Articles On Manual Therapy

What Is A General Osteopathic Treatment?
Definitions By One Of The Older Members Of The Profession

James Clarke Rule, D.O.
The Osteopathic Profession
February, 1938

WHAT is a general osteopathic treatment and who is in need of it?

When a student has finished a course in a college of Osteopathy and procured his diploma and license to practice, he has received his credentials as an engineer of the human body, an engineer who knows the anatomy, physiology and pathology, the structure and chemistry of the body he is to supervise.  Also he has served his apprenticeship as a master mechanics theoretically schooled and trained in the methods of correcting all pathological conditions.

To become an osteopathic physician in the truest and best sense of the term he must believe that the correction of structural abnormalities is the most potent therapeutic agent known to science and that most pathologies are amenable to this same mechanical treatment.  If this graduate believes what he his been taught and applies osteopathic treatment in every case where indicated it is only a matter of time until he will know that what he was taught to believe is right.

When he has given his first thousand treatments he will not be a finished master mechanics but if he has given intelligent thought to what he is trying to do in every treatment he will have a good start toward efficiency.  This statement should discourage no beginner.  I have given a hundred thousand treatments and am still far from perfection.  I make an effort every day to come nearer that goal.

Efficiency in Osteopathy

This question of efficiency is most important not only to the public but to the welfare and even to the very life of our profession.  That we should hope for near-perfection in every D.O. may be too high a standard to expect. On the other hand, the fact that we have allowed many to go out into the field credentialed as engineers and master mechanics but with a minimum of ability is greatly to be deplored.

Let me illustrate.  Thirty-four years ago this month I was a young man just out of school and in Pasadena with a private patient.  I had never known through personal experience what sickness was and had never received an osteopathic treatment.

One day I was chilled and aching from head to foot.  I decided to seek an osteopathic physician and get a treatment.  In the directory I found the name of a graduate of the same school where I had studied.  I went to his office and told him how I felt, and he said that maybe I needed a general osteopathic treatment.  This he proceeded to give me. Four or five minutes later I left his office the most disgusted person in California.  The treatment he had given me was literally nothing.  As I went home I said to myself, "Is it possible that this is what I have been spending my time and money to learn?"  Of course I knew better, but I was more sick over that poor demonstration of Osteopathy than I was over my aches and mounting fever.

At six o'clock the boy who was my patient came to my room to get me to go down to dinner.  I was under the covers and said, "No dinner for me tonight." In about two minutes the boy's mother was in to see what was the trouble.  A few questions, and her hand was on my hot forehead and she said I must have a doctor.  I said I did not want a doctor, and told her of my afternoon experience.  She said, "Well, you pick another osteopath or I'll have an M.D. come in." I said I had seen the sign of Dr. J. Strothard White out on East Colorado Street and that Bruce might phone him if she wished.  That evening Dr. White came in and gave me a general treatment, with one the next day and a third on the day following, and that ended my attack of influenza.  The contrast in the work of those two doctors was almost unbelievable.

Another illustration.  A few years ago, being in one of the largest cities of our State with a little extra time on my hands, I decided to call on Dr. Blank who was an old friend.  I found him in and not busy, so after a short visit asked him if he would give me a little general treatment.  It
was little, all right and it was terrible.

In contrast, one day while I was driving from Los Angeles to Stockton I decided to go a few miles out of my way to Porterville to say hello to one of my old patrons and to Dr. Reed.  Reed not being busy, I told him I had not had an osteopathic treatment for several years and asked if he would mind stretching out the old back.  In twenty minutes he gave me the best osteopathic treatment I had ever had.  The point is that there is altogether too wide a difference in the ability of our osteopathic technicians.

What Is A General Treatment?

What is a general treatment?  It may be very different in different cases.

Three years ago a distraught mother came to my office to consult me about her eight-months-old baby.  She gave a history of a normal birth and apparently normal health and development up to five months of age.  Then the child began to suffer from indigestion and malnutrition.  During this time the baby was under the care of medical specialists, but got steadily worse until they said it could not live.  They advised removal to the county hospital.  After ten days they told the mother that the bowels had ceased functioning, the kidneys were excreting free blood and pus, and that the baby could not last another forty-eight hours.

Of course the mother wanted me to say I could save her baby.  As an osteopathic physician I had no access to the county hospital, but the mother had the privilege of taking her baby home.  The doctor told her, however, if she took the baby home for me to examine it she could not bring it back again.  Naturally I envisioned a distressed mother bringing her baby home only to see it die, and therefore I did not encourage her though I did admit that there might be a possibility that Osteopathy might succeed where drugs had failed.

That evening on the dining-room table I examined a baby that had an ivory-colored skin stretched over a framework showing the outline of every bone and marked with prominent blue veins, the belly protruding upward like a young mountain.  The only apparent reaction to everything I did was a slight flutter of half-closed eyelids.  That baby received an osteopathic general treatment --  time ten minutes.  Treatment was continued daily for ten days, then less frequently for three months.  Case dismissed.  Today he is a four-year-old boy, active and normal.  Some D.O.'s say that they do not believe in general treatment.  I do.

Let me give another illustration. Twenty-odd years ago I received a telephone call in mid-afternoon.  I did not want to leave my office at that hour, but the parents were very insistent as their medical doctor had told them their baby would be dead in another hour.  I found an inert infant three months old in which I could distinguish no heart beat, no breath, no reaction of any kind save a slight papillary reaction to light.  Two weeks earlier the case had been diagnosed as pneumonia.  This infant received an osteopathic treatment for two hours.  One week later the case was dismissed.  When the family moved from Stockton this baby had grown to be a fine eleven-year-old girl.

Again, what is general treatment?  I would describe a typical general treatment for the case that comes to the office as one that stretches all spinal soft structures and puts every spinal articulation as nearly as possible through its normal range of motion.  This should be followed by an abdominal manipulation, with the patient on knees and elbows, drawing abdominal contents out of the pelvis and away from the spine, and freeing the abdominal circulation.

I speak of a typical general treatment, yet I presume every intelligently general treatment is atypical for this reason -- that in every case there is some structural imperfection that calls for specific corrective measures which became a part of that particular general treatment.

An osteopathic treatment, whether specific or general, is or should be a work of art.  The osteopathic fingers and intelligence must be trained to recognize the normal tissues, the fibrotic, the atonic, the toxic and all other variations from the normal.  This takes time, practice and diligence.

A general treatment should be a corrective, curative measure, but it may be and sometimes is a harmful, vicious thing.  We all know that when we have limited or no movement in one or more spinal articulations due to lesion, fibrosis or ankylosis we have increased movement in articulations above or below.  In such a case unintelligent, rough general treatment that merely hauls, twists and pops the spine without definite control as to movement and correction simply accentuates movement and creates lesions in articulations already overfunctioning in one of Nature's compensatory attempts while doing nothing to correct the primary lesions.  The victim of this kind of treatment eventually quits Osteopathy full of just criticism for its failure, or changes to an osteopathic physician who is an artist and knows his business.

Who Needs General Treatment?

Next, who needs general treatment?  The person who comes to one's office with altered curvatures due to bad postural habits; the person with various secondary lesions following a lower back primary lesion; the person with hypertension and the one with hypotension; usually the person with digestive tract disturbances; any person with chronic trouble where the contours of the back are not normal; some acute conditions, such as the baby cases described earlier in this paper; typhoid, etc.  However, a general treatment in many of these conditions may be widely different from the definition I have given of a typical general treatment.

One osteopathic physician whose work I respect highly once told me he did not give a general treatment.  Another time he told me that in almost every office treatment he checked up every spinal articulation and treated every one that was in lesion.  It is simply a matter of viewpoint and nomenclature.  I would say that he gave an ideal, intelligent and effective general treatment in all such cases.

I have often heard another one of our best doctors speak of the value of general treatment.  All do not agree on the necessity for general treatment.  I have heard a D.O. of some reputation and standing say on a national convention program that be was treating from fifty to seventy-five patients a day and his ambition was to pass the hundred mark.  Five minutes was his outside limit for a treatment, and he never gave a general treatment.  Take your choice.  I know which one a patient would choose if he could have a knowledge of both methods.

Of course there are many conditions that call for short, specific treatment only, not general treatment.  The differentiation in diagnosis and prescription is where your engineering ability comes in.  The carrying out of your prescription is where mechanics and art come in.

Again, who needs general treatment?  I would say every one past forty years of age and many others, including every D.O.

I was walking along a golf fairway with Chester Morris of Chicago one day.  He told me that the then U. S. amateur golf champion came to him once a week, the year around, for a general treatment.  Dr. Morris told me that this golfer had the most perfect back he had ever seen.  Why did he have continued general treatment?  To keep it that way.  A general treatment weekly for the person already in health is the soundest insurance against ill health.

I would recommend that every osteopathic physician arrange with a neighbor D.O. to exchange weekly general treatments.  A young, beginning D.O. could exchange with an older one, because the older D.O. needs the treatment and the younger one has much of value to learn from such a contact.

I have already said that there is a need for all of us to improve our mechanical knowledge and ability.  In this connection I would advise that a group of three or more beginning D.O.'s make arrangements with an experienced osteopathic physician to hold a series of clinics among themselves for the purpose of learning and perfecting their technic.  I also know by experience what pleasure and value this procedure can be to the oldster as well as to the youngster.

In conclusion, let me express the opinion that what Osteopathy needs is more and better master mechanics who believe in what they are trying to do.