Philosophy of Osteopathy
Andrew Taylor Still, D.O.
DIVISIONS OF THE BODY.
After many long years, treating and trying to teach
the student of Osteopathy how to hunt for and find the local causes of
diseases, not contagious, or infectious, I have succeeded in planning and
suggesting a method, which I am sure the doctor can easily follow, and
find any diversion from the normal, that would interfere with the nerves,
veins, and arteries, of any organ or limb of the body. I have formulated
a simple mental diagram that divides the body into three parts, chest,
upper and lower limbs. The first division takes in head, neck, chest,
abdomen and pelvis. The second division takes in head, neck, lower
and upper arm and hand. The third division takes in foot, leg, thigh,
pelvis and lumbar vertebra. I make this division for the purpose
of holding the explorer to the limits of all supplies. In the ellipse
of the chest is found all vital supplies; then from that
center of life we have two branches only, one of the arm, and one of
the lower limb. In each division we have five points of exploration.
[*Explore: (1) To seek for or after; to strive to attain by search; to
look wisely and carefully for; to search through or into; to penetrate
or range over for discovery; to examine through as, to explore new countries
or seas; to explore the depths of science; "hidden frauds (to) explore."
SEARCHING FOR THE CAUSE.
To illustrate, we will take the lower limb, whether
there is lameness, soreness, gouty, rheumatic, neuralgic, swollen, shrunken,
feverish, cold, smooth and glassy, sores, ulcers, erysipelas, milk-leg,
varicose veins, or any defect that the patient may complain of, who is
the only reliable book or being of symptomatology. For convenience
we will divide that lower limb into five parts, the foot, leg, thigh, pelvis
and lumbar region. The patient (symptomatologist) tells us he has
a pain in front, center and under part of foot. Now the doctor or
bird dog, can find quails of reason in but one field that would lead him
to the cause. As this field is divided into five parts and the hunter
has carefully searched four divisions, he will find the cause or causes
in the fifth and none other. If a dislocated bone is not found in
the foot after ascertaining that there has been no crushing by falling
bodies, horses feet, stepping on glass, nails and other things that would
penetrate the foot, and irritate by being broken off, closed and remaining
in the flesh; we will explore the leg for the quail, ascertain if the articulation
is normal at ankle and knee. If we find the bone is not broken, the
leg has no splinters of wood, nor injured flesh by bites from dogs or other
animals, nor any other substance that would injure the leg, we are prepared
to pass on and explore another place for pain in the foot. We go
on to division No. 3 or the thigh division, and ascertain if the thigh
is normal in all conditions, properly in socket, with all muscles,
ligaments and nerves unoppressed. There are but two more divisions
left for exploration, and they are the most important and interesting of
the five, the pelvis and lumbar, through which all the nerves of the limb
pass. We must stop at pelvis and observe carefully that there is
no twist of ligaments before going to lumbar, which is the last of the
five divisions. If we have found nothing in the previous four, and
have explored them as carefully as we should, we have but one brush heap
left, and that one contains the quail that we have been hunting for.
As the lumbar contains and conveys all nerve forces to the pelvis from
the brain and all divisions of the lower limbs, we will now examine the
articulations of that part of the spine, and in that we are very
certain to find the cause if we have made no mistake in our examination
in the preceding divisions of the limb. As we enter the exploration
of this part of the spine we must remember that we are about to deal with
the many divisions of the nerves of the cauda equina. The great question
before us, comes after this form. What would wound or bruise any
division of nerves that would lead by the way of the great or lesser sciatic,
to a bone in the front and under side of the foot? Jars, strains,
twists, and dislocations, must be carefully searched for. A partial
dislocation of one side of the spine would produce a twist which would
throw one muscle on to another and another, straining ligaments, producing
congestion and inflammation, or some irritation that would lead to a suspension
of the fluids necessary to the harmonious vitality of the foot, which is
the great and only cause by which the suffering is produced in a foreign
land, which we call a famine in the foot.
DUTY OF THE OSTEOPATHIC
This method of exploration is not directed by the
sound of the fog-horns of unreliable and unsatisfactory symptomatology.
Osteopathy has a method of its own, which is correct or it has no method
at all, and is guided by the surveyor's compass that will find all corners
as established by the orders of the government and surveyor's general.
Thus an Osteopath must find the true corners as set by the Divine Surveyor.
The general surveyor hands our plats and specifications to the division
general, with instructions to establish all lines and divisions, state,
county, township and sections, and mark each one by stones or otherwise,
so they cannot be lost; but are findable by any competent surveyor who
follows the field notes displayed in anatomy. Thus you would see
a successful Osteopath is guided by the field notes of nature to all corners,
his business is to know that every corner stone is in its place, standing
erect as nature designed and established it. If he tolerates any
variation of this stone or stones from the place or places that God the
grand surveyor of the universe has placed them, he will observe there is
an infringement and cause for inharmony and discord of the possessors of
the four quarter sections of land, for which this cornerstone was placed;
and his sworn duty is to bring this stone from any variation from the field
notes and establish it where it was first placed. Thus his ability
to find the true corners and adjust all stones will mark him as a successful
CLASSIFICATION AND DIVISION.
I will classify or divide man's body for convenience
of exploration for diseases into head and neck first; then head, neck and
chest; third, head, neck, chest and abdomen; then unite head, neck, chest,
abdomen and sacrum. I will take up a few diseases under each division
as they are located. By this method I think I can better show what
nerves should be more or less active.
A lesion may and does appear on a part or all of
the person which may appear as a growth or withering away of a limb in
all its muscles, nerves and blood supply. As in case of tumors on
scalp, loss of hair, eruptions of face, growth of tonsils, ulcers of one
or both ears, growths on outside and inside of eyes, a cause must precede
an effect in all cases. A pain in head is an effect; cause is older
than the effect and is absolute in all variations from normal conditions.
A tumor on the head and under the skin is an effect. It took matter
to give it size, it took power to deliver that substance, the fact that
a tumor was formed, shows that the power to build was present and did the
work of construction. Another power should have been the re to complete
at that location; that power is the offbearing of the dead matter after
the work of construction was complete.
If we think as men of reason should, we will count
five nerve powers. They must all be present to build a part, and
must answer promptly at roll call and work all the time. The names
of these master workmen are sensation, motion, nutrition, voluntary and
involuntary. All must answer at every roll call during life; none
can be granted a leave of absence for a moment. Suppose sensation
should leave a limb for a time, have we not a giving away of all cells
and glands? An undue filling up follows quickly because sensation
limits and tells when the supply is too great for the use of the builder's
purpose. Suppose the nerve power known as motion should fail for
a time, starvation would soon begin its deadly work for want of food.
again the nerves of nutrition should fail to apply the nourishing showers
we would surely die in sight of food. With the voluntary nerves we
move or stay at the will of he or she who wishes to give direction to the
motor powers, at any time a change by action is required. At this
time I will stop defining the several and varied uses of the five kinds
of nerves, and begin to account for growths and other variations, from
the healthy to the unhealthy conditions of man. The above named are
the five known powers of animal life, and to direct them wisely is the
work of the doctor of Osteopathy.
WITNESSES TO EXAMINE.
He has five witnesses to examine in all cases he
has under his care. He must give close attention to the source and
supply of healthy blood. If blood is too scant he must look to the
motor systems of blood making, that would surely invite his most careful
attention and study of the abdomen. He cannot expect blood to quietly
pass through the diaphragm if impeded by muscular constriction around aorta,
vena cava or thoracic duct. The diaphragm can and is often pulled
down on both vena cava and thoracic duct, obstructing blood and chyle from
returning to heart so much as to limit the chyle below the requirement
of healthy blood, or even suppress the nerve action of lymphatics to such
degree as to cause dropsy of the abdomen, or a stoppage of venous blood
by pressure on vena cava so long that venous blood would be in stages of
ferment when it enters the
heart for renovation, and when purified and returned the supply is
too small to sustain life to a normal standard.
Thus the importance of a careful attention to the
normal certainty of all the ribs to which the diaphragm is attached is
essential. The eleventh and twelfth ribs may, and do often get pushed
so far from their normal bearings, that they are often found turned in
a line with the spine, with cartilaginous ends down" near ilio-lumbar articulation.
When in such position they draw the diaphragm down heavily on vena cava
at about the fourth lumbar. 'Then you have cause for intermittent
pulse, as the heart finds no passage of blood through the prolapsed diaphragm
which is also stopping the vena cava and producing universal stagnation
of blood and other fluids in all organs and glands below the diaphragm.
Thus you have a beginning for abnormal growths of womb, kidneys and all
lymphatics of liver, kidneys, spleen, pancreas, and all tumors of abdomen.
CEREBRO SPINAL FLUID.
To satisfy the mind of a philosopher who is mentally
capable of asking for and knowing truth, when presented by nature, you
must come at him outside of the limits of conjecture, and address him with
self-evident truths only. When he takes up the philosophy of the
great subject of life, to him who does know truth, no substitute can to
any degree satisfy his mental demands. To the one who would deal
in conjectures or suppose so's, he will at once be placed in the proper
category to which he belongs, which is the driftwood that floats down the
dark river that is overshadowed by the nightmare of ignorance and superstition.
A seeker after truth, is a man of few words, and they are used by him only
by the truths or facts discovered. He has no patience with the unmeaning
records offered only to please the credulous, and by those of little or
no truth that appears during a long recitation of ungrounded statements.
From the above it is wisely seen that the object of these remarks is to
present a few truths for the purpose of stimulating the attention of the
listener. We will take man when formed. When we use the word
formed, we mean the whole building being complete. The brain with
all organs, nerves, vessels, and every minutia in form with all materials
found or used in life.
BODY IN PERFECT HEALTH.
We look at it in perfect health which means perfection
and harmony not in part, but of the whole body. So far we are only
filled with love, wonder and admiration. Another period of observation
appears to the philosopher. We find partial or universal discord
from the lowest observable to the highest in action and death. Then
the book of whys is opened and displays its leaves which calls out mental
labor even to the degree of agony, to know the cause or causes that produce
a failure of a limb in sensation, motion, nutrition, voluntary and involuntary
functional exhibits. His mind will explore the bona, the ligament,
the muscle, the fascia, the channels through which the blood travels from
heart to local destiny, with lymphatics and their contents, the nerves,
the blood vessels and every channel through or over which all substances
are transmitted all over the body, particularly the disabled limb in question.
It proceeds too and does obtain blood abundantly to and from the heart,
but the results obtained are not satisfactory, and another leaf is opened
of why no good results are obtained and where is the mystery, what quality
and element of force and vitality has been withheld? A thought strikes
him that the cerebro spinal fluid is the highest known element that is
contained in the human body, and unless the brain furnishes this fluid
in abundance a disabled condition of the body will remain. He who
is able to reason will see that this great river of life must be tapped
and the withering field irrigated at once, or the harvest of health be
As chemical compounds are not known to Osteopathy
to be used as remedies, then its use as a study for the student is only
to teach that elements in nature do combine and form other substances,
and without changes and unions, no teeth, bone, hair, or muscle could appear
in the body from the food eaten. Then chemistry is of great use as
a part of a thorough Osteopathic education, It gives us the reasons why
food is found in the body as bone, muscle and so on, to all kinds of flesh,
teeth and bones found in animal forms. Unless we know chemistry reasonably
well, we can not do away with much mental worry of what becomes of food
after eating. By chemistry the truths of physiology are firmly established
in the mind of the student of nature, that in man a chemistry of wonderful
powers does all the work of animal forms, and that in the laboratory of
nature's chemistry is the ruling power. By elementary chemistry we
are led to see the beauties of physiology only. Thus chemistry of
the elementary is one, and physiology is the witness that it is law in
man as in all nature. Thus in chemistry we comprehend some of the
laws of union in nature which we can use mentally with knowing confidence.
In chemistry we become acquainted with the law of cause and change in union,
which is a standard law sought by the student of Osteopathy.
Osteopathy believes that all parts of the human body
do work on chemical compounds, and from the general supply manufacture
for local wants; thus the liver builds for itself of the material that
is prepared in its own division laboratory. The same of heart and
brain. No disturbing or hindering causes will be tolerated to stay
if an Osteopath can find and remove it. We must reason that to withhold
the supply from a limb, to wither away would be natural. We suffer
from two causes. First, want of supply (hunger), and the burdens
of dead deposits along nerve centers, which five nerves by chemical changes
while in fermentation should regulate local or general divisions.
CORRECT METHOD OF REASONING.
In concluding this chapter we will confine our labor to
an effort to direct the beginner to a correct method of reasoning. When
he is brought face to face with the stern realities of the "sick room," the
Osteopath begins his inquiries and follows with his questions just far enough
to know what division of the body is in trouble. . If he finds an arm has lost
motion, he goes to arm to explore for cause. He can begin his hunt for
cause at hand, explore it carefully for wounds, strains or any lesion that could
injure nerves of the arm. If he finds no probable cause there, he should
explore bones for dislocations or strains of ligaments at elbow; if he finds
no defect there sufficient to locate cause in lower arm or hand, he has only
two more places left to inspect, the shoulder and neck with their articulations
of bone and muscles. If found normal at shoulder, then go to neck, out
of which go all or most of the nerves of the arm; if he finds no lesion or cause
equal to the trouble so far, then he has been careless in his search and should
go over and over from marrow to periostium of all bones of the neck and head,
because there are only five divisions in which a lesion can exist. Carefully
look, think, feel and know that the head of the humerus is true in the glenoid
cavity, clavicle true at both ends of its articulation, with sternum and acromion
processes. See that the biceps are in their grooves, and ribs on spine
are true at manubrium and spine, and that neck is true on first dorsal.
True in all joints of the neck, as the nerves of the arm come from the neck,
there must be no variation from normal, or trouble will appear from that cause.
As the neck has much to do with the arm, we should keep a living picture of
the forms of each bone, how and where it articulates with others, how it is
joined by ligaments, what blood vessels, nerves and muscles cross or range with
it lengthwise, because to overlook a small nerve and blood vessel you may fail
to remove a goitre, and all diseases of the head, face and neck.