Everyone is of the opinion that to forecast the probable result of a
disease is one of the most difficult problems the physician has to
meet. To state the duration, course, and termination of an attack of
disease as presented by its nature and symptoms implies an accurate
knowledge of both disease processes and changes, and an insight into
the individual’s idiosyncrasies backed by ripe clinical experience.
And after each of these factors has been carefully considered to
balance one against the other, nothing short of superhuman knowledge
may present a sufficient insight in order to render an accurate
prognosis. A prognosis represents the culmination of one’s learning,
an understanding of disease characteristics, and an insight into
temperament.
C. M. T. Hulett[29] says: “Only when we can know all the conditions,
causative and sequential, with their possible complications and
terminations, together with a full history of therapeutic results in
a large number of similar cases, and carefully analyzing and weighing
these various elements, are we prepared to really make a prognosis.”
Nettie H. Bolles[30] writes as follows: “The prognosis depends upon
the cause of the disease, the possibility of removing the cause, or
the likelihood of recurrence of causes, and the chances of avoiding
such recurrence. The circumstances to modify the outlook are various
and deserve careful consideration.” It is not the purpose here to
go into the many essential details, for that would mean an outline
and forecast of all disease processes, and the effect of numerous
extenuating circumstances. The medical profession have been gathering
data for these three thousand years and prognosis with them is still
inaccurate and incomplete. Osteopathic science will add just so much to
the accuracy of prognosis as the sum total of the knowledge displayed
in the fields of osteopathic etiology, diagnosis, pathology and
therapeutics. Suffice it to give here a few salient practical hints as
noted in the osteopathic treating room and at the bedside.
Osteopathically it may be said that prognosis depends, first, upon the
true conception of osteopathy; second, upon the relative value of all
factors pertaining to health and disease; and, third, upon the skill
(technique and native ability) of the osteopath. The first and second
being granted, the third includes a remarkably practical and pregnant
field, for in no school does the physician get into as close touch
and understanding of the actual condition of the patient’s disorder
as in the osteopathic. Although the fundamentals and principles of
the osteopathic conception of diseases are really broad, liberal,
and all-inclusive, still owing to the fact that each individual (and
thus each disease) is more or less a law unto himself should there
not be absolute tables and prescriptions to be governed by; remember,
however, this does not imply our fundamentals are not basic or our
principles are not truths, but rather the application and execution of
the same are as varied as the individual’s constitution, temperament,
and disease. Herein rests the really difficult practical consideration
of etiology, pathology, diagnosis, treatment, and prognosis. In other
words, if the diagnosis and treatment are accurate the result rests
entirely with the patient.
First, too much emphasis cannot be placed upon the fact that prognosis
is dependent upon the osteopath—his education, training, ability,
experience, and technique. One’s fitness is most important. And fitness
and personality complement each other. An osteopath may know theory and
still not be practical; still one cannot be practical unless he knows
theory.
Second, osteopathic treatment frequently changes the usual course of
acute disease. It is well known that many diseases have a certain
regular course in their history. Many times the osteopath will be able
to abort, lessen the severity, or cut short the ailment, thus changing
the recognized symptoms and termination.
Third, the knack of treatment, or knowing how to treat, not only one
region of the body but all regions, not only one temperament but all
temperaments.
Fourth, the preparatory treatment before correcting the lesion.
Prevention, palliation, or cure, and thus prognosis, may be dependent
upon a necessary preparatory treatment. Here is where a study of the
patient’s temperament is very essential.
Fifth, a prolonged treatment may defeat one’s purpose. As a rule a
comparatively short, thoroughly indicated, specific treatment is best.
Sixth, much, relative to prognosis, can be told by the tone of the
vertebral ligaments. When a lesion corrects too easily or does not
remain well in place it shows a lack of tonicity on the part of the
ligaments and muscles. Improvement is in direct ration to the increase
of tonicity.
Seventh, special care should be taken with the irritable spine. This
spine commonly precedes the debilitated spine. Unless precaution is
taken to apply inhibition before treating specifically a cure may be
prevented or at least the disorder prolonged.
Eighth, relaxation of muscles is not always essential, although
the lack of it may prevent the correction of primary lesions. The
relaxation should be carried out with care in order that all shock and
irritation may be kept at a minimum.
Ninth, needless stretching, traction, extending, rotation, and snapping
of the neck is not only useless but may be positively dangerous.
Rarely is it necessary to go through the above “movements” as many are
accustomed to do.
Tenth, it may be necessary, but not always, to give as additional
treatment, after the anatomical defect has been specifically treated, a
certain amount of stretching and moulding of the parts.
Eleventh, owing to the close personal relations of physician and
patient, personality has a powerful influence on prognosis.
Twelfth, too much emphasis cannot be placed upon the uselessness and
injurious effects of over and misapplied treatment.
All of the above have a positive bearing on prognosis. The osteopath
should study his technique well. He will find that it gradually changes
and improves from year to year. In a word, as he gains in experience
he will become more skillful by giving careful attention to the
development of the sense of touch, by noting the resistance of the
tissues, and a score of details that are very hard to describe but the
sum total of which determines and indicates the successful osteopath.
Another practical point that bears upon prognosis as well as upon the
health of the osteopath is the manner of giving treatment. First, the
height of the treating table should correspond to the height of the
practitioner. The table should be made for the practitioner and not the
practitioner fitted and warped according to a certain table. Second,
give part of the treatments on a treating stool. Here there is greater
freedom of movement on the part of the patient, hence greater and more
effective leverage can be obtained. Suit your treatment to the patient,
not your patient to the treatment. Third, make your weight count for
energy expended in the treatment. As soon as one set of muscles become
tired substitute another set, e. g., the back muscles and the arms, the
arms and the hands. Fourth, whenever possible substitute the weight of
the patient for expended energy. Fifth, when lifting keep the spinal
column straight; do the bending of the body at the knees. Hence a
better treatment and a more favorable prognosis, and besides that new
occupation neurosis, the “=osteopathic back=,” will be materially
lessened in both severity and frequency.