This statement seems almost self-evident, and yet it is not thoroughly accepted in practice. If the theories upon which our practice is based are true, and it seems inconveivable that they could fail in verity, then it must include the treatment of all that can injure the normal body. There is no room for superstition, or priest-craft, or for pretence in sane, rational, helpful therapeutics.
Rational therapeutics can be based on nothing else than rational diagnosis. Given a thorough understanding of the real condition of the patient, the most satisfactory method of dealing with his case is almost evident. People are sick, or they do not come to a doctor. If they are not sick in the way they suppose, the fact that they choose to appear sick is itself a symptom of some malfunction. So, it must be granted that they who seek the physician are always suffering from some abnormal condition. This abnormal condition must have a cause. There is no malfunction without adequate cause. This cause may be found in the structure of the body, or it may be in the environment, or it may be simply the persistence of a habit of disease. In any case, it must be granted that the existence of malfunction is absolute proof of some abnormal factor in structure or environment, or both. The duty of the physician is to correct that which is perpetuating the malfunction, whatever it may be. So, he must recognize the suffering. If he does not accept the fact that the patient is suffering, there is no right in his considering his case at all. He must recognize the suffering as present. He must determine the cause of the suffering. He may not be able to do this at once,--a thorough diagnosis is not to be made without time and care. Having determined the nature of the disease, it is evident that it is the duty of the true physician to correct whatever is causing or perpetuating the disorder. He may find that certain structural relations are at fault and that these may be corrected by his own fingers. It is clearly his duty to correct these structural conditions. These lesions may be the only cause of the disordered condition, and in such cases the “best thing possible” is the removal of the lesion and there will be a consequent absolute recovery. The manner of the removal of the lesion is a matter for study This work also must be done in the “best possible manner.”
Skilll in the technique of doing things is the result of practice. Not only must one know how to do a thing, but he must be able to do it. This skill is not to be secured in any easy manner, but it must result from continual practice. With an accurate knowledge of the structure of the bones and their articulations, the muscles and connective tissues related with them, and the character of the abnormality present in any particular case, the best method of relieving the condition is manifest. The study of the clinic cases of various lesions and of the methods employed by others for their correction is of benefit, but the essential thing is the training of one’s own muscles and sensory nerves. Muscles must be strong and trained to steady, efficient movements, fingers must be so sensitive as to seem almost possessed of brains of their own. This training comes not easily to any, though there are difference of natural bent and of previous training among persons. The continual training in the perception of touch, and in one’s powers of making coordinated movements is the best possible method of securing ease and efficiency in technique. The key to skill in osteopathic technique is practice, and thought, and more practice.
In other cases, structural maladjustments are a predisposing cause of the malfunction, and a factor in perpetuating it. The exciting cause is frequently bacterial infection, over work, cold, or some other of the slightly abnormal conditions to which all people are sometimes subject, and from whose malignant effects the normal body is able to protect itself. In the presence of certain structural maladjustments, with their interference with circulation, innervation, nutrition or elimination, the cells of the body become unable to withstand temperature changes, over work, or bacterial infection, and abnormal conditions of metabolism result. The “best thing possible” in these cases is the removal of the structural maladjustment as quickly as possible, the use of such measures as secure their normal environment to the tissues most affected, the destruction of the bacteria surrounding the body, and such instruction in hygienic measures as are indicated by the habit s of the individual.
There are other cases in which the structural maladjustment is the result of some acute disorder. There may have been some very unusual environal conditions to which the body was not adapted, and malfunction resulted. Disorders of digestion finally result from the use of improper food by the most nearly normal of people. The injury to the digestive tract thereby produced initiates abnormal sensory impulses to the centers in the spinal cord and the medulla which, in turn, cause motor impulses to the muscles of the back and neck. These relations have already been discussed in previous chapters of this book. This abnormal muscular tension is itself a source of other sensory impulses to the same and adjacent nerve centers. By means of the unequal pull of these muscles, the vertebrae and ribs are held in slightly abnormal relationship, -- not dislocated in the surgical sense, but held fixed in a position which they normally occupy only under certain very temporary conditions of movement. This slight, persistent, maladjustment is called a subluxation, or subdislocation, or bony lesions. It may be produced either by reflex muscular contraction, or by accident. The effects upon the function of the viscera innervated from the segment from which the abnormal structure is innervated are the same in both cases. The “best thing possible” for the secondary lesion, as for the primary lesion, is to remove it as quickly as possible under the circumstances.
Sometimes structural abnormalities are fixed. Pott’s disease is perhaps the most conspicuous example of this condition. Less noticeable instances come to light very frequently in practice. Abnormal tissue changes which have been a long time present cause adaptive changes in other tissues, so that what was in the beginning a source of injury becomes later a part of the normal condition. The condition is similar to that of the cells of simpler organisms, when they adapt themselves to an abnormal environment. The presence of abnormal structural relations never secures absolutely perfect adjustment, but it does secure an adjustment which is more nearly perfect than anything which might be expected from an effort at correction. It is often a very difficult matter to determine the extent of this adaptation. If the tissues of the body are becoming fairly well adapted to a certain deformity, “the best thing possible” is to let the deformity alone, and facilitate further adjustment, if necessary, by removing any conditions which render the process difficult. If the deformity is not arousing efficient efforts at adaptation, then its correction may be indicated. The line between the two conditions is not easily drawn. Only a very careful study of the condition of the patient and his history can settle the matter.
There are structural changes which are themselves incurable, but which may be met by efforts at compensation which result in a symptomatic cure. Absolute recovery depends upon the removal of the abnormal conditions. Symptomatic recovery may be secured by adaptation to abnormal conditions. This adaptation may be facilitated by securing those conditions which render the environment of the abnormal organs as nearly normal as possible.
The hypertrophy of the heart which follows valvular lesion is an instance of compensation. It may fail, yet the effort is toward a symptomatic cure. Hypertrophy is to be encouraged in such cases, by making the blood flowing through the vessels of the heart as pure, nutritious, and well oxygenated as possible, by removing every condition which interferes with the normal nerve impulses to and from the heart, by seeing that the blood pressure never rises above that which is normal to the heart during the period of its growth. The removal of one kidney is normally followed by the hypertrophy of the other. Nothnagel’s view of the mechanism of this process may be modified by the results of recent investigations as follows: The destruction or removal of one kidney causes the dilatation of all the arterioles innervated from the twelfth thoracic segment of the cord, including the supra-renals. The dilatation of the supra-renal vessels increases the amount of their internal secretion in the blood stream. Thus is caused dilatation of the arterioles of the remaining kidney, with high arterial pressure. This condition causes both increased function of the remaining kidney, and an increased food supply thereto. Both of these factors encourage hypertrophy. In such a case as this, “the best thing possible” is to keep the purest possible blood, flowing at the highest possible speed, under the most nearly normal pressure, to the kidney, and to keep the path of the nerve impulses to and from the kidney as nearly unimpeded as possible. In every instance of incurable injury compensation and hypertrophy are facilitated and hastened by the supply of good blood, normal blood pressure, free innervation, and such conditions of rest and temperature as are normal during the period of active growth of the organ whose function is being subjected to change. With our modern conditions of abnormal living, many cases of disease are due to faulty surroundings and habits.
For example, it may be that there is some faulty habit of eating which is causing, or helping to cause, the trouble. It must not be forgotten that the occurrence of one abnormal factor is no proof whatever that other factors instrumental in causing malfunction may not also be present. If dietetic errors be habitual, the physician must give the needful instructions plainly, in words adapted to the understanding of his patient. It is no compliment to a doctor for his patient to go to a grocery asking for “carbohydrates,” because he has been told to eat them. If other faulty habits are found to be causing ill health, or to threaten to cause ill health, it is the duty of the true physician to tell the patient about the matter. The utmost tact is needful in such cases, in dealing with some patients. Every patient, and every doctor, is a law unto himself in these matters, and the selection of the course of action which is “the best thing possible” is not always easy. There is no subject concerned in the maintenance of a normal life, or in causing disease, or in lessening the strength and the value of life, which may not be discussed by the physician with his patient. It is the duty of every physician to know all that it is possible to know concerning whatever affects the mental, or moral, or physical well-being of his patients and the community, and to do all that he can to make life more sane, and rational, and strong wherever his influence may be felt. The human body, and the life within that body, are wonderful and beautiful in health, and wonderful and pitiful in disease. Wise instruction in matters concerning the mysteries of life is gladly received by sensible, grown people, and if the matter is properly placed before fathers and mothers, they may be induced to see the wisdom of teaching the children in those matters which are so urgently important to them in their after lives. Whether the physician choose to deal with educational matters or not, he should at least be prepared to give rational instruction to all who ask his advice.
The physician may find that his patient stands in need of the work of some specialist. The principle at the head of this chapter does not signify that the osteopath should be able to do the work himself which is needed in every case. Such an interpretation would be manifestly absurd. The best thing possible under certain circumstances is to send the patient to a dentist. It is not expected that the osteopath pull teeth. But he must know enough to refer the cause of persistent neuralgia to a toothache if it is the toothache that is causing the pain. “The best thing possible” under certain other circumstances may be the elimination of high heels from shoes, or a swaddling collar from the neck. The osteopath is not expected to be that kind of a surgeon, but he should be able to prescribe that kind of surgery when it is indicated.
Under other circumstances, the best thing possible may be the fitting of appropriate lenses for the eyes. Some physicians of all schools, osteopaths among others, are able to do this work. There is no reason why many of them should not be prepared to prescribe lenses There is no reason why they should do this work unless they can do it well. The thing they must do, if they are true physicians, is to determine whether the lenses are needed, or whether some other condition is causing the poor vision, or the “nervousness,” or the headache, or whatnot. He must know enough to decide rationally whether this patient shall be sent to an oculist, or whether he shall be treated for a lesion in the cilio-spinal center, or whether both procedures are indicated. In either event, he must know enough to determine whether the glasses are giving the desired relief, after his patient has worn them for a time, and in the other case, whether his own treatments at the cilio-spinal center are as effective as they should be.
The same principles are concerned in major surgery. Not very many osteopaths are qualified to practice major surgery. In some states, they are not permitted to do so, even if they are qualified. In any event, surgery is a specialty. The surgeon must be only a surgeon, if he is to attain eminence. Now, the osteopath who knows his work well, must know when surgery is indicated, and when it is not indicated.. He must be able to consult intelligently with the surgeon concerning the nature of the work he considers needful, and he must know whether the work has been properly done or not. In some places, such consultation would be out of the question, but this need not lessen the ability of the osteopath to determine the diagnosis, the need of surgical interference, and the prognosis.
The same principle obtains in dealing with cases of alienism. It is for the physician to decide, often, whether the patient shall be sent to another place for proper care, or whether he himself can hope to assist him to normal conditions. Such questions as these come to the practitioner daily. He must decide them fairly, upon the basis of such facts as he is able to secure. Having decided upon his decision after thorough consideration, he must be ready to bear the responsibility which he has assumed. His authority must be equal to his responsibility, and he must so accept it. His advice disregarded, his responsibility is at an end, but so long as his advice is heeded, he must consider himself responsible. The measure of responsibility in such cases as these is very great for the young practitioner. But it need not be forgotten that opportunities for consultation are not lacking, that modern methods of diagnosis are very exhaustive, and that superhuman skill and wisdom are not to be attained by any one. The chief difference between the experienced physician and the doctor with his diploma yet damp, is that the new graduate will be unable to make his diagnosis so quickly as his older colleague. With our modern methods of laboratory diagnosis, and our exact methods of physical diagnosis, and those methods of diagnosis which are almost exclusively osteopathic, the cases in which a mistaken diagnosis is justifiable are becoming very rare. If the osteopath is the true physician, he will be thoroughly fitted to do the best thing possible under every conceivable circumstance of human suffering. |