Philosophy of Osteopathy
Andrew Taylor Still, D.O.




    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." -- WEBSTER.]


    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.


    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 Osteopath.


    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 the work
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.  Suppose
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.


    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.


    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.


    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 forever lost.


    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.


    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.