The : Cran ial WILLIAM o.Strmentawp Bowl . ORIGINALLY PUBLISHED 1944 REPRINTED 1960, 1978 EXTRACTS FROM LECTURES RELATIVE TO THE CRANIAL CONCEPT PUBLISHED AS AN AID TO CONTINUED STUDY “Osteopathy is a therapeutic gold mine. Many veins of high grade ore have been found, and are being worked; but others Just as valuable are yet to be dicovered.” C.B. ROWLINGSON, D. O., EDITOR The Western Osteopath.THE PRIMARY RESPIRATORY MECHANISM Following an address relative to the cranial con- cept, before the Academy of Applied Osteopathy, at Chicago, in 1944, the question was made: “Is the cranial concept religious?’ If the concept of the science of osteopathy may be considered religious, then the cranial concept is likewise. The concept of the science of osteopathy came during a sad period in Doctor Still’s life, when unable to save members of his own family. It was during a period when he lost all faith in the orthodox medical practice,—an hour when a sincere prayer went out to his Maker for guidance. It might be said that Doctor Still lived “closer than breathing” to his Maker. Throughout all his writings and lectures Doctor Still frequently referred to the Maker of the human body. The science of osteopathy is a specialty, and mem- bers of the profession who practice this specialty, as taught by Doctor Still, may be considered as special- ists. The cranial concept is not a specialty. It is a mere continuation into the study of the science of osteopathy. It is merely a firmer grip to the “tail” of Doctor Still’s symbolic “squirrel within the hole of the tree,” wherein lie undreamed possibilities rela- tive to intelligent care of the human body. Our subject concerns the primary respiratory mechanism wherein the diaphragmatic respiratory mechanism is secondary. This primary respiratory mechanism includes the brain, the intracranial mem- branes, the cerebro-spinal fluid and the articular mobility of the cranial bones; and also the spinal cord, the interspinal membranes, again the cerebro- spinal fluid and the articular mobility of the sacrum between the ilia. According to biblical history: A breath of LIFE was breathed into the nasals, and man became a liv- ing soul. Note that it was the breath of LIFE, not the breath of air; the breath of air being one of the material elements that the breath of LIFE utilizes in a mechanism to walk about upon earth. During the primary respiratory functioning, initi- ated by the spark or breath of life, the brain operates by expansion and contraction of its cerebral hemi- 3spheres, as well as by the cerebellum. During in- halation the hemispheres. like the wings of a bird, swing upward, the third ventricle dilates and lifts the little pituitary body riding in the sella turcica of the sphenoid bone, and thus elevates the saddle and tips the anterior end of the sphenoid bone downward into a nose-dive. At the same period the reciprocal tension membrane, consisting of the falx cerebri and the tentorium cerebelli, acting somewhat as a check- ligament, allows the ethmoid to drop downward and shifts the petrous portions of the temporal bones into external rotation, the spheno-basilar articular junc- tion being elevated into a flexion position. At the same period the spinal cord is drawn upward, and through the operation of the interspinal membrane the sacrum is drawn upward and posterior between the ilia. During the period of exhalation, the cere- bral hemispheres, like the wings of a bird, fold down, the third ventricle contracts, and allows the little pituitary body to drop the sella turcica, thus tipping the anterior end of the sphenoid upward. At the same period the reciprocal tension membrane, acting somewhat like a check-ligament, lifts the ethmoid up- ward, allows the spheno-basilar junction to drop downward into extension position, and shifts the petrous portions of the temporal bones into internal rotation. During the same period the spinal cord moves downward and the interspinal membrane drops the sacrum anteriorly between the ilia. Ac- cording to Hilton in his text “Rest and Pain”, the brain rests upon “water-beds” of cerebro-spinal fluid. To this I would add: not only rests, but rocks its cranial articular cradle, through the fluctuation of the cerebro-spinal fluid. CEREBRO-SPINAL FLUID FLUCTUATION It is quite important to implant a perfect image of the intracranial and interspinal membranes firmly in the mentality; and also that of the large body of cerebro-spinal fluid. It is through these mem- branes in their functional activity as reciprocal ten- sion agencies, or check-ligaments, that fluctuation of the cerebro-spinal fluid is brought about. Doctor Still called attention to the artery as supreme. I 4 would add: but the cerebro-spinal fluid is in com- mand. The cerebro-spinal fluid is within the ven- tricles and spinal cord, and surrounds the brain and spinal cord,. It is within the very core, or center of operation. One might say that it functions like a hydraulic brake system on your car. It fluctuates during the periods of respiration. It has an inter- change with the arterial blood at the area of the choroid plexus. As to how the interchange occurs, our authorities have diverse theories. It is sufficient to know that the interchange occurs, and that it is quite important to the systemic functioning of the body. Observe this illustration here of the cavernous sinus, one located on each side of the sella turcica of the sphenoid bone. The sinus is filled with venous blood” flowing in a posterior direction to reach its exit at the jugular foramen. Notice the internal carotid artery, passing through in the opposite direc- tion, with its flow of arterial blood. A branch of that artery passes upward through a “water bed” of cerebro-spinal fluid, immediately above the sella turcica, to reach the roof of the third ventricle, and then outward into the walls of the lateral ventricles, and back to the walls of the fourth ventricle. Within these walls and roof of the third ventricle it is known as the choroid plexus. The arachnoid membrane and cerebro-spinal fluid follow along with that branch of the internal carotid artery to the choroid plexus, to perform the function of interchange with the arterial blood. Note the bunched appearance of the choroid plexus, as it appears upon the inanimate specimen, wherein the ventricles are in the expiration period of respiration. Then visualize the bunched appearance being drawn apart, as the ventricles dilate during the period of inspiration, as occurs in the animate speci- men. The third ventricle dilates in a V shape during the inhalation period and contracts during the ex- halation period. The choroid plexus is upon the roof of the third ventricle. As the ventricle dialates in V shape the roof of the ventricle stretches out and the bunched appearance of the choroid plexus disappears. As the ventricle contracts the roof swings together and the bunched appearance of the choroid plexus reappears. Here you have the func- tional mechanism for the interchange between the 52erebro-spinal fluid and the arterial blood. The artery is supreme, but the cerebro-spinal fluid is in sommand. Understand that the cerebro-spinal fluid is within the walls of the ventricles in the area of the choroid plexus—upon the roof of the third, and within the walls of the lateral and fourth ventricles. There is a communication between the ventricles and subara- chnoid spaces within the fourth ventricle, wherein the cerebro-spinal fluid may pass from the ventricles into the body of fluid that surrounds the brain and spinal cord. Were one able to get within the cranium and compress the fourth ventricle as one compresses the bulb of a blood-pressure testing apparatus, it would send the cerebro-spinal fluid fluctuating up into the ventricles, down into the spinal canal, and out into the subarachnoid spaces surrounding the brain and spinal cord. Were one able to do this he would have all the systemic ailments of the body under immediate control. When we reach the period of cranial technic we will demonstrate how it is pos- sible to compress the fourth ventricle from without the cranium, and you will hear what former students in cranial instruction have heard repeated from time to time: If you do not know what else to do, compress the bulb. All the physiological centers, including that of respiration, are located in the floor of the fourth ventricle. The cerebro-spinal fluid not only fluctuates, but also nourishes the nerve cells. STUDY OF THE ARTICULAR SURFACES Like Swedenborg who studied anatomy two hun- dred years ago, in search of the soul, Dr. Andrew Taylor Still studied the handiwork of his Maker—the human body. Through that study he developed an unusual physiological-anatomical knowledge, tending to a superior skill in diagnosis and technic. Through a like knowledge of the body mechanism, osteopathic physicians may improve their skill in diagnosis and technic. Quoting Doctor Still: “An osteopathic physician reasons from his knowledge of anatomy. He compares the work of the abnormal body with the normal body.” Likewise, in the cranial concept, we must posses a knowledge of the cranial structure, both within and without. “We must know the position and purpose of each bone, and be thoroughly acquainted with each of its articulations. We must have @ perfect image of the normal articulations that we wish to adjust.” In order to have this perfect image, it will be necessary to study the articular surfaces of each separate cranial bone, as well as their various shapes and angles. The cranial osseous structure is mechan- ical. The osteopathic physician is a mechanic of the human body, and it is as necessary for him to under- stand the body’s mechanical operation as it is for an automobile mechanic to understand the mechanism of an automobile. Quite a number of the profession, receiving pre- vious instruction in the cranial concept, and realizing the need of a further physiological-anatomical pic- ture, took advantage of the postgraduate course at the Des Moines Still College of Osteopathy, October, 1944. With one accord they testified to the value received in the instruction of cranial anatomy, by Dr. Paul E. Kimberly of the College Staff. During this course, Dr. Beryl E. Arbuckle, pediatrician, of Philadelphia, and Dr. Raleigh S. McVicker of The Dalles, Oregon, assisted Dr. Sutherland in the pre- sentation of the cranial concept and technic. We will now take up the study of the articular sur- faces of the sphenoid bone. Notice this illustration here of the sphenoid bone. Direct the attention to this L-shape area upon the superior articular surface of the greater wing. It articulates with an L-shape articular surface beneath a frontal bone. There are two of these articular surfaces, one on each greater wing. They are like the L-shape articular surfaces found at the sacroiliac articulations. The sphenoid bone is suspended beneath the frontal bones, and the sacrum is suspended beneath the ilia. At birth there are two frontal bones, and in some adult skulls the sagittal suture continues to the ethmoidal notch. So from now on we might as well conclude: two frontal bones; the sphenoid bone being suspended from two frontal bones and the sacrum being suspended from 7two iliac bones. Keep in mind that there are two ossification centers, one for each frontal bone. Also remember the similarity of the sphenoid and the sacrum as being suspended between two bones, up- on L-shape articular surfaces; and both having anterior and posterior rotation, as well as side-bend- ing movement; both functioning as a unit during respiratory periods involuntarily. Now look at this little flat ethmoidal spine upon the middle-anterior superior area of the sphenoid, This little “jigger” fits into a slit or groove found upon the middle-posterior-superior area of the eth- moid. It provides the mechanical arrangement for movement of the ethmoid as the sphenoid makes its nose-dive for air, during the period of inhalation. Immediately lateral to the ethmoidal spine on the articular surface of the lesser wings of the sphenoid, are two bevel articular surfaces. They articulate with two bevel articular surfaces beneath the two frontal bones, lateral to the ethmoidal notch. This provides a mechanical arrangement for the accom- modation of articular mobility between the lesser wings of the sphenoid and the frontal bones during the periods of respiration. We need not look farther than these two indications found on the articular surfaces of the sphenoid bone for a truth signfying that a Master Mechanic designed the bones of the cranium for articular mobility. There are many others throughout the cranial bones signifying that truth. The proof of our assertion of cranial articular mobility is there on the articular surfaces, and it does not require even a mechanical mind to recognize the mechanical principle. As-osteopathic physicians we are mechanics of the human body. As mechanics we should become familiar with the cranial mech- anism. Here at the lower middle area of the sphenoid is a beak process, called the rostrum, and here we have the vomer bone. Note the cup-like articular provision that was designed to fit over the beak or rostrum of the sphenoid. It provides a movement somewhat like that afforded by a universal joint on an auto- mobile. From that articulation the vomer extends forward over the roof of the maxillae and palate bones, that also have mobility during the periods of 8 respiration. The vomer also articulates superiorly with the perpendicular plate of the ethmoid and the cartilaginous nasal septum. An intimate knowledge of this intricate mechanism is valuable in cranial technic applicable to sinus pathology. At this area of the sphenoid bone we have rockers, known as the internal and external pterygoid pro- cesses. Note that they are convex in shape, and hang beneath the boat-like form from the bottom of the sphenoid. When the sphenoid makes its nose-dive these “rockers” or pterygoid processes, rotate down- ward and backward. They articulate within the concave articular surface of the little palate bone. Observe and study very minutely this concave arti- cular surface on the palate bone that articulates with the convex articular surfaces of the pterygoid pro- cesses of the sphenoid. Note especially the double groove at the lower area, converging anteriorly and diverging posteriorly. Also study that little palate bone in all its details and articulations with the maxillae and its fellow palate bone, as well as the tiny orbital surface that sticks up into the orbital cavity. The sphenopalatine ganglion lies between the palate bone and the body of the sphenoid. Fixations occur that crowd the palate bone backward onto the ganglion, thus disturbing its normal functioning. The ganglion sends nerve fibres to the lacrimal gland, the turbinates, the nasal and postnasal areas, and to the mouth of the eustachian tube. The sphe- noid bone does not articulate with the maxillary bones, but it does with the palate bones; the palate bones articulate with the maxillary, and function as equalizers between the movement of the sphenoid and the maxillary. The sphenoid also articulates with another equalizer between its mobility and that of the maxillary. The second equalizer is the malar bone, which articulates with the greater wing of the sphenoid within the orbital cavity. As the sphenoid makes its nose-dive, during the respitory period of inhalation, it swings the malar bone outward and widens the orbital cavity. As the anterior end of the sphenoid rises up, during the period of exhalation, the greater wing of the sphenoid draws the malar bone inward and narrows the orbital cavity. The functioning also widens and narrows the spheno- 9maxillary fissure within the orbital cavity. This fact is taken into consideration in the diagnosis of a spheno-basilar lesion by observation. It provides the cue which may be later verified by the skilled art of osteopathic palpation. Note that the orbital surface of the palate bone is located immediately back of the maxillary, at the beginning of the spheno-maxillary fissure. The infraorbital nerve passes over that tiny orbital sur- face, just before it enters a groove in the maxillary to find its way to the infraorbital foramen. Were it not for that especially designed little orbital surface, the maxillary bone might wear the infraorbital nerve in two through its movement during the respiratory periods. The orbital surface of the palate bone is an equalizer that relieves the tension to the nerve. The orbital cavity is not like the solid osseous aceta- bulum of the ilium, but is formed by the articulation of the frontal bone, the orbital surface of the eth- moid, the lacrimal, the maxillary, the orbital surface of the palate, the malar and the greater and lesser wings of the sphenoid. It is a cavity designed by a Master Mechanic for mobility. The cavity functions during the periods of respiration, widening during inhalation and narrowing during exhalation. The wise Mechanic placed the origin of the extrinsic muscles of the eye-ball around the optic foramen, on the lesser wing of the sphenoid, with the exception of one or two that he placed a little farther forward. As the sphenoid comes forward during inhalation the eye-ball comes forward also; and as the sphenoid moves backward the eye-ball moves back also. In addition to the spheno-maxillary fissure that pro- vides the narrowing and widening of the orbital cavity we observe another fissure, the sphenoidal fis- sure, which is formed by the greater and lesser wings of the sphenoid. The cavernous sinus leads from this fissure, with its volume of venous blood flowing to- ward the exit at the jugular foramen. The ophthal- mic vein enters the cavernous sinus through the sphenoidal fissure. In case of glaucoma, let us reason from the fact that the ailment is nothing more nor less than a congestion of venous blood in the eye-ball, and that somewhere back along the intracranial membranous walls of the cavernous sinus, or in 10 those of the petrosal’ sinuses, there may be a mem- branous restriction that limits the venous return. The maxillary bones hang by their nasal processes from the frontal bones, lateral to the ethmoidal notch. There is a gap between these nasal processes that is capped by the nasal bones. Now just imagine the sagittal suture as continuing down to the eth- moidal notch, or ending between the nasal processes of the maxillary bones. The ethmoidal bone lies beneath the nasal processes. This ethmoid has pro- cesses known as the superior and middle turbinates. A lesion fixation of the nasal process of a maxillary bone would crowd the turbinate bones. Have you observed the spongy structure in the ethmoid bone, that functions as a filter in breathing? Notice its spongy articular surface, which articulates with another spongy articular surface beneath the frontal bones. It is a spongy arrangement by a Master Mechanic for expansion and contraction dur- ing the periods of respiration. This functioning being accommodated by a widening and narrowing of the ethmoidal notch that is formed by two frontal bones. It is not a rigid mechanism. Were it so, its functioning as a filter would not work satisfactorily. Life is motion. It is well to observe the thin, fragile, osseous tis- sue surrounding the openings into the sphenoidal sinuses. In the animate specimen, when the sap is present, this thin osseous tissue expands and con- tracts. In fact the body of the sphenoid bone breathes like the breast of a bird, during the periods of res- piration. The vomer bone, in its cup-like articulation with the beak or rostrum, functions like a plumber’s plunger, drawing the pure air in and expelling the impure air out. The sphenoidal sinuses are air chambers, and were it not for this mechanical ar- rangement by the Master Mechanic there would be a stasis of air within the chambers. There are similar arrangments for the antra of Highmore, with the malar bones functioning as the mechanical plungers, drawing the air in and expel- ling it out of the maxillae chambers. The turbinate bones function like the curling and uncurling of leaves during the periods of respiration. As one studies the spongy structure of the ethmoid