THE PRINCIPLES AND PRACTICE OF OSTEOPATHY.

Doctor, no medicine. We are machines made to live - organized expressly for that purpose. Such is our nature. Do not counteract the living principle. Leave it at liberty to defend itself, and it will do better than your drugs. - NAPOLEON.

Enough has been said about Osteopathy in the preceding chapters to give the reader a general idea as to its principles and their applications, and to differentiate it from all other systems. All knowledge pertaining to protoplasm, to the cell, to all varieties of tissues as to structure and function, to that all important element the life principle, etc., is involved in the fundamental principles enunciated, and is valuable to the osteopath. No attempt is made here to discuss these profound subjects in relation to Osteopathy. Only a few of the gross facts, as it were, are given.

DEFINITION.

It is doubtful whether or not a satisfactory definition of Osteopathy has ever been presented, and it may not yet be possible to make a formal specific statement as to what it is, because its limitations are not yet established. New fields are opening up daily, rich in possibilities for Osteopathy. There are but few intelligent osteopaths who have not found cases which they have successfully treated, but which were, at first, thought to be beyond the domain of osteopathic science and art. The three fundamental principles upon which Dr. Still founded Osteopathy, as shown in Chapter II, are the viewpoints from which every true osteopath surveys his work. They are fixed, and every conceivable case bears a certain relation to those points, which relation can be established with almost geometric precision.

Many attempts have been made to define Osteopathy. The late Dr. G. D. Hulett made the following statement on page 18 of his "Principles of Osteopathy:"

"All systems and sciences, whether related to healing or other aspect of human endeavor, are a result of growth. Growth presupposes a beginning less mature than the end. Hence it were presumption at the present time to attempt to set definite limits to the science of Osteopathy. Professor Ladd, of Yale, states a very important fact when he says that the proper definition of a science is one of the latest and most difficult achievements of that science. Recognizing the extreme youth of Osteopathy, we must be content with only a provisional setting of limitations in any attempt at a statement of its constituent elements. Admitting this to be the case, yet it is not deemed presumptuous to attempt to formulate in a concise manner the essential ideas in the form of what may be called a definition,"

On page 20, he suggests the following definition, which he elaborates in the chapters that follow:

"A system of therapeutics which, recognizing that the maintenance and restoration of normal function are alike dependent on a force inherent in protoplasm, and that function perverted beyond the limits of self-adjustment, is dependent on a condition of structure perverted beyond those limits, attempts the re-establishment of normal function by manipulative measures designed to render to the organism such aid as will enable it to overcome or adapt itself to the disturbed structure."

From many other proposed definitions the following are selected:

"Osteopathy is that system or science of healing that uses the natural resources of the body as curative agents. To this end means are used for the adjustment of structural conditions and relations that may have become abnormal, in order to insure the proper preparation and distribution of the fluids and forces of the body, and to secure the co-operation of functional activities, so as to promote harmony within the body mechauism." – J. Martin Littlejohn, Ph. D., M. D., D. O.

"Osteopathy is a system of medicine characterized by close adherence to the physiological axiom that perfect health depends on a perfect circulation and perfect nerve control in every tissue of the body. Its etiology emphasizes physical perversions of tissue relations as causes of disease. Its diagnosis is mainly dependent on the discovery of physical lesions by means of palpation. Its therapeutics comprehends (1) manipulation, including surgery, for purposes of readjusting tissue relations; (2) scientific dietetics; (3) personal and public hygiene." - Dain L. Tasker, D. O.

"Osteopathy is a system of treating disease without drugs by the use of the hands to adjust all parts of the human mechanism to perfect mechanical relations. It is that science which finds in disturbed mechanical relations of the anatomical parts of the body the causes of disease, and which is employed to cure disease by applying technical knowledge and high manual skill to the correction of all disturbed relations occurring in the mechanical arrangement of the body. It is a science founded upon the principles of anatomy and physiology.

"The word does not mean the treatment of the bones, nor of bone diseases. It was used as a name because the founder discovered the importance of disturbances in the bony framework of the body in causing disease. He studied the skeleton as the foundation of anatomy, upon which science he grounded his system. The meaning of the word applies not only to derangements of bony parts, but as well to disturbed relations of ligaments, tendons, blood-vessels, muscles, nerves, and of any body tissue." - Journal of Osteopathy.

"Osteopathy is that science or system of healing which, using every means of diagnosis, with a view to discovering not only the symptoms, but the causes of disease, seeks, by scientific manipulations of the human body, and other physical means, the correcting and removing of all abnormalities in the physical relations of the cells, tissues, and organs of the body, particularly the correcting of misplacements of organs or parts, the relaxing of contracted tissues, the removing of obstructions to the movements of fluids, the removing of interferences with the transmission of nerve impulses, the neutralizing, and removing of septic or foreign substances from the body; thereby restoring normal physiological processes, through the re-establishment of normal chemical and vital relations of the cells, tissues, and organs of the body, and resulting in restoration of health through the automatic stimulation and free operation of the inherent resistant and remedial forces within the body itself." C. M. T. Hulett, D. O.

The present writer ventures to suggest the following: Osteopathy is that school of medical practice whose distinctive method consists in (1) a physical examination to determine the condition of the mechanism and functions of all parts of the human body; (2) a specific manipulation to restore the normal mechanism and re-establish the normal functions; and, (3) the adoption of all hygienic measures conducive to the restoration and maintenance of health. This definition lays stress upon the following points: (1) Correct diagnosis based upon a physical examination. The osteopath must know the normal and recognize any departure from it as a possible factor in disease. There is not one fact known to the anatomist or physiologist that may not be of vital importance to the osteopath. Hence a correct diagnosis based upon such knowledge is necessary. (2) Removal of the cause of disease. A deranged mechanism must be corrected by mechanical means specifically applied, which is the most natural and only direct method of procedure. This work is not done by any of the methods of other schools. After the mechanism has been corrected little remains to lie done to restore function; but stimulation or inhibition of certain nerve centers may give temporary relief and aid nature. (3) Wholesome living, both in sickness and in health. All the means employed by other schools, including proper use of pure air, water, food, heat and cold, exercise and rest, cleanliness and surgery, and public hygiene and sanitary science, are the common heritage of all schools, and especially in line with osteopathic theory and practice.

It will be seen that practically all of the above definitions lay stress upon diagnosis in the sense of determining the first cause, the causa causans, and the relations between it and the secondary causes which often determine the most noticeable symptoms. This is a new principle in diagnosis, absolutely unlike any ever applied, except in occasional cases, by any other school of physicians. The definitions also provide for treatment in accordance with the diagnosis; hence the treatment suggested, except in occasional cases, is absolutely unlike any other that has ever been proposed.

It is not claimed that no one ever recognized an osteopathic principle or put it into practice before Dr. Still. History shows that many had grasped and applied principles essentially osteopathic long before Osteopathy, or anything like it, as a complete system ever entered the human mind. But in almost every case where the principle was seen, its application was never dreamed of. Men in all ages of the world had observed the force of steam, and many of them had seen it lift the kettle lid as often as Watt had; but only he thought of developing a machine which would enable him to use steam whenever power was wanted. So others knew much of anatomy, physiology, and pathology, but only Dr. Still thought of developing a system based upon that knowledge which would enable him to cope with all disease to which the human body is heir.

There is probably no one thing more noticeable in medical literature today than the almost universal failure to recognize the osteopathic idea that diseased conditions are, or ever may be, due to derangement of form and consequent disturbance of f unction. Any change of size, texture, structure, position, relation, is a change of form, an anatomical derangement, a lesion in the osteopathic sense, a possible cause for disease. A failure of any part of the body to do its duty is a disturbance of function, generally caused by some derangement of form. These are essential osteopathic ideas, but they are almost completely ignored by the drug schools of practice; hence the firm basis upon which Osteopathy rests in contrast with those systems based upon symptoms in both diagnosis and practice.

It is remarkable how little the statement of the fundamental ideas underlying Osteopathy have changed since first enunciated by Dr. Still in 1874. Yet not surprising, because he stated in plain language the truth, and truth then is the same now and will not change with the lapse of time. Dr. Still was the first to discover and announce a great truth, - a scientific fact, - the one upon which Osteopathy is built, and restatements of that truth must always mean the same thing, no more, no less, or the language in which it is stated is at fault. Chapter II contains a statement of those fundamental principles from which Osteopathy was evolved, and it is not necessary to repeat them here. A later presentation of the subject by Dr. Still appears in the Journal of Osteopathy for August, 1902. It serves as a definition and makes clear the whole theory and practice as viewed by the founder of the science:

"Disease is the result of physiological discord. With this fact established in the mind of the doctor of Osteopathy as a truth, he is warranted then in hunting the facts that would prove the position, that disease is the result of physiological discord in the functioning of the organs or parts of the physiological laboratory of life. Thus, as an explorer or seeker of the cause of disease he would naturally reason that the variations from the physiological perfection would naturally be found in disordered nerve connections to the degree of breaking or shutting off the normal circuit of nerve force from the brain to any part of the body that should be sustained by that force when normally conducted to any organ as the power necessary to its process of vital functioning. If this be true, there is nothing left in his procedure but to find the break or obstruction to the natural passage of blood or any other fluid that is necessary to a normal condition, which is health itself. Thus, the physician of any school of the healing art must know and act upon the philosophy that disease is the result of physiological discord. The cause of disease can be traced to bony variations from the base of the skull to the bottom of the feet, in the joints of the cervical, dorsal, and lumbar vertebrae, the articulations with the sacrum, also the arms and lower limbs. Strains by lifting, jolts, jars, falls, or anything that would cause any organ of the chest or abdomen to be moved from its normal to an abnormal position, is cause sufficient to confound the harmony of natural functioning of the whole viscera both above and below the diaphragm and be the cause of an unhealthy supply of nerve fluid and force to the limbs and the organs of the body both internal and external with the brain included. Thus, we have given about what we consider a short philosophical definition of what we mean by the word Osteopathy. We use the bones as fulcrums and levers to adjust from the abnormal to the normal that the harmonious functioning of the viscera of the whole body may show forth perfection, that condition which is known as good health."

DR. A. T. STILL THE FIRST OSTEOPATH.

All history points to the fact that the measures used by osteopaths were not used, except in a few isolated and generally obscure instances, under the name Osteopathy, massage, manual therapeutics, bone setting, or any other appellation, before they were employed by Dr. A. T. Still. Furthermore, it is not practiced in 1905, by any except graduates of regularly established schools of Osteopathy. It is true that certain manipulative methods resembling Osteopathy are used by some who have taken a correspondence course or read an illustrated book; but they generally fall so far short of the osteopathic idea that it is as unreasonable and as incorrect to speak of there as osteopaths as to call a layman who gives a drink of catnip tea to a sick child a doctor, or one who takes a little splinter out of a finger or binds up a wound, a surgeon. Yet in a number of cases the essential facts of Osteopathy have forced themselves to the attention of thoughtful men; but not one of them, till Dr. Still, had the grasp of intellect, the accuracy of knowledge, the persistency of purpose, the thirst for truth, the desire to relieve suffering, the love for man, and the confidence in God to enable him to formulate those facts, and through them establish a complete system of therapeutics.

OTHERS APPROACHED THE OSTEOPATHIC IDEA.

That others came near grasping the osteopathic idea is evidenced by the following taken from an article in the Osteopathic World for July, 1903, on "Osteopathic Forerunners," by A. A. Erz, of San Francisco. His translation is from "Der Arzt als Hausfreund" ("The Physician as a House Friend"), by Dr. S. Rupprict, fourth edition, published at Glogan, in 1861.

"When we consider that through the nerves alone the vital force is diffused over the whole body and that on not only the sensation and motion, but also the, nutrition, the making of the blood and juices, every secretion and excretion, in short, the whole animal household, are depending, and considering that the spine is the root of diversified nerve branching; thus one will understand not only how highly important, but also how very various the disturbances of our health can be, as being based on a morbid or abnormal condition of the spine. Every only somewhat essential part of our body has its own peculiar nerves on which depend its function as well as its sensibility; and all have their separate origin in different parts of the spine. Now, if these parts of origin become diseased or affected, the whole nerve at the same time becomes diseased; however, only at its end, i.e., at that portion for which it is originally intended this diseased condition is noticed by observing that either sensation, or motion, or the special function of that part or organ of our body appears to be disturbed, in consequence of which either violent pain or convulsions and cramps, or other disturbances in life of that particular tissue will appear; because its life supporting and regulating force is morbidly changed or suppressed. Thus the throat, the heart, the lungs, the stomach, the liver, the bladder, the uterus, the limbs, etc., may get into diseased condition, just as that portion of the spine is diseased or affected whence the respective nerves belonging to that particular part of the body take their origin. Such a disturbance, however, is very easily and quite often produced by an inflammatory irritation, which has this peculiarity that the pain is usually insignificant in the back and may indeed be wanting there altogether, and that it can only be perceived by gently pressing every single vertebra of the whole spine from the neck down. Only then the patient often feels but a slight sensation, be it at one or more vertebrae; often, however, a very severe pain is felt, which as quick as lightning is transmitted to the suffering part in a distance. Yes, indeed, sometimes the most intense pains in other parts may bring the patient to the point of despair without imagining that the cause of this could be looked for in the back. This is actually one of the principal reasons why the trouble very often is not understood, and the condition of the spinal column is overlooked, although there is nothing easier than to come to an understanding about that, because anybody can soon locate the sore spot in a patient by means of the pressure mentioned. With troubles of the head, for instance, in case of vertigo, or buzzing in the ear, or disturbed eyesight, etc., one must not neglect to examine carefully also the upper vertebrae of the neck by means of that pressure described already.

"From this rather superficial allusion it must be evident that there is hardly a disease the origin of which may often be due to no other cause than such an inflammation or irritation of the spine, or a spinal lesion of some kind, and certainly, far more important than the feeling of the pulse, the examining of the tongue and of the urine, is the examination of the spine, as mentioned above. I have seen how approaching amaurosis, dangerous hemorrhages of the uterus, malign stomach troubles, leukorrhea, pulmonary consumption, even recurrent miscarriages were caused by such spinal lesions, and often have I been fortunate enough - only through my means of correctly recognizing and locating the seat of the trouble to render speedy relief where the patient had been suffering for years."

Dr. Erz comments on the above as follows:

"He does not tell us what further osteopathic use he made of his discovery, and in what his peculiar treatment - if he did have any consisted. He may have had some peculiar physical treatment of his own, and may have kept the secret for himself. Finally he recommends the old-time customary bleeding or an application of cantharides, or a blistering salve, etc."

The above statement by Dr. Rupprict was doubtless read by thousands of the most learned doctors half a century ago. But it probably made no impression whatever upon most of them. They continued with their dosing, bleeding, and. other anti-physiological methods, and looked with contempt upon any treatment strictly in accord with the announced facts of anatomy and physiology.

Most physicians are more or less familiar with Hilton's great work on "Rest and Pain." It teems with thoughts suggestive to the osteopath. Dr. J. M. Littlejohn, in an article in the Boston Osteopath for February, 1901, brings out so clearly the fact that Drs. Hilton, Martyn, and Embleton grasped very clearly certain facts in anatomy essential to Osteopathy, yet never applied them, that he is quoted at length:

"Hilton says that ‘pain in the anterior and lateral parts of the head, which are supplied by the fifth nerve, would suggest that the cause must be somewhere in the area of the distribution of the other portions of the fifth nerve. So if the pain be expressed behind, the cause must assuredly be connected with the great or small occipital nerve, and in all probability depends on disease of the spine between the first and second cervical vertebrae.’

"Another important principle enunciated by Hilton is that 'diseases of the spine may begin in the vertebrae or in the intervetebral substance - I think upon the whole, most frequently in the intervertebral substance, or where this is joined to the vertebra. This rather supports the view that diseases of the spine are very often the result of accident, because we know that in accidents, at least so far as I have been able to discover, the most frequent lesion or injury to the spine is a partial severance of the vertebra from the intervertebral substance; and I suspect the same thing obtains with respect to diseases of the spine. The pain associated with diseased spine to which I now refer, is found upon the skin supplied by the nerves which escape from the vertebral canal through the intervertebral foramina close to the bones or intervertebral substances, either of which, as I have said, may be the seat of the disease. It is upon the recognition and right interpretation of the cause of this pain upon the surface of the body that we ought to place the best prospect of early and correct diagnosis in spinal disease.'

"Why does the lesion involve the juncture of the vertebra with the intervertebral substance? Because 'the junction of a more to a less elastic body is the weakest spot, and therefore receives the full effect of a strain.' This illustrates how Hilton makes use of the vital characteristics of nerve expression and tissue vitality as the basis of diagnosing diseases. Numberless other instances may be gleaned from the work on 'Rest and Pain.' For example, in a case of severe abdominal pain, increasing in the erect posture, on both sides just above the pit of the stomach, Hilton, in 1851, found 'disease with slight displacement, between the sixth and seventh dorsal vertebroa, and pressure upon the vertebra produced the pain in front.'

"Dr. Martyn, in the British Medical Journal for 1864, explains why dorsointercostal pain is limited almost entirely to the sixth, seventh, and eighth intercostal spaces on the left side. 'The aortic arch impinges on the left side of the third dorsal vertebra, and opposite the fourth, fifth, and sixth it receives contributions to its plexus from the corresponding ganglia of the sympathetic, while its plexus again contributes to the heart. These sympathetic ganglia have, however, just received branches from the intercostal nerves themselves; and so it is that the heart and the intercostal spaces (fourth, fifth, and sixth) are supplied by the same nerves. Now the fourth, fifth, and sixth intercostal nerves are those which give off large lateral cutaneous branches, descending over two ribs before they terminate in the skin over the sixth, seventh, and eighth intercostal spaces."'

"Along this line, Dr. Embleton, in a paper published in 1870, presented to the British Medical Association, explains the shoulder tip pain, on the basis of its origin in the pneumogastric filaments which enter the hepatic plexuses, 'and that then by the intimate connection between the vagus and the spinal accessory it is expressed in the branches of the latter which supply the trapezius and which communicate beneath it with the third and fourth cervical nerves. Its ordinary seat is not in the clavicle, but in the edge of the trapezius rather than in the clavicle; and the trunks of the vagus and the outer division of the spinal accessory, as far as they are amenable to examination, are abnormally sensitive to pressure."'

The following quotation is from an article on "Brain-fag, and Its Effects on Health," by John Knott, M. A., M. D. (Univ. Dub.; M. R. C. P. I.; M. R. I. A., Dublin), in the New York Medical Journal and Philadelphia Medical Journal, November 2.1, 1903. It confirms the osteopathic theory, but the application made by Osteopathy in the curing of diseases does not receive a hint.

"A fairly accurate knowledge of the structure and functions of the central nervous system has been attained only within a very recent period indeed. It is now well known that the human body, as in the case of other animals, is essentially formed of a series of minute conducting threads, called 'nerves,' each of which is connected at one end with one of the fundamental cells of which the various tissues are built up; and, at the other, with a nerve cell, which regulates all the functions of the latter. The rest is merely padding and protective covering - the 'leather or prunello' of the complete organic structure. The nutrition of these physiological units is supplied from the blood, minute tubular vessels containing which ramify everywhere among those threads and cells of the body. The blood-vessels are themselves supplied by absorption, from the products of digestion within the alimentary canal; and the nutrient contents pass out, by a process of leakage, to the various tissues in their neighborhood. How the latter select their own pabulum from the constituents of the blood, and so skillfully repair the waste which continually goes on during the existence of life, is explainable only by the influence of a vital force - a power of organic life, the heart of whose mystery has not yet been plucked out by the scientific physiologist. It is, however, well known that the amount of blood supplied to the tissues, and the peculiar selective power of the latter, by which they regulate their own nutrition, are both directly governed by the central nervous system. Accordingly, when the influence of the latter has been completely cut off from any portion of the living body, nutrition entirely fails, and local death is the result. When the demonstration of this connection has once been satisfactorily understood, it will be seen to follow, as a corollary, that if the nervous system is not in a condition to perform its usual functions the nutrition - i.e., the health of the
whole body must suffer."

Authorities not only warrant the claims of Osteopathy, but unconsciously in many cases, answer the ill-advised criticism against the system. "By their own mouths shall they be convicted" C. P. McConnell, M. D., D. O., in an article describing the spinal column, which appeared in the Journal of Osteopathy, December, 1903, cites several standard authorities. The quotations and comments on them are so apt that they are given below in full:

"'The spinal cord is suspended within the spinal canal in subarachnoid fluid, which entirely insulates it, and, meantime, surrounded by this liquid, and insulated by it, the spinal cord itself is out of reach of any blood-supply, except such as can come to it from the brain above, or else along the nerve-roots at the sides. And, in fact, the supply of this important part becomes, if I may so speak, one of nature's difficulties. Let us see how the difficulty is met. The blood-supply to the spinal cord is carried out by slender [word(s) missing in original]. There are three of these arteries, one on the front and two on the vessels which come from the vertebral arteries within the cranium, back of the cord; they are very slender, and yet have to run along its whole length. No arteries so small as these run so great a length elsewhere in the body, and pressure falls rapidly in minute arteries as the length of pipe increases, so that it becomes necessary to reinforce these slender vessels whenever possible, and advantage is taken of the nerve-roots to send up little reinforcing arteries along these. When you approach the tip of the cord the supply from below becomes exceedingly precarious, and even apt to fail entirely because upon the long strands of the cauda equinia the small arteries are too narrow and too long to reinforce the cord with certainty.

"Hence we see that the tip of the spinal cord, corresponding to the lower limbs and sphincters, is much more weakly organized as to its circulation than all the upper parts of the cord. I believe it is by impediment to the exceedingly and peculiarly difficult blood-supply of the caudal end of the spinal cord that all these various conditions lead to paralytic weakness of the lower limbs, and they are to be met by conditions improving the circulation, if possible." - Croonian Lectures, quoted in Clevenger on 'Spinal Concussions,' page 195.

"The foregoing is certainly an interesting quotation and shows logically and conclusively the efficiency of osteopathic treatment on the spinal cord. If Osteopathy is anything it is a common sense rational treatment, Those who desire the study of the physiology of the blood-supply farther and, also, some more of the detailed osteopathic theory, I must refer to osteopathic works and Schaffer's 'Physiology,' Volume II. I would like very must to go more in detail, but my article is already getting lengthy. The student will find some exceedingly interesting material in the references.

"'What has happened, when a man has fallen with his back upon the ground? It is possible that the spinal marrow, obeying the law of gravitation, may, as the body fails, precipitate itself in the same direction, fall back toward the arches of the vertebrae, and be itself concussed in that way. Or the little filaments of the sensitive and motor nerves, which are delicately attached to the spinal marrow, may, for a moment, be put in a state of extreme tension, because, as they pass through the intervertebral foramina, they are fixed there by dura mater; and, if the spinal marrow be dragged from them the intermediate parts must necessarily be put upon the stretch, producing at the same time the 'pins and needles' sensation, and also explaining the symptoms felt on the following day. It is impossible hat these symptoms could be the result of anything but some structural disturbance; and they are, to my mind, the evidence of decided injury to the nerves or marrow, although what that injury may be is not ascertainable.'

"The foregoing quotation is from Hilton's 'Rest and Pain.' Clevenger comments upon it as follows:

"'These views of Hilton's are capable of, extension to wrenches, etc., of the vertebre, not only disturbing the precarious circulation of the cord, but by strains inducing more or less permanent irritation of the nerve-roots and meninges, and, what seems to have been wholly lost sight of by all writers, lesions of the soft and poorly protected spinal sympathetic communicating fibers.'

"Is not this hitting pretty close to osteopathic ideas? But alas! They forget their application of practical anatomy when it comes to treatment.

"Relative to the sympathetic nerve importance I must refer the reader to another work besides Clevenger, Fox - "Influence of Sympathetic on Disease." I am sorry space and time forbids further extracts on the sympathetic nerve in relation to spinal injuries.

"Another writer – Moullin - 'Sprains - Their Consequences and Treatment,' 1891, page 152, among many fine ideas has the following to say relative to sprains of the back and neck:

"One of the most singular features in connection with these sprains is the way in which the backbone itself, and the muscular and ligamentous structures around it, are overlooked and ignored. Even in the ordinary accidents of every day life there is a great tendency to lay everything that is serious and lasting to the credit of the spinal cord. In railway cases there is no hesitation at all; if any serious result ensues, it must be the consequence of damage this structure has sustained, or of inflammation following it. Little or no attention is paid to anything else. Yet it is difficult to see why the other structures should enjoy immunity. The vertebral column may be strained, especially in the cervical and lumbar regions; the ligaments torn or stretched; the nerves bruised or crushed; the smaller joints between the segments twisted and wrenched; the muscles detached from their bed and torn across, or thrown into such a state of cramp that they become rigid and unable to act with freedom; or the fibrous sheath which contains them and helps to secure the bones laid open and filled with blood. Results, in short, of the most serious description are not uncommon, and often leave lasting evidence of their existence behind, when the spinal cord escapes completely.'

"The foregoing was written some fifteen years or so ago by an English surgeon, and what good did it do the medical profession? Even the surgeon that wrote it did not know how to meet the conditions rationally. It has remained for Dr. Still to give to the world a logical system of therapeutics. The M. D.'s have been running after false therapeutic gods. When occasionally they found one of the converging paths they immediately lost its significance and got into a diverging road. I can not resist the temptation to give just one more short quotation from an old book, Page, 'Railway Injuries; with Special Reference to Those of the Back and Nervous System,' 1892, page 29, that is apropos of our article:

"'While then the victims of railway collision [the author is treating of railway injuries in particular, but other injuries bear the same features] are not by any means exempted from liability to suffer from any and every form of lesion of the spinal cord and its membranous coverings, accumulated experience leaves no longer any doubt that these grave results are most uncommon, and that though the back is especially prone to suffer injury in this form of accident, it is the extra spinal structures which, in ninety-nine cases out of a hundred, bear the brunt of the violence and suffer from it.'

"The question naturally arises, why was not Osteopathy discovered before? This can only be answered by the question, why have nearly all the great advances in surgery been discovered in the past decade or two? Simply ignorance and superstition. Hence, it is seen there is plenty of detached and fragmentary evidence bearing upon our interpretation of spinal injuries and mat-alignment; although not one authority prior to Dr. Still even suggested the osteopathic method of cure or relief of these spinal disorders, let alone their application to diseases in general."

We often find writers in medical journals advancing old ideas with all the eclat of a discoverer. Below is given a quotation from a very good article in Medical News, March 18, 1906, by John P. Arnold, M. D., by way of illustration. It is osteopathic as far as it goes, but he fails to give expression to the fundamental osteopathic idea. Judging from the way his school has denounced osteopaths for accepting such ideas, we might expect a tirade of abuse to be hurled against the author; but as it comes through the good old channels, we may look for many of them to accept what he says and go right on giving drugs to correct those defective backs. It is a good beginning, and it is a pity that every M. D. in the United States cannot read the article, and follow it by the study of scores of other facts just as essential to the osteopath. Let them get back to the primary conditions and their causes. Then they will be prepared to grasp the idea of the osteopathic treatment. Dr. Arnold dwells upon the importance of the vasomotor cells, all of which is very good, but which is so old to the osteopath that he wonders how the importance of this knowledge has been "almost entirely neglected" by the medical profession so long. Among other good things, Dr. Arnold says:

"In the physical examination of patients one very important part of the body is almost entirely neglected, and in general diagnosis this neglected part of the body is one of the most important to be examined, namely, the back.

"In every case of disease, whether acute or chronic, marked indications will be found by a careful examination of the spine in the region supplied by the posterior primary divisions of the spinal nerves corresponding to those segments of the spinal cord from which the affected parts derive their innervation. No part of the body can be functionally or structurally diseased without there being a disturbance either primarily or secondarily in those segments of the cord from which the part receives its nerve supply, and these diseased conditions invariably express themselves by indications which can be readily detected along the spinal column by a careful examination.

"The question will be immediately asked by the readers of this paper as to what physical signs may be elicited which indicate these conditions? In the first place, I may state that there are so few people in perfect health that it is seldom that one sees a perfectly symmetrical back. There are few people who are not compelled at some time during their lives to seek the advice of a physician, and in all of those cases in which the individual struggles through life with some crippled organ, there will be found expressions of distinct impairment of the nervous mechanism of the parts involved which are invariably indicated by a careful examination of the back. In all of the cases of chronic disease which have come under my observation there have been disturbances of the nervous mechanism of the disordered part, usually dependent upon a deficient tonus of its blood vessels, which is the result of a deficient blood supply to the segments of the spinal cord from which the vasomotor nerves arise."

The same Dr. John P. Arnold quoted above has an article in the New York Medical Journal and Philadelphia Medical Journal, May 13, 1905, in which he shows the futility of drug medication and the imperfect knowledge at present of living protoplasm. But he thinks he has made some wonderful discoveries, all of which were applied by Dr. Still about forty years ago. It will be observed, however, that Dr. Arnold says nothing about the real causes of the spinal conditions as demonstrated by Osteopathy; and, of course, he does not make use of the fundamental osteopathic procedures in correcting the derangements which are the primary causes of the conditions. In short, inhibition and stimulation, the old drug ideas in a greatly improved form, seem to be his only methods. Here are three quotations:

"I found that pressure upon the occipital nerves produced a certain amount of cerebral anemia."

"We find that pressure along the spinal column and in certain regions of the neck does produce distinct changes in the circulation in the central nervous system."

"We find that internal conditions, no matter what they may be, manifest themselves by certain distinct signs that may be observed by the proper, examination of the back. For instance, I have not seen any case of dyspepsia, no matter of what type, in which there was not distinct evidences in the mid-dorsal region of a disturbance of the nervous mechanism controlling the stomach, and here we have to realize the fact that we have not only a nervous mechanism to the blood vessels of the stomach, but one controlling in part the musculature of the walls of the stomach itself. If we examine a case of asthma we will find the disturbance in the upper dorsal region between the third and the seventh, and so on throughout the whole list of diseases."

CONTRAST OF METHODS.

The facts set forth in the above quotations, and many others, were discovered independently by Dr. Still and have been in constant use by osteopaths in diagnosing diseases ever since the advent of Osteopathy. Contrast their methods with that of other schools which rely almost wholly upon symptoms distant from the seat of the real cause of the trouble, except in a few isolated cases, such as those given above.

Dr. Still does not consider the M. D.'s methods of diagnosis of much value when it comes to treating the disease. He has but little respect for the doctor that has to resort to the use of a clinical thermometer, - a "pig tail thermometer," as he often calls it, every time he wants to find out the conditions of the patient's temperature. In his characteristic manner he makes the following statement as to the methods of examination and diagnosis by medical doctors. He resorts to a semi-military language in keeping with his long experience in the military service of his country. The quotation appears in The Bulletin for January, 1902:

"He has learned how to tell what his patient's temperature is each day for a week. How much headache, limbache he has had, how body-tired and how sore he has been. How thirsty he was; how many times the bowels moved in twenty-four hours. How brown, red, or furrowed the tongue has been in the first, the fifth, seventh, ninth, and fifteenth days, but he has never been told by his school that these symptoms are only the effects and not the cause of disease.

"'Now we have the symptoms and we will put them all in a row and name the disease,' says the medical doctor. 'We will name it typhoid, bilious, or some other name before we begin to treat it. Now that we have named it we will run out our munitions of war and pour in hot shot and shell at each symptom.' The command is given, 'throw into the enemy's camp a large shell of purgative, marked mereurous chloride.' Then the order comes to stop that groaning and those pains, 'fire a few shots into the arm with a hypodermic syringe loaded with a grain of morphine,' is the next command. Then one might add, 'look at the pigtailum oftenum and note the temperumm till it reaches 106,' but he is given no idea of the cause of the trouble on which to reason."

The above criticism gives an idea of what Osteopathy is not. It may be tinged with sarcasm and saturated with ridicule, but it does not so seriously arraign the methods of the medical doctors as the following, taken from the Journal o f the American Medical Association for January 4, 1902, which evidently is intended to tell what the regular practice of medicine is as well as what it is not:

"I want to ask you seriously: Has this branch of medicine, namely, materia medica, as far as real merit of the matter that enters into the remedies, kept step with the rapid advancement of other departments of the healing art? I believe I must answer this negatively.

"Now what is the use of making a diagnosis which entails so much study and work? We auscultate, percuss, use the microscope, analyze the blood, urine, and sputum, take cultures, test eyes, hearing, reflexes, palpate; we explore with the X-ray, sounds, specula, meatoscope, laryngoscope; we catheterize ureters, and, in fact, what do we not do to a patient, - well, we finally arrive at a diagnosis. We know what is the matter; then we begin to prescribe, and the trouble begins.

"As long as we use uncertain missiles, at uncertain distances, with uncertain hope that something may do some good, I see no use in drilling our medical recruits unless we can equip them with a more eiact and uniform armamentarium."

We have the testimony of Dr. Frank Billings, in his inaugural address as President of the American Medical Association, as published in the journal of the association, May 9, 1903, that the profession has not, with few exceptions, passed beyond the ability to name diseases. "We hopefully look," and go on experimenting in the good old way that has accomplished so little

"With most of us, our present methods of clinical observation enable us to do little more than name the disease. In the vast majority of the infectious diseases we are hopeless to apply a specific cure. Drugs, with the exception of quinine in malaria, and mercury in syphilis, are valueless as cures. The prevention and cure of most of the infectious diseases is a problem which scientific medicine must solve. What is true of the infectious diseases is also true of the afflictions of mankind due to chemical influences within the body. We know but little of diabetes, of the primary blood diseases, or of the various degenerative processes of age and disease. We hopefully look to chemistry to reveal to us the cause of these and other conditions. Experimental medicine must be the means of removing the ignorance which still embraces so many of the maladies which afflict mankind."

On the other hand, the osteopath examines his patient in an entirely different way. His mind is fixed upon finding the cause, yet he does not overlook the symptoms. When he has found the cause he goes to work directly and specifically to remove it, knowing that the symptoms will disappear when the cause is removed. All his treatment has a direct physical relation to the primary cause of the disease. It is all determined by the actual physical condition of the patient. There is no guesswork, no experimenting; no "cut and try" method. It is as direct and specific as the work of any surgeon. The osteopath does not "use uncertain missiles, at uncertain distances, with uncertain hope, that something may do some good." Probably no clearer statement of the difference between osteopathic and medical practice has been made than the following by Dr. C. M. T. Hulett:

"Every application, appliance, method or procedure used in the treatment of disease may be classified under one of two heads. If its effect is to modify the vital processes themselves, it is medical.

If its effect is to remove conditions which are interfering with those processes, it is osteopathic. Among the first are most drugs used for their physiologic effect, much surgery, electricity, hot air, vibrators, and similar devices. Among the second are manipulations - the removal of lesion, legitimate surgery, antiseptics, germicides, regulation of diet, habits, and life environment. If the X-ray or Finsen light will kill the lupus or cancer germ, the principle of their action is osteopathic"

THE SCOPE OF OSTEOPATHY.

Osteopathy is often severely criticized by its opponents for presuming to be a system for the treatment of all ailments of the human body. The criticism will apply with equal or greater force to every other system. No intelligent osteopath will claim to cure all kinds of disease nor indeed all cases of any one kind. Destruction or impairment of tissue may become so great as to be beyond all hope of restitution. While such cases are hopeless so far as a cure is concerned, it is no more reprehensible for an osteopath, than for any other doctor, to minister to them. The sick in any stage are entitled to the best services available, and if Osteopathy will give relief as nothing else will when the shadows of death lengthen, it is worthy of all commendation. It has already established the fact that it is able to handle successfully practically all diseases that yield to other methods; and the complete restoration of health to hundreds who sought for it in vain through other systems ought to inspire confidence in Osteopathy.

Upon what basis of fact, the reader may ask, is an osteopath justified in making so strong a claim for his science? The reply is at hand. It is not necessary for him to resort to mysticism, to distort facts, or to manufacture testimony to establish his points. Most of the facts necessary are already fixed by the labors of anatomists, physiologists, and pathologists. Those facts briefly stated are these:

(1). Each and every part of the body has its proper place, form, structure and function, and all are so combined as to form a perfectly working machine capable of self-regulation and self-repair.

(2). Each part of the body is provided with nutrition carried to it in the circulating fluids, and all waste, except from surfaces, is carried away from each part by the same means.

(3). Every part of the body is supplied with nerves which control all its functions, such as motion, sensation, circulation of blood, growth of tissues, secretion, and heat generation and regulation. Impairment or destruction of any of these nerves results in. the disturbed, or destroyed, function of the part supplied by them.

(4). Every part of the body will do its duty if it has a chance. That is what it is for and it is a contradiction of thought to say that it will not. This is an axiom, the denial of which involves the denial of both health and disease; it would even mean the denial of the existence of the human body as we know it.

(5). Air, water, and food are the only elements necessary to be put into the body in order to maintain and restore health. The fact that millions have lived healthy lives without anything else is proof that substances foreign to the body are not necessary to its well being. Their presence means discord.

The original osteopathic theory has never been abandoned. No application of osteopathic principles has ever been found useless. No treatment has ever been given by a genuine osteopath without the minimum of injury and the maximum of good to the patient. The osteopath does not experiment with ear, eye, nose, teeth, throat, bronchial, lung, heart, stomach, liver, spleen, pancreatic, intestinal, kidney, bladder, uterine, ovarian, and skin troubles. The treatment of nervous and mental ailments is not an experiment with an osteopath. He seeks the causes of all troubles, removes them, and gives nature a chance to demonstrate its curative power. It is true, that every osteopath may come across cases that puzzle him, Even then he does not resort to the "cut and try" methods of other schools. Knowing as he does the sources of vitality to the part affected, he can stimulate to greater activity or quiet excessive activity and thus accomplish results impossible by any other means.

THE OSTEOPATH'S WORK.

What then does the osteopath do ? He simply removes the cause of the trouble if in the physical organism. If there is literally a thorn in the flesh, he removes it. If there is a dead tooth that is giving trouble, he will advise the patient to consult a dentist. If it is a piece of steel imbedded in the substance of the eyeball, he will, unless he has made a specialty of surgery of the eye, recommend an oculist. If he finds an infernal tumor that endangers health or life, and the knife is to be used, he will advise that a surgeon, skilled in that special work, be called upon to remove it. In all these things he does just as all physicians of all schools do. These are cases calling for the -removal of a foreign substance or of parts that are practically dead and have virtually become a foreign substance so far as their surroundings are concerned. Experience and common sense generally dictate that the offending substance should be removed. But such cases as those mentioned comprise a very small proportion of all the cases a physician is called upon to treat.

The volume of the work of the physician is in the prevention of disease and in the restoration of health to any and every part of the body. Here is where the osteopath excels, to the surprise of those who are not grounded in the essential principles of the science. He succeeds because he applies the same principle he applied when he removed a thorn that was giving trouble. He goes directly to the cause, removes it, and thus gets rid of the obstacle to health of the part. He knows that if a part is not doing its duty there is a cause for it. That cause may be a foreign substance, or a malposition, interfering with the free flow of fluids or the transmission of nerve force, thus interfering first with function and second with structure. He proceeds at once to remove the cause of the trouble, and in doing that sets free all the forces of the body involved in combating disease and maintaining health.

The prevalent theory of so many doctors that most diseases are due to germs, may be believed. What can the osteopath do to kill them? Surely he must use a germicide. True, he may use an antiseptic, or possibly only soap and water, to remove dead matter and its accompaniments when within reach. But what about those germs that are in the blood, in the walls of the intestines, in the liver, in the kidneys, in the lungs, in the spinal cord and brain? Surely he will have to administer a drug to kill them. Not at all. When you call to mind the fact that pure blood flowing naturally is the greatest antiseptic known for internal conditions, that no germ can live long or multiply in it, you see what Osteopathy may do. But, you say, if the blood is not pure it must be purified by taking some drug. What are the spleen, the liver, the lymph glands, the lungs, etc., for if not to make pure blood when the food is supplied from which blood is made? Pure blood is not manufactured in an apothecary's shop. It is made in that matchless laboratory within the human body, and when that laboratory is in working order it will send forth a supply of its goods perfect in quality and exact in quantity.

Let it be remembered also that germs do not thrive in live tissues, and that every organ withinn the body as well as all other parts are supplied with nerves that are necessary to keep them alive. Surround the infected area with healthy tissue and the germs will soon die for want of suitable nourishment. Thus it is evident why Osteopathy has met with such remarkable success in the treatment of such disease as malaria, influenza, tuberculosis, typhoid fever, diphtheria, measles, etc., etc., which are acknowledged by all to be determined by the presence of germs.

Furthermore, it is the nature of the organism to combat these germs. The tissues of the body will destroy them if they have half a chance. There are thousands of cases in which nature has done this work successfully for every one cured by the introduction of an antitoxine. Of course, cleanliness without and within, is the first element in overcoming all germ diseases. Cleaning Havana stopped yellow fever and small-pox. The medical men said cleaning up the city stopped the yellow fever and vaccinating the people stamped out small-pox. One medical man was so unkind as to say 'if they had vaccinated every body for yellow fever and cleaned up the city for small-pox, the results would have been the same.'' The story is told of General Butler, that when he took possession of New Orleans during the Civil War, the first thing he did was to order the Mayor to clean the city; and, to enforce his command, told the Mayor he would hang him if yellow fever broke out. No other effective means has ever been found for preventing or overcoming epidemics. Internal cleanliness is also essential, but is impossible without a perfect distribution of nerve force, nutritious blood, a free circulation of all the fluids of the body, and unimpeded excretion. These are the lines along which osteopaths have proven themselves to be experts.

The question is often asked, how does an osteopath treat a patient. It might be proper to say that he does not treat a patient at all; he works to remove the cause of the trouble, according to the conditions found. If your watch stops you do not inquire how the repairer is going to treat your watch to make it run. You know he first examines it to see what is wrong. If it is only dirty he cleans it; if the mainspring is out of order, he fixes it; if a pinion is loose, he tightens it; and so on with all the parts. So with the osteopath in treating a patient. If he finds something wrong in the neck, the back, the hip, he corrects it. If he finds something wrong with the stomach, the heart, the brain, he searches for the cause of the disturbance and tries to remove it. He may not succeed in some cases any better than the jeweler succeeds in repairing every broken or worn out watch that is brought to his shop because it does not keep correct time; but no one would think of blaming a jeweler for not performing a miracle.

The watch repairer uses a variety of instruments in doing his work. None of those instruments have sensation, life. They are tools without power in themselves. The osteopath generally uses his hands only. They have sensation, life. They arc trained to detect, instantly, anything wrong, and they are so skillful in movement that they can manipulate the most delicate and sensitive parts with little or no pain and absolutely no danger. The delicate living tissues of the human body are too precious to be pummeled with pounding machines, pierced with steel probes, scraped with curettes, and cut with the scalpel in the hope of curing disease. But if a part is dead it is the province of the surgeon to remove it, making use of the best instruments devised for that purpose. Hence it is evident that a correct osteopathic treatment is the correction of some abnormality by the application of the simplest scientific principles.

DISEASES TREATED.

What diseases then is the osteopath justified in treating confident that in almost every case he can do as much as, or more than, any other? Negatively, it may be said that if there is a part of the body diseased without cause, or that is not dependent upon the free circulation of the blood and lymph for its nutrition, or that is not maintained in structure and in function by its nerve supply, that part is not amenable to osteopathic treatment.

Many think, honestly, that Osteopathy is good for chronic diseases, but cannot reach acute cases. By what principles of common sense or by what rules of logic one can arrive at that conclusion is hard to understand. Every one knows that the sooner a displaced or a fractured bone is fixed, the better. Every one knows that the sooner an antidote is given for a poison or the sooner it is removed, the better. Every osteopath knows that it is easier to overcome an acute attack of grip and prevent bad after effects than it is to remove the complications so often found after the drug treatment of this terrible malady. The same is true of other acute diseases as well as grip. The little fire just starting is more easily extinguishedthan the conflagration resulting from it.

It is hard to get people to understand these simple facts because the reverse has been impressed upon their minds from infancy. They honestly think they must "take something" for every ailment. In order to satisfy their whims many good drug doctors give them bread pills or colored water, and allow nature a chance to do the curing. Let us commend them for this, if it is the best they know.

PROPHYLAXIS.

Osteopathy is better able to judge of the probability of a disease before it makes its appearance by the usual symptoms than any ether system. Almost any one, even a layman, may say with truth and in absolute confidence that a certain person with a flat chest, a long neck, sloping shoulders, projecting shoulder blades, and extreme obliquity of the ribs is a fit subject for consumption (phthisis). Why? Because all the conditions favorable for the development of that disease are so evident that "he who runs may read." The osteopath is trained to look for and recognize every possible cause that may weaken a part so as to lay it subject to disease, and then apply the treatment necessary to remove those causes; or in case it is not absolutely removable make it as nearly inoperative as possible. He does not stop with an examination of these physical signs of weakness, but examines every part of the body, the derangement of which could possibly be a cause for disturbance, to see whether or not any impairment exists.

One illustration will suffice. No one, except possibly some M. D. who wishes to bring Osteopathy into disrepute, as one once did while inveighing against the writer in conversation with a patron, will deny that the nerves and blood and lymph vessels of the feet are wholly dependent for their action upon their unbroken connection with the trunk. Now a disturbance in the foot may be due to a local condition only, as a wound of any kind, in which case local treatment only may be necessary. So far a D. O. would not differ from an M. D., except that, in his treatment, he would not risk impeding the progress of nature by unnatural applications. The osteopath would, however, want to be sure that there was no interference between the injured point and the sources of force and nutrition in the trunk which supply the injured part with life and the power of regeneration. If no local causes were apparent in the foot, the osteopath would, naturally, conclude that the trouble lay nearer the source of the supply of vitality to the foot and treat accordingly.

Again, suppose an osteopath were examining a man for a life insurance company. Would he consider him a good risk if the innervation to the kidneys was interfered with so as to invite Bright's disease; or to the lungs so as to make pneumonia inevitable on the slightest provocation; or to the head so as to interfere with the nerves to the blood vessels of the brain making them liable to rupture and produce paralysis? The osteopath does not have to wait till the worst has happened before he can do his patient any good. In fact, in the very beginnings of disease, long before the symptoms which all other schools look for appear, he can give the warning and do what no other system does by any direct means ; namely, treat where the first cause lies so as to remove it, or at least lessen its influence. Herein lies one of the strongest merits of Osteopathy; one that has not been applied much yet to the spreading of health and happiness, and to the saving of thousands from the many forms of clearly preventable disease and suffering. Can anyone want a higher mission?

Osteopathy does not injure a healthy part in treating any case of disease. The stomach is strengthened in treating for lung troubles, rheumatism, sciatica, etc., instead of being weakened as in the administration of opiates or salicylates. The heart, or circulation, is not injured in headache or any form of nervous diseases as by the taking of a coal tar preparation or any kind of a depressant. The well parts of the body are kept well and the diseased parts are put in a condition to recover, if recovery is possible.

In short, Osteopathy is simply common sense. Theoretically, it rests upon verified knowledge of the human body. Practically, it rests upon the application of skill in recognizing and correcting abnormalities of the human body. It has been attacked by abuse, misrepresentation, ridicule, sneers, contumely, secret contempt; but it has never been opposed by argument. It stands today as the only system which requires a thorough study of the human body in health and disease, and which is built upon unassailed and unassailable scientific facts.