P EER -R EVIEWED

The Role of Vibration or Oscillation in the Development S ECTION of Osteopathic Thought by Zachary Comeaux, DO, Athens, OH

Abstract derstanding of the nature of the pa- The osteopathic definition of the Introduction tient as a person. The novelty of his person is the key to osteopathic On the surface, the Percussion Vi- approach, and our challenge today, is science. Dr. Still encouraged us to bratory Techniques of Robert Fulford the extent to which decisive informa- bring philosophy into clinical seem unusual and as representing a tion about this state of being can be practice. Following his inclination, philosophically insular approach, per- discerned through manual contact. Robert Fulford developed an haps not really osteopathic manipu- His primary vehicle for teaching was energetic concept of the person and lation at all. What makes a technique the anatomy, the tangible evidence of developed various effective clinical Osteopathic? The current panoply of the work of Divine intention. Still’s approaches including percussion manipulative techniques challenges analogies were consistently driven by vibration. one to recall the unifying focus in the idea of reading the orderliness of Vibration or oscillation has been theme and conviction of the founder, the Creator and the patterns of body used as a component of diagnosis and Dr. Still, namely that the person is a organization for health, thereby, im- treatment in various forms since the functional unity in a functional uni- plied. Progressively, he attended to beginning of osteopathy. Besides the verse. The presuppositions of one’s subtle more profound patterns of or- instinctive application of rhythm as worldview are rarely included in ganization of body function in the de- an aspect of motion, vibration has a medical discussion. This article re- velopment of his thought. special place in the development of a views some of the essential elements Still’s thought developed in a so- cosmology in which to interpret the of the osteopathic approach to the cial context. As observed by Still bi- state of the patient. patient, including philosophical is- ographer, Carol Trowbridge, much of This article follows the roots of sues, and the appearance of vibratory the underpinning for Andrew Still’s vibration and oscillation in the or oscillatory methods used in the philosophy was the thought of philosophical milieu at the time of application of osteopathic philosophy Herbert Spencer and the intellectual Still, Sutherland, and Fulford, by key members of the profession. climate produced in America by his including various levels of influence integrated approach to evolutionary from Herbert Spencer and Walter Intellectual Roots biology and cosmology.22 Spencer Russell. The specific application of Recall that Dr. Still never taught held that the unifying principles de- the use of vibration in numerous technique. He felt that effective di- fining existence involved the com- contexts is explored. agnosis and treatment was targeted at pounding of the rules of motion force The role of oscillatory processes the root cause, not symptoms, of a between all bodies, inert, organic, or in the further elucidation of somatic loss of health. He used whatever social. Each creature existed in a state dysfunction and the neuromuscular method worked but his vision was of interactive balance of physical physiologic explanation available in directed toward a fuller, deeper un- forces with those around it and conventional science is introduced. → Fall 2000 The AAO Journal/19 changed due to the absorption or dis- Carnegie, and John Burroughs. The tion, he saw further implications in sipation of motion. All motion was purpose of the club was to contem- Still’s attention to the potency of the considered rhythmic, due to the shift- plate and discuss solutions for the central nervous system.19 Still saw the ing of balance in attraction-repulsion new century from a downward trend characteristic of the living organism as the distance between bodies in civilization. as the infusion of an extraneous ethe- changed after contact. real force into matter to form what Progression of he called Biogen, consistent with “From the ensemble of the facts as Osteopathic Thought classical theories of animism or vi- above set forth, it will be seen that talism. Sutherland was able to take Although Still’s vision was to si- rhythm results whenever there is a this vital potency to the level of pal- multaneously attend to the comple- conflict of forces not in equilibrium. pable diagnoses and facilitative treat- mentary function of all aspects of the If the antagonist forces at any point ment using the organizing concept of whole person, generationally, there are balanced, there is rest, and in the “the Tide”.20 Early on he seemed to has been a shift of focus from one absence of motion there is of course give this a physical substrate in the subset of variables to another. Articu- no rhythm. But if, instead of a bal- form of the CSF, attempting to rec- lar position, restriction of motion, ance, there is an excess of force in oncile Still’s vitalism with conven- functional dynamics, response to res- one direction, then for that motion to tional physiology. However, as noted piration, an array of tender points re- continue uniformly in that direction, by Jealous and others as cited below, flecting symptoms have each taken it is requisite that the moving matter this Tide was viewed as more than a their turn as the cue for treatment. The should, not withstanding its unceas- hydraulic unfolding of the CNS dis- greater challenge is to return to at- ing change of place, present unchang- seminated through peripheral tis- tending to these aspects, but as part ing relations to the source of the force sue. It was not delimited by his physi- of an appreciation of a larger pattern by which its motion is produced and cal definitions and he still reflected of organization of the person, or a opposed. This, however, is impos- on it as a Life Force. universe. sible. Every further transfer through Sutherland, however, through in- The summary principles from the space must alter the ratio between the troduction of attention to the Tide, fifties, now popularly taught in our force concerned – must increase or introduced the dimension of temporo- colleges, articulate the osteopathic decrease the predominance of the one spatial organization with periodic interest in the interrelationship of force over the other – must prevent character into the arena of freedom / structure and function. Much time is the uniformity of movement. And if the restriction of motion. However de- spent in modern osteopathic training movement cannot be uniform, then, fined, periodic fluctuation of the Life in the sciences to elucidate structure in the absence of acceleration or re- Force became the leading principle (through anatomical studies) and tardation continued through infinite behind Sutherland’s later work, prin- function (through physiological stud- time and space (results which cannot cipally in diagnosis. (We will return ies), but less time is spent on the fo- be conceived), the only alternative is to Sutherland’s import and concepts cusing on the aspect of the interrela- rhythm.”18 below.) tionship. This is reflected in the dy- namical, as well as spatial, character of Spencer’s 500-page First Prin- the parts and whole. The concept of Other Still Students ciples creates a foundation for Still’s vibratory or oscillatory assessment and Elmer Barber, DO, who wrote an description of the interrelationship intervention relates to the dynamical early text on osteopathic technique in between structure and function. Rules 1 assessment of the living person. 1898, mentions vibration as a means of motion and physics are noted in to break up congestion and inflam- observations in the natural world and Sutherland mation. The application of periodic analogized as consistent rules for mobilizing force is more directly ex- W.G. Sutherland, DO, an early stu- form, function of the individual, evo- pressed in the teachings of another of dent of Still’s, is best known for his lution of species, and patterns for so- Still’s early students, J. M. Littlejohn. demonstration and defense of the con- cial behavior. His work was expanded Although Littlejohn’s focus is articu- cept of cranial mobility. His thought in several directions, including the lar correction, the maintenance of went through a lifelong evolution formation of an intellectual move- dysfunctional relationships is mark- with regard to the root concept of os- ment focused through the “Twilight edly dynamical. Club” among whose American mem- teopathy, the nature of freedom and restriction of motion. Beginning with bers were Oliver Wendell Holmes, “ In all adjustive movements it is the concept of cranial articular mo- Walt Whitman, Mark Twain, Andrew necessary to overcome the passive 20/The AAO Journal Fall 2000 resistance of inertia in the mechan- “Harmonic motion in osteopathic sequence. His “Osteopathic Rhyth- ics of the structures, and the resis- treatment has been in existence from mic Resistive Duction Therapy”14 tance of muscular activities. In the the earliest times. Still had many stu- was described as a rhythmic muscu- former, the ligaments and cartilages dents, one of these was J.M. lar contraction by the patient, to re- are principally involved, assisted by Littlejohn, the founder of the Chicago store normal muscle tone. Either the weight of the body and, in treat- College of Osteopathy and the Brit- hypertonus or atony of musculature ment the freest possible position of the ish School of Osteopathy in London. is a characteristic of somatic dysfunc- body must be adopted. In the latter, He taught several of my tutors, tion. A strategy of repetitive contrac- posture may reduce the body to a state Wernham, Hall, Middleton, Webster- tion of the musculature attached to a of relative inactivity, but it is essen- Jones, Blagrave, Hardy, Stoddard restricted “unit” during the direct tial to ask the patient to allow the and many others. They all used some treatment procedure was, among body to remain passive assisted by form of harmonic rocking and oscil- other effects, intended to “engender” distracting the patient’s attention lating in their treatment patterns.”7 normal afferent impulses to all nerve from the field of adjustment, by ask- centers particularly the pre-motor ing the patient to inhale and exhale E. Lederman, DO includes a brief cortical area for reestablishing normal freely. In the attempt to maintain the section on oscillatory stretch consis- muscle tone. Quite a bit of attention passive state the muscles all over the tent with the quotation of the intent in this model is paid to restoring nor- body should be relaxed: in the cervi- of Littlejohn above. First, he de- mal neurological balance, limited by cal region a series of gentle move- scribes the concept of hysteresis and the conceptualization of the neuromus- ments to the head and neck will gen- principles of treatment involving the cular system at the time. However, the erally produce sufficient relaxation to parameters of loading force and du- role of rhythmic activity is again intro- enable a rapid adjustive movement ration in stretch. He then describes duced as an aspect of treatment. before the muscles have sufficient cyclic stretching in which the force Fred Mitchell, Jr., DO, converts time to establish tension. In the dor- applied in each cycle is small (com- this technique to an active oscillatory sal and lumbar regions, the best pared to an equivalently effective motion against constant patient con- method of relaxing muscles is the arm constant stretch), but that there is sig- tractive force to treat scalene tight- and leg leverage during which the nificant cumulative effect. The first ness under the heading of Vibratory adjustment is made, or immediately four cycles of a stretching to 10% be- Isolytic Technique as a strategy of afterwards. yond the muscles resting length are overcoming the myotactic reflex as- The relaxed arm, or leg, represents found to produce 80% of the length sociated with somatic dysfunction by a neutral state in the mobility of the change expected.11 “possibly overwhelming the proprio- body, and this is why we practically In Littlejohn’s view, “relaxing the ceptive mechanism.”13 always use the arm and leg leverage muscles” is preparatory. Subse- in the correction of the dorsal and quently, Denslow demonstrated a Sutherland and Russell 9 lumbar lesions.” concomitant sympathetically driven Robert Fulford was a recent osteo- hypertonus, which seemed to be part pathic graduate when he accompa- When one recalls that the empha- of maintaining the altered motion nied Dr. Sutherland to collaborate sis here is on articular correction or characteristic of somatic dysfunction with Walter Russell, a practical phi- 2 adjustment, the coupled oscillatory or the osteopathic lesion. losopher who saw the world in terms motion becomes an essential part of compatible with Sutherland’s prin- normalization of muscle tone. This Developments ciples of palpating the Life Force as becomes even more obvious when in Rhythmic a way of working in complementary one watches this in action on video Resistive Duction fashion with the Creator. Walter through the teaching of one of Russell, after Spencer, was the coor- The muscle energy model of diag- Littlejohn’s still living students, John dinator of the Twilight Club men- 23 noses and treatment recognizes Wernham, DO. One can easily de- tioned above. His cosmology began muscle hypertonus as a primary caus- scribe a definitive role to the oscilla- by saying that “The universe in its ative force in articular restriction of tory aspect as well as the intended entirety is One thinking, living, motion. T. J. Ruddy, DO, one of the articulatory maneuver. Such is the breathing, pulsing universal being.”15 acknowledged sources of the thought, point of Harmonic Therapy described Being, motion and thought were in- 7 which later blossomed as Muscle by Laurie Hartman, DO, and Eyal tertwined concepts and interactive 10 Energy Technique, used oscillatory Lederman, DO. forces. Russell held this philosophi- manipulation as a part of a treatment → Fall 2000 The AAO Journal/21 cally, Sutherland saw it clinically. guidance varies from manual ma- marks an attempt to balance the This reinforced Sutherland in the sig- nipulation. During the application, electromagnetics of patient and op- nificance of the motion he had pal- fingers of one hand establish a con- erator to enhance the energetic nature pated, as an extension of an endowed tact over lymph nodes while a trans- of the patient using the eastern model vital process, associated with breath- mitted vibration is initiated through of meridians to describe the nature of ing. It underscored the integration of the other hand, which is placed on man. Stone recognized Fulford as an this respiration with participation in top of it. A quiet pause-rest should astute and insightful student.16 a larger dimension of life. Respira- occur between applications. The first Fulford identified Stone’s power not tion became the Breath of Life, con- application is to the upper left tho- so much in his conceptualization of the comitant with Russell’s description of rax near the axilla. The second is nature of the body but “It was his the Life Force. Russell’s cosmology done with a lift to the area above the VOICE.” Apparently Stone had a deep also included the Pythagorean con- receptaculum chyli. The third is at the resonance which was commanding. cepts of harmonic influences in cre- great omentum, with a lift. The trans- In any case, in 1955 by apparent ation. He extrapolates this to describe mitted vibration initiates the siphon- chance, Fulford received a mailing all interactions as having a common ing process.” advertising the Foredom Percussion balanced electro-magnetic aspect. Vibrator as a physical therapy adjunc- This both recognized the importance Despite Sutherland’s reference to tive device. Fulford saw, “This was of rhythmic motion to all levels of life the application of vibratory motion to exactly what I was looking for.”6 Be- and could provide a basis for physi- enhance a physiologic process, most ginning intuitively, he felt this to be ologic induction of indigenous cyclic of Sutherland’s students did not inte- an effective means of transmitting his motion through intention, as is grate this concept into their expres- therapeutic intention. According to brought forth more clearly in the sion of cranial osteopathy. Most de- his mentors cited above, musculosk- thought of Sutherland’s student, fined the cranial concept in articular eletal restriction of motion existed Rollin E. Becker, DO. terms, as was the pattern of first in the energetic or “eathric” body Some other concepts of Russell’s, Sutherland up until this point. They of the patient. The percussion perpen- which later had influence on Fulford’s did not see it as an impetus toward dicular to the surface of the skin maxi- thoughts included the idea that “Mind an expanded concept. However, mized the potential for the skin to act is the concept force of this created Fulford began a semi-independent as a transducer of energy from the universe of form. Form in matter is train of thought, integrating oscilla- physician to patient. The physician’s the reflected expression of the con- tory or vibratory motion into the ar- intention was amplified by the per- cept force.” Or, “Matter is the sub- ticular concept. cussive vibration. As in any treat- stance of mind”. Another was the con- ment, the monitoring hand at a stra- cept of “Balanced Rhythmic Inter- Robert Fulford’s tegic location assessed and modulated change”: Russell uses it in his cos- Integration the placement and speed of the vibra- mogony to describe interaction at all tion, and assessed the appropriate end levels, while Fulford was later to ap- of Vibratory Motion point of treatment. Progressively ply it in clinical practice to coordi- Fulford, even as a young person, through empiric trials he found asso- nate the interaction of trauma, dys- had been looking for unifying con- ciations between symptoms, personal function and treatment in the patient. cepts that would coordinate the vari- history of trauma, and palpable subtle While Sutherland included a place ous treatment approaches he had been changes in the person that he for intention, spiritual dimension and taught. He intuited a connection be- reconceptualized as changes in the oscillatory diagnosis, he applied the tween Russell’s and Sutherland’s pe- eathric or energetic body. These could concept of therapeutic vibration in a riodic rhythms and wanted ways of be palpated on or off the body. Clearly confined field. In Teachings in the amplifying the concept to assist pa- there were correlative findings in Science of Osteopathy,21 there is a tients. He followed these themes of terms of tissue texture change and sequence of lymphatic mobilization. vibratory motion though a series of alteration of motion characteristics. trials. His 1940s black bag included However, Fulford’s main criterion for “The physiologic emptying re- homeopathic remedies. He pursued a determining success was his assess- quires a gentle and rather unique si- course of study with Randolph Stone, ment of the state of the body in the phoning process in the thoracic duct. DO, who had traveled the Orient “eathric” field. His expression of this This process can be assisted or fa- studying Ayurvedic and other healing was as “The Breath of Life” which cilitated by the use of feeling, seeing, systems and translated the concepts was compatible with Sutherland’s thinking, and knowing fingers. This into Polarity Therapy. Basically this expression of the Tide, or Life force. 22/The AAO Journal Fall 2000 Building on the ideas of Russell, related to the study of osteopathy. His treated in Sutherland’s cranial model. Fulford reflected further on the writ- reply was “how can you be success- They review the hypotheses put forth ings of the neurophysiologist H.S. ful without the knowledge of osteopa- to explain the intrinsic motility of the Burr, whose writing describing a thy for diagnosis.”6 brain, make note of other biologic measurable L- field (life field).3 oscillatory functions and phenomena Fulford, from another source, de- The key to Fulford’s methods was in the body, and hypothesize that “the scribed the physical breath and a view of the person as a dynamic CRI is the perceptible entrainment, a coexpressive with this breath of life. system in which restriction of this palpable harmonic frequency of mul- Consistent with eastern dynamic process was responsible for tiple biologic oscillators.” “Our en- conceptualizations of pranic breath- loss of health, motion and comfort. trainment hypothesis may also ex- ing, Fulford made a connection be- Restriction was not limited to mate- plain how CST (craniosacral treat- tween diaphragmatic breathing and rial mechanics. In his thoughts we see ment) practitioners bring about thera- an energy exchange beyond what we the root ideas of Still, Sutherland, peutic changes in the patients.” Here commonly express as oxidation-re- Spencer, Russell, and Stone as noted they develop the theme of coupled duction through alveolar exchange. above. oscillation as a phenomenon in nature His palpation of respiration evolved and its applicability to operator-pa- as a hybrid between the primary res- The Next Generation tient interaction.12 piration of Sutherland and the polar- The current generation of students James Jealous, DO, elaborates a ity issues involved with Randolph of Sutherland, Littlejohn, and Fulford history of Sutherland’s appreciation Stone’s thought. In any case, breath- have the challenge of sorting this out and description of the oscillatory as- ing had an energetic character, which and deciding how to take it further pect of biologic process in a person. was part of assessing the well being into a synthetic model of osteopathic He uses, as Fulford did, the interre- of the patient, and was impacted by approach to the patient, the expanded lated concepts of the Tide, the Breath trauma and amenable to manipulative osteopathic concept. of Life, as avenues for diagnosis and release. It had more significance than Carlisle Holland, DO, who has treatment. Again, the means of en- simple mechanical motion. done considerable work in applying gagement is synchrony with endog- Although sometimes construed to cranial osteopathy to children, has enous rhythmic motion. As with the contrary, Fulford’s main interest utilized the percussion vibrator, the Sutherland, the means of intervention was not with vibration per se but with “hammer” as Fulford sometimes is manual, but augmented by a shift enhancing freedom of function on all called the vibrator, as a device to cre- of attention and loving intention as levels, using the energy state of the ate an opportunity for connective tis- with Fulford. The perceptible move- body as the vehicle for diagnosis and sue release. As an extension of cra- ment is considered significant beyond treatment. He used subtle touch, mag- nial and connective tissue the mechanical and includes dimen- nets, quartz crystals and other means, conceptualizations of the body, he sions which are vitally transcenden- correlated with intention, to intervene uses one or more machines in reso- tal, spiritual, and in any case more for healing. On several occasions late nant or dissonant fashion. The vibra- sublime than the physical, biome- in life, Fulford read at meetings the tory force is envisioned as remobiliz- chanical only. However, through following position statement: ing adherent fascial planes after trau- transmutation of forces, manual con- matic restriction. Emphasis is placed tact in the context of loving intention “The human body is composed of on the energetic nature of the body in can induce clinical improvement. complex interflowing streams of mov- maintaining its form, including con- Clinical effectiveness is increased by ing energy. When these energy nective tissue arrangements. attending to the “Long Tide”, an os- streams become blocked or con- Richard Koss, DO and Rajiv cillatory dynamic with characteristic stricted we loose the physical, emo- Yadava, DO, at the request of Dr. base rate of one cycle each 2 to 3 tional, and mental fluidity potentially Fulford, continue to teach the course minutes. As noted above, this ap- available to us. If the blockage lasts in which they assisted him during the proach integrated the osteopathic long enough, the result is pain, dis- last years of his life. Their primary emphasis of treating according to 5 comfort, illness and distress.” intention is to preserve his thought. one’s progressively refined apprecia- John McPartland, DO and Eric tion of the nature of the person, be- 8 When in a discussion regarding a Mein, MD have applied the principles ginning with embryogenesis. treatment using a Vogel cut crystal as of entrainment of harmonic oscilla- The author teaches a course in an amplification device for vibratory tors as a means of influencing the cra- Fulford’s synthetic methods. Addi- treatment, Fulford was asked how this nial rhythmic impulse of patients → Fall 2000 The AAO Journal/23 tionally he has derived a manual ap- about the nature of the patient in di- pp. 19-23 plication of oscillatory manipulation agnosing and treating. Led by intu- 3. Burr. HS, Blueprint for Immortality, the electric patterns of life, Saxton Walden, as an extension of Fulford’s synthe- ition and a desire to serve, his clini- Essex England 1972. sis called Facilitated Oscillatory Re- cal effectiveness preceded his ability 4. Comeaux, Zachary, Facilitated Oscillatory lease.4 Clearly there are commonali- to explain. This paper is an effort to Release, 1998, unpublished paper in review. ties with other approaches, especially place Fulford’s concepts in the con- 5. Fulford, R, “Vibrating Energy”, AAO Wernham’s application of the teach- text of the classical struggle of oste- Convocation presentation, 1992, person- ally transcribed notes. ings of J.M. Littlejohn. However, opathy to treat the dysfunctional com- 6. Fulford, R, Cranial Academy Convocation there are unique considerations evolv- ponent as an aspect of the whole per- Presentation, Chicago, 1997, personally ing from the desire to apply Fulford’s son. But, our view of the whole per- transcribed notes. amplification methods and philoso- son is framed by our perception of the 7. Hartman, L, personal communication via e-mail in response to inquiry to web site, phy of the nature of the patient with- nature and laws of function of the 1998. out the availability of a percussion universe. This dimension is not rou- 8. Jealous, J, Emergence of originality: a bio- vibrator, crystal, or other device. The tinely taught in medical school but is dynamic view of Osteopathy in the Cra- approach includes considerations of clearly an aspect of Still’s thoughts nial Field, course workbook available trauma on multiple planes of body and is implicated in the work of many from author, Franconia, New Hampshire. 9. Littlejohn, JM, The Fundamentals of Os- organization. To further elucidate the of his subsequent serious students. teopathic Technique, reprinted by John structural-functional interrelatedness Wernham College of Classical Osteopa- of the person, additionally, the author “The Osteopath finds here the field thy, Maidstone, Kent, England pp. 98-99. is involved in biophysiologic research in which he can dwell forever. His 10.Lederman, E, Harmonic Technique, Churchill Livingston, Edinburgh, 1999. to demonstrate the compatibility of duties as a philosopher admonish 11.Lederman, E, Fundamentals of Manual the energetic or vibratory approach to him, that life and matter can be Therapy, Churchill Livingston, Edinburgh, somatic dysfunction and newer united, and that union cannot con- 1997, p. 32. conceptualization in the field of neu- tinue with any hindrance to free and 12.McPartland, J, and Mein, E, “Entrainment robiology of oscillatory function. absolute motion”.19 and the Cranial Rhythmic Impulse”, Al- ternative Therapies, Jan 97, vol. 3, no. These include central pattern genera- 1, pp. 40-45. tion, and resonant cell assembly mod- The process of elucidating this 13.Mitchell, F, The Muscle Energy Manual, els for explaining the binding and quest did not begin or end with Still. Vol. 2, MET Press, 1998, p. 94. coding of perceptual experience. Ap- From his predecessors as represented 14.Ruddy, TJ, “Osteopathic Rhythmic Resis- tive Duction Therapy “, Academy of Ap- plication to the peripheral nervous in Spencer (rhythm is a necessary plied Osteopathy, 1961 Yearbook, pp. 58- 17 system may clarify the nature of pos- characteristic of all motion) and his 68. tural as well as proprioceptive pat- students through several generations, 15.Russell, W, The Universal One, Univer- terns of muscular coordination and as illustrated above, including Rob- sity of Science and Philosophy, dysfunction. Certain investigators ert Fulford, observation, diagnosis, Schwannanoah,VA, 1926. 16.Stone, Randolph, unpublished letters to R. implicate temporo-spatial coding as and treatment may include this rhyth- Fulford, 1955. the means of internal communication mic aspect of motion. Methodologi- 17.Spencer, H, First Principles, A.L.Burt of the neuromuscular system as a cal decisions of emphasis and abstrac- Publishers, New York, 1880, pp. 220, 221. complement to the classical view of tion of various aspects of human na- 18. Still, AT, The Philosophy and Mechani- cal Principles of Osteopathy, Hudson and the order through a network of path- ture have included vibratory or oscil- Kimberly Pub., Kansas City Mo., 1902, ways and ganglia, and nuclei. Practi- latory approaches. Percussion Vibra- pp. 44-46. cal applications of these oscillatory tory treatment, and other Fulford 19.Still, AT, Philosophy of Osteopathy, events may further define the nature methods of applying energetic treat- Kirksville, MO, 1899, p. 197. of the person as a way of understand- ment, is embedded in the context of 20. Sutherland, WG, Contributions of Thought, The Sutherland Cranial Teach- ing dysfunction in the style of inves- osteopathic tradition and thought and ing Foundation, 1967 pp. 142-143. tigation of Still and others as elabo- its current expression. 21.Sutherland, WG, Teachings in the Science rated above. of Osteopathy, The Sutherland Cranial Teaching Foundation, 1990 pp. 136-138. References 22.Trowbridge, C, Andrew Taylor Still 1828- Summary 1. Barber, ED, Osteopathy Complete, 1898, 1917, The Thomas Jefferson University Robert Fulford, DO, challenged reprinted by Lifeline Press, Virginia Press, Kirksville, MO, 1991, p. 164. Beach, Virginia. osteopathic physicians to expand on 23.Wernham, J, Applied Osteopathic Thera- 2. Beal, M, Ed., Selected Papers of John peutics, Institute of Classical Osteopathy, the mechanical interpretation of bio- Stedman Denslow, DO, 1993 yearbook, Maidstone, Kent, England 1996.❒ physics and include other knowledge American Academy of Osteopathy, 1993,

24/The AAO Journal Fall 2000