a look of fear or anxiety.
In some severe cases the face will be expressionless, while in others it
may be that of an adult.
The condition of the eyes is important. They may have a dull
expressionless look. The lids may droop and the eyeballs be sunken. In
cerebral incoördinations there may be strabismus, or the eyeballs may be
rolled upward and inward. These symptoms are significant and should all
be very carefully noted, for, as has been stated, there will be no chance to
profit by subjective symptoms.
After a careful observation of the face and facial expression has been
made, the child should be undressed and placed in a convenient position
for further observation. Before the clothing is removed the room must be
heated to a proper temperature so the infant will not take cold or be
exposed to an atmosphere that will be distressing. A temperature suitable
for the bath will be satisfactory. The child should be placed on his back
and every movement of the body observed. Such movements as the
flexing of the thighs on the abdomen, as in abdominal pain, may lead the
chiropractor to a conclusion on the zone involved.
The general appearance of the child must be carefully considered,
whether the child is properly developed and whether or not there are any
deformities. The chiropractor should look for dyspnea and other
objective symptoms. A very careful inspection should be made of the
spine to determine any malformations or marked curvatures. The
character of the cry is sometimes important, as for instance in pneumonia
or bronchitis there is a short, catchy cry; the cry of laryngitis and croup
will be hoarse. In extreme prostration, as in many cases of malnutrition,
the cry will be very feeble.

Respiration

Since the chiropractor must depend almost entirely upon objective

symptoms and upon the palpation of the infant in determining the
character of the incoördination he should be thoroughly familiar with the
characteristics of the normal child. The rate of respiration of the infant,
especially during sleep, is of some importance. The following table is
given by Holt and Howland and indicates the normal rate of respiration
at different ages:
At birth 35 per minute
At the end of the first year 27 ” ”
At two years 25 ” ”
At six years 22 ” ”
At twelve years 20 ” ”

Respiration is very much faster than this when the child is awake. If
the child is at all active it may be twice as fast. It is advisable to observe
the respiration to determine whether it is normal or labored, shallow or
deep, regular or irregular.
Irregularity of respiration in infants is characteristic and must not be
mistaken for indications of incoördination. The least excitement will
disturb the rhythm; as a matter of fact, the only time there will be perfect
rhythm is during sleep. In observing infants it will be found that the
lungs sometimes do not expand equally. This is due to the delicate
muscular walls of the thorax and does not necessarily indicate
incoördination. It is well to take this into consideration when observing
the infant. This must be very carefully considered when incoördinations
of the lungs are suspected. Placed in certain positions one lung may
expand very much more than the other in normal respiration; or in some
positions, and sometimes for unknown reasons, there may be practically
no expansion in one lung for a short time. This peculiarity is due to the
inability of Innate to maintain adaptation through the delicate structures
of the thorax to the atmospheric pressure. This might be very misleading
and result in the conclusion that one lung was badly affected when there
would be nothing at all wrong. However, if there are symptoms which
indicate an incoördination in the lungs there should be a very careful
palpation made of the upper dorsal region to locate the subluxation and
the hot box.
In infants the respiration is altogether diaphragmatic; it is irregular at
times; it may be superficial for a time and then deep. This irregularity
continues in the child more or less until the seventh year. After this such
an irregularity indicates some disturbance and should receive
consideration.
The muscular walls of the thorax are very feebly developed and are
therefore very soft and yielding; a slight obstruction in respiration will
result in a marked sinking of the thorax from the normal atmospheric air
pressure.

Pulse Rate

It is not necessary to take the pulse of the infant, but it might be well
to know what the normal pulse rate is at different ages. The following
table will give the desired information:

At birth the pulse rate is from 130 to 150 per minute

One month of age 120 to 130 ” ”
One year of age 108 to 120 ” ”
Two years of age  90 to 108 ” ”
Three years of age  80 to  90 ” ”
Seven years of age  72 ” ”

Very slight disturbances will often increase the pulse rate out of all
proportion to the severity of the condition. The heart will beat very much
faster just from the handling of the child in making the analysis, or as a
result of any excitement or crying. It may be very difficult to count the
pulse because of its rapidity.
 Often a very moderate incoördination will result in a marked increase
in the pulse rate and especially is this true in cases in which there is
slight fever.
An increase of the heart action does not, necessarily, mean that heart
place should be adjusted. This increased action may be due to the natural
adaptation because of handling or to nervousness at the presence of
strangers. Especially is this likely to be true of the child that is old
enough to notice things. It is not uncommon to have the pulse beat
increased as much as 25 beats per minute in this way.
During sleep the pulse may be slightly irregular, even when the child
is normal. In cerebral disturbances it will be slow and irregular. In
cerebral tumor it may be as slow as 40 or 50 beats per minute. In acute
incoördinations the pulse rate may be very greatly increased. With
incoördinations in such families as the poison, fever, degeneration, and
some incoördinations in the spasms family, the pulse rate may be very
high, even when the condition is not at all alarming. It is well to take this
into consideration when observing a case so that the chiropractor will not
be misled in making the analysis and that the objective symptoms may
be of greatest value to him.

Zones Involved

In analyzing an infant it is well to keep in mind the zones in which

incoördination is most commonly found. In the majority of cases these
zones will include the gastro-intestinal tract, the respiratory tract, the
kidney zones and the brain. Very frequently there will be incoördinations
of the pharynx, tonsils and mouth.
The incoördinations found in the digestive tract will include all forms
of indigestion and dysentery. Such incoördinations as pneumonia and
bronchitis will involve the respiratory tract. From the kidneys there are
the various conditions involving the poison family due to improper
elimination. Meningitis and all forms of cerebral incoördinations as well
as conditions of the eyes and ears are common to infancy and childhood.
It must be remembered that with an infant grave symptoms may
develop in a very short time, likewise recovery may take place very
quickly following even the most alarming symptoms. However, no
chances should be taken for it is not uncommon for an infant previously
in good health to become sick very suddenly and die within a few hours.
Therefore, in handling children most careful attention should be given
and conditions should always be regarded more or less serious until
developments prove otherwise. The chiropractor must realize that his
success in handling infants does not depend entirely upon his
observations of the case, for with every patient there must be a thorough
and complete analysis of the spine. The only value to be received from
the observations is that they may lead him to specific regions of the
spine.

The Child’s Cry

It is not uncommon for an infant to cry with no apparent localized

cause. This crying may continue for hours with no other symptoms.
There will be no indication of colic or other symptoms to denote the seat
of the pain. The crying is constant and, while in some cases may be quite
violent, yet there are no paroxysmal attacks; this indicates that the pain is
constant. It is easily distinguished from a hunger cry in that the child
usually refuses to nurse. If the crying persists for hours there will be
more or less exhaustion. Such cases are very pitiful and draw heavily
upon the sympathies of the chiropractor as well as upon other attendants.
In such cases the first thing to do is to strip the infant of all clothing and
look for open safety pins, rough places in the clothing, such as folds or
wrinkles; foreign objects, as small buttons, for example. Usually,
however, this will be done before the chiropractor is called. It may be an
advantage for the chiropractor to observe the infant very carefully for a
few minutes after the clothing has been removed, in an effort to locate
the seat of the pain. However, this is not so very important because first,
in most of these cases it is practically impossible to determine the
location of pain, and second, because a very careful palpation of the
child will always reveal the causative subluxation. In making the
analysis the chiropractor should give himself plenty of time to make a
thorough palpation. He should not be in too great a hurry to adjust the
child merely because of his anxiety to relieve the crying. He must not
allow the incessant crying of the child to work upon his nerve and
destroy his efficiency in caring for the patient. In these cases the
subluxation may be located in any part of the spine, although it is less
often found in the cervical region. If there is a subluxation in the cervical
region, great enough to produce this constant crying, there is very likely
to be cerebral symptoms. In these cases the subluxations are usually
quite exaggerated and very often the hot box becomes the determining
factor.
In a case recently an infant three weeks old had been crying constantly
for several hours. The clothing had been removed and the child very
carefully bathed and powdered; then instead of the clothing being
replaced the child was wrapped in a blanket. Still the crying persisted. A
very careful observation of the patient gave no information whatsoever
as to the possible location of the cause for the crying. There was nothing
that would quiet the child. He finally grew so exhausted that the cry
became little more than a whimper, beads of perspiration standing out
over the entire body. There were no signs of colic or tympanites. A
careful palpation revealed the sixth dorsal very badly subluxated and a
slight subluxation of the first lumbar. These were adjusted and the child
stopped crying almost instantly and in less than ten minutes was sleeping
normally. There was no return of the abnormal crying and the child had
no further adjustments.
We have many such cases on record, but the citation of this one is
sufficient to illustrate the results that are obtained in such cases.

Palpating the Infant

In palpating an infant the first thing to look for is the hot box. It may
be possible to locate it very easily and if this is so it then becomes
necessary only to list the direction in which the vertebra is subluxated. In
looking for the hot box it is necessary to use care so as not to be misled
by the difference in the temperature of the back due to some article of
clothing being in contact with the back and raising the temperature in
that region. Notice that there has not been some woolen garment, such as
the band, pressing against the spine. To eliminate the possibility of thus
being misled the entire back should be exposed to the atmosphere a
sufficient length of time to allow the back to become influenced alike to
the temperature of the air. The majority of incoördinations of infancy are
acute, therefore the hot box is present. After the hot box is located then a
very careful palpation should be made to determine the direction in
which the vertebra is subluxated. It is not sufficient to consider that
because the patient is an infant all that is necessary is to list the vertebra
straight posterior and adjust it accordingly. Laterality, superiority and
inferiority are quite as essential, and the chiropractor should not be
satisfied until he has convinced himself on the question of these
directions. If there is no laterality, superiority or inferiority then the
adjustment should be given straight toward the anterior.
In palpating an infant it is usually best to place the child on the knees
of an adult in the position for an adjustment. The child will be almost
constantly on the move. It will therefore be necessary for the
chiropractor to adapt himself to this constant moving. The child should
be placed in as many different positions as possible to make the
palpation. He may be held up over the shoulder of the mother or nurse;
first on one side, then on the other, this giving opportunity to palpate
with both hands and make comparisons.
No effort should be made to force the child to be still. It is a good
policy to hold the palpating fingers on the spine and let the child wiggle
and squirm all he wants to, moving the spine beneath the palpating
fingers of the chiropractor. In this way a comparison may be made of
what is felt under the fingers while the child is moving.
It is quite difficult to nerve trace an infant in any measure of accuracy
because the infant can not coöperate to any degree of satisfaction. In
some, however, nerve tracing may be used to a certain extent by
producing slight pressure and noticing whether or not the child flinches.
It is very much more difficult to palpate the cervical vertebrae of an
infant than it is those of the dorsal and lumbar regions. The same
technique and tactics are used, however. It is sometimes an advantage to
place the child on the mother’s lap in such a way that the head will be
unsupported by the lap. One hand should support the child’s forehead,
while the other hand palpates or it may be necessary to place the infant in
some other position. The chiropractor should be sufficiently resourceful
to find a way to get an accurate palpation of the cervical region. Here,
again, he will meet with the difficulty of keeping the child still. This
makes it necessary that he be very alert and at the instant it is possible to
feel the vertebra to be ready to make his comparisons quickly and decide
the direction in which it is subluxated.
The cervical vertebrae of an infant are very hard to feel, but if one of
the segments is subluxated sufficiently to cause pressure on a nerve that
segment will be easier to feel because it is out of the median line;
especially will it be easier to feel if it is subluxated posteriorly. Every
possible means must be used to make an accurate palpation. If there is a
subluxation in the cervical region there will very likely be symptoms
which will indicate it. Subluxations are not as commonly found in the
cervical region as in the other regions of the spine.
In making an analysis of the infant the importance of the sacrum must
not be overlooked. It will be remembered that the segments of the child’s
sacrum are separated with cartilage and are subject to being subluxated.
These segments coalesce later in adolescence and form the sacrum into
one solid bone. Therefore it is highly important that the subluxations that
may exist between the segments be adjusted before this process takes
place.
The tubercular ridge formed by the rudimentary spinous process in the
median line of the posterior surface of the sacrum is of very little value
in palpating the segments of the sacrum. It is best to palpate the articular
crest on each side of the tubercular ridge. In this way it is possible to
determine if one segment is more prominent on one side than on the
other. This should be done very carefully and if a subluxation is found it
should be adjusted on the side that is most prominent. The contact is on
the articular ridge and the thumb may be used for nail point the same as
in the dorsal region; or if the child is large enough nail point one may be
used.
Whenever possible a spinograph should be made of the child. This
may not always be possible with the small child and with the very young
infant it may be very difficult. In many acute incoördinations it is
impracticable to try to get a spinograph, not because the spinograph
would not be of value, but because it is difficult to get to the office to
take it. In the chronic cases a spinograph should by all means be taken.
Every possible means should be used to verify the palpation.
 CHAPTER IV
ADJUSTING INFANTS
 CHAPTER IV
ADJUSTING INFANTS
The recoil is used in adjusting a child the same as in adjusting an
adult. The young infant can be placed upon the knees of the mother or
nurse instead of being placed on an adjusting table. The ordinary
adjusting table will be too large for the real small infant. Care must be
used that the child is placed in the correct position for the adjustment and
that the neck and head are properly supported. Placing the child on a
pillow on the lap of an adult is not satisfactory because the pillow is too
soft and makes it more difficult to move the vertebrae. If the child is
adjusted on the mother’s lap care must be exercised that the mother’s
skirt is not drawn tightly for it is best to leave the infant’s abdomen
unsupported or at least not to have too solid a support.
When the mother holds the babe on her lap there is a tendency for her
to raise her heel off the floor so as to make the knee supporting the
child’s head higher than the other. When the adjustment is given the knee
will not be sufficiently solid to support the child and the vertebra will not
move. For this reason the chiropractor must see that the mother’s heels
are both placed squarely on the floor. It is a good plan after the contact
has been taken and the chiropractor is ready to give the adjustment to ask
if both heels are on the floor. Nine times out of ten one heel will be lifted
and the toe will be supporting the weight of the child.
In adjusting small infants in the dorsal and lumbar regions the side of
the thumb may be used for nail point. In getting the contact one should
palpate in the usual manner, find the vertebra that is to be adjusted,
remove all fingers except the pointer finger, turn the hand so the finger is
parallel with the child’s spine, then instead of placing the pisiform bone
of the nail hand, place the side of the thumb in exactly the same manner
as if it was nail point one. This being done, remove the pointer finger.
Then instead of placing the hammer hand on the nail hand as in using the
pisiform bone for nail point, grasp the thumb that is being used for nail
point between the thumb and finger of the hammer hand and press the
tissues tightly to make the side of the nail thumb firm. The thrust is given
with a recoil just the same as in the usual manner.
It is best not to use too much force until it is determined just the
amount required to move the vertebra. One will be surprised, however, at
the amount of force required to move the vertebrae of a very small