Mémoire présenté pour le DIPLÔME EN OSTÉOPATHIE (DO) présenté et soutenu publiquement le 16 octobre 2012 à Montréal par Craig HARNESS B.Sc., RMT né le 8 octobre 1981, à Oshawa, Canada A complex exploration into the osteopathic philosophy as introduced by Andrew Taylor Still, MD, DO (Self-proclaimed) exemplified by commentary on the embryology, anatomy, and treatment of the peritoneal viscera Membres du jury : Président : Guy VOYER Pht, MD, DO Juges : Daniel MICHEL MD, DO Carla DELANGE Pht, DO Serge TURMEL DO Véronique DURAND DO Andy BURKE MSc Sport Medicine, DO Carl DUFRESNE DO Karyne MARIN DO Memoir advisor Chantale Bertrand DO Acknowledgements To my wife. Many people have had an influence on this process and probably are not even aware of it. That is the beauty of the interconnectedness of complexity. The following people are but an attenuated list. Mr. Guy Voyer, Pht, MD, DO for introducing me to the vast potentialities of utilizing efficiently a complex way of critical thinking. Ms. Chantale Bertrand, DO for always having the ability to govern me with an almost motherly strictness during this process. Your passion for osteopathy is unrelenting. Mr. John D’Aguanno for many profound philosophical conversations regarding the philosophy of osteopathy. Mr. Kevin Fairfield for never ceasing to amaze me with his depth of knowledge along with his ability and willingness to transfer it. Mr. Tony Grande for offering the sincerest of necessary reality checks on an ongoing basis. Dr. Shiraz Elkheir, MD for offering a both medical and surgical point of view to our many conversations either in the dissecting lab or otherwise. Mr. Scott Beylea for his generous assistance and valuable input during the final editing process of chapters 1 and 2. Table of Contents List of tables, charts, and boxes........................................................................................................i List of figures..................................................................................................................................ii Abstract............................................................................................................................................v Object of this research....................................................................................................................vi Résumé..........................................................................................................................................vii Objet de cette recherche...............................................................................................................viii Chapter 1: Introduction and Methodology................................................1 1.1 Overview of the Memoir Process..............................................................................................2 1.2 Methodology..............................................................................................................................3 1.2.1 Phenomenology.......................................................................................................................4 1.2.2 Ethnography............................................................................................................................4 1.2.3 Grounded Theory....................................................................................................................5 1.2.4 Data Collection and Potential Biases......................................................................................5 Chapter 2: Philosophical Framework........................................................7 2.1.0 Was Osteopathy Original?......................................................................................................8 2.1.1 Incubation Period of Osteopathic Thought.............................................................................9 2.1.2 Could Osteopathy be Taught?...............................................................................................10 2.2.0 Definition of Osteopathy.......................................................................................................13 2.2.1 Development of a Definition of the Osteopathic Philosophy...............................................14 2.2.2 Is the Definition Scientific?..................................................................................................15 2.3.0 What is Complexity Science?...............................................................................................17 2.3.1 Origins of the Theory of Complexity....................................................................................17 2.3.2 Refinement of Complexity Science towards Complexity Thinking.....................................19 2.3.3 Three Schools of Complex Thought.....................................................................................21 2.3.4 Definition of Complexity......................................................................................................23 2.4 Why the Osteopathic Philosophy is Complex.........................................................................25 Chapter 3: Embryology...........................................................................28 3.1 Why the Study of Embryology is Complex.............................................................................29 3.2 Embryologic Processes Applied to the Osteopathic Philosophy.............................................29 3.3 Details Pertaining to Carnegie Stages 5 – 8.............................................................................31 3.4.0 Details Within Carnegie Stages 9 – 15.................................................................................34 3.4.1 General Remarks...................................................................................................................34 3.4.2 Somites and the Associated Body Wall................................................................................37 3.4.3 Cardiovascular System..........................................................................................................39 3.4.4.0 Digestive System...............................................................................................................43 3.4.4.1 General Remarks................................................................................................................43 3.4.4.2.0 The Liver and Gallbladder..............................................................................................44 3.4.4.2.1 General Remarks.............................................................................................................44 3.4.4.2.2 The Venous Systems.......................................................................................................45 3.4.4.3.0 The Intestinal Canal........................................................................................................49 3.4.4.3.1 General Remarks.............................................................................................................49 3.4.4.3.2 Stomach and Intestinal Canal..........................................................................................49 3.5.0 Details Pertaining to Carnegie Stages 16 – 23......................................................................53 3.5.1 General Remarks...................................................................................................................53 3.5.2 The Stomach.........................................................................................................................53 3.5.3.0 Rotation of the Intestine.....................................................................................................54 3.5.3.1 Stage 1...............................................................................................................................54 3.5.3.2 Stage 2...............................................................................................................................56 3.5.3.3 Stage 3...............................................................................................................................58 3.6 General Development of the Lymphatic System.....................................................................58 3.7 The Fetal Period.......................................................................................................................59 3.8 Biomechanical Axes Operating in the Embryo.......................................................................60 Chapter 4: The Concept of Osteopathic Pathology.................................63 Chapter 5: Gross Anatomy......................................................................66 5.1 Introduction..............................................................................................................................67 5.2 The Walls.................................................................................................................................71 5.3.0 The Peritoneum.....................................................................................................................72 5.3.1 General Remarks...................................................................................................................72 5.3.2 External Topographical Anatomy.........................................................................................72 5.3.3 Internal Topographical Anatomy..........................................................................................73