I started a collection of texts from old osteopathic journals that could be of interest to osteopaths and people curious about osteopathy.

You can fin the full list here
Some were translated into French here

---

How osteopathy treats the spine

Imagine, if you will, twenty-four blocks of bone, more or less irregular but circular in outline, and varying in thickness from one-half an inch to one inch, and approximately an inch and one-fourth in diameter, set one on the other, making a column some two feet in length. Between each block is a piece of cartilage about one-fourth of an inch thick separating each block from its fellow, although processes of the block extend downward and upward to join its fellow in order that greater stability may be assured. Through the centre of this column, lengthwise, runs a canal one-half an inch to three-fourths an inch in diameter. Thus in the rough is pictured an outline of a spinal column.

Next clothe this spinal column from top to bottom with innumerable ligaments and muscles in order that the sections may be thoroughly bound together and that the column may be endowed with rigidity if the occasion requires, as well as motion in various directions, such as movements forward, backward, laterally, obliquely, and of rotation. In a word, we have a column that is well bound together, at the same time being fully movable in all directions.

Then so shape this column that in a normal state it is curved forward and backward twice in its entirety, each curve compensating the other, after the character of a much modified letter S. Between each section of the bones will be found grooves, one on each side, passing from the longitudinal canal outward in order to allow the ingress and egress of nerves and various nutrient vessels.

Our entire organ now presents a stable but yielding and elastic column of bones, ligaments and muscles and lacks only the insertion of the spinal nerves and blood vessels and lymphatics to the spinal cord by way of the little holes one on a side between each section, in order to make the situation more than doubly interesting.

The spinal cord within its canal is most thoroughly protected by not only its bony casement but by membranes and a spinal fluid. In fact, the only way it can be injured or bruised is from a fracture or displacement of one of the blocks of bone. Consequently this article deals but little, directly, with the all-important spinal cord. Injury to the cord directly is rare, but impairments of the cord indirectly is much more common as we will soon see.

One other factor in the framework of this section of the body I wish to bring to notice is the ribs. The ribs, twelve on a side, are attached by one of their ends to the spinal column. Approximately the two corresponding are attached to the same vertebra, thus including in all, twelve of our original blocks of bone, and the rib attachment is practically midway of the two ends of the column. It will readily be seen greater rigidity is given the midsection of the column by the ribs.

Spinal column subjects to injury

Now, the first point I wish to emphasize is the fact, that although we have a spinal column that is rigid and stable, the spinal column is readily flexed, extended and rotated and even easily stretched to the extent of eleven and one-half cm., on flexion, (see 1 below). This being the case it stands to reason, as well as observation, that the column is subject to any and all mechanical injuries common to any column. Not that the sections of bone (vertebrae) must be, or even are, often dislocated in order to do much harm, but the many thousands of muscular strands and the ligaments may be readily strained, torn and variously damaged. Then above all, many of the most serious results arise from several sections en masse of the spinal column being sprained and sprung out of normal alignment by mechanical injury. This springing of several segments together of the column may tend to obliterate normal curves or it may accentuate normal curves or it may establish the starting point of a new curve. Is this surprising? Take the most substantially built building. Is not there a tendency for that building to become racked when violence such as a hurricane strikes it? Then certainly an elastic, slim spinal column where even slight muscular changes can sway it would be subject to the thousand and one physical injuries as falls, slips, etc, to which all of us are daily subjected. The wonder is that we are not continually more seriously damaged. Mark you, I am not speaking about fractures and dislocations of this column, although such do occur, but I am confining myself to the more modest and lesser strains and tears, but still many times far reaching, of the bones, ligaments and muscles.

Supposing our spinal column is strained, what would happen? Outside of the mal-alignment of the column, tearing and bruising of ligaments and muscles, another feature the most important of all, should never be forgotten. This is the disturbance, an irregular spinal column must have upon the nerves and vessels passing through the openings of the column between the cord and outside. Nature leaves no vacuum or any extra space within the body. There is a right place for everything and everything must be in its right place for perfect health. Is it surprising then that injury may be done the tissues about these nerves and vessels or even the lumen of the grooves impigned upon? Herein lies one of the great practical features of osteopathic practice.

Practical features of osteopathic practice

Rarely is injury done directly to the spinal cord or its centers, and rarely do we as osteopaths treat primarily for effects directly, the spinal cord or its centres. What we do nine times out of ten or oftener is to repair the damaged spinal column, osseous, ligamentous and muscular, in order that an embarrassed nerve or vessel passing in or out of the spinal openings may be rectified. Naturally, the nerves to or from the cord or the vessels to or from the cord being disturbed would affect the cord indirectly, and may not only cause a functional disturbance but an organic lesion. Nevertheless, our primary work is not with the cord but with the nerves and blood vessels to and from the cord, from the standpoint of a damaged spinal column mechanically disturbed.

The osteopath flippantly speaks of spinal centres but he rarely does much with any of them. This erroneous idea (osteopathic centres) comes from his knowing that certain sections of the spinal column exit nerves to certain organs with tolerable regularity (as to definite location). This much the osteopath knows, that the stomach spinal nerves come from certain sections, that the kidney spinal nerves come from certain sections, etc., etc. But as to his treating centers for this or for that trouble, in most instances he does not. Likewise when stimulating here or inhibiting there these so-called osteopathic centres he is in the majority of cases wasting valuable time for the patient. Correct the mechanical derangements and nature will do the rectifying in the stimulating or inhibiting of the life forces as she may require. All she wants done is a liberation; the forces are pent-up and lack freedom.

Adjustment the keystone of practice

What is the character of the genuine osteopath’s work along the spinal column? The work of the osteopath that knows his business, along the spinal column is first, last and all the time that of readjustment. It is relaxing the muscles; and correcting mal-alignments of the vertebrae and reducing sub-luxated ribs—all for liberation of the spinal nerves and vessels and the sympathetic ganglia and fibres; not primarily for the spinal cord or its center, but indirectly only. Outside of relaxing muscles and readjusting vertebral ends of ribs, the spinal work is in most instances sort of en masse, i.e., several segments together. Single vertebrae, with one or two exceptions, are rarely affected; one part of the column is usually wrenched or twisted on the other, or a large portion, several vertebrae, are sprained out of line together. The inexperienced osteopath may attempt to correct these so-called lesions by working on the lesion only, but the fact of the matter is a so-called lesion is probably one end of several vertebrae mal-aligned en block. Such an osteopath would probably examine up or down the spine and find what he would term a second lesion while in fact it would be the other end of the mal-alignment or slight curvature.

This is the kind of work that Dr. Still always does—goes to the lesion and readjusts it. He never gives a general treatment or any such imitations. Dr. Still never discovered any movements as some good osteopaths have intimated. Osteopathy is not a movement cure. It is a universal method of healing. Dr. Still discovered the principle. It is for us to apply the principle whenever indicated. There are no stereotyped methods of applying it. No two cases are alike, consequently no two treatments are alike. When you hear one say new movements will be discovered put him down as something outside of the osteopathic school. He has yet to learn its philosophy.

To me an incontrovertible proof that the foregoing interpretation of osteopathic spinal treatment is correct is the fact that treatment below the lower end of the spinal cord proper obtains the same results as elsewhere. The spinal cord ends at the lower part of the first lumbar vertebra about the waist line. A large percentage of treatment to the colon, sigmoid, rectum, bladder, uterus, and legs is given below the spinal cord proper. Results are the same—cures are performed by readjustment of the spinal column in this region. Is it by way of cord centres several inches higher? I think not; it is liberation of spinal nerves and blood vessels. If such is true here, why not in other sections of the spinal column?

M.D.’s often overlook the real cause of disease

The osteopathic profession has been harshly criticised by the medical profession in particular, relative to the lesions we find in the spinal column, and, also, the frequency of our spinal treatments in the vast majority of cases. The average M.D., and he is the one densely ignorant of clinical anatomy, whoops and hurrahs that it is absurd to even suggest the possibility of a derangement of the vertebrae as suggested above.

Let us reiterate for emphasis our viewpoint of spinal column derangements, and mark you this knowledge is neither hypothetical nor theoretical, but absolutely practical facts based upon examination and curative results from thousands of cases by thousands of osteopaths in the United States during the past decade. Our observation has been, and without a shade of doubt that muscular contraction of the back muscles, that sprains, strains, jars, and falls of vertebrae and ribs, that postural habits, that compensatory deformities, and that reflex irritative conditions can so damage (irritate and obstruct) the spinal nerves, the allied sympathetic nerves, the spinal blood vessels and lymphatics in a direct or indirect mechanical manner that a large percentage of ailments may directly originate therefrom, predispose mal-nutrition or reflexly disturb diseases already situated in the various organs. Then, naturally, the modus operandi to correct these ailments is a manipulation as the situation or condition indicates (not an active or passive movement, but a scientific readjustment as the cases require, and no two cases are alike, based upon definite and known mechanical principles). Pills, plasters and liniments would not be common sense treatment any more than shoveling in more coal into the fire-box of a locomotive to get up more steam to straighten a bent piston rod or to correct a wrongly adjusted eccentric.

Reason for frequent treatment

Why is the spinal column treated so often? For the simple reason that the spinal cord and its nerves control the life and function of nearly every organ. The integrity of the cord and its nerves means either ease or disease.

I have personally heard it stated by competent M.D.’s, that really all a physician needs to know is a knowledge of drug action, and that all a surgeon needs to know is to cut soft tissues when encountered with a knife and to saw a bone when discovered and during the mean time to ligate the blood vessels. Of course, this is overdrawn but it illustrates the fact that most medical men place anatomy and physiology in the back-ground. How much confidence would you have in a mechanic who did not understand the principles of mechanics? The human body is a vital mechanism based upon the laws of mechanics and dynamics, and outside of food and hygienic considerations is self-regulating and self-supporting and contains absolutely its own reparative principles. Disease is a condition arising from abuse and overuse, not from a something that gains entrance into the body and must be expelled. To substantiate our claims a little more fully, if such is necessary, I wish to refer the skeptical reader first to two works (see two and three below).

The blood supply to the cord is very important from an anatomical and osteopathic standpoint. There are three blood vessels, an anterior and two posterior that run the entire length of the spinal cord. This means long slim vessels, the largest of their size in the body, and dependent of direct cardiac impulse. The pressure within the vessels is slight and gravity impedes return circulation. Then these long vessels receive reinforcement all along the spinal column from branches of large vessels within the body, and these branches, note this, pass through the little openings between each vertebra in order to reach the cord.

Authorities quoted

Bearing upon the anatomical features I desire to make a quotation (see four below).

” . . . . The spinal cord is suspended within the spinal canal in subarachnoid fluid, which entirely insulates it, and, meantime, surrounded by this liquid, and insulated by it, the spinal cord itself is out of reach of any blood-supply, except such as can come to it from the brain above, or else along the nerve-roots at the sides. And, in fact, the supply of this important part becomes, ‘if I may so speak, one of Nature’s difficulties. Let us see how the difficulty is met. The blood supply to the spinal cord is carried out by slender vessels which come from the vertebral arteries within the cranium. There are three of these arteries, one on the front and two on the back of the cord; they are very slender, and yet have to run along its whole length. No arteries so small as these run so great a’ length elsewhere in the body, and pressure falls rapidly in minute arteries as the length of pipe increases, so that it becomes necessary to re-inforce these slender vessels wherever possible, and advantage is taken of the nerve-roots to send up little re-inforcing arteries along these. . . . . When you approach the tip of the cord the supply from below becomes exceedingly precarious, and even apt to fail entirely, because upon the long strands of the cauda equina the small arteries are too narrow and too long to re-inforce the cord with any certainty. . . . .”

“. . . . Hence we see that the tip of the spinal cord, corresponding to the lower limbs and sphincters, is much more weakly organized as to its circulation than all the upper parts of the cord. . . . . I believe it is by impediment to the exceedingly and peculiarly difficult blood-supply of the caudal end of the spinal cord that all these various conditions lead to paralytic weakness of the lower limbs, and they are to be met by conditions improving the circulation, if possible.”

The foregoing is certainly an interesting quotation and shows logically and conclusively the efficiency of osteopathic treatment on the spinal cord. If osteopathy is anything it is a common sense rational treatment.

Those who desire the study of the physiology of the blood-supply farther and, also, some more of the detailed osteopathic theory I must refer them to other works (see below five, six and seven). I would like very much to go more in detail but my article is already getting lengthy. The student will find some exceedingly interesting material in the references.

Another suggestive quotation I desire to make (see below number eight).

“What has happened, . . . . when a man has fallen with his back upon the ground? It is possible that the spinal marrow, obeying the law of gravitation, may, as the body falls, precipitate itself in the same direction, fall back toward the arches of the vertebrae, and be itself concussed in that way. Or the little filaments of the sensitive and motor nerves, which are delicately attached to the spinal marrow, may, for a moment, be put in a state of extreme tension, because, as they pass through the intervertebral foramina, they are fixed there by dura mater; and, if the spinal marrow be dragged from them, the intermediate parts must necessarily be put upon the stretch, producing at the same time the ‘pins and needles’ sensation, and also explaining the symptoms felt on the following day. It is impossible that these symptoms could be the result of anything but some structural disturbance; and they are, to my mind, the evidence of decided injury to the nerves or marrow, although what that injury may be is not ascertainable.”

The foregoing quotation is from Hilton (see eight below). Clevenger (see nine below) comments upon it as follows:

“These views of Hilton’s are capable of extension to wrenches, etc., of the vertebrae, not only disturbing the precarious circulation of the cord, but by strains inducing more or less permanent irritation of the nerve-roots, and meninges, and, what seems to have been wholly lost sight of by all writers, lesions of the soft and poorly protected spinal sympathetic communicating fibres.”

Is not this hitting pretty close to osteopathic ideas? But, alas! they forget their application of practical anatomy when it comes to treatment. Relative to the sympathetic nerve importance I must refer the reader to another work besides Clevenger (see ten below). I am sorry space and time forbids further extracts on the sympathetic nerve in relation to spinal injuries. Another writer (see eleven below) among many fine ideas has the following to say relative to sprains of the back and neck: . . .

“One of the most singular features in connection with these sprains is the way in which the backbone itself, and the muscular and ligamentous structures around it are overlooked and ignored. Even in the ordinary accidents of every day life there is a great tendency to lay everything that is serious or lasting to the credit of the spinal cord. In railway cases there is no hesitation at all; if any serious result ensues, it must be the consequence of damage this structure has sustained, or of inflammation following it, little or no attention is paid to anything else. Yet it is difficult to see why the other structures should enjoy immunity. The vertebral column may be strained, especially in the cervical and lumbar regions; the ligaments torn or stretched; the nerves bruised or crushed; the smaller joints between the segments twisted and wrenched; the muscles detached from their bed and torn across, or thrown into such a state of cramp that they become rigid and unable to act with freedom; or the fibrous sheath which contains them and helps to secure the bones laid open and filled with blood. Results, in short, of the most serious description are not uncommon, and often leave lasting evidence of their existence behind, when the spinal cord escapes completely.”

The foregoing was written some fifteen years or so ago by an English surgeon, and what good did it do the medical profession? Even the surgeon that wrote it did not know how to meet the conditions rationally. It has remained for Dr. Still to give to the world a logical system of therapeutics. The M.D.’s have been running after false therapeutic gods. When occasionally they found one of the converging paths they immediately lost its significance and got into a diverging road.

I cannot resist the temptation to give just one more short quotation from an old book (see twelve below) that is apropos of our article.

“While then the victims of railway collision (the author is treating of railway injuries in particular, but other injuries bear the same features) are not by any means exempted from liability to suffer from any and every form of lesion of the spinal cord and its membranous coverings, accumulated experience leaves no longer any doubt that these grave results are most uncommon, and that though the back is especially prone to suffer injury in this form of accident, it is the extra spinal structures which, in ninety-nine cases out of a hundred, bear the brunt of the violence and suffer from it.”

The question naturally arises, why was not osteopathy discovered before? This can only be answered by the question, why has nearly all the great advances in surgery been discovered in the past decade or two? Simply ignorance and superstition.

Hence, it is seen there is plenty of detached and fragmentary evidence bearing upon our interpretation of spinal injuries and mal-alignment; although not one authority prior to Dr. Still even suggested the osteopathic method of cure or relief of these spinal disorders, let alone their application to diseases in general.

1. Golebienski—Diseases Caused by Accidents, p. 124.
2. Church and Peterson—Nervous and Mental Disease, p. 323.
3. Deaver—Surgical Anatomy, Vol. 1, p. 444.
4. Croonian Lectures, Royal College of Physicians, 1881, quoted by Clevenger, Spinal Concussion, p. 195.
5. Hazzard—Principles of Osteopathy.
6. Journal of Osteopathy—Dr. Hart’s Article, December 1898.
7. Schäfer—Physiology, Vol. 2.
8. Hilton—Rest and Pain.
9. Clevenger—Spinal Concussion, 1889, p. 197.
10. Fox—Influence of Sympathetic on Disease.
11. Moullin—Sprains; Their Consequences and Treatment, p. 152, 1891.
12. Page—Railway Injuries; With Special Reference to Those of the Back and Nervous System, p. 29, 1892.

Carl P. McConnell
Journal of Osteopathy, December 1903