A TEXT BOOK OF The Principles of Osteopathy G. D. HULETT, B, §,, D. 0, Proresson or Puxcipies ano Practice oF OSrEorarny, AMBRICAN Scnoon or OsrroraTHy; Meatsen OF CLINICAL STAFF OF THE ScHoon axp Starr oF PHYSICIANS oF THE A. T STILL Inrimatany, KIRKSVILLE, MISs0URI. (ILLUSTRATED, 1903 TJounnar Prowrixe CompanyCorrmenr 1908 By mm Avruon.PREFACE. In presenting this work on the Principles of Osteopathy, the author is aware of many imperfections both in thought and arrangement of subjects; yet he is further cognizant of the fact that, owing to the dearth of satisfactory literature of the nature of which this work is illustrative, there are many in the student ranks as well aa in the field who will welcome it in spite of its many faults. Tt must be understood at the outset that the work is designed primarily for the student who is but beginning to be interested in the new method of heal- ing. Hence to those who are already practitioners of that method the matter contained in the following pages may not ‘seem particularly new or satisfying in the way of suggesting ideas of an immediately practical nature. Yet we are not without hope that even to the latter class there are many points of interest which will help to throw light upon some of the many vexing problems that continually arise in the ex- perience of the busy practitioner. Neither should it be assumed that the work is intended to treat exhaustively of the numerous questions of theory that are associated with the science. That is entirely beyond the scope of a work that is prepared especially for him who,under the circumstances of a comprehensive curriculum of study crowded into a period of time all too short, must of necessity limit his reading in all subjects to those texts which give but a comparatively brief treatment. This work therefore, is rather but an outline of the various subjects that are most closely related to the fundamentals of the science, with sug- gestions as to the direction further investigation should take. ‘The various subjects outlined and the manner of their treatment are the result of the labor of the author which has been especially devoted to the principles of osteopathy duringPREFACE. his course as teacher in the American School of Osteopathy for the past three years. In large part the work here pre- sented is a revision of lectures delivered before the classes in Principles of Osteopathy. The work is divided into Parts I and II, indicating a dif- ference in the nature and arrangement of the matter treated. This difference lies in the more general nature of the sub- stance of Part I, the more specific in Part II. Certain funda- mental propositions bearing on the general problems of life, health, and disease are discussed in the former, while the de- ductions drawn therefrom are applied specifically in the lat- ter to the various regions of the body. Acknowledgment of indebtedness is hereby made to all those who, either directly or indirectly, have aided in the elaboration of the subject matter, and in the preparation of the volume. To Dr. A. T. Still, the founder of the science, special thanks are due for continued oversight and frequent correction—a fact for which is felt the deepest gratitude. Dr. Charles Hazzard, the pioneer as an author of a text book, and an exponent of osteopathy of wide and enviable reputa- tion, has as teacher and co-laborer, been of very material aid and inspiration in the work. Other members of the faculty of the American School of Osteopathy, as well as numerous practitioners in the field have incidentally or specifically con- tributed to the material which has been systematized and formulated in this volume. To Dr. C. M. T. Hulett, of Cleve- land, Ohio, the author is under obligation for many sugges- tions, and especially for his patience and care in reading the manuscript. Kirksville, Mo., August, 1903,CONTENTS. PART L CHAPTER I. InTRODUCToRY. An Evolution, 12. Hippocrates, Galen, Paracelsus, Harvey, Sydenham, Haller, Virchow, Ling, Hilton, Pasteur, Koch, Klebs, Krukenberg. The Revolution, 18 CHAPTER I. SOME FUNDAMENTAL CONSIDERATIONS. ‘The Boundaries of Osteopathy, 20 Definition, Legal, Technical. The Viewpoint of Life, 22. Definition of Life, Vital Force, Basis for Functioning, Law of Change. Structure and Function, 25. Develop Co-ordinately, First Product. Cell Doctrine Insufficient, 27. Ante-cellular Elements, Cellular Structure, Protoplas- mie Bridges, Syneytium, Body asa Whole, Chains of Disorders, Administration of Drugs, Inheritance. Cause of Disease not in the Cell, 32. Auto-intoxication, LaGrippe, Blood or Nerve Influence, Error, Modify Conditions, Inherently Healthy. Man a Machine, 36. Machine, Mechanism. The Body a Chemical Laboratory, 38. Conditions Needful, Fundamental Facts, Inferences, Tron, Fibrin. CHAPTER III. SomE FUNDAMENTAL CONSIDERATIONS (CoNn.). The Energy of the Body, 43. Conservation of Energy, Transformation of Ener gy2 PRINCIPLES OF OSTEOPATHY. Chemical Action, Molecular Attraction, Mass Attrac- tion, Mechanical Energy, Nerve Energy, Potential ve Kinetic, Summary. Body Fuel, 53. Essential, Metabolism, Reserve Supplies, Average Diet, Dining, Disease Conditions. More than a Machine, 59. Self-sufficiency of the Organism, 60. Self-regulating Power, Functionally in Health, In Disease, Structurally, Fundamental Proposition. Tendency to the Normal, 64. ‘Normal Condition, Symptoms, Heredity, Adaptation, Both Necessary, Physical Principles, Chemical Princi- ples, Vital Principles, Association of the Three. CHAPTER IV. Tue ErroLoay or DIszasE. Abnormal Structural Conditions, 69. Gross Anatomical Disturbances, Why Limit the Appli- cation, Evidence. Disease Maintained by Structure, 72. Original Stimulus, Acute Conditions, Predisposition. The Lesion, 75. Definition, Positional Relations, Size Relations. Media through which Lesions Produce Disease, 77. Direct Pressure, Artery,Vein, Lymph Channel,Nerves. Miscellaneous Notes, 80. Vitality of Tissue, Adjustment Possibilities, Transferred. Pain, Other than Pain Conditions. The Causes of Lesions, 84. External, Internal. CHAPTER V. ‘THE ETIOLOGY OF DISEASE (CoN.). Abuse of Function, 88. Over-use, Under-use, Perverted Use. Predisposing and Excit Causes, 91. Definition, Reversibility of Causes.CONTENTS. 8 Germ Theory of Disease, 94. Definite Relation, Buzzards, Manner, Immunity, Con- clusion. CHAPTER VI. ‘Tue Diacnosis oF DIsEAsE. The Symptom, 101. Heart Rate, Pain,Temperature, Vomiting and Diarrhea, Rapid Respiration, Glycosuria, Inflammatory Condi- tions, Disadvantage, Definition. Methods of Examination, 106. Inspection, Palpation, Percussion, Auscultation, Men- suration The Diagnosis of Lesions, 109. Functional Activity, Functional Rest, Perversion of Function, General Attitude, Position, Sensory Change, Definition of Pain, Direct, Referred, Segmental Struc- tures, Referred Tenderness, Tender Spots, Associated Muscle Tissue, Amplitude of Movement, Temperature Change, Color. CHAPTER VII. ‘Tur Trearwenr oF DISEASE. Prophylaxis and Therapeutics, 121. Prophylaxis, Therapeutics, Higher Plane. Curative versus Palliative Treatment, 125. Adjustment of the Osseous Lesion, 16. Exaggeration of the Lesion, Rotation, Pressure. Adjustment of Muscular Lesions, 129. For Diagnosis, Preliminary to Further Treatment, Pri- mary in Itself, Removal of Cause, Pressure, Stretching, Approximation of Origin and Insertion. Treatment of Other Lesions, 137. Perverted Size Relations, Connective Tissue. CHAPTER VIII. ‘ne Treatment or Disrase (Con.). Stimulation and Inhibition, 140. Definition.4 PRINCIPLES OF OSTEOPATHY. Difficulties in Direct Control, 143. Nerve Functions, Different Functions, Unusual Situ+ ations, Direct Manipulations, Reflex Basis, Proportion to Need, Recoil. Objections to Direct Control, 147. Interfere with Normal Function, Reaction, Conceal- ment, Treatment Habit, Choice of Evils. Indications for Attempts at Direct Control, 150. Lesion not Apparent, After Removal, Impossible Re- moval, Force Obstruction, Tide Over a Crisis, Treat Symptom. Do We Stimulate or Inhibit, 152. Deceptive Terms, Summary. ‘Treatment of Disease Caused by Abuse, 155. Negative, Where Unable’ to Abstain, Simple Absti- nenee. Miscellaneous Notes, 157. Lesions not Immediately Removed, Lesions not Entire- ly Removed, Frequency of ‘Treatment, Length of Treatment, Rapidity of Movement, Possibility of Harm. CHAPTER IX. Comparison with OTHER Sysrens. Drug Therapy, 164. : Empirical Method, Stimulant, Sedative, Neutralization, Substitution, Germicide, Results, Real or Satisfactory, Combat Effects, Adds to the Burden, Cumulative Ef- fect, Other Organs not Involved, Habit Formation, Un- certainty. Electrotherapy, 174. Curative Value, Effective or Satisfactory, Roentgen Ray, Phototherapy. Hydrotherapy, 177. Thermal Agent, Stimulant, In Constipation. Psychotherapy, 179. The Principle. Mechanotherapy, 181. Massage, History, Swedish Movements, Summary, Technique, Special Effects, New Growths, Control of Circulation, Nerve Massage and Vibration, TenderCONTENTS. 5 Points, Non-essential Differences, Essential Distine- tion Summary, 190. Similarity of Basis, Stimulant or Sedative, Neutraliza- tion, Substitution, Destroy the Micro-organism, Abso- lute Difference. : PART II, CHAPTER X. Tue Spine. General Survey, 194. Contour, Rigid Spine, Lateral Curvatures, Single Ver- tebr@, Serial Number, Position, Other Points, Relative Use, Median Furrow, Tenderness, Contracture, Sounds, Average Lesion Slight in Extent. General and Specific Hifects of Spinal Lesions, 202. Spinal Lesion, Entire Field. A Typical Condition, 203. Torsion, Artery, Vein, Lymphatic, Spinal Nerve, Sym- pathetic Nerve, The Sympathetic System, 206. Embryology, Gangliated Cords, Plexuses, Connection, First ‘Type White Ramus, Second, Third, First Type Grey Ramus, Second, Third, Fourth, Fifth, Last, Functions, Possibilities of Disorder. The Vaso-Motor System, 214, Definition, Two Classes, Local Mechanisms. Spinal Lesions Affecting Vaso-Motors, 216. Striking Fact, Irritation, Not Simple Condition, Mus- cle Contracture, Radiation of Impulses, Hart’s Theory. Other Effects, 223. Other Funetions, Secondary Contracture. CHAPTER XI. CERVICAL LESIONS—DIAGNOSIS AND TREATMENT. Superficial Structures, 226. Examine in Different Functional Conditions, Horizontal6 PRINCIPLES OF OSTEOPATHY. Position, Sternomastoid, Scaleni, Posterior Muscles, Hyoid, Throat Structures, Tonsils, Cartilages, Thyroid Gland, Vascular and Nervous Structures. Cervical Vertebre, 234. Examination, Atlas, Axis, Third to Fifth, Seventh. Adjustment of Cervical Vertebree, 240. Principles, Methods, Posture. ‘ Inferior Maxillary Bone, 243. Examination, Lesions, Treatment, Effects. CHAPTER XII. Cervical Lesions—Errecrs. Effects From Direct Pressure, 246, Spinal Cord, Thyroid Gland, Effects From Vascular Obstruction, 247. Carotid System, Vertebral, Intervertebral, Thyroid. Effects on Spinal Nerves, 251. Cervical Plexus, Brachial Plexus. Effects on Cranial Nerves, 254, Fifth, Facial, Glosso-Pharyngeal, Vagus, Spinal Ac- cessory, Hypoglossal. Effects on Cervical Sympathetics, 258. Superior Cervical Ganglion, Middle, Inferior, Connec- tion with Spinal Nerves, Eye, Ear, Fauces, Respiratory and Alimentary Canals, Heart, Thyroid Gland, Minor Plexuses, Grey Rami to Cord. CHAPTER XIII. Tuoracic AND LUMBAR LesioNS—SPINAL. Thoracic Lesions—General, 266, Examination, Flat Interscapular Region, Overcome the Condition, Lateral Swerve, Thickened Ligaments, Pos- terior Convexity, Overcoming the Posterior Curve, Dr. Still’s Chair. Thoracic Lesions—Local, 276. Torsion, Separations, Anterior Luxations. Lumbar Lesions, 277. Noting the Condition, Curvatures, Single Vertebra, Overcoming Lesions.CONTENTS. 1 CHAPTER XIV. Tuoracic anp Lumpar Lesrons—Cosrau. Examination, 282. Different Positions. Some General Types, 284. Flat Chest, Barrel-shaped Chest, Box-shaped Chest. Single Ribs, 286. Landmarks, Articular Mechanisms, Forms of Lesions, Tenderness, Contracture. Special Ribs, 291. Atypical, First Rib, Floating Ribs, Examination, . Up- ward Displacement, Posterior End. Adjustment of Ribs, 296. Considered as a Whole, Vertebral Disturbance, Specific Movements, First Rib, Floating Ribs. Sternum and Cartilages, 302. Primary Disorders, Treatment. The Clavicle, 304. Slight Subluxations. Treatment. The Seapula, 306. Change in Position, Treatment. CHAPTER XV. THoracic anp Lumpar Lesions—EFFECTS. Direct Pressure, 308. Flattened Chest. Vascular Obstruction, 308. Intervertebral System, Lumbar Vessels. Spinal Nerves, 309. Thoracic, Lumbar Plexus, Sacral Plexus, Nerve Trunks, Sympathetic Fibres. : Sympathetic Nerves, 312. Cervical Ganglia, Heart and Aorta, Arm, Lungs, Stom- ach, Liver, Spleen and Pancreas, Intestines, Ovary and Uterus, Kidney, Hypogastric Plexus, Generative Organs, Supporting Tissues, Lower Limbs. Direct Pressure from Ribs, 328. Lungs, Heart, Abdominal Organs, Stomach and Intes- tines.8 PRINCIPLES OF OSTEOPATHY. Rib Pressure on Vascular Channels, 332. Double Effect, Superior Opening, Intercostal System, Diaphragm. Rib Pressure on Nerves, 336. Superior Opening of Thorax, Intercostals. CHAPTER XVI. Petyrc Lesions. Examination and Diagnosis, 339. Pelvis, Landmarks, Examination, Upward Subluxa- tion, Length of Limb, Determination of Length, Which - Limb Involved, Posterior Superior Spines, Anterior Superior Spines, Lesions of Sacrum. Adjustment of Pelvic Structures, 346. Withdrawing the Wedge, Other Methods, Wheel and Axle, Knee, Pubic Articulation. Lesions of Coccyx, 349. Coceygeal Articulation, Common Subluxation, Treat- ment, Coccyx Alone. Effects of Pelvic Lesions, 351. Direct Pressure, Vessels. Effects on Nerves, 952. Sacral Plexus, Spinal Nerves, Pelvic Plexuses, Bladder, Uterus, Organs of Generation, Secondary Disorders.PART lI. CHAPTER I, INTRODUCTORY. A statement of the principles which underlie the science of osteopathy must, in the nature of things, be a very incomplete one. No one recognizes the fact more thoroughly than does the practitioner himself when he is compelled to apply theoretical propositions to actual cases. Nor should he be astonished at the discovery. If, as we continually re- iterate, osteopathy is a system built upon the factsof anatomy and physiology, then the foundation must be an absolute and knowableone before we may presume to pronounces the build- ingin any sense complete. Unfortunately for the building, the foundation itself is incomplete, but ‘ever becoming.” It is a perennially recurring surprise to the students of the bio- logical sciences, to learn that in comparison with what is yet to be determined, the total bulk of demonstrable fact relating to these sciences is infinitesmal. When the student, in tak- ing up the study of osteopathy, is told that the osteopath is successful by virtue of his complete knowledge of anatomy and physiology, he glories in the assertion. But when he learns, as hecertainly will, that the most expert is equipped with only a meager supply, he is likely to be disappointed. ‘True, in anatomy we are comparatively well grounded, but our knowledge of physiology and its related sciences is ex- tremely unsatisfactory and must remain so for long. Why need we then apologize for an incomplete statement of the principles of osteopathy? But another fact is very apparent. Dr. Still himself has repeatedly asserted that osteopathy is yet1o PRINCIPLES OF OSTEOPATHY. initsinfancy. Why pretend then that there be any possibility of presenting it in the garb of maturity. Because of its youth, we must be content with a proper modesty of state- ment. It is unfortunate thatin the rapid growth of the system and in the increase in number of its adherents, time has not been given sufficiently to a careful analysis and record of cases which tend to substantiate the fundamental propositions; and since only an infinite number of observed instances will thoroughly satisfy the demands of inexorable logic, sufficient data has not yet been collected to warrant unqualified state- ment. A careful presentation then of certain very general but unequivocal propositions,supplemented by numerous pro- visional ones, is the duty of him who would formulate a “‘plan and specification,” upon which the practitioner is to build his superstructure. It is further necessary to make a fairly clear distinction between principles and practice. It is a pecular character- istic of the average beginner to long for the opportunity to observe and experiment upon cases. He has imbibed the idea that osteopathy consists essentially in the performance of certain movements upon the patient, which in one sense is correct. Butitis necessary to emphasize that before such movement shall be intelligently applied, certain fundamental facts are essential; and itis in the development of these re- quired facts that the principles of osteopathy consists. Dr. Still has emphasized in his Philosophy of Osteopathy and time and again by word of mouth thata “plan and specification” is necessary before intelligent work can be done. There must bein the mind of the student a “living picture,” not only of the form and feature but also of the function, the ten- dencies toward and away from the line marked out by hered+ ity, and every phase and fact that may be known regarding the complete life of the individual. It is true no such pic- ture was held by the pioneer in earlier times. It is true that osteopathy like all other sciences had its beginning as an art. It is no discredit to the science that the art occupies first