Philosophy of Osteopathy by Andrew Taylor Still

The second book published by A.T. Still, it collects the basic principles of osteopathy, written over several years and then gathered in one volume. Despite the insistence of his friends, Still was not sure that the time was ripe to divulge his early science.

Publisher: Kirksville, MO: Published by the author. Reprinted in 1946 edited by The Academy of Applied Osteopathy: Edwards Brothers, Inc. Ann Arbor, Michigan (USA).

Year of publication: 1899.

1899. In 1946 the volume was reprinted thanks to the courtesy of Blanche Still, Blanche Still, daughter of A.T. Still, with a preface signed by the publication Committee of the Academy of Applied Osteopathy, dated 15th January 1946.

Numero di pagine: 289.

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In the preface Dr Still states to have decided to write the book in order to provide the correct information to students and people interested in osteopathy. He claims to have divergent opinions from the medical class” on almost all important matters” and for this reason no work on medicine is mentioned in this book.

The aim of the book is to enunciate the principles of osteopathy and favor their understanding, and not to describe its techniques or define its rules. It contains ideas developed throughout many years which the author declares to have carefully verified and organized in a treaty that could serve as a guide for the future. 

The book contains 22 chapters. Hereinafter, the quotations refer to the page numbering of the original edition in English.

In the first two chapters Still remembers that he had developed osteopathy after having ascertained that the remedies of the orthodox medicine did not work, and specifies how the study of anatomy, which also includes physiology (p.18), is the foundation of knowledge for an osteopath. 

The osteopath does not act casually but on the basis of a reasoning, seeking first the “physiological perfection of form, by normally adjusting the osseous frame work, so that all arteries may deliver blood to nourish and construct all parts.” (p.27). 

Dr Still also points out that the human being is constituted by a material body, a spiritual being and a mental entity much superior to all vital movements and material forms which “wisely manage this great engine of life” (p. 26). The phrase “To find health should be the object of the doctor. Anyone can find disease”, very often quoted and also present in other sources, is at page 28.

Still continues by describing the methods he has developed to identify the deviations from the norm, mentally dividing the body into three parts: thorax, upper and lower extremities. The first part includes the head, neck, thorax, abdomen and pelvis. The second includes head, neck, arm, forearm and hand. and the third one foot, leg, thigh, pelvis and lumbar vertebrae. From the ellix surrounding the thorax comes all vital supply, and from that center only other two branches start, the one of the arms and the one of the legs.

Still describes, for example, how to perform the search for the cause of a foot pain (pp.30-32). The osteopath has to pay great attention to the nerves’ pathways and to the blood supply. “His mind will explore the bone, the ligament, the muscle, the fascia, the channels through which the blood travels from heart to local destiny, with lymphatics and their contents” (pp.38-39) and, if the mystery allows it, a “thought strikes him that the cerebro spinal fluid is the highest known element that is contained in the human body” (p.39). If the brain does not produce this fluid in abundance the health status will be affected: “[he] who is able to reason will see that this great river of life must be tapped and the withering field irrigated at once, or the harvest of health be forever lost” (p.39).

on pages 39-41 Still explains the importance of knowing chemistry to understand the functioning mechanisms of the body, then he closes the introductory chapters by repeating one more time the modalities at the basis of the reasoning of an osteopath, in this case giving the example of a  case of arm pain.

The chapters from the third to the twelfth one are dedicated to specific subjects, for example, the head, pulmonary diseases, the lymphatic system, the diaphragm, the visceral organs, blood,  fascia, fevers and others.

The thirteenth chapter contains some thoughts on what is life and a series of questions on which all osteopaths should reflect. In the fourteenth chapter Still complains that the human race has produced only a few original thinkers.

The fifteenth chapter, which Still defines the most important of the book, is again dedicated to osteopathic reasoning. Still describes what is the spinal cord and how to treat the spine, highlighting the great responsibility of an osteopath who is approaching a living human being. It mentions the importance of a perfect drainage and the harmony of the five types of nerves (sensory, motor, nutritional, voluntary and involuntary).

The sixteenth chapter Still offers further reasonings to find the cause of diseases, in particular by considering some specific topics: the appendix and the appropriateness of a surgical intervention; the diaphragm and the consequences of its malfunctioning; symptomatology and its relative inutility.

The seventeenth chapter focuses on obstetrics. Still points out how the first obligation for an obstetrician is to examine the pelvis and spine bones of the mother to ensure that it is all in the norm. If not, he will have to inform the patient of the risks and possibly refuse to follow the case. Pages 240-249 contain some practical instructions to avoid laceration during childbirth, for the tying of the umbilical cord, the expulsion of the placenta, mastitis and first care for the mother and child.

After the eighteenth chapter dedicated to convulsions, Still offers some closing considerations in the nineteenth chapter. All physicians in history have tried to heal the sick but did not succeed for the lack of a philosophical system: Still suggests that the most important thing to solve many diseases is to prevent impurities from accumulating in the lymphatic system, which should never be overloaded (pp.259-61).

The twentieth chapter, dedicated to the superior cervical ganglion and to the effects of inhibition or stimulation of the nerves linked to it, is signed by Dr William Smith..

Strengths: an absolutely fundamental reading to understand from the voice of A.T. Still the reasonings at the basis of the osteopathic philosophy.

Weaknesses: the volume is written in the characteristic style of A.T. Still.

In the edition dated 1946 edited by the Academy of Applied Osteopathy, the signatories of the preface – A.R. Becker, K.E. Little, G.W. Northup, R.W. Rice, C.K. Smith e T.L. Northup (president) – highlight the importance of this work by Still, providing some information and suggesting further reading to put it into perspective. 

They note how at the time when Still enunciated the theory of the natural immunity Lister was developing the first methods of the antisepsis and Koch was identifying the organisms responsible for illnesses like tuberculosis, typhus, tetanus and diphtheria.

They go on to say that many other Still’s ideas have been reflected in the evolution of medicine, mentioning numerous works supporting this thesis.

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