To find health, should be the object of the doctor. Anyone can find disease.

And that’s usually where the most cited 'amputated quote' of the final paragraph of the first chapter of “Philosophy of Osteopathy” is concluded, by most unscrupulous “authors”. For the proficient readers, they know that it is after that quote, that the old Doctor gives you the practical algorithm, of how to find “health”. That algorithm, he calls the “grand round of the sentinels”.

The grand round of the sentinels, Still’s own way of telling us how to see health in the whole…

First some context:

During the American Civil war, America was practically split in two opposed thoughts: the Northern Unionists – the Southern rebels as Bacon’s Military map demonstrates.

Doctor Still was in the Unionist camp and joined the military as officer. It is from that experience, that his “grand round” image comes.

The northern Unionists (Blue coats) had a very well-ordered way to set up camp even in the field or in campaign, as this drawing from 1862 shows: not just the emplacement of the tents, fires and so on but also the positions and role of the sentinels.

Here ‘s an excerpt the orders: from 1863.

Instructions for Officers and Non-Commissioned Officers on Outpost and Patrol Duty and Troops in Campaign (1863).

• All sentinels have the following general orders:
• “I am required to take charge of this post and all public property in view; to salute all officers passing, according to rank; to give the alarm in case of fire, or the approach of the enemy, or any disturbance whatsoever; to report all violations of the Articles of War, Regulations of the Army, or camp or garrison orders; at night, to challenge all persons approaching my post, and to allow no one to pass without the countersign until they are examined by an officer or noncommissioned officer of the Guard.”

??????? When one looks at the modern definition of “sentinel”, it is clearly not what the old doctor meant: sentinel noun (definition today)

??????? 1. a soldier or guard whose job is to stand and keep watch.

??????? 2. an indicator of the presence of disease. (Medical)

Our dear Drew, is talking about “health” not disease, thus we forget this (out of time and context definition) and check in the Webster’s dictionary of 1828, which was his language. reference:

??????? SENT'INEL,?noun?[from Latin?sentio, to perceive.]

??????? In?military affairs, a soldier sent to watch or guard an army, camp or other place from surprise, to observe the approach of danger and give notice of it.? (in other words, HEALTH, being normal or abnormal- in jeopardy)

Now this makes more sense to you dear reader, let’s look at the whole quote now:

A.T. Still ??Philosophy of Osteopathy?? 1899, page 28, chaptre title: The osteopath should find health

??????? ‘To find health should be the object of the doctor. Anyone can find disease. He should make the grand round among the sentinels and ascertain if they are asleep, dead or have deserted their posts, and have allowed the enemy to get into camps.

??????? He should visit all posts.

??????? Before he goes out to make the rounds, he should know where all posts are, and the value of the supply he has charge of, whether it be shot, shell, grub, clothing, arms or anything of value to the Company or Division.

?The grand round of the sentinels for health:

·?????? Know where all sentinels are

·?????? Know what they are responsible of for the whole

·?????? Visit them and see their condition

·?????? If the alarm is raised intervene accordingly

That’s what we do in the clinical exam seminars after finishing the evolutionary physiology. Now in order to get out of our restricted-educated tunnel vision, and SEE the principles at play here, we mix up natural views of sentinels on patients, as well as seeing pictures of nature.

Participants are very often asking me how I’m able to spot so many amazing animals in such random environments. The answer isn’t as exciting as you may expect, I’ve learned progressively not only where to look, but how to look to SEE; and then practice, practice and once more practice.

In nature, with our Homo Sapiens senses and subsequent perception, we are a specialized species, which like every specialization carries advantages and disadvantages, our tunnel vison-education and society even makes a handicap of it, therefore the how and where really matters…

The “how”: our species are basically predators, that specific morphology gives us a natural sense of looking in “search” mode, or a focused binocular precision view. That predisposition makes us practically blind for the whole.? Prey species, morphologically tend to view in “scan” mode naturally, which gives a better view of a bigger part of the whole. The key is the position of the eyes in the skull, and their orientation, which trains the brains in “scan” or “search” mode naturally. Nicely demonstrated by the two following pictures: the predators and prey species views.

Obviously, we can’t change the eye position we were born with, however our brains and perception can be reeducated. Of course, to reeducate, we must first percept our “search” habit-handicap, understand the principles and then learn how to circumvent that handicap. That is exactly what dr. Still means with his “grand round of all the sentinels”, I think. Hence the hundreds of training-test exercises during the clinical exam. During the first part we focus mainly on the visual side, in the second part we discover it is similar with our palpation sense. Our hands are not equal, they are not even equal in themselves: a part of our hand excels in “search” mode while the other excels in the “scan” mode.

The “where”:

In “scan” mode, notice the anomalies, switch to “search” mode, see what they are, take note of them mentally and then mentally step out to go in “scan” mode again. That is the unnatural part for our species, we must train this. We naturally tend to be complacent, once something spotted in search mode, the habit tends to push us to stay in that mode and become practically blind for the rest.

The next time you take a walk, take time to really look at the trees, along their branches, and inside their holes for movement and shapes or outlines that don’t match the rest of the tree, the anomalies. When you’re looking at an open field, don’t just look for big animals towering over the grass, but into the grass itself for all the animals that take refuge there. It’ll amaze you when you start to see what has been right in front of you the whole time.

The patient’s sentinels…

We should really differentiate between the Frontier tissue and the Inner tissue. Why? Because most of the Frontier Tissue sentinels, are visited by the look and eventually secondarily by palpation and smell. The Inner tissue sentinels are mostly by palpation, as well in “scan” as in “search” mode, and some eventually looked at.

The Frontier tissue sentinels post’s?:

??????? Hair (single and as a whole)

??????? Skin, general and specific zones

??????? Flexion zones

??????? Smell (skin and breath)

??????? Fingertip and nail, idem for the toes

??????? Nail discoloration

??????? Tongue

??????? Lips

??????? Mouth-corners

??????? Gums

? A tip: study the micro-anatomy, especially the proportions of Frontier Tissue and Inner tissue, and their types and proportion of vascularization.

The most important, keep calm and take a step back, return to “scan” mode…

It’s really getting too hot I must hit the pool right now…

?Maybe when the next cool front passes some more on the Inner tissue.?

?