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Harold I. Magoun, Jr.,Doctor of Osteopathy

                                               THE POWER OF TOUCH                                                                           

The Sutherland Memorial Lecture by Harold I. Magoun, Jr., Doctor of Osteopathy, FAAO

Touch has a number of different connotations. Referring to the dictionary, we will  quote a number of them: To lay hands upon; to perceive or experience through tactile sense. To examine by feeling with the fingers.

These first two are what we most commonly think of, but there are other meaning as  well. To make an impression. We can “touch” other persons without any physical  contact. To reach the heart; to move to sympathetic feeling. These are more deeply felt  impressions, again without physical contact. To affect; a mental or moral sensitiveness or responsiveness. We can  accomplish this by words, deeds or attitudes. A mental response to visual, auditory; olfactory or gustatory senses. We all are  touched in many different ways by these various stimuli to our special senses, whether pleasant or noxious. The dictionary lists others, but these will serve our  purpose today.

In the physical act of touching, we can accomplish this in a great variety of ways:

In love, in tenderness, in sympathy, in exhilaration,  in anger, in professional help.

We are touched in may ways without any physical act involved. Who is not touched  by a beautiful sunset, a rainbow, a snow-capped mountain, an exciting sporting event  such as Dan Jansen finally winning his Olympic gold metal, a beautiful flower of a  child’s smile?

Who is not touched by the sound of beautiful music, or the thunder of waves  pounding on the beach or in apprehension by a child’s cry?

We are touched by our gustatory sense when we smell a favorite food being  prepared just the way we like it. The olfactory stimulation of fresh baked bread or a  hay field after the rain gives us pleasure, and, of course, we can have many  unpleasant responses, for instance, the small black animal with the white strip.

We are deeply touched by special occasions such as a birthday and special holidays.  We are touched by reading an interesting book, or about a heroic action or about  some monumental achievement. We can touch or be touched without ever knowing  or seeing a specific person by what we hear and what we experience from a situation. These effects can be either positive or negative.

In a very negative way, how many millions of people have been touched by the  madman Adolph Hitler? Through psychology and political opportunism, he became  the dictator of Germany, set out to conquer the world and purify the Arian race.  Estimates range up to 60 million casualties of World WadI. Hitler killed nearly 6  million Jews, and people still deny that the Holocaust happened. How can they? Germany killed around 3 million Soviet prisoners of war,. 500,000 gypsies and 250,000  handicapped persons. Germany lost 3 million of its armed forces and 780,000  civilians. We are still reliving the horrors of that time. Monuments and graveyards are  constant reminders, books and movies recount the horror and it commands a prominent place in history. More than 50 years later, we are still being profoundly touched by it.

More recently, the maniac Sadam Hussein ravaged a neighboring country and  mobilized much of the free world, especially the United States, to oppose his  aggression. Our troops performed brilliantly in “the mother of all battles” Desert Storm.  This touched us all with a surge of patriotism and with a deep sense of gratitude  when our casualties needed only 326 body bags, compared to the 16,000 the Pentagon had ordered! No one knows for sure, but it is estimated that Iraq suffered  more than 100,000 casualties. We are still being touched by Hussein. We can’t forget  the vivid picture of a country set on fire, and wondering if Hussein will again use  biological warfare with the growing awarness that many of our Desert Storm veterans are suffering from the “Gulf War Syndrome”. We also have a gnawing anxiety of  whether or not Hussein has and will use atomic weapons. Yes, we are all touched by  evil.

But, on the positive side, how many millions have been touched in a very uplifting way by Norman Vincent Peale, both through ministry and his writings? He is truly a positive influence. Untold millions have been deeply touched by Billy Graham, the evangelist’s evangelist. He is the very image of waht the stands for, with never a whisper of controversy. And, much of the world is touched by concern over his failing  health.

How many people have been touched by a gifted musician such as the brilliant Israeli violonist Itzak Perlman? Though handicapped by Polio, he has become one the worl’s  greatest musicians. In addition to his virtuosity, as you watch him play, you cannot  help but be touched by the love of his music which radiates from his face. An amusing story is told about him when, a number of years ago, he appeared in concert as part of a string quartet in a small midwestern city. This being an unusual occasion, the promoter had arranged the audience to come on stage afterwards and meet the members of the string quartet. Mr. Perlman, being the most famous, had a long line waiting to meet him. At the end of the line was a little old lady who patiently inched helself toward Mr. Perlman, and finally when her turn came, she gushed, IIOh Mr. Perlman, I was so excited to hear you perform. Your music was just beautiful, and I do hope your little orchestra just grows and qrows!”,

One third of the world is Christian, the largest of all religious groups. Christians believe Jesus Christ to be the son of God. Others believe him to be the greatest healer of all time. Time is measured before and after Christ. Not only has Jesus dramatically touched the world very directly for 2,000 years, his is a unique situation. He touched many people before his appearance on earth; because the prophets  foretold his coming, and people eagerly awaited that event. Even today some people await the second coming. His presence on earth created a religious movement that continues to spread like ripples in a pond.

In our consideration today, what does all this mean? As applied to us, it means that we as physicians touch patients in many ways before we lay our hands on them. Patients are touched by what they don’t know about osteopathy, and this will create impressions that can greatly affect the treatment outcome. We have a pressing need to better educate the public, third party payers and the adminnistrators of managed care organizations as to what osteopathy is and how cost effective it is. This will become critical as we move further into total managed care. Well educated osteopathic patients will help us in the battle.

Patients are touched by what they hear about us – “The doctor is so kind and understanding; the doctor is always so busy, he doesn’t have time to talk; the doctor is gentle; the doctor is rather rough, but he did help me” – and so on.

Patients are touched by the voice that greets them on the phone when they call the office. They are touched by what they see and when they enter our office. Is it neat and clean, or dirty and disorderly? Is it pleasantly and appropriately decorated? Are the magazines current? They are significantly touched by the promptness of the service, having to wait is the patients biggest complaint. They are immediately touched when we walk into the treatment room, and their response to us is affected by all of the previous factors we have discussed. If too many negative factors exist, they are apt to exhibit the well known medical phenomenon known as the II white coat hypertension”,

 

Patients are touched significantly by how we look – are we professional, well groomed, are we overweight, do we seem interested? They are touched by what we say and how we say it. They are affected by the appropriateness of our history. Then comes the most important moment of all, when we lay our hands on the patient, the physical touch. Are the doctor’s hands sure or hesitant, are they warm or cold, are they gentle or rough, are they clumsy or perceptive? Patients who have previously had OMT are particularly sensitive to these responses. Our application of touch can have a wide spectrum, the two extremes being the POWER of touch, an intrusive forceful exertion of our will on the patient through both our hands and attitudes, or on the other hand, the power of TOUCH, a perceptive, intuitive gentle application. The latter is a special gift. Where does the credit lie for this special gift?

Throughout recorded history, there have always been references to hand-on procedures. It is from the Bible that we get the term, “the laying on of hands”. We know the same type of manipulation was done at the time of Hippocrates, but it died out along with much of the Hippocratic holistic philosophy.

Then along came A.T. Still, who found that the laying on of hands in a variety of ways was much more effective in relieving his patient’s complaints than we had been doing, and so he sought to improve the practice of medicine, surgery and obstetrics. Even though he was unsuccessful doing that and was forced to open a school of medicine called osteopathy, his methods have touched more people than anyone else in the history of medicine, and his influence keeps spreading like a giant ripple on the therapeutic pond. Those of us who follow Dr. Still are in a position now to still chage the practice of medicine, surgery and obstetrics, as has been pointed out so  vividly by our own Dr. Korr. For many years, the “laying on of hands” was used derisively by the medical profession about osteopathy. But osteopathy’s dramatic success, and the work of others, such as Delores Krieger and her “Therapeutic Touch” plus the mushrooming of many forms of manual therapy, have caused the laying on of hands to not only be acceptable, but eagerly sought and even politically correct. Because of the great success of the osteopathic” power of touch”, many  others are copying it with varying degrees of success, so we need to make every  effort to remain the world leaders in this respect. We are about to witness a historic  change when allopathic physicians who practice manual medicine, with additional training and meeting certain standards, can become certified through our special certifying program.

When Dr. Still proposed his new philosophy, as has been the case with most medical pioneers, he was ridiculed and rejected, even by some of his own family. However, he held firm to his convictions and proved that he discovered the greatest diagnostic and therapeutic tool available to man – the human hand. He knew that his principles worked in perfect harmony with natural laws and with the way his God had designed the human body. He developed the power of touch to the extent that in a few years, patients sought his services from both America and Europe. It was only natural that others would want to learn his methods, so in 1892 in Kirksville, Missouri, he founded the American School of Osteopathic Medicine.

Dr. Still touched his students with varying degrees of success. Some failed to comprehend the great gift that was offered to them. Unfortunately, that same lack of comprehension exists today also. However, many of Dr. Still’s students were deeply touched and devoted themselves not only to following his philosophy, but digging on and adding new perspectives to  it.

When we consider the full implication of the power of touch, we can only consider one person, an early student of Dr. Still’s, deeply touched by Dr. Still, who took to heart the admonition to “dig on”, That, of course, is Dr. Sutherland whom we honor  today. Dr. Sutherland brought the power of touch into perfect focus, and he too has created a great ripple on the therapeutic pond, which will continue to spread.

Dr. Sutherland went to Kirksville in 1898 and graduated in 1900 with a class of 273, which gives you an idea of how rapidly osteopathy grew, considering the first graduating class in 1894 was only 19. Dr. Sutherland must have been one of Dr. Still’s brightest pupils. He must have asked a lot of questions. He certainly responded to Dr. Still’s admonition to know your anatomy and to Dr. Still’s urging to dig on. And,  dig on he did. His curiosity about the cranial sutures led to his discovery of what he referred to as “his skull notion” the cranial concept. But, he did not consider it a  separate entity. He said, “osteopathy is a science. The cranial concept is osteopathy.  It is not an integral part of osteopathy, it is osteopathy. It is not a therapy. It is a science that deals with the natural forces of the body.”

Dr. Sutherland did some mighty interesting things in proving his skull notion. Can you  imagine putting your head through the experimental manipulations Dr. Sutherland inflicted on his head? His expanding concept did not limit itself just to the head. He considered the whole body, the continuity of the fascias, the importance of the nervous system, the total interrelationship of all body parts, the crucial nature of the cranio-sacral mechanism and enlarged upon. Dr. Still’s belief that the cerebro-spinal fluid wasa the highest known element in the human body. Are you aware that this whole body concept is discussed in the Bible? The apostle Paul, in speaking of us being part of the body of the church, “Jews and Greeks, slaves or free, all of us” wrote to the Corinthians in chapter 12 of his first epistle, “Indeed, the body does not consist of one member, but of many. If the foot would say, because I am not a hand, I do not belong to the body, that would not make it any less part of the body, and if the ear would say, because I an not an eye, I do not belong to the body, that would not make it any less part of the body. If the whole body were an eye, where would the hearing be? If the whole body were hearing, where would the sense of smell be? But as it is, God arranged the members in the body, each one of them, as he chose. If all were a single member, where would the body be? As it is, there are many members, yet one body”. Dr. Sutherland considered all parts members of one body.

When Dr. Still formulated his osteopathic philosophy after the Civil War, he did it through intuition, experimentation, his knowledge of nature and anatomy and his belief in the natural laws of his God. He did not have the advantage of much at all in  the way of technology but this may well have been a blessing in disguise. I feel very strongly that today’s sophisticated technology very greatly inhibits on the part of many doctors, the use of natural diagnostic skills. We, as osteopathic physicians, are  highly skilled in the use of these inherent diagnostic abilities. It is well documented  that none of the principles expounded by technology. For many years, even though osteopathy was very successful clinically, the constant criticism was, ‘th ere is no specific proof’. That proof eventually came about through the work of Dr. Louisa Burns, Dr. Sted Denslow and his associates and the brillant work of Dr. I. M. Korr.

Dr. Sutherland went through the same critical process that Dr. Still did. He developed  his philosophy through inquisitiveness, observation, investigation, experimentation and  his strong belief in lithe Master Mechanlc”. Dr. Still frequently referred to the body as a complicated machine, and Dr. Sutherland was very much in accord with this concept in his reference to the Master Mechanic. And again, none of Dr. Sutherland’s teachings have been disproven by modern technology. In 1951, in the first edition of Osteopathy in the Cranial Field, my father wrote, “The mind of man will never fully comprehend the possibilities of the osteopathic concept. When the last great picture  is painted, it will clearly be seen that a monumental contribution to the unfolding of the osteopathic school of thought, and the amelioration of human disease and suffering has been made through the exploration and discovery of the cranial field in osteopathy”,

Although Dr. Still used and taught many different osteopathic procedures, or techniques if you will, he only wrote about his philosophy. The argument still exists  about whether or not Dr. Still used high velocity techniques. There is significant evidence that he did. He was known on the frontier as lithe lightning bone setter’, In  1893, a year after Dr. Still opened his first college in Kirksville, a D.O. Palmer spent two weeks with Dr. Still and was treated by Dr. Still and other faculty members, during which he learned some high velocity techniques, then returned to Davenport, Iowa, and announced his discovery of chiropractic. Many of Dr. Still’s early students did publish books on technique which do describe high velocity techniques. But Dr. Still used many indirect techniques, which students such as Dr. Sutherland concentrated on. I feel Dr. Still only wrote philosophy because he did not want his students to be limited by his emerging concept. He wanted them to dig on and expand the concept, which indeed many of them did. Dr. Sutherland on the other hand, wrote both philosophy and specific techniques. I think he felt his work was so intricate and specialized that it needed to be closely followed. In a lecture in 1946, he used the  analogy of working on a lady’s watch and how delicate that must be. In his desire to keep the true and pure nature of his teachings, he founded the Sutherland Cranial Teaching Foundation. My father was intimately involved in the incorporation of the SCTF in Denver in 1953.

Dr. Sutherland was aware at a very early time of the importance of the sense of touch. In 1914 he wrote an article titled, ‘Let’s Be Up and Touchinq”, in which he stated, I God gave him the instrument with which to feel. Let him touch with fingers capable of feeling, thinking, seeing. Fingers should pause and tarry.” He went on to say, “The osteopathic technique is governed by and through intelligent application of the cultivated sense of touch.” How often many of us go about our work with busy fingers. We should save that for the yellow pages.

I mentioned that Dr. Sutherland, like Dr. Still, developed his concept without the help of modern technology. Did Dr. Sutherland know that collagen fibers are hollow tubes that transport tissue fluids? No. That was discovered shortly after his death by the electronic microscope and X-ray diffraction. But, he didn’t need to know. He saw the change in fluid balance and knew the potency of those fluid forces in response to his  feeling, thinking, seeing fingers.

Did Dr. Sutherland know about the axonal transport of protein substances affecting tissue trophism? No. This was the first reported in 1966 by our own. Dr. Korr. But, Dr. Sutherland didn’t know the details. He saw the dramatic changes in trophism and  function in response to his keen sense of touch.

Did Dr. Sutherland know about the function of the neuro-transmitters and their nourishment by the cerebro-spinal fluid? No, the first of the neuro-transmitters was discovered after Dr. Sutherland’s death, and new ones are still being identified. But he knew there was a lot going on up there and understood both the physical and  chemical potency of the cerebro-spinal fluid.

Did Dr. Sutherland know about the sub-occipital myo-dural bridge, a connection between the rectus capitis posterior minor and the dura mater, indicating that small occipital skeletal muscle has a direct effect on the dura? No, that was discovered just last year by our own Jamie Lipton, DO, certainly a rising star in our profession and GarY Hack, DDS. But, Dr. Sutherland must have known that there was relationship there. He paid a lot of attention to the sub-occipital area, and the last thing he taught his devoted pupils was the venous sinus drainage series of techniques which starts in the sub-occipital area. This myo-dural attachment, along with the direct central- peripheral vascular link through the emissary veins of the scalp and skull help explain the changes we see, and Dr. Sutherland must have known there was a connection even though he could not specifically explain it with the knowledge available at this time.

Did Dr. Sutherland know that even though the sphenoid does not directly articulate with the maxillae, but does articulate with the palatines, which then act as “speed reducers” to reduce the movement of the maxillae in response to flexion and extension of the sphenoid, and further, that the zygomas through their articulation with the greater wing in the orbit also act as a “speed reducers” to the maxillae? That’s the trick question. Of course he did! Just as Dr. Still knew his anatomy and stressed its importance, Dr. Sutherland knew his anatomy intimately, stressed its importance and knew how to correct any abnormality, frequently just after visual examination.

Scientists today can take the body apart chemical by chemical, element by element and they can isolate and even alter genes. They are beginning to recognize that not all health problems are caused by chemicals, bacteria or viruses, and that some problems are functional problems related to changes in the neuro-musculo-skeletal system, but they lack the “power of touch” to do anything to restore normal function. Dr. Sutherland has given us a legacy that can never be equaled in the use of the power of touch in diagnosing and treating almost every ailment that befalls human beings. But, it is also a challenge. Few will ever achieve the skill that Dr. Sutherland  had, but we need to diligently dig on towards that goal.

Dr. Sutherland apparently imagined what it would be like to find a perfect human specimen. He stated in a lecture in Kirksville in 1953, liMy search for a perfect human specimen, either animate or inanimate ended finally in a fruitless endeavor with the conclusion that there were only two, Adam and Eve. Perhaps these tow lacked perfection, having erred according to historical record. Therefore, my talk this morning is subject to the verdict encountered by Speransky; in conclusion there is none. II I think Dr. Sutherland and Dr. Speransky both overlooked the one rather obvious exception to nonperfection. Let us return to the great healer Jesus of Nazareth for a moment. The Christian world considers him to be the son of God and a perfect human being. Those of you of a different belief, come along with me for just a moment and consider that he was a perfect human being – perfect mentally and  perfect spiritually. Would he not also have been perfectly physically? In spite of the  long hard miles he traveled, the many hardships he endured, the strain of constantly  giving to others, would he have not been perfect physically? I know of no reference in the Bible of any physical imperfections, until the moment the nails were driven through his hands and feet, and the spears thrust into his side. Can you imagine what  it would feel like to touch and palpate a perfect human body? Not an almost normal, but a perfect human body? I would hesitate to touch the hem of his robe, but I think  Dr. Sutherland would have been qualified. Indeed, I think Jesus would have said, “Yes Dr. Sutherland, lay on your hands.” Can you imagine the experience of feeling perfectly normal, smooth, elastic skin – free of blemishes or wrinkles? And under that, the resilient, all encompassing fascias full of the cranial rhythmic impulse, with freely flowing interstitial fluids. Feeling firm, perfectly toned muscles, responding instantly to any efferent impulse. Feeling joints, pliable and freely moveable with a complete range of motion. and a cranio-sacral mechanism, full and vibrant, abounding with energy – the energy to constantly give to others, the energy to overcome death. Can you imagine what a thrill that would have been for Dr .. Sutherland? Can you?

I think Dr. Sutherland would have smiled, nodded his head, and said, “This is the way it is supposed to be.” We owe so much to William Garner Sutherland, DO, for teaching us about the power of touch.

 

Health Spectrum 2012