Articles On Manual Therapy


Paper read before the A. O. A. at St. Louis,
 By LesLie E. Cherby, D. O.
Milwaukee, Wis.
Published in
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 lesion.

    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 the cell.

    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 same.

    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 stimulated.

    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.