Diagnostic Touch Its Principles And Application

DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION ROLLIN E. BECKER, B.Sc., D.O. Dallas, Texas

securing samples from the human adrenal Venus blood flow by passing a cardiac catheter to the left renal vein via the right saphenous vein and the inferior vena cava . With appropriate manipulation, the catheters entered the central adrenal vein. Contrast media injections outlined the adrenal venous network and the extent of the nonadrenal channels. Blood samples revealed levels of free cortisol ranging from 4 1 to 3 13 mcg . per 100 ml. of blood. This technique will make it possible to study rapid metabolic changes in the adrenal cortical steroids. Machines have been built that duplicate renal function so that serious renal dysfunctions can be handled for hours on end while work is being done to restore kidney functioning. Other machines permit open heart surgery and chest surgery that could not be permitted a few years ago. The use of electronics in the medical field is on the threshold of its development and already many electronic devices for diagnosis and study are making their way into the market. Electrocardiographic data can be transmitted over a telephone circuit to any place in the country. A Body Function Recorder can keep a constant close surveillance on as many as a dozen patients. Five variables can be watched simultaneously, the pulse rate, systolic and diastolic blood pressure, the temperature, and the air flow through the nostrils. Miniaturization and transistorized equipment are making many tests permissible. Blood pH can be monitored continuously for as long as six hours with a tiny electrode l/20,000 inch in diameter, placed in a standard hypodermic needle. At a glance, an attendant can observe the concentration of carbon dioxide in the blood stream of an anesthetized patient, the approach of shock in an accident case, or the intake of oxygen in an iron-lung patient. More and more of such devices will be available with time to develop them. Thus the science of diagnosis is demonstrating its strength in every phase of human

Diagnosis is an art and a science. In the realm of science man has extended his senses through instrumentation and has brought in a battery of tests upon the human body and its contents. There are the usual urine tests, simple blood tests, examination with the electrocardiograph, the sphygomanometer, opthalmoscope, otoscope, X-ray and other instruments that can be found in the office. But this is barely a beginning. The patient can be taken to a fully equipped laboratory or hospital and the variety of tests and the complexity of them are almost limitless. Blood chemistries can be run that can define the components of the blood stream down to the molecular level, for any given moment, their electrolytic balances and a host of other information. It is now possible to obtain an exact diagnosis of some virus diseases. Fluorescent antibody can be used to diagnose infectious disease by demonstrating antibody and/or demonstrating antigen. Thus immunological controls of the body are becoming available for testing in the laboratory. Machines now give accurate blood counts for both red cells and white cells, eliminating the human error in making such counts. If there isn’t a machine to do a differential count developed yet, human ingenuity should be able to come up with an electric eye to do the seeing, a small electronic brain to “remember” the different types of white cells, and a scanning device to make such a differential count, again eliminating human error. Enzymes, hormones, and other protein molecular actions and interactions are being analyzed and studied through a variety of approaches, electrophoresis , chromatographic processes, complex chemical techniques, radioisotopes, and the electron microscope. Sampling for the various materials needed in these tests can now be taken directly from the site of activity in many cases by the use of catheters that are passed through the arteries and veins directly to the point from which a sample is desired. A recent report tells of 32

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DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION -- BECKER existence and its potential for future development is practically unlimited. The physician of forty years ago was a simple soul who ‘had a relatively few instruments at his command and not too great an armamentarium of therapeutic aids with which to diagnose and treat the disease and trauma of his patients. Today’s physician must be a chemical engineer, an electrical engineer, a biological engineer and a physical engineer, in addition to being a physician. The physician of forty years from now will make the present-day physician look like a simple soul. Thus the pattern continues to unfold.

knowing touch. This latter I will enlarge upon later. Interpretative skills call for a knowledge of functioning within the human body, functioning that is related to past events leading to the present time he is seeing the patient, functioning of the present time, and the ability to project functioning patterns into the near future. This is different from the mere tests for functioning as recorded by the scientific tools at his command. The latter are transitory findings that reflect the picture of the moment. True functioning within the individual patient is that evaluation of what is being done by the patient with all of these variables; how is his system coordinating them; how is he adapting to the dysfunctions, where is the potential for the reversibilities of the dysfunctions. In other words, how is this patient functioning as a living being? He is sick. He comes to you for help. Where is he now, where was he when his problems began, what is his potential for return to normal? It is the intelligent use of the physician’s eyes, ears and touch that can give him knowledgeable answers to some of these questions. There are variables found in every case which must be taken into account. These are the factors that complete the case. They are as important to the physician as the vast array of scientific tools and the data therefrom, perhaps more so, because these variables are the factors the patient is concerned about. He is the one who is trying to get well.

Diagnosis as an Art Diagnosis as an art is an important component in the field of diagnosis. It has always been. It always will be. Diagnosis as a science brings to the physician those data that can be learned objectively with the minimum of human error. The blood count that can be done by a machine is more accurate than that run by a technician counting the cells. So it is with all the biological detail that can be done by scientific instruments. The art of diagnosis is that ability applied by the physician himself. It involves the following factors: his interpretative skill in analyzing the data supplied to him by his scientific tools and the use of his own personal skills in evaluating the patient before him. These are subjective in nature. These may not bring the finite detail of the instrument but neither are they limited by the finite detail that the instrument is only capable of perceiving. There is room for variables, there is the ability to perceive past events, present events, and predictability for forecasting future changes, There is a wider latitude of functioning in the subjective field in the art of diagnosis and this coupled with the scientific data gives the physician an over all picture that can bring a more complete and knowledgeable diagnosis. A scientific diagnosis is not enough. It is too limited. It is the composite use of both scientific (objective) and personal (subjective) tools that gives the physician a true diagnosis. Interpretative skills within the physician are a subtle mixture of many years of training, of knowledge of the available scientific tools and their use, of experience, of a mind that keeps itself open to any and all approaches that will enhance his abilities, of the development of his own personal subjective tools, his eyes in accurate inspection, his ears in accurate auscultation and percussion, his nose and taste where indicated, and his thinking, feeling,

Three Problems There are always three problems every time a patient enters your office. There are the patient’s ideas and beliefs of what he considers his problem to be: there is the physician’s concept of what he considers the patient’s problem to be; and, finally, there is the problem of what the anatomical-physiological wholeness of the patient’s body knows the problem to be. The patient of today is a better informed patient than the one of a few years ago. He reads medical articles in the periodicals. He translates this information into his terminology, not always correctly, and he has been to other physicians before coming to you. He has heard their diagnosis of his problem and adds that to his opinion. He tells you his story and tries to explain his physical feelings. He is sensitive to your opinions and if you can come up with a picture that will explain his problem to him in a satisfactory way, he is able to cooperate with you. But in the final analysis he still has his 33

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ACADEMY OF APPLIED OSTEOPATHY -- 1963 YEAR BOOK opinion, right or wrong. The physician’s concept of what is wrong with the patient is based upon a much more highly trained set of factors. He has had many years of rigid training, can run the necessary tests and physical examinations to try to bring the patient’s problem into focus, and is ab!e to formulate a more objective diagnosis. He has been taught to try to create a diagnosis that is couched in terminology with which he can communicate his findings to the patient and to other physicians. For example, the diagnosis of a “peptic ulcer”, “viral pheumonia” or “whiplash injury” conveys a whole syndrome of findings in the minds of other physicians to whom this same patient may present his case. While this ability to communicate is necessary, it is also a limiting factor in the true diagnosis. The body does not think of its problem in such a limited sense. But the physician has been presented a problem and has formulated his diagnosis. Finally, there is the third problem. What does this anatomical-physiological mechanism know about this case? It has the answer in every sense of the word from an over all pattern of total stress or disease down to the smallest or infinite detail. The anatomical-physiological mechanism and its structure-function or functionstructure (structure-function and function-structure are interchangeable) carry the total picture. The patient’s body has the answer written into and through the physiological functioning of his brain and nervous system, his circulatory patterns, his fluid balance interchange, his organ systems, his endocrine makeup, his structure-function interrelationsl$ps . T O sum it up as simply as possible, the patient is intelligently guessing as to the diagnosis, the physician is scientifically guessing as to the diagnosis but the patient’s body knows the problem and is outpicturing it in the tissues. It is possible to create a more accurate diagnosis, one that is c!.oser to the true pattern than either that of the patient’s opinion or the physician’s opinion. We can utilize the information, the facts, the know-how of the third problem, the patient’s body, to bring this diagnosis into existence. We can use the interpretative skills of ourselves as physicians as an integral part of this process. In addition, we can train our senses, .especially our sense of touch, to lead us into the structure-function of the patient’s anatomical-physiological mechanisms and make them give us the information we need. Needless to say, in invoking

this process, each physician will have to teach himself the details of the way into and through structure-function. It is a self-taught process. The steps of where and how to do this can give guidance but the physician himself is the final arbiter as to methods and results. We have to learn to feel structure-function messages from within the body of the patient, not the end results of a test, but what is happening now, when did it begin, how is it going to progress. It is quite a challenge. As indicated, the ability to understand function-structure within living tissues is a self-taught process by each physician. Through our eyes for accurate observation, our ears for accurate auscultation, we can learn some things that are happening to our patient. It is through the sense of touch that we can learn a great deal more about the patient. This is a touch designed to feel function within the tissues and to feel dysfunction when it is present. Function has to be distinguished from motion. Motion is not function; function always includes motion, but motion, per se, does not represent all the values of function. Witness the patient who complains of a leg ache. We can test the leg for motion both passively and by voluntary cooperation of the patient and find it working well according to motion. Yet the patient will say, “But, doctor, why does my leg hurt?” With a touch designed to feel the dysfunction within that leg causing it to ache, it is possible to say, “I find the source of your disability to be thus and so.” It is difficult to find words to describe function within living tissues. It is an evaluation that can be felt with a knowing touch similar to that experience of watching a patient walk into your presence with a knowing visual observation and being able to interpret information from that observation. With regard to the sense of touch, someone said to me one day, “You feel from the heart, don’t you?” That is right. You learn to feel into the heart of the patient’s problem from a still-leverage point that allows the functions and dysfunctions of the patient to be reflected back into your touch and feel. The first step in developing this depth of feel and touch is to reevaluate the patient from the third problem standpoint, just what does the patient’s body want to tell you? Take the patient’s story and opinion and set it aside, take your opinion and diagnosis and set it aside, then let the patient’s body give you its opinion. Place your hands and fingers on the patient in the area of his com34

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DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION -- BECKER Texas in the fall of 1961. Why a hurricane to describe potency? Because the principles and manifestations of a hurricane can, in my opinion, be shown to be very similar in analogy to the principles and manifestations of disease and trauma within the human body. The eye of the hurricane carries the potency or power for the whole storm, the spirals of the high winds feeding into the eye manifest the destructiveness of the storm. The eye of the hurricane carries the pattern for the whole storm. Any change in the eye automatically changes the spiralling effects of the winds feeding into the eye and thus the pattern of the storm. Witness the next hurricane that followed Carla. It was a hurricane that was spawned in the Atlantic and was approaching the New England states. While still some distance from the land, the eye of the hurricane closed and the hurricane was no longer a hurricane but just another gale. So it is the presence of this eye that determines whether it is a hurricane or just an ordinary storm. Within the eye is the potency “having authority or power” to create the manifestations of the spiralling winds making up the storm. Carla was born in the Caribbean Sea, south and east of the Yucatan Peninsula. As she grew, she curved her way past the Yucatan Peninsula towards the coast of Texas. She developed an eye that was thirty miles in diameter and 30,000 to 40,000 feet in depth. Feeding into the low pressure area of the eye were spirals of winds, travelling counterclockwise, a minimum of 600 miles in diameter. She travelled towards the coast at 12 to 15 knots per hour until she neared the land surface where she met resistance and came to a halt off the coast of Texas. She sat there for 12 to 18 hours. The tremendous winds in her spirals pounded the coast hour after hour with blinding rain at 100 plus miles per hour intensity. Finally, she moved inland and the edge of the eye had winds clocked at a maximum of 173 miles per hour and heavy rain. Imagine being bombarded by rain drops travelling at that speed. As the eye touched the coast, the winds ceased and all was still during the time that it took for the 30 mile diameter of the eye to travel northward in its curved pathway. When the backside of the eye was reached, the winds again struck at better than 100 miles per hour from the opposite direction. To show the over all capacity of such a storm, while the winds were 100 miles per hour at the coast, we in Dallas were experiencing winds up to 30 to 40 miles per hour from the east 400 miles north of the

plaint or complaints. Let the feel of the tissues from the inner core of their depths come through your touch and read and “listen” to their story. To get this story it is necessary to read functionstructure in tissues. To do this we need to know something about potency, which we will discuss now, and something about the fulcrum, which we will discuss later. Potency The knowledge of potency within tissues begins with a statement given to us by Dr. W. G. Sutherland who said, “Allowing the physiological function within to manifest its own unerring potency rather than the use of blind force from without.” (1) This is a statement of the principle upon which we will develop an understanding of what is potency. The diagnostic tool with which we will learn to read and understand this potency is the principle of the use of the fulcrum. We will use the principle of the fulcrum in applying our hands and fingers so as to create a condition in which the principle of the potency may become knowledge for our use in diagnosis and treatment. Webster’s dictionary defines potency as “the state or quality of being potent, or the degree of this; power; strength”. (2) It defines potent as “able to control or influence: having authority or power”. (3) We have heard for years that the body has within itself all the factors with which to maintain health and to heal itself in case of disease or trauma. This statement is basically true. The body has the capacity to express health through this inherent potency and it has the capacity to maintain compensatory mechanisms in response to trauma or disease through variant potencies. At the very core of total health there is a potency within the human body manifesting it in health. At the very core of every traumatic or disease condition within the human body is a potency manifesting its interrelationship with the body in trauma or disease. It is up to us to learn to feel this potency. It is relatively easy to feel the tensions and stresses of trauma and disease as they are manifesting this pattern of trauma or disease. But within these manifesting elements there is a potency that is “able to control or influence: having authority or power”. It centers the disturbance. It can be sensed and read by a feeling touch. To bring the idea of what it means to feel potency within a given problem let us consider something outside of ourselves and describe it to demonstrate the power within potency. Let us consider the hurricane Carla which struck 35

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ACADEMY OF APPLIED OSTEOPATHY -- 1963 YEAR BQOK after the passage of the eye. Men trained to understand mechanisms of this type of storm can know the various factors within the storm pattern by the interpretation of their own senses in addition to that information given to them by the instruments they are watching. They know when they are in the eye or in the periphery of the spirals. They can feel it with their whole being. Thus it seems logical to me that the physician can train his touch to recognize and accept the fact that within every trauma or disease pattern there is an “eye” within or without his patient, which has within it a potency to manifest this traumatic or disease condition. It is a point of stillness within that focus. It is invisible, to be sure, but it can be perceived by the trained discerning touch of the physician. How do I know? I have been aware of this potency hundreds of times. This is something that has to be learned by personal experience. It was forced upon me by learning to read structure-function within the patients who brought their problems to me. I became aware of this area of stillness centering the trauma or disease. Slowly over a long period of time, knowledge and understanding came as to why it existed and its part in the traumatic or disease picture. I observed through the years that when any change took place in the area of stillness there was manifest a whole new change in the trauma or disease pattern. Like the eye of the hurricane that closed in the storm off the New England coast, it was no longer a hurricane. If any change had taken place in the eye of Carla before she hit the Texas coastline, her entire pattern of spirals, the intensity of her winds and other factors would have modified to meet the change in the potency within the eye : Thus I slowly learned to add this diagnostic insight to my armamentarium until it has become a day to day experience with every new patient as well as with those I am seeing over a period of time. It was by deliberately taking the patient’s opinion and setting it aside, taking my diagnosis and setting it aside, and going to the structure-function of the anatomical-physiological mechanisms of the patient’s body that I was able to acquire this knowledge. This is not something that I have discovered. It exists of itself. It merely asks acceptance of its existence and time to develop a sense of touch and awareness with which to perceive it. The problem remains, as always, how to find words to express that which it is and methods whereby it may become part of one’s experience. It is a self-taught process.

coast. Not only were there high winds but there were also other manifestations within the ends of the spirals. Tornados were being formed, one of which went through the city of Galveston after the eye of the hurricane had travelled a considerable distance inland. As long as the hurricane travelled over the Caribbean Sea, the winds around the eye increased in intensity due to lack of anything to slow them up but when the eye continued inland the surface of the continent began slowing down the intensity of the wind. By the time the eye reached Fort Worth the winds had reduced to 60 miles per hour on the front edge of the eye, then a period of stillness during the passage of the eye and again 60 miles per hour winds from the opposite direction on the backside of the eye. Finally, Carla continued her way north into Oklahoma and Kansas and was dissipated by the land over which she travelled until her eye no longer had enough energy in it to maintain her identity. Millions of dollars of property damage due to flooding, high tides, rain, strong winds, and tornados were the result of this one storm. Practically no lives were lost due to excellent communication systems. 500,000 people evacuated the coastal area in advance of the storm proper. Those who did stay more or less on the fringe of the storm center were able to watch the eye of Carla on their television screens through the radar readings that were being taken at the time of the storm. Modern instrumentation and communication have given us a very complete picture of Carla. Tiros, one of the satellites going around the earth in its orbits, sent down pictures of the eye and of the huge spirals of winds feeding into the eye. Hurricane hunters flying B-29s flew into the storm and into the eye itself and registered dozens of different data concerning her and plotted her course from early in her existence in the Caribbean. Radar readings followed her progress. Radio, television and news copy kept up with her throughout. This brief description, then, brings us the story of Carla, a hurricane, While those of US who sat on the sidelines were able to watch the growth, the development, and progress of Carla’s existence, those scientists who flew in the B-29s were able to literally know and and experience the high winds in the spirals and the potency of the eye of the hurricane. It was a physical awareness to them. It was an awareness to those who were in the direct path of the eye as it crossed the state of Texas, first the winds, then the stillness of the eye, then the following winds from the opposite direction 36

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DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION -- BECKER that the fingers can mold themselves to the patient’s body. It is a gentle contact yet one with firmness and authority. To borrow a descriptive analysis from Dr. Sutherland, “It is necessary to develop fingers with brain cells in their tips, fingers capable of feeling thinking, seeing. Therefore first instruct the fingers how to feel, how to think, how to see, and then let them touch. There must be a ‘finger-feel’, a ‘finger-thought’, a ‘fingersight”’ (5) with which to read the functions and dysfunctions of the body. The mechanisms of the body and their potencies are always in action and can be felt with a thinking, feeling, seeing touch that in time becomes a knowing touch. It is like getting onto a moving train. The train continues in motion and action as I get on it, analyze the roughness of the road bed, the side sway around the curves, its relative speed, and then get off the train while it continues in action. So it is with the problems within the patient. I move in on a living mechanism that continues to function, I make my diagnosis, administer my treatment, and leave the mechanisms continuing their ever changing patterns. My touch is think-deep, see-deep, feel-deep and yet does not limit or lock the structure-function of the tissues I am examining. I can go another step in developing my touch, Through the still-point at the fulcrum and the depths of my finger-touch, I can develop knowledgeable awareness of potency and structure-function in tissues within the patient's body. This awareness goes beyond the physical sensations of the physician’s five senses. This is not what I feel with my finger-touch. That would be my opinion. Instead this is what the patient’s body is reporting through my fulcrum and finger-touch. This is awareness. This is a “listening” finger-touch. This is the patient’s body’s opinion. This is knowledge gained from the patient’s body, not mere information. I can control the gentle yet firm contact of my hands and fingers by the manner in which I establish a fulcrum from which I will develop this touch. Establish a fulcrum to provide a working point from which to operate and evaluate the case and yet let it be free enough to allow it to shift, while maintaining still-leverage functioning, to adapt to the changing needs from within the mechanisms under examination. Try examining a hyperactive child and you will see the need for a shifting fulcrum and hand-finger lever, not only within the child’s mechanisms but also for the child itself. The hand and finger contact can be light and gentle, yet it

Fulcrum To develop this sense of touch it is necessary to learn the principle of the fulcrum and then to develop a method of using the fulcrum in the diagnostic approach to these problems. Webster defines a fulcrum as “the support or point of support on which a lever turns in raising or moving something; “hence, a means of exerting influence, pressure, etc. (4) Dr. W. G. G. Sutherland in describing the fulcrum in relationship to the two halves of the tentorium cerebelli and falx cerebri stated, “The Fulcrum (the junction of the falx cerebri and tentqrium cerebelli at the straight sinus) is the stillleverage junction over and through which the three sickles function physiologically in the maintenance of balance in the cranial membraneous articular mechanism. Like all fulcrums, it may be shifted from point to point, yet remaining still in its leverage functioning.” The key to understanding the principle of a fulcrum is to realize that it is a still-leverage junction, yet it may be shifted from point to point while remaining still in its leverage functioning. On a gross level of functioning the scientists on the B-29s were relatively still points, riding in a plane that was responding to the storm into which they were flying. The scientists’ whole bodies reflected the movements of the storm and the potency or stillness of the eye of the hurricane. This was something they could feel during the flight, could report, and interpret. The physician must bring this principle down to a much finer degree of use than that of the whole body. He must set up a still-leverage mechanism with which he can feel the stress and tension in the tissues under his hands and fingers and find the potency or area of stillness within that area of stress. He does this by placing his hand or hands near the area in which the patient is experiencing difficulties and then establishes a fulcrum with his elbow, his forearm, his crossed fingers, or any other part of him that is convenient to his comfort. From this fulcrum, his fingers become the end of a lever that can note the changes taking place within the body. His fulcrum point can be shifted from time to time to adapt to changes within the body, yet remaining still in its leverage functioning. Touch In placing the hands and fingers on the tissues under examination, do so with the idea 37

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ACADEMY OF APPLIED OSTEOPATHY -- 1963 YEAR BOOK can be observed that increasing the amount of pressure at the fulcrum automatically increases the depth of palpatory touch at the end of the lever, the hand and fingers; decreasing the pressure automatically decreases the depth of palpatory touch at the end of the lever. Thus with knowing fingers and the use of the fulcrum I become aware of potency within my patient. Thus I can modify my touch to meet the various needs of the kinetic energies expressed by the manifesting anatomical-physiological mechanisms and their potencies. Every patient is different and each patient is different each time he comes in for attention. The work continuously builds the physician’s fund of knowledge and insight. For example, a patient comes in with a low back problem. With the patient supine upon the table, it is possible for the physician to sit beside the patient and to place his hand under the sacrum with the finger tips extended upward so their contacts are on the lower back. By leaning comfortably on his elbow, the physician establishes a fulcrum from which to read the changes taking place in the back. The patient may flex his knees with his feet on the table, if it is more comfortable for him to do so. The physician’s other hand can be brought from the side and placed under the lower back. The fulcrum for this contact can be the edge of the table against the forearm or the elbow on the physician’s knee. By applying a modest increase of pressure at the fulcrum to cause a slight degree of compression through the sacrum towards the head, he will initiate the kinetic energy that will allow the structure-function of the stress area to begin its pattern to be reflected back to his touch. He learns to read these changes from the fulcrum point that he establishes at the elbow, or from both fulcrum points, if he is using more than one contact. He will feel the pull and tug of the tissues deep within them, he will feel the patterns of mobility and motility, and he will become conscious of the fact that there is a quiet point, a still-point, an area of stillness within the stress pattern. This is the point of potency for that particular strain. This is the point at which the stress pattern is maintaining its focus to be a stress pattern. I am not talking about the anatomicalphysiological units of tissues. I am talking about the kinetics of the energy fields that make up this stress pattern. The anatomicalphysiological tissue units are manifesting this kinetic energy and are expressing this dysfunction as tissue changes and symptoms. Any change within the kinetics of the energy field of the potency will change the pattern of functioning

within the anatomical-physiological units. Another example would be a sick liver in a case of hepatitis. With the patient supine, the physician can sit comfortably beside the patient, place one hand under the lower rib cage on the right side beneath the liver. Then he can place the elbow or forearm of that hand on his own knee. Thus he has his fulcrum point on his knee or thigh and his examining fingers under the sick organ. The other hand can be placed on the rib cage above the liver and the elbow or forearm placed on some point that is comfortable to maintain its contact. Thus he will have the sick organ between his examining hands. By reading from these double fulcrums, he will be able to note structurefunction changes taking place within the area of the liver. He will be able to sense whether the liver is moving or functioning upon its falciform ligament as it is supposed to do in health. He will be able to sense whether it responds to rhythmic up and down movements of the diaphragm during respiratory inhalation and exhalation as it is supposed to do in health. He will be able to allow the area of stillness, the potency for this particular problem to come to a focus. He will learn a great deal about this sick liver with time and repeated examinations on subsequent calls. As the liver as an anatomical-physiological unit regains its capacity to respond to respiratory changes of the diaphragm, its normal movements in relationship to the falciform ligament, and its venous and lymphatic drainage to begin to open and function, he will know that this is a case of hepatitis that has reversed its pathological state and is returning to normal. All of these changes are perceptible to the discerning touch from the fulcrums he establishes to examine this organ. Application The application of the principle of the fulcrum is as varied as the list of complaints that walk into the physician’s office. Each case calls for its own application. The patterns of setting up a fulcrum or fulcrums from which the examining fingers can study the problem are an individual development each physician must make for himself. The physician must know anatomy and physiology and as much functionstructure that accompanies anatomical-physiological units as is possible. With the development of this type of touch through fulcrum points into and through the structure-function patterns manifesting their changes under his hands, this 38

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DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION -- BECKER body and as such can be used by the understanding physician to determine function-structure within the anatomical-physiological units of the body. What is this potency? No one knows. Nor is it necessary to know, anymore than the engineer has to know what electricity is before he puts it to use. The physician can learn to recognize this potency, accept its presence, and use it for diagnosis and treatment. As was said early in this paper, at the very core of total health there is a potency within the human body manifesting itself in health. At the very core of every traumatic or disease condition within the human body is a potency manifesting its interrelationship with the body in trauma and disease. It is necessary to become aware of and use this potency. Within it is the key to reverse the pathology that is present and to allow the basic potency that is health to remanifest itself. This paper is a statement of principles and methods whereby to apply those principles in the diagnosis of health, disease and trauma. It is not a paper to describe manipulative procedures. The power and authority inherent within the potencies and the structure-functioning of the anatomical-physiological mechanisms provide the motive kinetic energy with which to diagnose and modify the problems we find in our patients. We establish our contacts and utilize that which is built into the tissues themselves. However, a point to consider for those of us who do use manipulative procedures is that if we add the principle of the fulcrum to our manipulative procedures we will be making those applications much more efficient. After we have introduced the leverage we may be using in the manipulation pause a moment, establish a fulcrum, pause again and let the thinking, feeling, seeing fingers interpret the degree of leverage and the amount of force we need to use to complete the procedure. We will find that we need less application of force from without and that we will be able to control that leverage with much greater precision. Let it be remembered, though, that it is possible to utilize that which is already built into the problems we find in our patients. We merely have to contact it and let it do the work for us. Using the principle of the fulcrum and the kinetic energies of the anatomical-physiological mechanisms with their potencies will resolve and reverse the pathological dysfunctioning towards the normal health of the individual. The question has been asked me as to the amount of time it takes to use this approach. This is not a time consuming process. Because we are using mechanisms already in action, it

knowledge becomes an ever-increasing degree of understanding. It opens the door as to why this patient is experiencing the complaints he expresses. Many times the laboratory tests fail to reveal the source of the complaints but his trained touch will bring him this understanding Why is it necessary to establish these fulcrum points? The physician is attempting to feel function within living tissues and to find the still-point from which this pattern of stress is manifesting its symptoms. He has to establish a still-point with which to be aware of the still-point within the tissues. As was said earlier, he feels from the heart of his stillpoint into the heart of the still-point within the patient. When is this type of trained touch applicable and to what kind of cases does it apply? There is no limit to its application. It is a tool that has some form of use for practically every type of complaint that comes to our attention. It will distinguish the difference between the congestive headache and the vasospastic type of headache. It will locate the specific sinus that is chronically or acutely filled with material. It will localize the specific lobe of the lung that is sick in lobar pneumonia. It will locate the strains and stresses of the musculoskeletal system. It has uses from the top of the head to the soles of the feet. It is a diagnostic tool that is added to the routine examination of the patient along with the laboratory findings. It will add insight as to the chronicity of the case, the present status of the case, and the possible prognosis for the case. Another analogy might be of interest at this point. The skilled electrical engineer is able to apply his art and science because he accepts the fact that electrical energy is present in his machinery. He takes his wires, his transistors, his printed circuits, his vacuum tubes and strings these things together to produce radios, radar equipment, television sets, and electrical circuits for home and business. He knows that the energy for these is electrical in nature and puts it to use. He does not know what electricity is itself but he can use it to develop functioning mechanisms. Electricity, too, is invisible but it can be measured and felt, instrument-wise and sense-wise. The physician has available to him a form of energy within the living body which has been called the potency in this paper. It is not intended to call it electricity in the sense that it corresponds to the electrical energy the engineer uses. It is a form of energy that is in the living 39

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ACADEMY OF APPLIED OSTEOPATHY -- 1963 YEAR BOOK is only necessary to contact them and let them speak for themselves. It is possible to make ‘a diagnosis in less than ten minutes. The average patient that comes in with a problem does not require that he be minutely examined from head to toe. He comes in with a complaint in a specific area. It is possible to go to that area and make an examination that will give the information you need to explain to him why he is having his difficulties. Of course, this may be only a small portion of the interrelated total picture of his problem but it is a beginning from which to go to other areas and finally to bring the complete diagnosis into focus. Herein is where the physician’s knowledge of anatomy and physiology plays an important role. He is able to correlate his knowledge with his sense of touch and to trace the pattern of the disability and dysfunctioning until the whole diagnosis is clarified in his thinking. Subsequent office

calls will add more insight until he is able to use his knowledge to understand the past history of the dysfunction, its present status, and project a prognosis for its eventual outcome. Old strains feel like old strains and can be dated as being weeks, months, or years old. As they modify their patterns, there is a point at which the physician knows that this pattern or patterns has reversed its hold upon the patient and that it will be a matter of days, weeks or months until a good resolution will have been accomplished. New strains feel like new strains. Their time-clock can be correspondingly charted. The same applies in disease conditions. It is productive work. There is something new to be learned each time you apply it. It is also work that opens many doors for better understanding only to discover that opening those doors exposes more doors to open.

REFERENCES: (1) Sutherland, W. G., Preface to Reprint Edition of THE CRANIAL BOWL issued by the Osteopathic Cranial Association. (2) Webster’s New World Dictionary, College Edition; 1960; pg. 1143 (3) Webster’s New World Dictionary, College Edition: 1960; pg. 1143 (4) Webster’s New World Dictionary, College Edition; 1960; pg. 585 (5) Sutherland, W. G., “Let’s Be Up and Touching”, The Osteopathic Physician; 1914

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