In his historically significant and intriguing document, R. Kendrick Smith, MD, DO,¹ quotes a passage from Carl McConnell, MD, DO, to explain his approach to osteopathic medical care. In the quotation, Dr McConnell emphasizes the assessment of “the tension of muscles, the status of glands, the flexibility of the vertebral joints, the mobility of the chest wall, and the vital response of viscera” in osteopathic diagnosis. Dr McConnell¹ also asserts the importance of addressing the “edematous barrier of the involved lymphatic tissues” to “enhance drainage and leucocytic [sic] activity.” Thus, in our November 2008 article,² we used the term “comprehensive lymphatic treatment”—that is, treatment that addresses the multiple factors that contribute to lymphatic flow.³ 

To develop our protocol, we used the most recent edition of Foundations for Osteopathic Medicine³ for current and standardized descriptions of osteopathic manipulative treatment techniques. 

We caution the reader against making direct comparisons between Dr Smith's 1920 report¹ and our recent study² because of differences in purpose, research design, methods, and study populations—as well as different historical contexts. 

We collected subjects' heart rate measurements using a pulse oximeter, as stated in the “Methods” section of our article,² but we did not record subjects' oxygen saturation levels. An analysis of heart rate measurements is noted in the final paragraph of our “Results” section.² 

We found no condition × time interaction effects for red blood cell count or differential leukocyte counts.² Please refer to the Table for the requested data on these variables. 

Finally, the “Comment” section of our article² notes that we did not confirm results of previous studies of hematologic effects of lymphatic techniques in healthy subjects.^4,5