We know that if we ever know the whole, we must first know the parts.
                  -- A. T. Still

Holism and anatomy are inextricably linked in Osteopathic philosophy. Andrew Taylor Still taught the Osteopathic profession how to access what is holistic in our patients, by way of the parts. "The parts" referred to by Dr. Still are the details of anatomy. He invited us to be proficient in anatomy and he emphasized the significance of a lifelong study of anatomy as a pathway to clinical excellence and success.

Perhaps the word "invited" is insufficient to describe the emphasis Dr. Still placed upon knowing anatomy in Osteopathic practice. Dr. Still implored us to prioritize anatomy. His request was more of a requirement when he said, "The osteopath must remember that his first lesson is anatomy, his last lesson is anatomy and all his lessons are anatomy" -- he further emphasized his anatomic priority by stating, "In early life I began the study of anatomy, believing it to be the 'alpha and omega,' the beginning and the end, of all forms and the laws that govern forms . . ." -- and finally, he drove his point home with, ". . . let your morning, noon and evening prayer be this, Oh Lord! Give me more anatomy each day I live, because experience has taught me the unavoidable demands when in the “sick room."

Dr. Still demanded that every Osteopath have an intimate knowledge of anatomy. Dr. Still’s appreciation of anatomy was not two-dimensional, as imparted from anatomy textbooks. His appreciation of anatomy was living, functional, and applied. His knowledge of anatomy was ultimately practical and meant to be utilized every day by practicing Osteopaths in what he called the "sick room," or what we today call our treatment rooms.

I don’t imply that we should give up the study of anatomy by using textbooks or atlases. Dr. Still considered anatomy textbooks to be the true Osteopathic reference books that guide our treatment. He also required that Osteopaths learn the basics of three-dimensional anatomy from dissection. He was a master anatomist who dissected hundreds of bodies. He said, "I had printed books, but went back to the great book of nature as my chief study. The poet has said that the greatest study of man is man. I believe this, and would have believed it if he had said nothing about it. The best way to study man is to dissect a few bodies."

We learn the distinctive language of anatomy from textbooks. We appreciate the intricate three-dimensional relationships of anatomy through the vehicle of dissection. We then relate this masterful knowledge of anatomy to the living form presented to us -- as a patient -- when we utilize the hands-on method of treatment known as Osteopathic Manipulation.

The development of a successful and skilled Osteopath requires a lifelong commitment to increasing our anatomic knowledge through the study of textbooks and to expanding our understanding of the living anatomy presented to us by the practiced application of Osteopathic Manipulation. We learn to understand how anatomy works through offering Osteopathic Treatment to tens of thousands of patient visits over the lifetime of our careers. Dr. Still said, ". . . you begin with anatomy, and you end with anatomy, a knowledge of anatomy is all you want or need, as it is all you ever will use in your practice, although you may live one hundred years." His imperative is as essential today as it was in 1892 when he wrote these words.

A deliberate understanding of anatomy guides our hands during Osteopathic Treatment. Osteopathic skill and clinical acumen are based upon a detailed appreciation of structure. The more exact our anatomic knowledge, the more precise is the treatment. Precision increases the likelihood of positive outcome. Osteopathic Manipulation is fundamentally an applied anatomic treatment.

Dr. Still often spoke of having a "living picture" of the patient's structure in our "mind's eye." He spoke practically of having our "minds full of pictures of the normal body" and of having an "image of every bone, muscle, nerve, organ, and part of the human body." Discerning normal structure from abnormal structure is indispensable in any discussion of Anatomy in the Osteopathic Field. Having an image of a patient's living anatomy is not a mental picture created by one’s imagination. The picture in our mind's eye is not conjured up to fashion a normal anatomic template for us to fit our patients in to. As Osteopaths, we receive the living picture from our patients. The information we receive through our Osteopathic physical exam combined with the data given to us from the history create the mind's eye image. The mind's eye image is a diagnosis. We use this living picture of a patient’s structure to then offer a patient-specific treatment.

Understanding anatomy is not merely concerned with learning the statistics of detail. It is not just knowing the names of parts. It is not exclusively obedient to recognizing the material elements of structure. Anatomy in the Osteopathic Field is concerned with structure and function. Function includes the "living" aspect of our patients. A cadaver does not contain function. The non-material qualities of function also allow us to find relationships, or connections, that are clinically significant. Function and structure together make a unified whole. Function and structure are interdependent and inseparably related.

What is the relationship between Dr. Still's Osteopathic vision of anatomy and holism? A. T. Still did not coin the word holism. J. C. Smuts, a South African scholar in 1926, conceptualized holism. In his book, Holism and Evolution, Smuts created the word holism from the Greek word holos, which means whole. He then outlined the philosophy of holism, which reiterates Aristotle's philosophy of "the whole is greater than the sum of its parts." According to Smuts, the mechanical putting together of parts does not account for the characteristics or functioning of a living and unified holistic human being. He described holism as a universal phenomenon and a recognizable expression of nature. Later in the 1960's, many authors revitalized J. C. Smut’s theories on holism and integrated them into the alternative health care movement.

Though Dr. Still did not use the word holism, he did euphemistically speak of holism. In other words, he spoke of holism without using the word holistic. He used expressions, or what we might now call key-words, such as those listed in Table 1.

Table 1: A. T. Still key-words for holism

The human body as a whole
Connected oneness
One common whole
Harmony and harmonious action
The body functioning united
The whole being, the whole person, and the whole body United in form
Man in his completed form
The universality of fascia

Dr. Still said, "I do not claim to be the author of this science of Osteopathy. No human hand framed its laws. I ask no greater honor than to have discovered it." A. T. Still did not invent Osteopathy. J. C. Smuts did not invent holism. Osteopathy and holism are known functions of the natural world.

When Dr. Still said, "We look at the body in health as meaning perfection and harmony, not in one part, but as the whole," He was telling us that health, perfection, and harmony are some of the characteristics of holism. By perfection, I believe Dr. Still intended the word to be defined as "mankind's highest good." He implied that, we couldn't mechanically put together the parts and then achieve harmony. Dr. Still was a master at discovering the interrelations between the material elements to discover how the whole mechanism is affected. Holism can be accessed either by means of the structure or form, as in contacting the "universality of the fascia," or by non-material phenomena associated with function, as in perceiving the unifying matrix of Health.

Dr. Still was ultimately a student of Nature and Natural law. Nature is inherently holistic. Holism is a concordant function that cannot be measured but can be appreciated. We appreciate what is holistic, in our patients, as a field, or a matrix, engaged by what I call our "other sensory perceptions." We don’t utilize the material neurologic end-organs of our five known senses when experiencing the matrix of holism; instead, we have an awareness of function that manifests oneness, unity, completion, and universality.

This field of health, perfection, and harmony can manifest with many different textures. What is holistic in our patients is the originator of the therapeutic process. Healing does not emerge from what is diseased or dysfunctional. Healing is an effect of what is right or healthy in the organism. The physiologic "highest good" is an aspect of what is holistic. Holism is synonymous with the Osteopathic principles of Health.

Osteopathic Manipulative Treatment is the hands-on application of Osteopathic philosophy. Osteopathic Manipulation is the most common, but not the only vehicle through which a DO gains access to, and experiences holism. Until we put our hands on a patient in a caring and therapeutic way, we have no dependable experience of holism. Before we put our hands on a patient, holism is an idea; up to that point, it is for the most part only accessible through our consciousness. We can think Osteopathically. We can discuss Osteopathy philosophy verbally. However, until we place our hands on a patient -- until we touch our patients -- what is holistic cannot be fully accessed and then utilized as the motive force for healing.

Osteopathy is a hands-on system of health care. Osteopathy is a physically based healing art that uses the body as a doorway to the non-material or esoteric healing phenomena. Osteopathic Manipulation translates an idea into action. The action we understand is the appreciation of harmony, unity, completion, and universality. When these expressions of holism are not perceived, we "see" with our hands the presence of inharmony, disintegration, incompletion and discord, which are manifestations of disease and fractionation.

From an Osteopathic perspective, the opposite of holism is when a patient feels fractionated to us during the examination and diagnosis phases. When we place our hands on a patient and do not feel harmony, then disease and dysfunction are present -- or the preclinical manifestations of disease are in the earliest stages The true goal of an Osteopathic Treatment is to help restore the organism to holism. Once harmony, unity, completion, and universality are restored then Nature’s inherent abilities to heal do the rest.

The conscious and wise application of Osteopathy is extremely simple. We must identify the dysfunction, during our physical exam; and this requires having a detailed understanding of normal structure and the functional anatomy we call physiology. Then, we must identify some quality of holism. I commonly utilize the matrix of Health as a readily accessible unifying phenomenon. Skilled Osteopathic Treatment involves just bringing together what is holistic with what is dysfunctional. Finally, we leave Nature to do the rest. The ultimate source of healing is Nature. The Osteopath is present only to assist Nature.

Our mission as Osteopaths is to have a consummate understanding of applied anatomy. Our duty as Osteopaths is to be able to find what is holistic and utilize it as the motive force for healing. I believe that the most important philosophic tenet imparted by Dr. Still was summarized in this quote, "To find health should be the object of the doctor. Anyone can find disease." Health is holistic. Health is one of the accessible and perceivable fields of holism.

Our motto should be to study anatomy and find Health. That is all we need to know to become a skilled and successful Osteopath.

Steve Paulus, DO