To the Editor:  

I wish to congratulate William Evan Rivers, DO, and his coauthors¹ for their original contribution in the November 2008 issue of JAOA—The Journal of the American Osteopathic Association. 

Although a small pilot study, the results of the research conducted by these individuals represent an enormous amount of time and dedication. The osteopathic medical profession needs more original research to be published on questions that relate to our profession's unique contributions to healthcare. Specifically, efficacy and mechanistic studies are needed, both of which are currently far too few in number. 

Despite the value of the study by Rivers et al,¹ I have several modest criticisms of the article. In the introduction, the authors state that “comprehensive lymphatic treatments were reported to decrease mortality rates during the influenza pandemic of 1918,” and this statement is referenced with a 1920 JAOA article by R. Kendrick Smith, MD, DO.² 

This reference citation is misleading, however. First, Dr Smith does not refer to osteopathic medical treatments during the 1918 pandemic as being comprehensive lymphatic treatments. In fact, he does not provide any details about the treatments or techniques that were used at the time. Rather, he presents an analysis based on 2445 case reports that were collected during the pandemic, he describes how the mortality rates were estimated, and he discusses the significance of the findings. Dr Smith² also emphasizes the importance of mobilizing the spinal column—a procedure that was not performed in the lymphatic treatment protocol used by Dr Rivers and his coinvestigators.¹ 

Another problem with citing the Smith² article is that the treatment protocol used by Dr Rivers and colleagues¹ relied heavily on lymphatic pump techniques. However, it is unlikely that lymphatic pump techniques were used commonly—if at all—during the 1918 influenza pandemic. It was not until the 1920s that C. Earl Miller, DO,^3,4 developed techniques intended to circulate lymphatic fluids and first coined the phrase “lymphatic pump.” 

I have a number of other questions regarding the article by Rivers et al.¹ Results of oxygen saturation measurements are not reported. Can we assume that these data were unremarkable? 

It also appears from the article by Rivers et al¹ that complete blood counts were collected. If that is true, it would be interesting to learn the results of the red blood cell and differential cell counts, because these data would likely complement work conducted by previous researchers (myself included).^5-7 

For example, in experiments with direct splenic pump stimulation, Castlio and Ferris-Shift^5,6 measured pre- and posttreatment red blood cell counts and leukocyte differential cell counts in healthy individuals and in patients with infectious disease. In addition, Mesina and colleagues⁷ measured complete blood cell parameters after application of lymphatic pump techniques, reporting that all results of these measurements were negative, except for basophil measures. 

As Dr Rivers and his coinvestigators¹ noted, comparisons between studies must be made with caution because the treatment protocols vary from one study to another. Nevertheless, such comparisons would surely be of some value. 

These minor criticisms notwithstanding, I again congratulate Dr Rivers and his coauthors¹ on their diligent efforts.