Philosophy of Osteopathy
Andrew Taylor Still, D.O.




    At the present time more than at any other period since the birth of Christ, the medical and surgical world have centralized their minds for the purpose of relieving locally inside, below the kidney of the male or female, excruciating pain, which appears in both sexes in the region above described.

    From some cause, possibly justifiable, it has been decided to open the human body and explore the region just below the right kidney in search of the cause of this trouble.  Such explorations have been made upon the dead first.  Small seeds and other substances have been found in the vermi-form appendix, which is a hollow tube over an inch in length.  These discoveries, as found in the dead subject, have led to explorations in the same location in the living.  In some of the cases, though very few, seeds and other substances have been found in the vermiform appendix, supposed to be the cause of local or general inflammation of the appendix.  Some have been successfully removed, and permanent relief followed the operation.  These explorations and successes in finding substances in the vermiform appendix, their removal, and successful recovery in some cases, have led to whit may properly be termed a hasty system of diagnosis, and it has become very prevalent, and resorted to by the physicians of many schools, under the impression that the vermiform appendix is of no known use, and that the human being is just as well off without it.


    Therefore it is resolved, that as nothing positive is known of the trouble in the location above described, it is guessed that it is a disease of the vermiform appendix.  Therefore they etherize and dissect down for the purpose of exploring, to ascertain if the guess is right or wrong.  In the diagnosis this is a well-defined case of appendicitis; the surgeon's knife is driven through the quivering flesh in great eagerness in search of the vermiform appendix.  The bowels are rolled over and around in search of the appendix.  Sometimes some sub-stances are found in it; but often to the chagrin of the exploring physician, it is found to be in a perfectly healthy and natural condition, and so seldom is it found impact with seeds or any substance whatever, that as a
general rule it is a useless and dangerous experiment.  The percent of deaths caused by the knife and ether, and the permanently crippled, will justify the assertion that it would be far better for the human race if they lived and died in ignorance of appendicitis.  A few genuine cases might die from that cause; but if the knife were the only known remedy, it were better that one should occasionally die than to continue this system, at least until the world recognizes a relief which is absolutely safe, without the loss of a drop of blood, that has for its foundation and philosophy a fact based upon the longitudinal contractile ability of the appendix itself, which is able to eject by its natural forces any substances that may by an unnatural move be forced into the appendix.  [*My first Osteopathic treatment for appendicitis was in 1877, at which time I operated on a Mr. Surratt and gave permanent relief.  During the early eighties I treated and permanently cured Mrs. Emily Pickler of Kirksville, mother of our representative, S. M. Pickler, and mother of ex-congressman John A. Pickler of South Dakota.  The infirmary has had bad cases of appendicitis probably running up into hundreds without failing to relieve and cure a single case.  The ability of the appendix to receive and discharge foreign substances is taught in the American School of Osteopathy and is successfully practiced by its diplomates.  In the case of Mr. Surratt I found lateral twist of lumbar bones; I adjusted spine, lifted bowels, and he got well.  When I was called to Mrs. Pickler had been put on light diet by the surgeon, preparatory to the knife.  She soon recovered under my treatment without any surgical operation and is alive and well to this date.


    To a philosopher such questions as this must arise: Has the appendix at its entrance a sphincter muscle similar in action to that of the rectum and oesophagus?  Has it the power to contract and dilate? --contract and shorten in its length and eject all substances when the nerves are in a normal condition?  And where is the nerve that failed to execute the explosion of any substance that may enter the cavity of the appendix?  Has God been so forgetful as to leave the appendix in such condition as to receive foreign bodies without preparing it by contraction or otherwise to throw out such substances?  If He has He surely forgot part of His work.  So reason has concluded for me, and on that line I have proceeded to operate for twenty -five years without pain or misery to the patient, and given permanent relief in all cases that have come to me.  With the former diagnosis of doctors and surgeons that appendicitis was the malady, and the choice of relief was the knife or death, or possibly both, many such cases have come for Osteopathic treatment, and examination has revealed that in every case there has been previous injury to some set of spinal nerves, caused by jars, strains or falls.  Every case of appendicitis, gall or renal stones can be traced to some such cause.  These principles I have proclaimed and thought for twenty-five years.


    We should use much caution in our assertions that nature had made its work so complete in animal forms and furnished them with such wisely prepared principles that they could produce and administer remedies to suit, and not leave the body to find them.  Should we so conclude and find by experiment that man is so arranged, and wisely furnished by deity as to ferret out disease, purify and keep the temple of life in ease and health; we must use great care when we assert such is not undeniably true up to the present.  The opposite opinion has had full away for twenty centuries at least, and man has by habit, long usage, and ignorance so adjusted his mind to submit to customs of the great past that should he try, without previous training, to reason and bring his mind to such altitude of thought of the greatness and wisdom of the infinite, he might become insane or fall back in a stupor, and exist only as a living mental blank in the great ocean of life, where beings dwell without minds to govern their actions.  It would be a great calamity to have all the untrained minds shocked so seriously as to cause them to lose the mite of reason, they now have, and be sent back once more to dwell in Darwin's protoplasm.  I tell you there is danger, and we must be careful and show the people small stars, and but one at a time, till they can begin to reason and realize that God has done all that the wisest can attribute to Him.


    There is but one method of reasoning.  That method is by the laws governing the subject to be reasoned upon.  Reasoning is the action of the mind while hunting for truths.


    As we are about to camp close to the abdomen for a season of explorations and a more reasonable knowledge of its organs and their functions, we will search its geography first, and find its location on the body or globe of life.  We find a boundary line established by the general surveyor, about the middle of the body, called the diaphragm.  This line has a very strong wall or striated muscle that can and does dilate and contract to suit for breathing, and quantities of food that may be stored for a time in stomach and bowels for use.  The abdomen is much longer than wide.  In short, it is a house or shop builded for manufacturing purposes.  In it we find the machinery that produces rough blood or chyle, and sends it to heart and lungs to be finished to perfect living blood, to supply and sustain all the organs of this division.  This diaphragm or wall has several openings through which blood and nutriment pass to and from abdomen to heart, lungs and brain.  I want to draw your special attention to the fact that this diaphragm must be truly normal.  It must be anchored and held in its true position without any variation, and in order that you shall fully understand what I mean, I will ask you to go with me mentally to all the ribs, beginning with the sternum, see attachments, follow across with a downward course to the attachments of this great muscular septum to the lower lumbar region, where the right crus receives a branch or strong muscle from the left side, and the left crus receives a muscle from the right which becomes one common muscle known as the left crus, the same of the right crus receiving a muscle or tendon from the left, which you will easily comprehend from examining descriptive cuts in Gray, Morris, Gerrish, or any well illustrated work of anatomy.  You see at once a chance for constriction of the aorta by the muscles under which it passes, causing without doubt much of the disease known as palpitation of the heart, which is only a bouncing back of the blood that has been stopped at the crura.  Farther away from the spine near the center of the diaphragm we find the return opening through this wall, provided to accommodate the vena cava.  To the left a few inches below the vena cava we find another opening provided for the oesophagus and its nerves; like the aorta, it has two muscles of the diaphragm crossing directly between oeophagus and the aorta, in such shape as to be able to produce powerful prohibitory constriction to normal swallowing.


    At this point I will draw your attention to what I consider is the cause of a whole list of hitherto unexplained diseases, which I think are only effects, caused by the blood and other fluids being prohibited from doing normal service by constrictions at the various openings of the diaphragm.  Thus prohibition of free action of the thoracic duct would produce congestion of receptaculum chyli, because of not being able to discharge its contents as fast as received.  Is it not reasonable to suppose a ligation of the thoracic duct at the diaphragm would retain this chyle until it would be diseased by age and fermentation, and be thrown off into the substances of other organs of the abdomen and set up new growths, such as enlargement of the uterus,
ovaries, kidneys, liver, spleen, pancreas, omentum, lymphatics, cellular membranes, and all that is known as flesh and blood below the diaphragm?  Have you not reason to explore and demand a deeper and more thorough anatomical knowledge of the diaphragm and its power to produce disease while in an abnormal condition, which can be caused by irritations, wounds or hurts, from the base of the brain to the coccyx?

    Remember this is an anatomical and philosophical question that will demand your attention to the mechanical formation, physiological action and the unobstructed privileges of fluids when prepared in the laboratory of nature, to be sent at once to their ordained destination, before such substances are diseased or dead with age.  You must remember that you have been well drilled, or talked out of patience in the room of symptomatology and all you have learned is, something ails the kidneys, and are told their contents when analyzed are not normally pure urine.  In urinalisis you are told "here is sugar," "here is fat," "here is iron," "here is pus," "here is albumen," and this is diabetes, this is Bright's disease, but no suggestion is handed to the student's mind to make him know that these numerous variations from normal urine are simply effects, and the diaphragm has caused all the trouble, by first being irritated from hurts, by ribs falling, spinal strains, wounds and on from the coccyx to the base of the brain.  Symptomatology is very wide and wise in putting this and that together and giving it names, but fails to give the cause of all these abdominal lesions.  Never for once has it said or intimated that the diaphragm is prolapsed by misplaced ribs to which it is attached, or that it is diseased by hurts of spine and nerves above its own location.  Allow yourself to think of the universality of the distribution of the superior cervical ganglion and other nerves which are of such great importance that I will by permission insert in the last chapter of this book a description of that great system of the sympathetic nerves by Dr. Wm.
Smith, whose superior knowledge of anatomy makes him eminently qualified to describe the location and uses of this great sympathetic system of the nerves of life.


    As you read his able essay remember there are four other sets of nerves equal to, and just as important in their divisions of life, which are the motor, nutrient, voluntary and involuntary.  All of which you as an engineer must know, and by proper adjustment of the body give them unlimited power to perform their separate and united parts in sustaining life and health.  Now as I have tried to place into your hands a compass, flag and chain that will lead you from effect to cause of disease in any part or organ of the whole abdomen I hope that many mysteries which have hung over your mental horizon will pass away, and give you abiding truths, placed upon the everlasting rock of cause and effect.  You have as little use for old symptomatology as an Irishman has for a cork when the bottle is empty.  Osteopathy is knowledge, or it is nothing.