Articles On Manual Therapy
Paper read before the A. O. A. at St. Louis,
By LesLie E. Cherby, D. O.
Journal of the American Osteopathic Association
1905, 4(6), pp. 219-224
In the development of a science a vocabulary limited
in a sense to that science springs up. That is, words may take on new shades
of meaning as they are applied to a special line of thought. As the science
develops it may outgrow these words as a child outgrows the swaddling clothes
of infancy, and when it arrives at the fullness of maturity it may look
back upon them as useful only as they played their part in its growth.
The question arises in the discussion of the subject
assigned me whether the time has come in the development of osteopathy
when we should lay aside the terms stimulation and inhibition? Whether
in fact there is any such thing as stimulation?
If it can be proven that stimulation is an independent
factor in osteopathic practice, the case, so far as the name it bears,
is proven. For nothing in the nomenclature of a science should be changed
where accepted words or phrases may be employed.
From the definition in Gould's dictionary it is evident
that stimulation exists in medicine. Experience has shown that it is one
of the indispensable elements of medical practice. It is derived from a
Latin word meaning goad, and is first quickening or increasing some trophic
or functional process, this being the only portion of the definition which
we shall consider. There are four forms of stimulation, viz.: chemical,
electrical, thermal and mechanical.
Granting that stimulation exists in osteopathic practice,
our system would come under the fourth class, namely, mechanical. I have
stated this as a supposition because some in our profession disclaim the
idea of stimulation. Their argument is that there is always a primary lesion
which must be corrected and that in such correction the forces of nature
are liberated, that the normal only is reached, that the term stimulation
is a misnomer and therefore misleading in character.
This is an attractive theory, one which at first
thought would seem to be sufficient. Osteopaths are iconoclasts. We have
shattered the theories of the older schools by proving our own but in so
doing is it necessary to claim that the lesion theory is the only one we
can adopt and be true to osteopathy?
Sooner or later in the discussion of any subject
germane to osteopathy, we strike the lesion theory. This is inevitable,
for it is that which permeates the entire system, differentiates it from
others and makes it what it is. Though it is old it is ever new, many times
illuminating subjects which otherwise would be in the shadow. Let us for
a moment consider the meaning of the word. It has been too much limited
in its application to lesions of an osseous nature.
Those who call themselves "lesion osteopaths" would
lead to the inference that they differed from others in that they believed
in and treated lesions only, but whether we thus denominate ourselves or
not no one can be an osteopath, true to the first principles of the science,
and not believe primarily and finally in lesions.
Carry the meaning of the word to the extreme. A lesion
is any abnormality of the bodily organism. This being true anything which
interferes with the normal functioning of the body may be considered a
Biology teaches that the mainspring of life is in
the cell. Therefore, a certain amount of energy is there resident. Whether
it be much or little depends upon its resistance. An agent which we call
a stimulus is essential in changing the energy which is latent within the
cell itself to that which is active and therefore capable of a certain
amount of measurement. Lack of normal structural relation of the component
parts of the cell to each other constitutes disease. Dr. Hulett at the
Cleveland meeting said that the lesion existed in the cell.
The logical conclusion from an osteopathic standpoint
would be that here was the primary lesion, as one cannot get away from
In the discussion of the subject we shall not consider
the natural stimuli, heat, light, food, exercise, etc., which cause the
cell to give forth its energy, but only the stimulation which osteopathy
affords, as a factor in removing disease. In disease the resisting power
of the cell is lessened. It is therefore more easily attacked by outside
forces and may result in a diseased area, in some portion of the body.
Dr. Tasker in his late work on "Principles of Osteopathy" has given a good
illustration of this point. He says "A fall or sprain may be responsible
for a slight subluxation of a rib. This subluxation affects the nutrition
of the cells forming in lungs, resistance is lowered. Bacilli of tuberculosis
may be present in the inspired air. They find a fertile spot, in this area
of lessened resistance. Resistance must be increased in this area in order
to head off the disease process."
One thing more might have been added. Simulation
of those portions of the body outside of the diseased area might have caused
its absorption and the poison eliminated by natural processes. In no other
way are we able to account for the degree of success attending the practice
of schools of therapy, which pay no attention to the primary cause of disease
as we understand it. In fact, I believe all osteopathic practitioners have
treated cases when practically no impression was made on the apparent primary
lesion, yet the patient (if not the doctor) was satisfied with the result.
No other explanation offers itself than that the
nerves supplying the part affected after their exit from the spine (where
we are supposing the primary lesion to be located) were stimulated or inhibited
as the case demanded, superinducing activity in the diseased part bringing
it up to a condition of quasi-health.
Do not understand me as advocating anything less
than removal of the first cause. My point is this: We must have a factor
which can operate in a sense independent of the removal of the first cause
which may be beyond our reach, either because we may be unable to locate
it, or because the condition of the patient may be such that it cannot
be at once corrected. This factor we believe to be stimulation. It may
wear a new dress and be called a "corrective" or "palliative treatment,"
but we see no reason for the change of name while conditions remain the
However, considering the word "lesions" as commonly
used, the question arises: "Is osteopathy limited in its scope to treatment
of primary lesions?" I use the word limited advisedly, for if osteopathic
treatment cannot act upon the sluggish circulation, influence digestion,
quiet overwrought nerves, except as it removes primary lesions, we are
barred from the treatment of many acute diseases.
Can osteopathic methods produce an increase of any
functional process above the normal? Undoubtedly the ulnar nerve is acting
either above or below normal when it is struck at the elbow joint. You
may call it inhibition or stimulation as you like, but one of these conditions
must exist. Ability to superinduce stimulation involves ability to superinduce
inhibition, as one is the opposite of the other.
A similar condition may be produced where nerves
may not be reached as directly as the ulnar, pudic and others.
A blow over the solar plexus has produced death.
Use of the spymograph has shown that the heart action
can be lowered by osteopathic stimulation and increased by inhibition of
the pneumogastric. Inhibition of the phrenic stops hiccoughs.
Bronchial asthma may be relieved through inhibition
of the dorsal nerves.
In the treatment of fevers stimulation and inhibition
are employed. Inhibition of the vaso-constrictor nerves to reduce blood
pressure, stimulation of the lungs, kidneys, bowels, sweat glands, in fact
all the organs of elimination to remove the toxic elements.
Stimulation and inhibition should be employed in
all forms of acute disease as palliative measures until such time as the
primary lesion may be removed.
These are mentioned simply to call to mind that we
employ the methods in treating diseases. Why not call them by the name
of stimulation and inhibition? In the one case we are endeavoring to get
an increase of functional activity. It matters not whether above the normal
or bringing it up to that point - it is stimulation. In the other case
we produce a decrease of activity no matter whether it is carrying it below
or bringing it down to normal - it is inhibition. We are aware that excessive
stimulation becomes inhibition - also that the point at which stimulation
and inhibition begins has not been defined, but this is an argument neither
against the existence nor the practical use of either.
The exact point at which the tissues derive the nutrition
which each requires is not known, but this does not prove its non-existence,
nor disprove the fact that the tissues derive their nourishment at that
very point. The point at which latent energy is transformed into active
is unknown, yet because this point cannot be demonstrated is no argument
against its existence.
No class of practitioners deal more directly with
vaso-motor influences than osteopaths, but our system would be open to
criticism should it teach that the only method of correcting vaso-motor
irregularities was in removing primary lesions. Stimulation and inhibition
are two indispensable factors towards this end. "The amount of stimulation
which can be given the capillary circulation by the osteopath is surprising,"
says Dr. Pratt.
Cell life is dependent upon circulation. Any treatment
which induces a normal circulation of the fluids of the body is acting
upon the very seat of life - the cell. One of the secrets of the success
of osteopathic treatment is inhibition. We are aware that excessive stimulation
becomes inhibition, that by the stimulation employed cell resistance is
built and kept up to the normal.
In no field is osteopathy more successful than in
the treatment of nervous diseases. It is unnecessary to state in this company
that osseous lesions are not responsible for all forms of neurosis.
A case is recalled of a man of powerful physique
practicing law, who neglected all forms of physical exercise, making immense
demands upon his mental faculties. The nervous system called for a greater
amount of nutrition, nature responded and sent blood to the nerve centers
which through exhaustion were unable to take up the nutrition; the result
was an engorgement of blood at these centers. Here was the seat of the
primary lesion. There was perfect alignment of the vertebrae. In place
of muscular contraction there was a flabby condition due to muscular inactivity.
Osteopathic stimulation and inhibition judiciously
employed reduced the engorgement of blood at the nerve centers and restored
it in other parts of the body.
Pneumonia may be caused by a subluxated rib resulting
in secondary lesions which may require weeks to correct. Aside from the
removal of muscular lesions through vaso-motor influence, the calibre of
the blood vessels may be largely controlled and the organs of elimination
There is a large difference of opinion among authorities
as to the function of the vaso-motor nerves. Byron Robinson says: "It is
not definitely settled whether the vaso-motor nerves are constrictors or
dilators. Some assert that there is a constrictor nerve only and that dilation
of the vessel is paresis of the constrictor."
"By slight irritation one can produce a white line
(vaso-constriction) and by more severe irritation a red line (vaso-dilation).
The significance of vaso-constrictor nerves becomes evident when it is
considered that they are so powerful that they can drive or squeeze all
the blood out of a part."
Foster contends that the vaso-motor nerves in the
dorsal are constrictor fibres; in the cranial and sacral, vaso-dilator
fibres. Experience has proven to my satisfaction that this is the case.
Inhibition of the dorsal spine, especially at the second to the fourth
and splanchnic areas produces a powerful influence on blood pressure.
The speaker has been successful in the treatment
of the worst types of congestive headaches, by treatment of the dorsal
spine. In many cases no other treatment being needed than a strong inhibition
of the splanchnics. The explanation is this: Excessive tonicity of the
constrictor fibres of the abdominal blood vessels was forcing blood from
these areas to the head, where for the time being the blood was engorged.
Inhibition relieved this influence, relaxed the constrictor fibres, and
blood pressure in all parts of the body assumed normal relations. Those
who insist upon a dorsal osseous lesion being the first cause may say that
a cure can only be effected by its removal. Granting this, it may be some
time before such lesion can be corrected. Were it possible to reduce it
at once it might be hours, days or weeks before the general tone would
be restored to the blood vessels - meanwhile the patient is suffering.
Inhibition must take its place as an independent
factor in the treatment of congestive headaches.
The same may be said of gynecological practice. Prominent
gynecologists bear testimony to the fact that stimulation and inhibition
are indispensable factors in their success along this line. Many other
instances might be cited, but time is limited.
We claim that osteopathy has proven its right to
be called an independent system; that it is complete in itself. This is
a radical statement to make. Can this be true if we eliminate from our
theory the ideas of stimulation and inhibition, which are the "sine qua
non" of other schools of therapy?
Up to the present time the speaker has found it unnecessary
to resort to the much talked of adjuncts: but should he eliminate from
his practice osteopathic stimulation, it is a question in his mind whether
he would not be obliged to call to his aid some agent, mechanical or otherwise,
which would take its place. In clinging closely to the germinal idea of
lesions as the fundamental thought of our system, we may with perfect propriety
keep enlarging our sphere of activity.
There is no question but that during the last ten
years there has been not only a large increase of knowledge on the part
of the public concerning osteopathy, but also on the part of its practitioners.
From an intellectual point of view we stand today far in advance of a decade
ago. This is the natural order in the development of any system having
for its foundation scientific thought, and for its exponents men and women
devoted to its advancement. With experience has come confidence. Diseases
that were untouched ten years ago are today our common practice. This is
true not only because the public, but Osteopaths themselves, have an increased
confidence in the science.
We see in our system unlimited fields for research.
Where is there greater opportunity than exists in the field of osteopathic
literature? So far our literature is not adequate to an education along
osteopathic lines. Nor can it be for many years to come. We are forced
to go to authorities of other schools for data. We constantly find the
principles of stimulation and inhibition referred to in these works. Since
osteopaths must have something which applied in a natural way will take
the places of stimulation or inhibition why not call them by the same names.
It would not be proper for me to assert that Shakespeare
was wrong when he said that "a rose by any other name would smell as sweet,"
perhaps it would; but the law of association of sense with sound is so
powerful that I doubt it. Perhaps stimulation under some other name would
be as effective, but why the change since the principle back of the name
is the same.
As a matter of fact we believe that such a change
at the present time cannot be made, for two reasons: First, conditions
do not demand it, and second there is nothing as good to substitute.
The Japanese have a system of dwarfing trees. They
plant an acorn and by a method peculiar to themselves pinch off the growing
shoots, and in the course of time have a perfect oak which adorns their
tables in a flower pot. How different from the majestic tree which lifts
its branches with their wealth of foliage to the sun and air. Both trees
are oak, both grew from acorns, both have the same sort of vital energy;
yet the one is an object of admiration for its perfect symmetry as a dwarf,
while the other stands for beauty, strength and utility.
There are two ways in which we may treat osteopathy.
We may cling so closely to the germinal idea of lesions that we can see
nothing else; we may strike off every developing idea and in the end have
a perfect system but a dwarf. How much better is that method which
happily prevails in our ranks today, that of fostering the powerful vitalizing
germinal idea of lesions as the basis of disease and letting it develop
in whatever manner it will.
Theories in a sense independent and yet dependent
will develop because of the strength of the germ. The leaf is independent
in a sense, and yet its life is in the trunk. Let us by every method within
our reach, by every energy that we possess nurture the germinal thought
of our system and develop it into the most perfect and symmetrical school
of therapy in the world. Such we believe it is destined to be.