Studies in the Osteopathic
Basic Principles: Volume
Louisa Burns, M.S., D.O., D.Sc.O.
THE TRUE OSTTEOPATH IS THE TRUE PHYSICIAN. HE MUST
BE THOROUGHLY PREPARED TO DO THE BEST THING
POSSIBLE UNDER EVERY CONCEIVABLE CIRCUMSTANCE
OF HUMAN SUFFERING.
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.
Therapeutics Rest on Diagnosis.
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.
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.
duty of the physician is to correct that which is perpetuating the malfunction,
whatever it may be.
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.
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
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.”
No Royal Road to Skill.
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
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.
Secondary Structural Changes.
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
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.
“best thing possible” for the secondary lesion, as for the primary lesion,
is to remove it as quickly as possible under the circumstances.
Adaptation the “Best Thing.”
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.
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
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.
“Hypertrophy the “Best Thing.”
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.
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:
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.
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.
our modern conditions of abnormal living, many cases of disease are due
to faulty surroundings and habits.
Instruction the “Best Thing.”
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.
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.
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.
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.
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.
Advice the “Best Thing.”
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.
Lenses the “Best Thing.”
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.
Surgery the “Best Thing.”
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.
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
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.
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.
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.