Philosophy of Osteopathy
Andrew Taylor Still, D.O.




    Let us halt at the origin of the splanchnic and take a look.  At this point we see the lower branches; sensation, motion, and nutrition, all slant above the diaphragm pointing to the solar plexus which sends off branches to pudic and sacral plexus of sensory system of nerves; just at the place to join the life giving ganglion of sacrum with orders from the brain to keep the process of blood forming in full motion all the time.  A question arises, how is this motion supplied and from where?  The answer is by the brain as nerve supply, heart as blood supply, all of which comes from above the diaphragm, to keep machinery in form and supplied with motion, that it may be able to generate chyle to send back to heart, to be formed into blood and thrown into arteries to build all parts as needed, and keep brain fed up to its normal supply of power generating needs.  We see above the diaphragm, the lungs, heart and brain, the three sources of blood and nerve supply.  All three are guarded by strong walls, that they may do their part in keeping up the life supply as far as blood and nerve force is required.  But as they generate no blood nor nerve material, they must take the place of manufactories and purchase material from a foreign land, to be able to have an abundance all the time.  We see nature has placed its manufacturies above a given line in the breast, and grows the crude material below said line.  Now as growth means motion and supply, we must combine in a friendly way, and conduct the force from above to the region below the septum or diaphragm, that we may use the powers as needed.  This wall must and does have openings to let blood and nerves penetrate with supply and force to do the work of manufacturing.


    After all this has been done and a twist, pressure or obstructing fold should appear from any cause, would we not have a cut off of motion to return chyle, sensation to supply vitality, and venous motion to carry off arterial supply that has been driven from heart above?  Have we not found the cause to stop all processes of life below diaphragm?  In short, are we not in a condition to soon be in a complete state of stagnation?  As soon as the arteries have filled the venous system, which is without sensation to return blood to the heart, then the heart can do nothing but wear out its energies trying to drive blood into a dead being below the diaphragm known as the venous system.  It is dead until sensation reaches the vein from the sacral and pudic plexus.


    Previous to all discoveries that have been made a demand for the usefulness of such discovery, is felt and talked of for years, centuries and cycles of time.  Its discovery is an open question and free to all, because in this fact all are interested.  That lack may be felt and spoken of by all agriculturists, and the inquiry directed to a better plow, a better sickle or mowing machine with which to reap standing grain.  The thinker reduces his thoughts to practice, and cuts the grain, leaving it in such condition that a raker is needed to bunch it previous to binding.

    His victory is heralded to the world as king of the harvest, and so accepted.  The discoverer says, "I wish 1 could bunch that grain." He begins to reason from the great principle of cause and effect, and sleeps not until he has added to his already made discovery, an addition so ingeniously constructed that it will drop the grain in bunches ready for the binder.  The discoverer stands by and sees in the form of a human being hands, arms and a band; he watches the motion then starts in to rustle with cause and effect again.  He thinks and sweats day and night, and by the genius of thought produces a machine to bind the grain.  By this time another suggestion arises, how to separate the wheat as the machine journeys in its cutting process.  To his
convictions nothing will solve this problem but mental action.  He thinks and dreams of cause and effect.  His mind seems to forget all the words of his mother tongue but cause and effect.  He talks and preaches cause and effect in so many places that his associates begin to think he is mentally failing, and will soon be a subject for the asylum.  He becomes disgusted with their lack of appreciation, seeks seclusion and formulates the desired addition and threshes the grain ready for the bag.  He has solved the question and proved to his neighbors that the asylum was built for them, not for him.  With cause and effect which is ever before the philosopher's eye, he ploughs the ocean regardless of the furious waves, he dreads not the storms on the seas, because he has so constructed a vessel with a resistance superior to the force of the lashing waves of the ocean, and the world scores him another victory.  He opens his mouth and says by the law of cause and effect I will talk to my mother who is hundreds of miles away.  He disturbs her rest by the rattling of a little electric bell in her room.  Tremblingly the aged mother approaches the telephone and asks "Who is there?" And is answered, "It is me, Jimmie," and asks, "To whom am I talking?" She says "Mrs.  Sarah Murphy." He says, "God bless you, mother; I am at Galveston, Texas, and you are in Boston, Mass."  "She laughs and cries with joy; he hears every emotion of her trembling voice.  She says to him, "You have succeeded at last.  I have never doubted your final success, notwithstanding the neighbors have annoyed me almost to death, telling me you would land in the asylum, because no man could talk so as to be heard 1000 miles away; his lungs were too weak, and his tongue too short."

    Now, friends, I have given you a long introductory foundation previous to giving you the cause of disease, with the philosophy that I have given upon cause and effect.  I think it absolutely clear and the effect so unerring in its results, that with Pythagoras I can say "Eureka."


    To know we have found a general cause for disease, one that will stand the heights and depths of direct and cross examinations, as given by the high courts of cool headed reason, has been the mental effort of all doctors and healers, since time began its record.  They have had to treat disease as best they could, by such methods as customs had established as the best known for such diseases; notwithstanding their failures and the great mortality under such a system of treatment.  They have not felt justified to go beyond the rules of symptomatology as adopted by their schools, with diagnosis, prognosis and treatment.  Should they digress from the rules of the etiquette of their alma maters they would lose the brotherly love and support of the medical association to which they belong, under the belief that, "A bad name is as bad as death to a dog."


    He says that in union there is safety, and resolves to stick to, live and do as his school has disciplined all its pupils, with this command, "The day thou eatest thereof, thou shalt surely die.  Stick to the brotherhood."


    The explorer for truth must first declare his independence of all obligations or brotherhoods of any kind whatsoever.  He must be free to think and reason.  He must establish his observatory upon hills of his own; he must establish them above the imaginary high planes of rulers, kings, professors of schools of all kinds and denominations.  He must be the Czar of his own mental empire, unincumbered with anything that will annoy while he makes his observations.  I believe the reasons are so plain, so easily comprehended, the facts in its support so brilliant, that I will offer the same, though I be slaughtered on the altar of bigotry and intolerance.  This philosophy is not intended for minds not thoroughly well posted by dissection and otherwise of the whole human anatomy.  You must know its physiological laboratories and workings with the brain as the battery, the lungs as the source or machine that renovates the blood from all impurities, and the heart as the living engine or quarter-master, whose duty is to supply the commissaries with blood and other fluids to all divisions and subdivisions of the human body, which is busily engaged producing material suited to the production of bone and muscle, and all other substances necessary to keep the machinery of life in full force and action.

    Without this knowledge on the part of the reader, the words of this philosophy will fall as blanks before reaching his magazine of reason.  Thus this is addressed to the independent man or woman that can, will and does reason.


    At this point we will introduce the diaphragm, which separates the heart, lungs and brain from the organs of life that are limited to the abdomen and pelvis.  A question arises at this point; what has the diaphragm to do with good or bad health?  At this time we will analyze the diaphragm; we will examine its construction, and its uses; we will examine its openings through which blood passes both above and below.  We will examine the opening through which food passes to stomach.  We will carefully examine the passage or opening for nerve supply to the abdomen below, to run this great system of chemistry, which is producing the various kinds of substances necessary to the hard and soft parts of the body.  We must know the nerve supply of the lymphatics, womb, liver, kidneys, pancreas, the generative organs, what they are, what they do, and what are demanded of them, before we are able to feed our own minds from the cup that contains the essence of reason as expressed from the tree of life.


    The diaphragm surely gives much food to the one who would search for the great whys of disease as reported causes seem to be far back in the fogs of mystery.  It may help us to arrive at some facts if we take each organ and division and make a full acquaintance of all its parts and uses before we combine it with others.


    In all ages, the Doctor has for lack of knowledge of the true cause of diseases, combatted effects with his remedies.  He treats pain with remedies to deaden pain; congestion to wash out overplus of blood that has been carried to parts or organs of the body by arteries of blood and channels of secretions and not taken up and passed out and off by the excretories.  He sees the abnormal size and leaves the hunting of the cause that has given growth to such proportions, and begins to seek rest and ease for his patient.  Then he treats to reduce by medicine to carry the waste fluids to bowels, bladder and skin, with tonics to give strength and stimulants to increase the action of the heart in order to force local deposits to the general excretory system.  At this time let the Osteopathic Doctor take a close hunt for any fold in muscles of the system that would cause a cut-off of
the normal supply of blood or suspend the action of nerves whose office is to give power and action to the excretory system sufficient to keep the dead matter carried off as fast as it accumulates.  Let us stop and acquaint ourselves with the true condition of the diaphragm.  It must be normal in place, as it is so situated that it will admit of no abnormality.  It must be kept stretched, just as Nature arranged that it should, like a drum-head.  It is attached all around to the chest, though it crosses five or six ribs on its descent from the seventh rib to the sternum at the lower. point and down to fourth lumbar vertebra.  It is a continuous slanting floor, above bowels and abdominal organs, and below heart and lungs.  It must, by all reason, be kept
normal in tightness at all places, without a fold or wrinkle, that could press the aorta, nerves, Esophagus, or anything that contributes to the supply or circulation of any vital substance.  Now can there be any move in spine or ribs that would or could change the normal shape of the diaphragm?  If so, where and why?


    The diaphragm is possibly the least understood as being the cause of more diseases, when its supports are not all in line and normal position, than any other part of the body.  It has many openings through which nerves, blood and food pass while going from chest to all parts below.  It begins at the lower end of the breast-bone and crosses to ribs back and down, in a slanting direction to the third or fourth lumbar vertebra.  Like an apron, it holds all that is above it up, such as heart and lungs, and is the fence that divides the organs of the abdomen from the chest.  Below it are the stomach, bowels, liver, spleen, kidneys, pancreas, womb, bladder; also the great system of lymphatics of the whole blood and nerve supply of the organs and systems of nutrition and life supply.  All parts of the body have a direct or indirect connection with this great separating muscle.  It assists in breathing, in all animals, when normal, and when prolapsed by the falling in and down of any of the five or six ribs by which it is supported in place, then we suffer from the effects of suspended normal arterial supply, and venous stagnation below diaphragm.  The aorta meets resistance as it goes down with blood to nourish, and the vein as it goes back with impurities contained in venous blood, also meets an obstruction at the diaphragm, as it returns to the heart through the vena cava, because of the packing of a fallen diaphragm on and about the blood vessels that must not be obstructed.  Thus heart trouble, lung disease, brain, liver, womb, tumors of the abdomen and through the list of effects can be traced to the diaphragm as the cause.

    I am strongly impressed that the diaphragm has much to do in keeping all the machinery and organs of life in a healthy condition, and will try and give some of the reasons why, as I now understand them.  First, it is found to be wisely located just below the heart and lungs; one being the engine of the blood, and the other is the engine of the air.  This strong wall holds all substances or other bodies away from any chance to press on either engine, while performing their parts in the economy of life.  Each engine has a sacred duty to perform under the penal law of death to itself and all other divisions of the whole being, man.  If it should neglect its work of which it is a vital part, should we take down this wall and allow the liver, stomach and spleen to occupy any of the places allotted to these engines of life, a confusion would surely be the result; ability of the heart to force blood to the lungs would be overcome and cause trouble.


    Suppose we take a few diseases and submit them to the crucial ordeal of reason, and see if we do, or can find any one of the climatic fevers that appear with its full list of symptoms and have no assistance from an irritated diaphragm.  For example take a case of common bilious fever of North America.  It generally begins with a tired and sore feeling of limbs and muscles, pain in spine, head, and lumbar region.  At this point of our inquiry we are left in an open sea of mystery and conjecture as to cause.  One says, "malaria," and goes no farther, gives a name and stops.  If you ask for the cause of such torturous pain in head and back, with fever and vomiting, he will tell you that the very best authorities agree that the cause is malaria, with its peculiar diagnostic tendency to affect the brain, spine and stomach, and administers quinine and leaves, thinking he has said and done all.

    Reason would lead seekers for cause of the pain above located to remember that all blood passes first as chyme up to heart and lungs, directly through the diaphragm, conducted through the thoracic duct, first to heart, thence to lungs, at the same time rivers of blood are pouring into the heart from all of the system.  Much of it very impure, from diseased or stale blood.  Much of the chyle is dead before it enters the great thoracic duct and goes to the lungs without enough pure blood to sustain life.  Then disease appears.

    As a cut-off the diaphragm, when dropped front and down, and across the aorta and vena cava by a lowering of the ribs, on both sides of the spine; it would be a complete pressure over coelic axis, with liver supply, renal, pelvic, to a complete abdominal stoppage.  Then we have over-due blood for other parts to send off dead corpuscles by asphyxia, with no hope that it can sustain life and health of the parts for which it was designed.  Thus we know that nature would not be true to its own laws, if it would do good work with bad material.


    Why not reason on the broad scale of known fact, and give the "why" he or she has complete prostration when all systems are wholly cut off from a chance to move and execute such duties as nature has allotted to them.  Motor nerves must drive all substances to, and sensation must judge the supply and demand.  Nutrition must be in action all the time and keep all parts well supplied or a failure is sure to appear.  We must ever remember the demands of nature on the lymphatics, liver and kidneys, that nerves work all the time or a confusion for lack in their duties will mark a cripple in some function of. life over which they preside.


    At this time we see by all systems of reason that no delay in passage of food or blood, can be tolerated at the diaphragm, because any irritation is bound to cause muscular contraction and impede the natural flow of blood, first through the abdominal aorta, and even to a temporary, partial or complete stoppage of arterial supply to the abdomen.  Or the vena cava may be so pressed as to completely stop the return of venous blood from the stomach, kidneys, bowels and all other organs, such as the lymphatics, pancreas, fascia, cellular membranes, nerve centers, ganglionic and all systems of supply of organs of life found in the abdomen.  Thus by pressure, stricture or contraction to the passage of blood can be stopped, either above or below the diaphragm, and be the cause of blood being detained long enough to die from asphyxia, and be left in the body of all organs below the diaphragm.


    Thus you see a cause for Bright's disease of kidneys, disease of womb, ovaries, jaundice, dysentery, leucorrhoea, painful monthlies, spasms, dyspepsia, and on through the whole list of diseases now booked as "causes unknown," and treated by the rule of "cut and try." We do know that all blood for use of the whole system below the twelfth dorsal vertebra does pass through the diaphragm, and all nerve supply, also passes through the diaphragm and spinal column for limb and life.  This being a known fact, we have only to use reason to know that an unhealthy condition of the diaphragm is bound to be followed by many diseases.  A list of questions arise at this point with the inquirers that must and can be answered every time by reason only.  The diaphragm is a musculo-fibrinous organ and depends for blood and nerve supply above its own location, and that supply must be given freely and pure for nerve and blood or we will have a diseased organ to start with; then we may find a universal atrophy or oedema, which would, besides its own deformity not be able to rise and fall, to assist the lungs to mix air with blood to purify venous blood, as it is carried to the lungs to throw off impurities and take on oxygen previous to returning to the heart, to be sent off as nourishment for the system.  It is only in keeping with reason, that without a healthy diaphragm both in its form and action, disease is bound to be the result.  A question from our side of the argument is: How can a carpenter build a good. house out of rotten, twisted or warped wood?  If he can, then we can hope to be healthy with diseased blood, but if we must have good material in building, then we should form our thoughts to suit the heads of inspectors, and inspect the passage of blood through the diaphragm, pleury, pericardium and the fascia, superficial, deep and universal.  Disease is just as liable to begin its work in the fascia and epithelium as any other place.  Thus the necessity of pure blood and healthy fascia, because all functions are equally responsible for good and bad results.


    At a given period of time the Lord said, "Let us make man." After He had made him He examined him, and pronounced him good, and not only good, but very good.  Did He know what good was?  Had He the skill to be a competent judge?  If He was perfectly competent to judge skilled arts His approval of the work when done was the fiat of mental competency backed by perfection.  Since that architect and skilled mechanic has finished man and given him dominion over the fowls of the air, the beast of the field and fishes of the sea, hasn't that person, being or superstructure proven to us that God, the creator of all things, has armed him with strength, with the mind and machinery to direct and execute?  This being demonstrated and leaving us without a doubt as to its perfection, are we not admonished by all that is good and great to enter upon a minute examination
of all the parts belonging to this being; acquaint ourselves with their uses and all the designs for which the whole being was created.  If we are honestly interested with the acquaintance of the forms and uses of the parts in detail by close and thorough examination of the material, its form and object of its form, from whence this substance is obtained; how it is produced and sustained through life in kind and form.  How it is moved, where it gets its power, and for what object does it move?  A demand for a crucial examination of the skull, the heart, lungs, of the chest, the stomach, liver and other organs of the abdomen is made.  The septum of the brain, the pericardium of the chest-the diaphragm of the abdomen which is a dividing septum between the abdomen and chest.  In this examination we must know the reasons why any organs, vessel or any other substance is located at a given place.  We must run with all the rivers of blood that travel through the system.


    We must start our exploring boat with the aorta, and float with this vital current; see the captain as he unloads supplies for the diaphragm and all that is under it.  We must follow him and see what branch of this river will lead to a little or great toe, or to the terminals of the whole foot.  We must pass through the waters of the dead sea by the way of the vena cava, and observe the boats loaded with exhausted and worn out blood, as it is poured in and channeled back to the heart, with all below the diaphragm.  Carefully watch the emptying of the vena azygos major and minor, with the veins of the arms and head all being poured in from little or great rivers to the vena innominate on their way to the great hospital of life and nourishment; whose quarter-master is the heart; whose finishing mechanic is the lung.  Having acquainted ourselves with the forms and locations of
this great personality we are ready at this time after examination, and found worthy and well qualified to enter into a higher class in which we can obtain an acquaintance with the physiological workings separately and conjoined of the whole being.  At this place we become acquainted with the hows and whys of the production of blood, bone and all elements found in them, necessary to sustain sensation, motion, nutrition, voluntary and involuntary action of the nerve system.  The hows and whys of the lymphatics, the life sustaining powers of the brain, heart, lungs, and all the abdominal system, with their various actions and uses, from the lowest cellular membrane to the highest organ of the body.


    When we consult the form of the cross-bar that divides the body in two conjoined divisions and reason on its use, we arrive at the fact that the heart and lungs must have ample space or room to suit their actions while performing their functions.  At this time a question comes up: What effect would follow the removal of the fence between heart, lungs and brain, above that dividing muscle, and the machinery that is situated below said cross-bar?  We see at a glance that we would meet failure to the extent of the infringement on demanded room for normal work of heart to deliver below lungs to prepare blood, and the brain to pass nerve power to either engine above, and all organs below the diaphragm.


    The life of the living tree is with the bark and superficial fascia which lies between the bark of the body of the tree, its periostium.  The remainder of the tree takes the position or place of secreting.  Its excretory system is first upwards from the surface of the ground, and washes out frozen impurities in the spring, after which it secretes and conveys to the ground through the trunk of the tree to the roots which is like unto the placenta attached to mother earth, qualifying all substances of constructing fiber and leaf, of that part of the tree above the ground.  Each year produces a new tree which is seen and known by circular rings called annular growths.  That growth which was completed last year is now a stale being of the past and has no vital action of itself.  But like all stale beings its process is a life of another order, and dependent upon the fascia for its life and cellular action which lies under the bark, for its own existence as a living tree.  It can only act as a chemical laboratory and furnish crude material which is taken up by the superficial fascia and conveyed up to the lungs, and exchanges dead for living matter, to receive and return to all parts of the tree, keeping up vital formation.  With frost its vital process ceases through the winter season until mother earth stimulates the placenta, and starts the growth of a new being, which is developed and placed in form on the old trunk.  Thus you see everything of animal growth as we would call them, is a new being, and becomes a part of the next being or growth formed.


    Should this form of vitality cease with the tree another principle which we call stale life takes possession and constructs another tree which is just the reverse of the living tree, and builds a tree after its own power of formulation from the dead matter, to which it imparts a principle of stale life, which life produces mushrooms, frogstools and other peculiar forms of stale beings, from this form of growth.

    Thus we are prepared to reason that blood when ligated and retained in that condition of dead corpuscles, and no longer able to support animal life, can form a zoophyte and all the forms peculiar to the great law of association, as tumefactions of the lymphatics, pancreas, liver, kidneys, uterus, with all the glandular system, be they lymphatics, cellular, ganglia or any other parts of the body susceptible of such growths, below the diaphragm.  Thus we can account for tubercles of the abdomen and all organs therein found.


    This same law is equally applicable to the heart, lungs, the brain, tissues, glands, fascia and all substances capable of receiving without the ability to excrete stale substances.

    As oedema marks the first tardiness of fluids we have the beginning step which will lead from miliary tuberculosis to the largest known forms of tubercles, which is the effect of the active principles of stale life or the life of dead matter.


    At this point we will draw the attention of the reader to the fact that the diaphragm can contract and supend the passage of blood and produce all the stagnant changes from start to completed deadly tubercle.  Also the cancer, the wen, glandular thickening of neck, face, scalp, fascia and all substances found above the diaphragm.  In this stale life we have a compass that will lead us as explorers from the North star, to the South pole, the rising sun of reason, and the evening dews of eternity.  This diaphragm says: "By me you live and by me you die.  I hold in my hand the powers of life and death, acquaint now thyself with me and be at ease."


    The truth of the presentation of facts should be the principle object of every person who takes his pen with a view to give the reasons why certain witnesses' testimony are indispensable to establish supposable or known truths.  This being the case I have summoned before this court of inquiry an important witness.  He has now taken the oath to tell the truth, the whole truth and nothing but the truth, of the case before this court.  His name is the Great Omentum.  Mr. Omentum, state if you know of any reason why or how by irritation from a misplacement of your body or any of its attachments to or about the diaphragm, the spine, stomach or other places that could cause irritation and thickening by congestion of your own body to such degree as to impede the flow of arterial or venous blood, over whose position you occupy much space from the diaphragm downward?  State what effect a falling down of the eleventh and twelfth ribs on both sides of the spine with their cartilaginous points turned inward and down; if they should draw the diaphragm down and across your body?  What would be the effect on circulation of the blood, and other fluids on the kidneys and other organs of the abdomen and pelvis?  Would it not be the foundation for destructive congestion, and abnormal growth?  State if you know if any such ligation would cause swelling by retention of blood in the spleen, liver, kidneys or other organs of the abdomen and pelvis?  Would it be reasonable to suppose that you could perform your functions in office with any irritating condition caused by prolapses of diaphragm?  Would not an irritation of your attachment to the diaphragm, spine or stomach be great enough to impede the blood on its passage through the aorta to the abdomen, or impede the flow of blood back and through the diaphragm?  If so state how and why?