In the etiologic study the osteopathic characteristics have been
designated structural maladjustment, although at the same time not
losing sight of the angle that the body is not only a physical
mechanism but also a vital organism. Structural perversions
characterize the osteopathic distinction when dealing with the
physical body, and remembering the vital or biochemic mechanism,
mental attitude, diet, hygiene, etc., are not forgotten. To retain or
attain health, thorough appreciation of both the physical and vital
mechanisms should be kept in view, for there is both an independent and
dependent interaction on the part of each. The living body being an
entity premises a system of therapeutics both physical and vital, that
acts in direct accord and harmony with physical laws and physiological
functioning.
Osteopathic pathology deals with the distinctive osteopathic lesion as
a factor in production and maintenance of disease. Then the province
of pathology is, first, to determine whether the lesion is in reality
an etiologic factor; second, the immediate character of the lesion
disturbance; and, third, how organic life becomes involved.
Inspection, palpation, clinical results, dissection and laboratory
experimentation include the methods employed to prove that the lesion
is of practical consequence. That the lesion is an etiological
factor can be known only through clinical and experimental proof;
the immediate character of the lesion disturbance can be determined
by dissection; and how organic life becomes involved requires the
summation of histological, physiological and pathological data.
The following outline assumes that the reader is familiar with anatomy,
physiology and pathology. Osteopathic pathology does not add to
medical pathology an absolutely new pathology in all of the present
known numerous details, but instead interprets much of clinical
pathology anew, and furthermore it presents absolutely new data that
is exclusive, but germane to the present general medical and surgical
fields.
Nervous tissue and arterial blood are the master tissues, the
controlling and governing factors in health, and disturbances of these
tissues are necessarily the cause of ill health. The rule of the artery
and the control of the nerve must continue uninterruptedly in order
that physiological functioning remains intact. The body should be
looked upon as a being complete, no more or less, each tissue and organ
essential to the whole and the organism as a whole essential to every
part. This is fundamental and germane to a living structure, and hence
disturbance to the governing and controlling tissues, the nerves and
vascular channels, must necessarily cause a break in the concatenation
and disease must logically follow.
Thus in the osteopathic pathology we look to those influences that
primarily disturb the nerve or artery, study the disease process or
extension from inception to effect and from primary lesion to morbid
results, and note action and interaction of tissue upon organ and organ
upon organ.
That all parts of the body are in intimate and dependent relations each
with the other through the media of the nervous and endocrine systems
is a well known fact based upon histological and physiological grounds.
The neurone being the physiological unit implies that any disturbance
to the cell quickly disturbs any or all of its processes. It may be
said that “nervous tissue is dependent for its integrity upon two
things, blood supply and trophic influences. The nerve cell is solely
dependent on a proper supply of blood, and dies when this is withdrawn.
But the nerve fiber is more dependent on the trophic influence of the
cell of which it is a prolongation. It dies when cut off from the cell
but it can get along for a time with but little direct blood supply. On
the other hand, if the nerve fiber is injured it reacts on the cell,
leading to a partial but curable degeneration of the cell body.”[18]
Here is the immediate pathologic key to many diseases. Whatever cuts
off or obstructs the artery leading to the cell is a primary etiologic
factor; this then leads to degeneration of protoplasmic processes and
axone. It should be carefully noted that if the obstructed blood vessel
is one to the nerve fiber only the resultant partial injury to the cell
is curable.
“When an axone degenerates the retrogressive process involves not only
the main axone, but also its terminals, together with the collaterals
belonging to it with their terminals.”[19] This is an exceedingly
important link in the explanation of osteopathic pathology, that
distant organs may be affected by the osteopathic lesion. Moreover,
“degenerations of a secondary character may occur in those systems of
neurones which are more or less dependent upon the peripheral sensory
neurone system for their impulses.”[20] This is equally true with the
central motor neurone, or any neurone. It shows how far-reaching a
degenerative process and its effects may be. It further makes clear
that nerve intactness is directly and absolutely dependent upon a
normal circulation, and that it is self-evident any blockage either to
blood vessels or to neurones will vitally affect those tissues that
govern and control the life processes of the body. The integrative
action of the nervous system is one of the outstanding facts of
physiology.
The above is presented so the student may see how osteopathic spinal
lesions, if deeply seated and effective enough, can involve remote
tissues and organs. No one will doubt that fractures and complete
dislocations of the spinal column will seriously affect visceral life,
or a prolapsed kidney will be a cause of nutritive disturbance, or a
displaced uterus the cause of ovarian congestion, or a dislocated hip
the cause of atrophy of the leg muscles, but it has remained for the
osteopath to offer proof that slight misplacements of the vertebræ or
ribs, incipient curvatures, postural defects, slight deformities, and
unsymmetrical bodies are of sufficient etiological importance on the
physical plane to affect neurone integrity and obstruct artery courses,
and thus organic life.
The question at once arises, what is the immediate or direct effect
upon blood vessel or nerve of the osseous, ligamentous, muscular,
visceral or composite lesion? The osseous lesion will be taken as
a type. The direct effect is usually one of hyperemia or ischemia,
generally the former, for as physiologists and clinicians observe
irritation commonly precedes debility. In the vertebral and rib lesions
there may be direct pressure upon the spinal nerve at its spinal
foramen exit or on the sympathetic chain directly contiguous to the
heads of the ribs. This causes congestion, inflammation, ecchymosis,
and degeneration of the nerve fiber, followed by macroscopic and
microscopic changes as connective tissue proliferations, arterial
scleroses, etc. Or, as seems probable in experimental work, the
inception of the pathology may be frequently the result of blockage to
nervous stimuli, which when maintained affects the efferent vasomotor,
secretory, trophic and other fibers so that circulation and nutrition
are definitely involved.
Thus the cells so sensitive to altered vascular changes are directly
and remotely affected, and disease characteristics dependent upon
structure and function of tissue, and degree of irritant are evident.
This can vary, in degree only, with the muscular lesion that involves
collateral spinal cord circulation, the visceral lesion that irritates
sympathetic life, or the composite lesion that deforms or perverts
structure en masse.
But is the physical noxa as potent an etiologic factor as the chemical
or bacteriologic? Adami[21] informs us whether an irritant is physical,
bacterial or chemical, no satisfactory distinction can be founded on
the duration of the irritation; that a local irritation of the nervous
system may lead apart from “direct reflex action, to changes of nervous
origin, in the region of the injury and in the reflexes affecting
associated regions, the higher centers; and through them the system
at large, may become affected by paths that it is not always easy to
trace.” Again he says that “centrifugal impulses alone, apart from any
local injury, may originate a succession of phenomena of inflammation
in a part.” And “in all probability a nervous and central origin must
be ascribed to some, at least, of the sympathetic inflammations seen
to occur in areas supplied by the other branches of a nerve supplying
a part primarily inflamed; and again in areas supplied from the same
region of the brain or cord as the inflamed organ.” Other inflammatory
changes, of course, may occur independently of centrifugal nervous
influences, and the vessels react independently of central influences.
This, then, presents a situation postulated thus:
1. The body follows definite structural relations and is influenced by
mechanical arrangements in its morphology.
2. The integrity of tissue depends upon structural freedom of nutritive
courses.
3. The above predicates a structural etiology as exact and precise as
structural relations are important to nutrition.
What proof, then, of the foregoing have we to offer?
First, the =clinical proof=. Clinical results have been obtained in
tens of thousands of cases that include disease of various types
and lesions, and of all sections and organs of the body. The art of
osteopathy has been perfected in many of its details, based upon actual
experience and splendid results. The cure of the patient is paramount
to all other consideration, and whereas the osteopathic school has
been shown a superior system it logically follows on _a priori_
grounds that relief and cure of suffering is of the first and final
importance.[22]
Were it not for clinical results no new system of therapeutics could
withstand criticism and calumny and finally triumph and be publicly,
legislatively, and scientifically recognized.
Second, the =autopsy proof=. Many dissections have been made and
autopsies held with the view of discovering the character and the
potency of the osteopathic lesion. This very important work has borne
out the osteopathic theory of disease. Vertebral and rib displacements
have been noted, corresponding ligamentous tissues thickened,
associated nerve tracts and vascular channels disturbed, and finally
the related organ found diseased.[23]
Third, the =experimental proof=. Experimental proof appeals, logically,
to the scientific mind. This proof[24] is being gradually developed.
Experimental investigation has been successfully carried out upon
numerous animals. The experiments conclusively prove that not only
spinal inhibitory and stimulatory manipulations (mechanical) are
productive of immediate physiological changes in the viscera, but that
the structural anatomical lesion or noxa is an important factor in
the etiologic field. Pathological changes in several organs directly
follow the artificially produced vertebral and rib lesions, showing
beyond doubt the reality and effectiveness of the osteopathic lesion.
This emphasizes the point that centrifugal impulses originate an
inflammation in a previously healthy and uninjured tissue or viscus.
And as “inflammatory phenomena may be sympathetically developed in
regions innervated from the same area in the brain or spinal cord”
it remains to prove the actuality of vertebral and rib lesions, i.
e., structural perversions really affect contiguous nerve courses
and vascular channels; and this has been demonstrated in laboratory
experiments and at the autopsy. Consequently the vertebral, rib, or
other lesion may be an important etiologic factor either to the nerve
strand from cord or brain to viscus or from viscus to cord or brain.
Dr. Still says in his Autobiography that “all nerves depend wholly on
the arterial system for their qualities, such as sensation, nutrition
and motion, even though by the law of reciprocity they furnish force,
nutrition and sensation to the artery itself.” It matters little in
this outline whether obstruction to nervous integrity is by way of
an impinged artery or by direct pressure, or both, or otherwise,
for the primary consideration is the noting that the osteopathic
lesion is a real and potent factor of disease. Sajous[25] informs
us that “a neurone is directly connected with the circulation (via
neuroglia-fibril) by one or more of its dendrites, which serve as
channels for blood plasma,” that a neurone receives its nutrition
directly from the general circulation, and that from the axone the
blood passes into a lymph space connected with a vein. Thus in reality
a part of the circulatory system is that of the entire cerebrospinal
system.
The student is referred to the various publications of the Research
Institute and Deason’s Physiology for experimental data confirming the
validity of the osteopathic theory, although it should be emphasized
that clinical evidence is quite conclusive. Malalignment injuries of
the vertebral articulations, for example, ranging from imbalance of
muscular tension to infections, is certain to result in some type of
rotation and sidebending of the segments to an extent that apposition
is compromised and abnormal anchorage supervenes. There are many
factors of the pathology: muscular tension and fibrosis; damaged
ligaments, particularly the capsular; interference of nervous stimuli,
blockage of impulse directly and reflexly as shown by pathologic
involvement in cord centers and sympathetic ganglia, and in certain
cases direct obstruction of nerve fibers as revealed by Wallerian
degeneration; involvement of circulation as shown by damage to
blood-vessels, local edema and local acidosis, and effect upon local
tissue respiration and drainage. Through a combination of these various
factors circulation, nervous equilibrium and chemism of related parts
are involved, both anatomical and physiologic balance is upset, and
resistance of corresponding viscera affected. Reciprocal innervation
and the axone reflex are also disturbed, all of which are important
predisposing causes that disturb resistance of tissues and organs,
upset their correlated mechanisms and render active various possible
infections and toxins that otherwise a normal circulation, nervous and
endocrine systems, and oxygen supply would rapidly and successfully
combat and restore the organism to normal. Thus from the practitioner’s
standpoint there are three points to always keep in mind: readjustment
of the lesion; correction of the forces, habits, environment, etc. that
produce the lesion; and hygienic attention of the body after lesion
adjustment in order that normal condition may be maintained. A thorough
study of the physiologic movements of the spine is a prerequisite
to an understanding of the various possible abnormal appositions,
though it should be appreciated that these movements are not consonant
or applicable to many abnormal conditions. Pathology reveals many
gradations and combinations not found in normal conditions. Frequently
the key of a successful technique rests upon an understanding of the
individual make up of the interosseous lesion.
It has not been the purpose of this section to go into details but
rather to follow logically an outline of osteopathic etiology and
pathology. The various details will be found in the osteopathic works
on Principles as well as in the experimental articles referred to. It
should be understood that the osteopath believes thoroughly in _vis
medicatrix naturae_ whether the indications are for stimulation or
inhibition or for the basic readjustment. Generally speaking, however,
therapeutic philosophy resolves itself (ultimately) into the principle
that a cure depends upon giving an impetus to impaired, habitual and
latent forces, which in the osteopathic field implies fundamentally
adjustive manipulation whereby the resultant impetus or physiological
stimulus is initiated.
In a word, osteopathy premises that the body is a vital and physical
mechanism subject to derangements, structural alterations, and
functional changes, as results of violence on the mechanical plane,
as well as disturbances on the psychic and biochemic planes. Hence,
osteopathic philosophy is inclusive of preventive, palliative and
curative measure.