Philosophy of Osteopathy
Andrew Taylor Still, D.O.




    When in the course of human events and actions of life, a woman disregards the laws of nature to such an extent as to overload the stomach beyond its powers and limits; or another way to present the thought, we will say, if you fill the stomach so full as to occupy all space, or so much of the space as to cripple the laws of digestion and retain the food, the decomposition sets up an irritation of the nerves of mucous membrane to such a degree as to cause sickness and vomiting, or any other method of disgorging the stomach, which is the natural process to unload an overloaded vessel.  When the nerves cannot take up nutrition, they will then take up destruction and other elements which are detrimental to the process of nutrition, and there is no other process for relief but to unload.  The loading that has been deposited in the stomach was for the purpose of sustaining a being.  The stomach itself is a sack.  When filled to its greatest capacity, it irritates all the surroundings, and in return they irritate the stomach.  Thus it unloads naturally for relief.  Now we wish to treat of another vessel similar in size, similar in all its actions, which receives nourishment for a being, which nourishment is contained in the blood, and conveyed from the channels commonly known as uterine arteries.  To all intents and purposes this nourishment is taken there to sustain animal life, after having constructed the machinery then it appropriates the blood to the growth and existence of a human being.  One is the womb, the other the stomach.  The placenta in the womb is provided with all the machinery necessary to the preparation of blood, such as is used for all purposes in forming and developing a child.  Which is the stomach?  Which is the womb? and what is the difference?  Both receive and distribute nourishment to sustain animal life.  Both get sick, both vomit when irritated and discharge their loading by the natural law of "throw up" and "throw down." Now note the difference and govern yourselves accordingly.  One is midwifery, or treatment of the lower stomach during gestation and delivery.  The other is the upper stomach that takes coarser material and refines the unrefined substances, keeps the outer man in form and being; the other contains the inner man or child, and by the law of ejection, when it becomes an irritant, it is thrown out by the nerves that govern the muscles of ejection.


    To illustrate: I will say, just as long as digestion and assimilation keep in harmony and the mother generates good blood in abundance, the child grows, and by nature the womb is willing to let the work of building the body of the child go on indefinitely; but nature has placed all the functions of animal life under laws that are absolute and must be obeyed.  We by reason are asked to note the similarity of the stomach and the womb, as both receive and pass nutriment to a body for assimilation and growth.  When a stomach gets overloaded, sickness begins, as digestion and assimilation has stopped, then the decaying matter is taken up by the terminal nerves, and conveyed to the solar plexus, and causes the nerves of ejection, to throw the dying matter out of the stomach which is above.  Try your reason and see the stomach below sicken and unload its
burden.  Is this sickness natural and wisely caused?  If this is not the philosophy of mid-wifery what is?  As soon as a being takes possession of its room, the commissary of supplies begins to furnish rations for that being, who has to build for itself a dwelling place.  The house must be built strictly to the letter of the specifiction.  Much bone and flesh must be put into the house of life, and some of all elements known to the chemist, must be used and wisely blended to give strength; also all material to be used in the house must be exact in form and given strength equal to all forces, that may be necessary to execute the hard and continued labors of the machinery that may be used in all transactions and motions of mind and body.  Now we must go to the manufacturing chief, and have him through the quarter-master deliver and keep a full supply of all kinds of material for the work, and when the engine is done, put it on an inclined plane and cut the stay-chains and let it run out of the shop.  Be careful and not let the engine deface nor tear the door as it comes out.  A question is asked: On what road does the quartermaster send the supplies?  As there is but one system over which an engine can bring supplies, we will call that road the uterine system of arteries.  The mechanic reports that he will open the door of this great shop of manufacturing, and let it roll out the engine by the power and methods prepared to run out finished work.  First you see a door open because the lock is taken off by a key that opens all mysteries; and the great ropes that have been far inferior to the force of resistance, that has held the door shut, are all sufficient in power.  By getting sick, muscles become convulsed to rigidity of great strength with force enough to push the new engine of life out into open space easily, by nature's team that never fails to obey orders to deliver all goods intrusted to its care.


    A student of midwifery can only learn a few general principles, before he gets into the field of experience.  Actual contact with labor teaches him that much that he has read and had told to him by professors of midwifery in the lectures, is of but little use to him at the bedside.  What he needs to know is, what he will have to do after he gets there.  He must know the form and size of the bones of a woman, how large a hole the three bones of the pelvis make, for the reason that the child's head will soon come through that hole.  He must know a normal head cannot come through a pelvis that has been crushed in so much as to bring the pubis within one and one-half to two and one-half inches of the sacrum.  He must examine and know, and do this soon after he is called, for the reason, that he will have to use intruments in such deformities, and may wish the counsel of an older and more experienced doctor.  And this precaution will give him time to be ready for any emergency.

    But more than ninety per cent of all cases are of a very simple nature.  The mother is warned by pains in back and womb, coming and repeating at intervals of one-half hour to less time.  When by the finger the doctor can tell the mouth of the womb has opened to the size of a quarter or half dollar, he then may know that labor will soon start in good earnest, and at this time it is well to call for a twine, cut two strings about a foot long, to tie around the navel cord.


    The first duty of the obstetrician is to carefully examine the bones of the pelvis and spine of the mother, to ascertain if they are normal in shape and position.  If there is any doubt about the spine and pelvis being in good condition for the passage of the head, through the bones, and you find pelvic deformity enough to prohibit the passage of the head, notify the parties of the danger in the case at once, and that you do not wish to take the responsibility alone, as it may require instruments to deliver the child, as there is danger of death to the child and mother also, but less danger to the mother than to the child.  Now you have done that which is a safeguard against all trouble following criminal ignorance.

    I will give you a condensed rule of procedure in all normal cases of obstetrics.  With index finger, examine os uteri; if closed and only backache, have patient turn on right side, and press hand on abdomen above pelvis, and gently press or lift belly up just enough to allow blood to pass down and up pelvis and limbs.  Relax all nerves of the pelvis at pubes.


    Caution: Wait a few hours; examine os again.  If still closed and no periodical pains are present, you are safe to leave case in the hands of the nurse, instructed to send for you if regular pains return at intervals.  On your return, explore os again, if found to open as large as a dime, you are by this notified that labor has begun its work of delivery.  You now place patient on her back, propped to an easy angle of near thirty degrees, with rubber blanket in place.  After you find os, dilated to nearly the size of a dollar, then relax nerves at pubes.  Soon you will find in mouth of womb an egg-shaped pouch of water, which you must not press with fingers till very late in labor, for fear of stopping labor for perhaps many hours.  Remember the head can and does turn in pelvis to suit the easiest passage through the bones, while in the fluids of the amniotic sack.  Now, as you know why not to rupture sack and spill fluids, you are prepared to proceed to other duties, which are to prevent rupture of perineum.  Place the left hand on the belly, about two inches above symphesis and push the soft parts down with the left hand; support the, perineum with the right hand until head passes over.  This is necessary to prevent rupture of perineum.


    If you follow this law of nature, lasceration may occur in one out of a thousand cases, and you will be to blame for that one, and may be censured for criminal ignorance.  Now you have conducted head safely through pelvis and vagina to the world.  You will find pains stop right short off for about a minute, which is the time to learn whether the navel cord is wrapped around the child's neck.


    If it is found all around the neck once or more, you must slip finger down neck and loosen cord to let blood pass through the cord till next pain comes, in order to ward off asphyxia of child.

    When pain comes, gently pull child's head down toward the bed.  There is no danger of hurting the perineum now since the head has passed the soft parts.  At this time the danger is suffocation of child.  Never draw child too far away from mother's birth place by force, as you may tear navel string from the child and cause it to bleed to death.  If you value the life of the child, then you must be careful not to place the navel end of the string in any danger of being torn off.  Now you have made a good job for both mother and child so far.  The child is in the world; and you want to show the mother a living baby for her labor and suffering of the past nine months.  The baby is born and the mother is not torn, but the baby has not yet cried.  Turn it on its
side, face down, run your finger in its mouth and draw out all fluids, thick or thin, to let the breath pass to the lungs.  Then blow cold breath on its face and breast to cause its lungs to act.


    Baby cries, all is safe now.  Baby is born safely and cries nicely, but still has cord fastened to afterbirth.  It has no further use for cord, as life does not depend upon blood from the afterbirth any longer.  Take the cord about three inches from the child's belly, between thumb and finger, we and strip towards child to push bowels out of the cord if there should be any in it, as a safeguard for bowels, then tie a strong string around cord, first three inches from child's belly, second, four inches; take the cord in your hand and look what you are doing.  If baby's hand should fall back to cord, you might cut off one or two fingers, or wound the hand or arm very seriously.  Cut cord between the two ties just made on navel string.  Look out for your scissors; pass the child over to the nurse to be washed and dressed, while you deliver the after-birth from pelvis or womb.


    When the child's shirt is on, cut a hole the size of your thumb in a doubled piece of cloth, five inches long by four wide, put the hole two inches from one end, and run the cord through the hole.  Lay the cloth across the child's belly, then fold the cloth lengthwise over the cord, which must lie across the child so it will not stretch cord by handling or straightening child out.  Now you are ready to finish the delivery of the afterbirth.  You have a plug of soft and tender flesh to get out of the womb and vagina.


    As the afterbirth has been grown tight to the womb during all the days of mother's pregnancy, and furnished all the blood to build and keep the child alive in the womb for nine months, it has done, all it can do for the child, and is now ready to leave the womb.

    You are there to assist it to get out of the place it has occupied so long.  You must begin first to rotate or roll the placenta first one way and then another, up, down and across the vagina, by gently pulling the cord.  Look out or you will pull the cord loose from the placenta; then you will have made your first blunder, -- no cord to pull placenta with, and the mother bleeding and faint from loss of blood.  Now is the time and place to save life.  Pass your hand forward into the soft parts to get your fingers behind the placenta; now give a rolling pull and bring it out with the hand.  You will find it an easy matter to get your hand into the vagina and womb after the birth of the child.  Get all the placenta out, then take a wad of cloth or rags as large as the child's head, and press it under the cross bone of the pelvis; push the cloth under and up, so as to completely plug the pelvis.  Now pull the hair gently over the symphesis, which will cause the womb to contract by irritation.


    All is now done but to provide for the mother's comfort, which is your next duty.  Draw her chemise down her back and legs until it is straight, then with safety pins, pin the chemise on inner side of thighs so that the chemise will go around both thighs separately.  Now you have the shirt fast to keep it from sliding upwards, and you are ready to make a band of the chemise to support the womb and abdomen.  Bring the chemise tightly together for two or three inches above the pelvis to form a band.  Previous to pinning, draw the lump (womb) you feel above symphesis, up, then pin, and the belt, you have made of the chemise will support the womb.  All is safe now, but you must not leave for two hours.  You may have delivered a feeble, woman, who
may flood to death after delivery of the child, if you do not leave her safe.  I have in mind one case who flooded all of two quarts at a single dash.  The first symptom was a pain in the head.


    I know of only two causes that would produce hemorrhage or bleeding after the child is delivered.  One is when the afterbirth (placenta), is separated from its attachment to the womb and still retained in the womb or vagina, or when a part is separated and still lies in the womb, that retention of placenta prevents the natural circular contraction of the womb, to close on itself and retain it, with force enough to prevent the further discharge of blood, would give a chance for a continued stream.  Then should the patient bleed profusely after the placenta has been removed, another cause would be in pulling away the afterbirth, as part of the upper portion of the womb may be pulled to an inverted position, which would be like a hat if you press the top down with the hand.  Then there is a chance for leakage because of this unnatural fold made in the womb.


    My method of relief is to insert the hand, and with back of fingers smooth out all folds.  Before you draw the right hand from the womb place left hand on abdomen, catch the womb between the thumb and finger and withdraw hand.  With the left hand pull the hair above symphesis or scratch the flesh just above across the region of the symphesis, just enough to make an irritation.  After the hand is out of vagina pass a small bundle of cloths as far under the symphesis as would be necessary to hold everything up, then fasten chemise; beginning at symphesis draw it tight for about two inches above symphesis and with strong pins fasten it.  Be sure you keep garment tight by pulling down between limbs.  The coarser the chemise the better, as you want to make a strong bandage at that point so as not to push the womb down into the pelvis.  If the patient's general health is fairly good let her tell you what she wants to eat, and go and get it.  Let her diet be after her usual custom.  You must remember she has just left the condition of a full abdomen.  Lace her up, fill her up and make her comfortable for six hours; then change her bedding.


    Remember this, if you stop digestion on her for some hours with teas, soups and shadows to eat, you carry her to the condition where it would be dangerous to give her a hearty meal.  My experience and custom for forty years has been crowned with good success.  I never lost a case in confinement.  I have universally told the cook to give her plenty to eat.


    If she begins to have fever followed by chilly sensations, with swelling of one or both breasts, I relieve that by laying her arm ranging with her body.  Let some one hold the arm down to the bed, then I place both of my hands under the arm, pull it up with considerable force till I get it as high or higher than normal position of the shoulder.  Then pull her shoulder straight out from the body a fairly good pull, then pull the arm up on a straight line with the face, and be sure that you have let loose the axillary and mammary veins, nerve and artery, which have been cramped by pulling the arm down during delivery.

    No breast should become caked in the hands of an Osteopath.  Do not bother about the bowels for two or three days.  It may be necessary to use the catheter if the water should fail to pass off after inhibiting the pubic system.  This is straight midwifery and will guide you through at least in ninety per cent of the cases you will meet in normally formed women.

    Right here I wish to say one word: I think it is very wrong to teach, talk and spend so much time with pictures, cuts, talks and lectures, and hold up constantly to the view of the student, births coming from the worst imaginable deformities and call that a knowledge of midwifery.  It is normal midwifery you want to know and be well-skilled in. The abnormal formations are few and far between, and when a case of that kind does appear, it is your knowledge of the normal that guides you through the variations.  You will very likely never find two abnormals presenting the same form of bone.  As this is intended to only present to the student natural delivery I will let the subject drop with one word about the sore tongue of the mother.  Adjust her neck, relieve constrictor and all other muscles that would impede any blood vessel that should drain the mouth and tongue.  Remember this, that a horse that is always hunting bugars never finds a smooth road.