DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION - Four articles by Rollin E. Becker From the ACADEMY OF APPLIED OSTEOPATHY (AAO) YEAR BOOKS 1963, 1964 & 1965 OF SELECTED OSTEOPATHIC PAPERS Published by THE ACADEMY OF APPLIED OSTEOPATHY Affiliated with the AMERICAN OSTEOPATHIC ASSOCIATION Margaret W. Barnes, D.O., Editor P.O. Box 1050 Carmel, California AAO Year Book 1963 DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION -- Rollin E. Becker, D.O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 [PDF p. 2] AAO Year Book 1964 DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION - Part II -- Rollin E. Becker, D.O. . . .. . . . . . . . . . . . . . . . . . . 153 [PDF p. 19] - Part III -- Rollin E. Becker, D.O. . . .. . . . . . . . . . . . . . . . . . . 161 [PDF p. 35] AAO Year Book 1965 Vol. II DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION - Part IV - Trauma and Stress -- Rollin E. Becker, B.Sc., D.O. . . . . . . . . . . . . . . . . . . . . . . . . 165 [PDF p. 45] In converting these articles by OCR the complexity of making them appear in their two column format etc. was not practical. Therefore, they have simply been done as Word documents with easy to read font and then made into PDFs. However, the exact page is given where each article starts and within the text there are inserted brackets with the page numbers that are placed exactly where page changes take place (mid-sentence or even as a word is hyphenated across pages). This should facilitate appropriate referencing for quotes etc.

DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION ROLLIN E. BECKER, B.Sc., D.O., Dallas, Texas (AAO 1963 p. 33) 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 de- fine 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. Ma- chines now give accurate blood counts for both red cells and white cells, eliminating the human error in making such counts. If there isnt 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 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 out- lined the adrenal venous network and the extent of the non-adrenal 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 (p.32 - 33) 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. Todays 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.

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 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 overall 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, 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 physicians 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 there-from, perhaps more so, because these variables are the factors the patient is concerned about. He is the one who is trying to get well. Three Problems There are always three problems every time a patient enters your office. There are the patients ideas and beliefs of what he considers his problem to be: there is the physicians concept of what he considers the patients problem to be; and, finally, there is the problem of what the anatomical-physiological wholeness of the patients 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 satisfactory way, he is able to cooperate with you. But in the final analysis he still has his (p. 33 34) opinion, right or wrong. The physicians 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 patients problem into focus, and is able 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 overall pattern of total stress or disease down to the smallest or infinite detail. The anatomical-physiological mechanism and its structure-function or function-structure (structure-function and function structure are interchangeable) carry the total picture. The patients 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 interrelationships. To 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 patients body knows the problem and is out picturing it in the tissues. It is possible to create a more accurate diagnosis, one that is closer to the true pattern than either that of the patients opinion or the physicians opinion. We can utilize the information, the facts, the know-how of the third problem, the patients 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 patients 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, dont you? That is right. You learn to feel into the heart of the patients 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 re-evaluate the patient from the third problem standpoint, just what does the patients body want to tell you? Take the patients story and opinion and set it aside, take your opinion and diagnosis and set it aside, then let the patients body give you its opinion. Place your hands and fingers on the patient in the area of his com- (p.34-35) -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 function-structure 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 with-out. (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. Websters 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 Texas in the fall of 1961. Why a hurricane to describe potency? Because the principles and manifestations of 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 counter-clockwise, a minimum of 600 miles in diameter. She travelled towards the coast at 12 to 15knots 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 18hours.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 173miles 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 north-ward 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 overall capacity of such a storm, while the winds were100 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 (p.35 -36) 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 through-out. 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 Carlas existence, those scientists who flew in the B-29s were able to literally know 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 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 patients 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 patients 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 aware-ness 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 ones experience. It is a self-taught process. (p. 36 37) 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. 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 tentorium-cerebelli at the straight sinus) is the still-leverage junction over and through which the three sickles function physiologically in the maintenance of balance in the cranial membranous 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 that the fingers can mold themselves to the patients body. It is a gentle contact yet one with firmness and authority. To borrow 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 finger-sight (5) with which to read the functions and dysfunctions of the body. The mechanisms of the body and their potencies are always inaction 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 roadbed, 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 patients body. This awareness goes beyond the physical sensations of the physicians five senses. This is not what I feel with my finger-touch. That would be my opinion. Instead this is what the patients body is reporting through my fulcrum and finger-touch. This is awareness. This is a listening finger-touch. This is the patients bodys opinion. This is knowledge gained from the patients 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 childs mechanisms but also for the child itself. The hand and finger contact can be light and gentle, yet it (p. 37 38) 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 physicians 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 physicians 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 physicians 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 anatomical-physiological units of tissues. I am talking about the kinetics of the energy fields that make up this stress pattern. The anatomical-physiological 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 ribcage 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 structure-function 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 physicians 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 function-structure 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 (p.38 39) 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 still-point 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 muscular-skeletal 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 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, any more 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 inter-relationship 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 re-manifest 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 (p. 39 40) 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 physicians 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) Websters New World Dictionary, College Edition; 1960; pg. 1143 (3) Websters New World Dictionary, College Edition: 1960; pg. 1143 (4) Websters New World Dictionary, College Edition; 1960; pg. 585 (5) Sutherland, W. G., Lets Be Up and Touching, The Osteopathic Physician; 1914

DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION: PART II ROLLIN E. BECKER, D.O., B.Sc. Dallas, Texas (AAO 1964 p. 153) A diagnostic touch is as essential in the accuracy of determining the diagnosis of a patients problem as is the routine physical examination and the tests made by the laboratory and scientific instruments. What is a diagnostic touch? It is a form of palpation designed to fulfill the principles expressed in the statement: in the science of health, disease and trauma, allow biodynamic intrinsic force within to manifest its own unerring potency rather than using extrinsic force from without. The physician places his hand or hands upon the tissues and then establishes a fulcrum through which to read the functioning and dysfunctioning from within the living body of the patient. This is the health or the problem in the patient manifesting itself through to the hands of the physician as it is read through the fulcrum point. If I feel it, it is my opinion, if the body manifests itself through the fulcrum point to my touch, it is the body s opinion. It is the latter which we are seeking in developing a diagnostic touch. What are some of the sensations that can be felt from the functioning and dysfunctioning within the body? Since man is in total interrelationship and intra-relationship with his environment, it is possible to use terminology from all of the natural and practical sciences, astronomy, engineering, physics, chemistry, electronics and others, through to biodynamics, biology, and anatomical physiology. A partial list of terms would include compression, decompression, tensity, flaccidity, stress, drag, sag, strain, sprain, shock, contraction, expansion, torque, rotation, twitching, vibration, pulsation, mobility, motility, immobility, agitation, disturbance, oscillation, wobble, restriction, fullness, flatness, swelling, atrophy, dystrophy, irritability, strength, weakness, vigor, force, vitality, tone, power, potency, stillness, balance, fatigue, fluctuation, and many others. Here are a few questions a physician can ask himself utilizing a diagnostic touch: In a sprained ankle case, can you feel the shock in the tissues in addition to the

malposition of the ligaments and the osseous articular mechanism? If you are examining for an internal or external rotation of the acetabulum, can

you determine these positions with the innate forces within the acetabular region without manually testing for them?

If you have two low back cases come into your office, one with a hard fall on the buttocks resulting in a compression strain in the lower back and the other with a rotation strain, can you determine each type of strain with a diagnostic touch?

In treating a serious psoas muscle problem, can you determine when that muscle is beginning a better drainage mechanism during the treatment program?

Can you feel the total shock in the thorax that accompanies every moderate to severe post-coronary syndrome?

In a case of lobar pneumonia, do you know that there is a relative restriction of mobility of the temporal bone mechanism on the side of the consolidated lobe of the lung? Can you feel it? Do you understand the anatomical-physiological connection of the tissues as to why this situation is true ?

In treating a bursitis of the shoulder or a brachial neuralgia or neuritis, can you feel the onset of a better drainage mechanism from these congested areas during a treatment? With severe cases, this is the time to stop treatment for the day in order to avoid fatigue within the sick tissues.

In a wryneck, can you feel the dissipation of the forces that caused this wryneck with your (p. 153 154) diagnostic touch? Remember, most of the strains of the body make changes at micrometric levels of measurement in structure and function at the core or center of the disturbed area. Can you feel the forces melting out of the strain pattern under examination?

Can you feel the flatness and loss of vitality that accompanies every case of so called nervous breakdown, or, in all post-encephalitic syndromes? Can you feel the upsurge towards the normal vitality during your treatment of that case?

In a case of sinusitis, can you locate the sinus involved by the use of a diagnostic touch: its degree of involvement? In the lobar pneumonia case, can you find the specific lobe that is consolidated with such a touch, in addition to percussing for its location?

In a recent whiplash injury, can you determine the direction of force from the front, rear or side of the car by laying your diagnostic hands on the tissues involved?

Can you feel fatigue in tissues, either in the patient as a whole or in specific areas of trauma or disease? This is a most important factor in diagnostic and therapeutic considerations.

Can you understand what you are feeling?

These are a few, among hundreds, of items available to a diagnostic touch. There are qualitative, quantitative, prognostic, diagnostic, and therapeutic considerations for each item listed and for each descriptive word listed. Some of these factors will be further discussed in this paper. In this field of endeavor, diagnostic touch, no one is an expert. That living body lying before you on the examination table is the taskmaster. It is challenging you to find its problem. The use of a diagnostic touch, through a fulcrum, opens the door for securing cooperation from that living body in finding the trouble within it. It has been my observation that very few physicians use diagnostic touch with the degree of skill or potential that is available. Diagnostic touch is too valuable a tool to be left on the shelf to gather dust. There are several steps involved in developing a diagnostic touch. These may be summarized as follows: Position your hand or hands upon or under the tissues you plan to examine: (I

frequently have the patient supine upon the examining table so that I may slide my hand under the patient or place my hand on top of the area I am examining. I am comfortably seated by the patient .)

Establish a fulcrum- point for each hand contact from which to operate; (If my hand is under the patient, I can lean on my forearm or elbow in contact with the table. If my hand is on the top, I can cross my knees and place the elbow for that hand on my own knee.)

Let your palpating hand or hands and fulcrum point or points become one with the tissues involved; (The weight of the patient upon my underneath hand is sufficient to make a good contact, the weight of my hand and arm upon the patient is sufficient for the top contact.)

Allow tissue functioning and dysfunctioning to come through to your hands and fulcrum points rather than trying to feel something in the tissues: Allow biodynamic intrinsic force within to manifest its own unerring potency rather than using extrinsic force from without. For example, try examining a knee and extending the sense of a diagnostic touch through to the thigh and acetabular region. Have the patient seated on the examination table and place your hands around the knee with your fingers interlaced in the popliteal fossa. Try to feel what you can with as much understanding as you can. Now apply a slight degree of compression through the knee towards the acetabulum and

see what you can feel in that area. You will be able to get some information but not much.

Now examine these same areas using a fulcrum. Place your hands around the knee with the fingers interlaced in the popliteal fossa and, sitting comfortably in front of the patient, drop your elbows onto your own knees. Now read the story the knee is telling you through the fulcrum points you have established. Apply a slight compression through the thigh towards the acetabular region and again read through the fulcrum points. Feel how the innate natural forces within the thigh and pelvis want to turn the acetabulum either into an internal rotation or an external rotation position. Note the quality of that turning and the quantity of that turning. Note that if you lean lightly on your elbow fulcrum points you get a more superficial reading from the tissues under your hands even though your hand and interlaced fingers remain light in their control. Note that if you lean more firmly on your elbow fulcrum points you get a deeper and deeper impression from the tissues under examination, depending on the firmness at the fulcrum contacts. The depth is dependent upon the firmness at the fulcrum contacts, not on the firmness of the examining finger contacts. If there is a problem of stress or strain deep within this area, experience will teach you that it is necessary to make a more firm contact at the fulcrum points in order to read the dysfunctioning (p.154 155) that is manifesting itself within the area of the stress or strain. Experience and the nature of the problem you are examining will perfect your understanding of this point.

This simple example illustrates one use of the diagnostic touch through the knee, through the thigh, to the acetabulum. A similar type of application can be used for every part of the body from the head to the feet. Place your hand or hands upon or under the tissue you wish to examine, establish a fulcrum point for each hand contact, and start listening to the bodys story of its own problem. There are two more important considerations. The physician has to know his anatomy and physiology in order to interpret that which the body is telling him through his fulcrum contacts and, secondly, at the same time he has to divorce himself from doing something to the area under examination thus letting the story come through to him. He has to get out of the road, so to speak. This is difficult to do. As a physician, he has been given techniques to do something to this body he is examining. He is trained to do and here he is told to divorce himself from this

problem and let it do the job of doing by reporting to his sense of touch; He has learned to listen to the verbal account of his patients problem, now he must learn to listen to a tactile account through his developing sense of a diagnostic touch. This example illustrates the fact that there are no techniques involved, in the ordinary use of the word. The physician is trained in surgical techniques, eye, ear and nose techniques, urological techniques, etc. In developing a diagnostic touch, there are no techniques. He only has to lay his examining hand or hands upon or under the tissues, establish a fulcrum or fulcrum points from and through which to read what is going on inside the patients body and then he allows biodynamic intrinsic force from within to manifest its own unerring potency rather than using extrinsic force from without. He is utilizing the innate energies within the health, disease, or traumatic condition to provide the motive power to bring him the story of the problem involved. Thus he has no techniques and he is told to get out of the way. Yet both of these steps are necessary in the art and science of developing a diagnostic touch. How else can the body report to you if you keep doing something to it during your examination? How is the body going to report to you unless you establish a listening post through which it can report. Your fulcrum point or points are your listening posts. Let the tissues tell you their story and you be quiet and listen. I have said there are no techniques and yet in describing the procedure for examining a knee and the acetabular region, I suggested applying a slight compression through the thigh towards the acetabular region. In examining any area or part of the body, one does position his examining hand or hands upon the body, one does establish a fulcrum or fulcrum points through and from which to read the responses from within the body, one does modify the amount of pressure on the fulcrum points to gather various depths of tissue activity and function, and finally, one can add a slight degree of compression or traction through the examining hand or hands to initiate the motive forces from within the tissue under examination. However, this is not actively testing the tissue yourself, such as manually turning the acetabulum into an internal rotation or an external rotation with your examining hands. Rather this is to activate already existing forces within the patients body so that they will turn the acetabulum into an internal or external rotation with their own built-in-power. Thus the use of diagnostic touch is more than a passive laying on of hands. It is a form of

palpation that one might call an alert observational type of awareness for the functions and dysfunctions from within the patient, utilizing the motive energy deep within the tissues themselves. It is not the patient voluntarily turning the acetabulum for you but his tissues within that acetabulum turning it for you to observe. That acetabular area has a natural tendency to want to go into either an internal or external rotation when the forces within it have an opportunity to express themselves. When you position yourself, establish your fulcrum points and apply this slight degree of compression towards the acetabulum, these forces within that region are now able to express themselves and they activate the process to go into an internal or external rotation. You can feel it happen and are able with your anatomical-physiological knowledge to know whether it is a normal physiological mechanism at work or one that is in a state of dysfunction. If you are not sure, go to the other knee and thigh and test them. They both may be normal or one will be normal and the other not. That is up to you to determine. Why is it necessary to develop a diagnostic touch when there is so much that can be learned from routine physical examinations and with the use of the hundreds of laboratory tests available? It is possible to make a very accurate diagnosis with these aids without the use of a diagnostic touch. These tests can give you information clear down to the subcellular level of what has (p.155 156) happened within this patient. You can read the monitoring devices attached to the patient, such as the electrocardiograph, and watch every electrical detail of every heartbeat, If you can get the patient to give you a complete history for every illness, for every accident, in all the detail that it would take to get the whole picture, and correlate the information with the tests you can run on him, you have made a practical diagnosis with the present day tests and examinations. A diagnostic touch is essential because there are subtleties of tissue functioning and dysfunctioning that cannot be explored by any other means than that of a skilled, sensitive, knowing sense of awareness through the use of this type of touch. A case history will serve as an example. A lady comes in with a complaint of violent headaches for the past two years. Her history is taken and various tests are run to try to determine the reason for the headaches. Finally you are able to localize the areas in which she is having her headaches and you are able to tell her the type of headache she is experiencing, a congestive type, a vasospastic type or some other form. This is fine as far as it goes. Adding the use of a diagnostic touch

to the examination, you find an old chronic concussion in the base of the skull that has limited the mobility of the cranial base which interferes with venous drainage from her head and induces an irritability of the intracranial and extra-cranial tissues through which the nerves pass in connection with her headaches. You ask her when did she have an accident that could have produced a concussion or an accident in which she saw stars. She then tells you of an accident as a child in which she sat down so hard that she was unconscious for a short time and saw stars. Now, you not only have located the area of her headaches and determined the type of headache, but you have also found their etiology, both in their early beginning as well as their present state and disability. This information could not have been gained by any other means than by use of a diagnostic touch; a touch that could literally feel the dysfunctioning within those tissues; a touch that told you this was an old injury: a touch that told you specifically which tissues were doing what in their functioning and dysfunctioning; a touch that told you a lot of other information for which it is difficult to find words to express. This same touch also gave you prognostic information as to the potential help for this case. Furthermore, a diagnostic touch is essential because it is a co-partner with what one might call a therapeutic touch. Taking the case just described, one can give her some symptomatic relief with the proper medication and physiotherapy but if you were to try to secure a correction for the problem, you would have to do something about removing the etiology: the old concussion that had affected the base of the skull. This calls for the use of a therapeutic touch. A therapeutic touch utilizes the same biodynamic principles and energies from within the tissue as does the diagnostic touch. One of the most important factors in the use of a therapeutic touch is a diagnostic touch to guide and direct you through all the living corrective processes that take place within that concussion mechanism during its resolution. Therapeutic touch will be discussed in detail in a later paper. A diagnostic touch, in addition to other tests, is therefore essential for accurate diagnosis. It brings to the surface finite detail from the past, the present status of the problem, and prognostic information for the future from the tissues themselves. It picks up strains at micrometric levels of measurement. It takes you to the specific center of dysfunctioning patterns. It gives you information that cannot be gained by any other form of examination. In the case of the lady with the headache problem, the use of a diagnostic touch was the most efficient way

to discover the etiological factor in her case. The only other way would have been to have secured a history from her of her fall in childhood producing this strain. This would have been difficult, because her severe headaches were present for only two years and she would not have easily correlated them with a fall taking place forty years ago. Even if you had possibly thought of such an accident and questioned her about such a fall, you would still need a diagnostic touch to accurately assess whether this was the beginning of the problem. You have to specifically feel this dysfunctioning at work and thus know that the fall and its present manifestation, headaches, are one and the same unit. Yes, there is a need for diagnostic touch in addition to the routine physical examination and laboratory tests. (Clinical results substantiated the diagnosis made in the lady with the concussion. Within a month, after starting a treatment program, she was symptom free and has remained so for the past year. There is still evidence, to the diagnostic touch, that the concussion mechanism is present, but it has been restored to its compensatory capacity to reciprocate with the physiological balance of the rest of the body. This is another factor in developing a diagnostic touch. In addition to finding the problem area within the patient, one should learn to determine what is happening in its relationship with the total physiology of the patient. Where is the potency or still-point or balance point that is (p.156 157) maintaining this problem area? What is its potential for restoring it to total normalcy or to a compensatory balance in its relationship to the physiological needs of body functioning? In this particular case, a compensatory balance was restored: her symptoms have disappeared for now, but they will recur if and when there is a regression in her bodys capacity to maintain physiological functioning within the problem area. Subtleties within subtleties are thus available to the trained diagnostic touch.) There is a particular group of patients in which a diagnostic touch serves a most useful purpose. This is the group who have been told, I cannot find any reason for your complaints. Your physical examination and tests are all negative. Its all in your mind. Its just nerves. You are paper healthy. These people are frequently called neurotics, psychosomatics, crocks A diagnostic touch defines and confirms the physical evidence to support and explain the vague aches and pains these people bring to your attention. There has to be a somatic component in these psychosomatic problems and the routine tests and physical examinations

are on too gross a level to pick up the dysfunction that is expressing itself as symptoms. The findings that one discovers using a diagnostic touch are at a subclinical level as compared to other tests. It is possible to obtain information from the patients body on the first visit that will give you a clue as to the reason for the complaints. Subsequent visits and continued study of their anatomical physiology will finally unfold a very complete understanding of the total problem. This introduces an interesting point. If ones examinations reveal a true physical picture to explain the disabilities that have caused these people to suffer for months or years, can they truly be called neurotic or psychosomatic? I dont believe so. My reasons for this feeling are based on the fact that, if one is able to diagnose the subclinical strains and stresses that are responsible for the complaints, then one has found the avenue through which these stresses and strains can be corrected, thus bringing back a state of normalcy or re-compensation within that individual. A sensitive, highly trained, diagnostic touch has provided the necessary diagnostic tool to unlock the understanding required in these cases. It is a great help to these people to find a physical basis for their problems. They will frequently follow through with a treatment program, and again, a diagnostic touch is valuable in analyzing the corrective changes that take place during the treatment to resolve these physical strain and stresses. In either case, diagnosis or treatment for this large group of patients, a diagnostic touch is the added tool that is most efficient in handling this type of case in your practice. The clinical results you obtain will be most gratifying to those who have suffered so long with their subclinical syndromes. The hypochondriac turns out not to be a hypochondriac after all. There are legitimate palpable reasons for his or her complaints. The development of an adequate diagnostic touch is not an easy task to accomplish. To be able to find a state of health or of a strain is one thing: to be able to feel and interpret the functioning or dysfunctioning within that area of health or of strain with a trained touch is something else. The body may be considered as being basically composed of solids (bones), semisolids (soft tissues), and fluids (body fluids). This solid-semisolid-fluid structure of the human body is endowed with the biodynamic living principles of life. It is highly organized and is capable of expressing living changes taking place within its own environment. An area that is in strain within this living body can be found because that area of the body is expressing itself as being in strain. What one feels with his diagnostic

touch is kinetic energies within that strained area operating as a pattern of dysfunction within a solid-semisolid-fluid mechanism. The physician interprets this kinetic energy manifestation in physiological and clinical language based on anatomical-physiological knowledge of body functioning. All anatomical-physiological units express and utilize kinetic energy in manifesting their functioning in health, in disease, and in trauma. It is the art of learning to use these kinetic energies, with their centering potencies, wherein one develops a perceptive, sensitive, diagnostic touch. These energies vary in intensity, in quantity, and in quality for every environmental situation within patients. In discussing this phase of diagnostic touch with an electrical engineer one day, he made the statement to me, It takes a lot of energy to make a transistor or a vacuum tube work but it takes only a small amount of energy to direct that work. Similarly, in human physiology, there is already present a great deal of biodynamic energy at work but it takes only a minimal amount of energy on the operators part to learn to read and use that kinetic energy for diagnostic and therapeutic purposes. The transistor or vacuum tube has to have electrical energy supplied to it to make it work; in human physiology, biodynamic energy is already doing the job for the operator. The operators minimal energy requirement is applied through the fulcrum point or (p.157 - 158) points from which he learns to use the biodynamic intrinsic kinetic energy already in action within the patient. The results of such an examination would be phrased in clinical anatomical-physiology or pathology, such as a subdeltoid bursitis, acute hepatitis, psoas muscle strain, or whatever clinical entity the problem turned out to be. The biodynamic kinetic energies involved and the diagnostic touch of the physician are tools to isolate and define the clinical problem within the patient. What is expressing this kinetic energy within this patient? It is biodynamic intrinsic force within integrated, highly organized fluid-fascialosseous mechanisms and fluid-membraneousosseous mechanisms of the living body. The term fascial is used because the fascial envelopes of the body surround and enfold the somatic cells of body functioning -- the liver cells, the muscle fibers, the alveolar lung cells or whatever cellular structure is involved in body physiology. The potential for clinical pathology to be examined by a perceptive diagnostic touch is unlimited. One has only to review the cases that he has seen on any given day in his practice to appreciate the variety of the problems involved: Bells palsy,

trigeminal neuritis, sinusitis, bronchitis, ileitis, a cerebral palsy child, a whiplash injury, psoas muscle strain, a ruptured disk problem an autonomic nervous system imbalance, an endocrine problem, congestive headache, an acne problem, a lifting injury problem, an epileptic, a rheumatoid arthritic, and so on through case after case. The amount of information one can gain as the tissues respond to the use of a diagnostic touch is truly remarkable. As ones perceptive skill increases, the issues will reveal something about the past history of their disability, the present status of their problem, and a prognostic evaluation as to their capacity to return to complete normalcy or to a compensatory state of functioning. All three of these factors reveal considerable detail in these findings. The cases that show promise of a good recovery indicates this to a diagnostic touch. The cases that are slow to respond or that are making an inadequate response demonstrate their lack of response and give insight as to why they are not responding. This is a big help to the physician who needs to know how to plan further care for the cases that are giving him difficulty. There is need for a diagnostic test that can give accurate guidance in the care of any case. A diagnostic touch provides this type of guidance. There is a corollary to the statement: allow biodynamic intrinsic force within to manifest its own unerring potency rather than using extrinsic force from without. It is: allow the mind to explore and interpret the biodynamic intrinsic force within as it manifests its own unerring potency rather than using extrinsic force from without. It is possible to develop a sensitive diagnostic touch capable of palpating this biodynamic force and its unerring potency but in addition it is necessary to develop ones mind so as to be able to explore this functioning and to be able to interpret intelligently the changes that are taking place. Let us set up an example to clarify this thought. Biokinetic energies or forces are always at work in all physiological and pathological processes. If we were to add an environmental force or kinetic energy to body physiology so as to produce a strain, such as a blow, a fall, or a twist, we would now have a specific pattern of disability manifest within the body mechanism. It is now a biodynamic energy field plus an environmental energy field, the force it took to produce the strain. We place our hand or hands upon or under this area for examination. We establish a fulcrum point for each hand

contact through which to initiate and sense the changes that are taking place within the strained area. Within a few seconds, we will find a change taking place within the tissues as they start manifesting the pattern of disability that is present within them. It is the biodynamic intrinsic energy within that pattern going to work. To the outside observer watching our work, our hands are apparently lying quietly on the patient but the motion, the mobility, the motility we sense from within the patient is considerable, depending upon the problem. There is a deliberate pattern that the tissues go through in demonstrating the strain that is within them. Kinetic-energy-wise, they work their way through to a point at which all sense of motion or mobility seems to cease. This is the point of stillness. Even though it is still, it is endowed with biodynamic power. This is the area of the potency for this strain pattern. This is a still-point within this functioning unit. A change takes place at this time that the physician records more with a sense of awareness that such a change took place rather than actually being able to feel it. Following this point a total new pattern manifests itself as the tissues create a new state of functioning. It is a more normal pattern of functioning as compared to the disability that was present at the beginning of the examination. Where does the second statement concerning the mind fit into this picture? The physicians mind becomes an observing tool, an analytical tool, an exploring tool, and an interpretive tool (p.158 159) that accompanies the sense of touch as it follows the changes that are taking place. One might say that the physicians mind alertly parallels the sense of touch throughout the diagnostic process just as a trained observer might sit at the sidelines of a visual contest and study the participants of that contest. However, here within this tissue functioning pattern, the physicians mind must follow deep within the patients body and go with the sense of touch as the biodynamic intrinsic energies manifest their own unerring potency in the pattern under examination. The biokinetic and environmental energies within the pattern provide the motive power, the sense of diagnostic touch follows the whole sequence of events from initiation through to what fulfillment is available for this one examination, and the mind observes, evaluates, and interprets the changes that are taking place. Because the physician has anatomical and physiological knowledge in his basic training, he is able to interpret his findings in biological language, in pathological language, in clinical language, and in anatomical-physiological language. He knows, for example, that it is a psoas muscle strain pattern he has been examining, or a consolidated lung, or whatever the pathology happens to be. By his sense of diagnostic touch he is

able to feel this dysfunctioning process as the body manifests it. With time and experience, the physician is able to read some of the past history of that disability, its present status, and prognostic evaluations for the future. This is interpretive mental skill. It is highly important to keep the mind alert and, at the same time, wide open to accept that which the tissues have to report rather than that which the physician hopes to find. Here again, let the tissues tell their story. The physician listens. With experience, an amazing amount of information comes through for interpretation. Despite the fact it sounds complicated and time consuming, it is not time consuming when one has learned the knack of securing the bodys cooperation. A lot can be learned within a five to ten minute period. That which has been called the potency in these papers cannot be described. It can be discussed. It can be understood. It can be used both diagnostically and therapeutically with the development of a sensitive knowing touch. It is a fundamental principle in nature and, certainly, the anatomical-physiology of the human body is part of nature. Any fulcrum is the site of the potency. A fulcrum has been described as a still-leverage junction over and through which action and reaction takes place. A fulcrum can and does shift from point to point, yet remaining still in its leverage functioning. The examples in nature that illustrate this functioning are multitudinous. The eye of a hurricane around which the cyclonic storm is manifesting itself is the fulcrum for that storm and contains the potency; the funnel of a tornado is centered by a still fulcrum area and yet that funnel moves across the land; the tides of the oceans ebb and flow twice a day and there has to be a fulcrum area somewhere in that fluid mass over and through which the tides operate. You can take a glass of water and by transmitting a fine vibration to it; it is possible to see the water form a pattern centering itself in the middle of the glass. This, too, is a still point around which the pattern of water is forming in response to the vibration transmitted to it. In all of these examples, it is important to realize that there is not only tremendous action taking place in the periphery around the fulcrum centers but that the potency in the fulcrum area is also part of this total kinetic energy pattern. These examples have been used because they point to the fact that there can be fulcrum points in masses of air and in liquids as well as the ones we commonly associate with solids, such as a teeter totter. In human anatomy and physiology there is a potency in all the fulcrums of activity within the bodys functioning and, like the world of nature in which this body is

operating, this functioning is providing its own motive power biodynamically. It takes skill, time, and patience to learn to feel this functioning: to learn to sense the movements, the motion, the mobility, the motility within tissues as initiated by these living structures (not that motion that as I as an operator can do to the body nor that motion which my patient may consciously do with his body but that motion which is already present as that patient lies quietly on the table): to learn to follow the patterns that are being expressed by living structures; to learn to recognize the fulcrum points or points within those patterns: to learn to be aware of the potency within the fulcrum points; to be aware of the moment that a change took place within the potency during the diagnostic or therapeutic examination: to learn to feel the unfolding of the pattern after going through the stillpoint; and to learn to analyze and interpret this material into sound physiological reasoning. Despite the complexity of trying to portray the development of a diagnostic touch in words, it is a relatively simple procedure in actual practice. Working through a fulcrum point which the physician has established after placing his examining hand upon or under the patient, he is ready to receive the information that is available within the ana-(p. 159 160) tomical physiology of the patients body, to read the biodynamic intrinsic forces at work within anatomical physiological mechanisms of the living body. For those who have followed the discussion up to this point there probably has developed a great deal of skepticism. There are two good reasons for such skepticism: it may seem that there is too much importance put on the need for the development of a diagnostic touch and that a diagnostic touch does not fulfill all that has been ascribed to its use. A sense of skepticism is a most valuable asset in this work. It serves to keep ones feet on the ground, so to speak. The physician is seeking information from the living body through his trained touch and he wants that information to come from the body itself. If he is totally skeptical to the fact that this information is available to him with the use of a diagnostic touch, he will receive very little information. If he will allow his mind to be open to the idea that such information is available with just enough skepticism to make the body prove that it is providing this information, then he will be in a position to more accurately evaluate that information. Let the body prove itself in demonstrating this functioning and dysfunctioning. It serves a useful purpose to be slightly skeptical. The importance and the degree of usefulness a diagnostic touch serves the physician will depend on the time and effort the physician takes to develop his diagnostic touch.

Can a diagnostic touch be called a scientific method of examination? The scientific method or test has been defined as one that can be reduplicated, repeated, and reproduced with the same end results in test after test on the same item under examination. In using diagnostic touch, we are developing one of the five senses of the physician. It is well known that the variability of different individuals in their use of any of the five senses, sight, hearing, smell, taste or touch, would be great enough to preclude the advancement of the idea that this could be a scientific form of examination. However, diagnostic touch is scientific. It is not the variability of the physicians ability that concerns us. It is the problem within the patient that we are seeking. The problem within the patient is going to be present regardless, whether he is examined by one physician or several physicians. If a group of physicians have prepared themselves to utilize this form of examination adequately, they will each come to the same approximate conclusion concerning the patients problem. I use the word approximate because successive examinations, one after another the same day, will modify the pattern of disability enough for each physician to get a slightly different picture. However, if this patient has a relatively subacute problem and the examinations are made with a time lapse period to allow it to remanifest itself each physicians findings will correlate with his colleagues. A diagnostic touch is scientific because the problem is in the patient, not in the physicians ability or inability to find it. The emphasis throughout this paper has been upon the development of a diagnostic touch. This is not to depreciate the effectiveness of the routine physical examinations and laboratory procedures. Both of these types of examination are scientific in nature and result in a detailed insight into the patients problem commensurate with the degree of skill of the physician to bring the patients problem into focus. Diagnostic touch is an added tool for use in understanding this patients problem. The physician is seeking to perfect himself in those arts and sciences that will help mankind, to diagnose their problems, to find therapeutic avenues through which to alleviate these problems, to bring back to the individual a state of health and normalcy within his body physiology. Why not go to that body physiology and ask it to explain itself to the physicians understanding? A few minutes additional examination learning to use a diagnostic touch in every case each time that patient comes to the office will perfect this form of examination for the physician. It will give him an insight into basic anatomy and physiology in greater detail than any other form of examination. It

will give him an insight into anatomical and physiological detail, in depth, within that specific patient that he has never experienced before. It will give the patient a sense of knowing that the physician is truly seeking the etiology for his particular case. It builds the patients confidence that his doctor understands his problem. It contributes diagnostic insight and therapeutic considerations for every patient for every visit. The time and effort it takes to perfect the art and science of a diagnostic touch is in keeping with the physicians goal in life, that of serving mankind.

DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION: PART Ill ROLLIN E. BECKER, D.O., B.Sc. Dallas, Texas (AAO 1964, p. 161) Part I of these papers was a discussion of the general principles of a diagnostic touch. Part II indicated the usefulness of a diagnostic touch. Part III will be a group of pictures demonstrating clinical application of a diagnostic touch. A physician has two jobs to do when a patient comes to him; one, to make a diagnosis of the patients problems, and secondly, to administer therapeutic aid for the problems. A diagnostic touch contributes to both of these procedures. When a diagnostic touch allows biodynamic intrinsic forces within to manifest their own unerring potency rather than the use of extrinsic force from without, the physician is securing diagnostic information of inestimable value to him in the care of that case. When a diagnostic touch allows biodynamic intrinsic forces within, to pass through their own unerring potency rather than the use of extrinsic force from without, the physician is securing a corrective process within the problem that leads towards health for that patient. At all times, the patient and his problem presents a challenge to the physician. In this work of using a diagnostic touch, the patient is the taskmaster. His problem is the schoolroom. His biodynamic intrinsic forces and their unerring potency are the teachers. The diagnostic touch of the physician, operating through a fulcrum-point for each hand contact, is the pupil. Diagnostic touch involves learning to feel and understand the biodynamic intrinsic forces and learning to be aware of the unerring potency within them. I am asking the biodynamic and biokinetic forces and their potencies within the patient to report their findings to me through my fulcrum points. They do so without failure on their part. When there is a mistake made, it is my inability to read that which is going on and to interpret it correctly in sound physiological knowledge and reasoning. To begin an examination using diagnostic touch, I am going to get a careful history of the patients complaint. Then I am going to place my hand contacts in the area of the complaint, establish a fulcrum point for each hand contact, and initiate the pattern within the complaint area into action. This is done by a slight compression at my fulcrum points, not at my hands. The biodynamic and biokinetic intrinsic

forces within the patient will begin manifesting the pattern within the patient. These forces will go through a definitive and palpable cycle of operation towards the area of the potency for that pattern. It goes through the area of the potency, changing or modifying the power within the potency, this pattern has received the treatment that is available for this examination. Diagnostic-wise, I feel the intrinsic forces at work in the pattern going to the potency and the corrected pattern that follows the change in the potency through my fulcrum points; I am aware of the change that takes place in the potency area with my knowledge that such an area exists within the patient and the experience of having observed it happen many hundreds of times in many patients. This cycle of operation, from initiation through to the change that takes place within the potency, will vary from as short a time as one minute to several minutes, depending upon many factors within the patient. My attention, as a physician using diagnostic touch, is on the potency within this patient because I know that within the potency is power and many other attributes around which the disease state or the traumatic condition within the patient is manifesting itself. I know that if a change takes place within this potency a whole new pattern will manifest itself, usually towards health for the (p. 161-162) patient. I know there is some basic potency that can be found in the patient when he is in a state of health. I have found that when the various potencies that are present in traumatic or disease conditions have dissipated, there is a potency and a general feeling of biodynamic intrinsic forces manifesting themselves that tell me this patient is well again. In my own thinking, I differentiate between biodynamic intrinsic forces within human physiology and biokinetic intrinsic forces within traumatic conditions and disease states. Using diagnostic touch and exploring problems in a patient through my fulcrum points has taught me that when trauma or disease conditions are found, there are energy forces added to body physiology in order to produce and maintain the strained or pathologic state. This added energy I call biokinetic energy and each field of biokinetic force has within it a potency. When a corrective change takes place in this potency during a treatment, further normalizing changes take place between office visits. The next visit of the patient calls for a new evaluation of the prob