Studies in the Osteopathic
Basic Principles: Volume
Louisa Burns, M.S., D.O., D.Sc.O.
LIFE IS SHORT, OPPORTUNITY FLEETING, JUDGMENT
DIFFICULT, TREATMENT EASY, THOUGHT HARD; BUT
TREATMENT AFTER THOUGHT IS PROPER AND
statement is as true as it is old. Hippocrates was contemporary with
Plato and Socrates and Sappho and Demosthenes and all the other famous
Greeks of the “Golden Age.” But the teachings of Hippocrates made
the first step toward osteopathy. Hippocrates was the first person
who is known to consider medicine as a thing apart from superstition and
priestcraft. He magnified the physical, mechanical aspect of the
human body and its ills. Even to this day the value of “Hippocratic
succession” is recognized in physical diagnosis.
Treatment is Easy.
is easy.” There is nothing much easier than to make the average sick
person feel better, or, rather, to make him think he feels better.
It is true that temporary relief is often a very important matter; it is
sometimes all that the most skilled and thoughtful person can hope to accomplish
under certain circumstances. But temporary relief is not satisfactory
to either patient or physician for very long. The normal environment
of the normal person does not include a doctor, be he never so skillful.
The doctor who keeps his patients may be a very successful person, considered
as a business man, but this is not quite the best proof of the successful
physician. The successful physician’s patients seldom return except
to bring their ailing friends. The exceptions to this rule are self-evident.
any system of practice it is easy to do things which help the average person
to some extent, at least temporarily. The average person recovers,
anyway, even with no help at all. Under the old system of drug giving,
it was easy to prescribe some harmless thing which did not do much of anything,
but made the patient feel better, partly because he knew somebody was trying
to help him, partly because when the doctor was called he stopped worrying
about having to call him. If he knew that a bill of size and dignity
awaited his recovery, that fact might have some effect upon the speed with
which the malfunction disappeared.
Rational Therapeutics Rest upon Rational Diagnosis.
is difficult,” becomes emphatically true when it is remembered that rational
therapeutics must rest upon rational diagnosis. The term “diagnosis”
has been often mis-used. Its literal significance is “to know through,”
or “to know thoroughly,” and in that significance it must be used by the
osteopath if he is to attain the full measure of his possible success.
too many physicians of all schools of practice, diagnosis is held to be
satisfactory if the disease of the patient be named. It is supposed
that a certain entity, a disease, affects people, and that these certain
individual diseases can be driven from the body, or can be killed, etc.
That is, by the ordinary practitioner as well as by the layman, diagnosis
is considered satisfactory without any thought of etiology or pathology.
This view is not at all satisfactory if diagnosis is to be used as a basis
for the determination of therapeutics. Diagnosis must include not
only the naming of the symptom complex, but also the determination of the
exact condition of the patient. Even when the name is determined,
the description of diseases given in the ordinary text books dealing with
the nature and diagnosis of disease are almost worthless so far as giving
any real knowledge of the condition of the patient is concerned.
Present Diagnosis Unsatisfactory.
question, “What is the matter with him?” is very rarely answered in any
satisfactory manner. It is true that our most careful study does
not always permit a satisfactory answer to such a question as this, but
it is also true that there is very little hope of our ever attaining any
more satisfactory knowledge so long as we are satisfied with our present
attainments. So long as our knowledge of the condition of the patient
is unsatisfactory, so long will our therapeutic methods fail in doing the
best thing for the patient.
and etiology are described with much detail in the textbooks of the older
systems of medical practice. The amount of work that has been done
in disentangling the knots and uneven webs in disordered metabolism is
simply marvelous. Lives upon lives have been freely given in these
investigations, and they have been profitable, in a way. But in the
descriptions of diseases, after all this tremendous amount of work, etiology
bears almost no relation to diagnosis or pathology, and none of these,
apparently, bear any further relation to therapeutics than the fact that
the naming of a disease renders a convenient index possible. If the
name of any symptom complex referred to any well defined condition the
present system might be defended. But this is not true.
differential diagnosis is based upon the subjective symptoms, the history
of the case, according to the statement of the patient and his friends,
and the laws of averages. Possibly, the findings of some simple laboratory
tests may be considered, or some methods of physical diagnosis may be suggested.
The theories of averages and chances are very useful to the insurance man,
no doubt, as well as to men in less respectable lines of business, but
such considerations have absolutely no place whatever in professional life.
If only one person in a thousand suffers from a certain group of symptoms,
he suffers just as certainly as if the other nine hundred and ninety-nine
were troubled in exactly the same manner. By the older schools of
practice, it is still considered good diagnosis to name the disease, and
good therapeutics to treat the disease.
osteopathy differs in any respect from these irrational and unscientific
methods it is in these respects that it is good osteopathic diagnosis to
know the condition of the patient from top to toe, and it is good osteopathic
therapeutics to treat the patient who is in that condition.
problems which each patient offers to the judgment of his physician are
complicated by very many and very diverse factors. For this reason,
the ultimate cause of any disease is often unrecognizable. In most
cases the diseased condition of the patient who seeks a physician is not
the manifestation of a single abnormal factor, but of a very complex series
of coincident and successive factors. In many cases the symptoms
of disease are the efforts at compensation or adaptation, and the efforts
to combat these form one of the causes of further discomfort, if not of
added embarrassment to the already injured body. Any abnormal condition
of long standing, and many of those of apparently recent manifestation,
must be considered as the resultant of many forces, some tending to a return
to the normal function and structure, and some making for further injury
or embarrassment. The judgment of the physician is at fault if he
does not consider these predisposing factors as well as the exciting cause;
the less noticeable elements of the complex of symptoms and laboratory
findings, as well as the more evident manifestations of malfunction and
Illustration of Complexity of Disease.
an illustration of these conditions, almost any disease might be cited.
The common case of indigestion is useful in illustration because it is
familiar to most people. If anyone who is in good health becomes
very weary, and at once eats a hearty meal, his digestion is very apt to
be temporarily impaired. The indigestion is not due to the hearty
meal alone, nor to the fatigue alone, but to the improper relation of these.
A third factor often present in these cases is the existence of a mal-alignment
of the ribs, or vertebrae, or both, which causes an abnormal flow of nerve
impulses to and from the spinal and bulbar centers concerned in digestion.
The slight malfunction so induced is temporary if not subjected to unwise
tampering. If the patient repeats his error, or if he forces himself
to eat again before his stomach is ready for food, or if he adds to the
abnormal condition by the use of various methods of dosing, flushing, fasting,
stuffing, purging and whatnot, the condition may become chronic.
The judgment which is difficult must recognize the effects of the abnormal
therapeutics, as well as the efforts of the original disorder.
Bacteria as a Determining Factor.
the person who is weary, or is hungry, or is poorly nourished because of
the faulty quality of his food, or is over-fed, or whose habits of life
have been abnormal, may be subjected to some bacterial invasion.
His immunity is decreased by the abnormal conditions, and the bacteria
are able to make themselves at home in his body, and to produce the symptoms
characteristic of their presence. The specific disease that is produced
is determined by the character of the organisms which gain entrance to
his body, but the fact of invasion is determined by his bad habits, his
deficient nourishment, his deficient elimination, or the structural mal-adjustments
which interfere with the normal function of the tissues. The symptoms observed
in such cases are not to be wisely interpreted without a consideration
of the conditions which render the bacterial invasion possible. The presence
of the bacteria or other parasite is merely an additional factor in the
complex array of symptoms.
are many examples indicative of the complexity of diseases usually considered
the most simple. It is evident to one who gives independent thought to
the study of disease conditions that almost every patient must be to a
certain extent unique. He alone has just such a body as his own. He alone
has lived just such a life as his own, he alone suffers just such structural
mal-adjustments, such mal-function, and such symptoms.
is difficult, thought hard; but treatment after thought is proper and profitable."
a thorough diagnosis, the best methods of treatment are fairly evident.
The determination of the treatment best adapted to the requirements of
the case is not difficult, and the prognosis is usually fairly evident.
Prognosis must always be somewhat uncertain, since it rests upon certain
possibilities of cell reactions which can not be determined by any methods
of investigation with which we are familiar. But there are very many factors
which modify the prognosis in any case which are subject to modem methods
of investigation, and these are part of a rational diagnosis.
"'Thought is Hard."
therapeutics must rest absolutely upon rational diagnosis. If judgment
and thought have been given, if the physician knows the condition of his
patient as thoroughly as is possible under the condition of the case,
if he gives that “thought” which Hippocrates calls “hard,” then the thing
which is done for the patient is that which will bring his body into normal
relationship with a normal environment, if this is possible; or will assist
him to a symptomatic cure by securing adaptation or compensation; or which,
recognizing the utter impossibility of any cure, will make his last days
as comfortable as possible.
“judgment is difficult,” because “thought is hard,” “treatment after thought
is proper and profitable.”
The Future of the Race.
thought of the physician must not be limited to the immediate good of his
patient. So closely are all the individuals of civilized races bound
together in mutual dependence, in a unity of thought and desire and endeavor,
that the inheritance of future generations includes all of this generation’s
endeavor that is worth perpetuating, whether the devisers of any certain
good leave children or not.
a life be turned from weakness to strength, if brains be made normal and
muscles be made strong, not only will that life be freer from pain and
longer in years, but the world will have gained the fruits of the labor
of those muscles and those brains, both in this generation and in all those
which are coming. Even if the life of any patient seems of no particular
value, the principle remains unchanged. The duty of the physician
is to give to every person an opportunity to do his best possible work
in the world.
normal brain has the wider outlook, the truer logic, the clearer conception
of the relations of things with each other and with the individual; the
more normal brain gives the more normal answer to environal changes; the
more truthful viewpoint leads to the more generous attitude, the deeds
characteristic of the altruistic spirit. These are the things that
live, because these are the things that are characteristic of health in
such brains as ours.
The Responsibility of the Physician.
responsibility of the physician is, then, first to his patient himself.
To him he owes all that he can give which makes for thorough and permanent
recovery. Next, he owes a duty to the world, that his patient shall
be able to do his proper work therein. Then, he owes a duty to the
future, that the descendants of his patient shall be worthy of life.
Under certain conditions, it is the duty of the physician to conserve the
best interests of the race by seeing that his patient is the last of his
family. In other cases, reproduction should be encouraged.
“Judgment is difficult” in no more superlative degree anywhere than in
dealing with such considerations as these. These questions come to
the doctor, and they are within his province.
system of therapeutics which neglects the consideration of these
factors is not fit to survive. If it sacrifice the good of the race
to the good of the individual in any sufficient manner, it will perish,
ultimately, by the extirpation of its devotees. But if it sacrifice
the good of the race to the good of the individual in only slight degree,
it may persist almost indefinitely, perpetuating a race of people who are
fairly normal, who live fairly well, who are fairly progressive, but who
never reach the possibilities of strength, longevity, mentality, and helpfulness
which should be within their reach. Perhaps it is not altogether
unwarranted to say that such a condition is that of a very large proportion
of people in the world today. Very few people are living up to their
potential best, either physically or mentally, and there are very few deaths
which are not made the more sorrowful because they are known to be premature.
The Doctor As Teacher.
task which awaits the rational physician is no easy one. His judgments
are difficult. We who have lived in the world have been taught that
the doctor is a person who takes our aches and pains away. We believe
that he can “cure” us. We know that there are certain laws that govern
the rest of the universe, but we think these laws cease their action at
the limits of our bodies. We smile at childish faith in rabbits’
nests, new moons and four-leafed clovers, then we solemnly take a spoonful
every hour as per direction. We know our lives are abnormal, but we refuse
to yield one tidbit of the leeks and onions while we expect our doctor
to guide us safely through to the promised land of ease and rest.
have been taught for ages that we were not expected to know anything about
the care of our bodies. It is a pleasant doctrine, and takes kindly
to our self-esteem that we are not to blame for our ignorance, that ill
health is innocent, that amidst a universe of law, our own bodies are subject
to caprice and unreason.
rational doctor must live up to the literal meaning of his degree, and
become a teacher. He must see that the environment of every individual
is such as is normal to one of his race and history. He must see
that the environment of each organ of his patient’s body is such as is
best adapted to its best functioning. He must teach his patients
such laws of life as they are able to comprehend. Above all, he must
teach that nothing but rest, nothing but work, nothing but play, nothing
but air, and food, and drink, can supply the place of these things.
Nothing but good blood, freely moving, can supply the needs of any tissue
of the body. None but normal nerves can guide the body wisely, and
none but clean and well-fed brains can serve as the organ of strong and
rational and efficient thinking.
A.—According to Marcus Aurelius, “What is good for the bee is good for
the hive.” There is no field of human endeavor more productive of
genuine good to the race than the effort to help people into clean, wholesome,
rational, helpful lives. The person who wishes to give the most efficient
aid to his fellow-man finds no finer opportunity than that afforded in
the life of a physician.
of Laboratory Diagnosis, C. A. Whiting in the Report of the Third Annual Meeting
of the Osteopathic Association of the State of California.