DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION
ROLLIN E. BECKER, B.Sc., D.O.
Dallas, Texas
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 com-
plexity 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 immuno-
logical 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 isn’t a
machine to do a differential count developed
yet, human ingenuity should be able to come
up with an electric eye to do the seeing, a
small electronic brain to “remember” the
different types of white cells, and a scanning
device to make such a differential count, again
eliminating human error.
Enzymes, hormones, and other protein
molecular actions and interactions are being
analyzed and studied through a variety of
approaches, electrophoresis , chromatographic
processes, complex chemical techniques,
radioisotopes, and the electron microscope.
Sampling for the various materials needed in
these tests can now be taken directly from the
site of activity in many cases by the use of
catheters that are passed through the arteries
and veins directly to the point from which a
sample is desired. A recent report tells of
32
All Rights Reserved American Academy of Osteopathy®
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 mani-
pulation, the catheters entered the central
adrenal vein. Contrast media injections out-
lined the adrenal venous network and the extent
of the nonadrenal channels. Blood samples
revealed levels of free cortisol ranging from
4 1 to 3 13 mcg . per 100 ml. of blood. This
technique will make it possible to study rapid
metabolic changes in the adrenal cortical
steroids.
Machines have been built that duplicate
renal function so that serious renal dysfunctions
can be handled for hours on end while work is
being done to restore kidney functioning. Other
machines permit open heart surgery and chest
surgery that could not be permitted a few years
ago.
The use of electronics in the medical
field is on the threshold of its development
and already many electronic devices for
diagnosis and study are making their way into
the market. Electrocardiographic data can be
transmitted over a telephone circuit to any
place in the country. A Body Function Recorder
can keep a constant close surveillance on as
many as a dozen patients. Five variables can
be watched simultaneously, the pulse rate,
systolic and diastolic blood pressure, the
temperature, and the air flow through the
nostrils. Miniaturization and transistorized
equipment are making many tests permissible.
Blood pH can be monitored continuously for as
long as six hours with a tiny electrode
l/20,000 inch in diameter, placed in a standard
hypodermic needle. At a glance, an attendant
can observe the concentration of carbon dioxide
in the blood stream of an anesthetized patient,
the approach of shock in an accident case, or
the intake of oxygen in an iron-lung patient.
More and more of such devices will be available
with time to develop them.
Thus the science of diagnosis is demon-
strating its strength in every phase of human
 DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION -- BECKER
existence and its potential for future develop-
ment is practically unlimited. The physician
of forty years ago was a simple soul who ‘had a
relatively few instruments at his command and
not too great an armamentarium of therapeutic
aids with which to diagnose and treat the disease
and trauma of his patients. Today’s physician
must be a chemical engineer, an electrical
engineer, a biological engineer and a physical
engineer, in addition to being a physician. The
physician of forty years from now will make the
present-day physician look like a simple soul.
Thus the pattern continues to unfold.
Diagnosis as an Art
Diagnosis as an art is an important com-
ponent in the field of diagnosis. It has always
been. It always will be. Diagnosis as a science
brings to the physician those data that can be
learned objectively with the minimum of human
error. The blood count that can be done by a
machine is more accurate than that run by a
technician counting the cells. So it is with all
the biological detail that can be done by scien-
tific instruments. The art of diagnosis is that
ability applied by the physician himself. It
involves the following factors: his interpreta-
tive skill in analyzing the data supplied to him
by his scientific tools and the use of his own
personal skills in evaluating the patient before
him. These are subjective in nature. These
may not bring the finite detail of the instrument
but neither are they limited by the finite detail
that the instrument is only capable of perceiving.
There is room for variables, there is the ability
to perceive past events, present events, and
predictability for forecasting future changes,
There is a wider latitude of functioning in the
subjective field in the art of diagnosis and this
coupled with the scientific data gives the
physician an over all picture that can bring a
more complete and knowledgeable diagnosis.
A scientific diagnosis is not enough. It is too
limited. It is the composite use of both scien-
tific (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 develop-
ment 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,
33
All Rights Reserved American Academy of Osteopathy®
knowing touch. This latter I will enlarge upon
later. Interpretative skills call for a knowledge
of functioning within the human body, function-
ing that is related to past events leading to the
present time he is seeing the patient, function-
ing of the present time, and the ability to
project functioning patterns into the near future.
This is different from the mere tests for function-
ing as recorded by the scientific tools at his
command. The latter are transitory findings
that reflect the picture of the moment. True
functioning within the individual patient is that
evaluation of what is being done by the patient
with all of these variables; how is his system
coordinating them; how is he adapting to the
dysfunctions, where is the potential for the
reversibilities of the dysfunctions. In other
words, how is this patient functioning as a
living being? He is sick. He comes to you
for help. Where is he now, where was he when
his problems began, what is his potential for
return to normal? It is the intelligent use of
the physician’s eyes, ears and touch that can
give him knowledgeable answers to some of
these questions. There are variables found in
every case which must be taken into account.
These are the factors that complete the case.
They are as important to the physician as the
vast array of scientific tools and the data 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 patient’s ideas and beliefs of what he
considers his problem to be: there is the
physician’s concept of what he considers the
patient’s problem to be; and, finally, there is
the problem of what the anatomical-physiological
wholeness of the patient’s body knows the
problem to be.
The patient of today is a better informed
patient than the one of a few years ago. He
reads medical articles in the periodicals. He
translates this information into his terminology,
not always correctly, and he has been to other
physicians before coming to you. He has heard
their diagnosis of his problem and adds that to
his opinion. He tells you his story and tries to
explain his physical feelings. He is sensitive
to your opinions and if you can come up with a
picture that will explain his problem to him in a
satisfactory way, he is able to cooperate with
you. But in the final analysis he still has his
 ACADEMY OF APPLIED OSTEOPATHY -- 1963 YEAR BOOK
opinion, right or wrong.
The physician’s concept of what is wrong
with the patient is based upon a much more
highly trained set of factors. He has had many
years of rigid training, can run the necessary
tests and physical examinations to try to bring
the patient’s problem into focus, and is ab!e to
formulate a more objective diagnosis. He has
been taught to try to create a diagnosis that is
couched in terminology with which he can
communicate his findings to the patient and to
other physicians. For example, the diagnosis
of a “peptic ulcer”, “viral pheumonia” or
“whiplash injury” conveys a whole syndrome of
findings in the minds of other physicians to
whom this same patient may present his case.
While this ability to communicate is necessary,
it is also a limiting factor in the true diagnosis.
The body does not think of its problem in such a
limited sense. But the physician has been
presented a problem and has formulated his
diagnosis.
Finally, there is the third problem. What
does this anatomical-physiological mechanism
know about this case? It has the answer in
every sense of the word from an over all pattern
of total stress or disease down to the smallest
or infinite detail. The anatomical-physiological
mechanism and its structure-function or function-
structure (structure-function and function-struc-
ture are interchangeable) carry the total picture.
The patient’s body has the answer written into
and through the physiological functioning of
his brain and nervous system, his circulatory
patterns, his fluid balance interchange, his
organ systems, his endocrine makeup, his
structure-function interrelationsl$ps .
T O sum it up as simply as possible, the
patient is intelligently guessing as to the
diagnosis, the physician is scientifically
guessing as to the diagnosis but the patient’s
body knows the problem and is outpicturing it
in the tissues.
It is possible to create a more accurate
diagnosis, one that is c!.oser to the true pattern
than either that of the patient’s opinion or the
physician’s opinion. We can utilize the infor-
mation, the facts, the know-how of the third
problem, the patient’s body, to bring this
diagnosis into existence. We can use the
interpretative skills of ourselves as physicians
as an integral part of this process. In addition,
we can train our senses, .especially our sense
of touch, to lead us into the structure-function
of the patient’s anatomical-physiological
mechanisms and make them give us the informa-
tion we need. Needless to say, in invoking
34
All Rights Reserved American Academy of Osteopathy®
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 evalu-
ation 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 informa-
tion from that observation. With regard to the
sense of touch, someone said to me one day,
“You feel from the heart, don’t you?” That is
right. You learn to feel into the heart of the
patient’s problem from a still-leverage point
that allows the functions and dysfunctions of
the patient to be reflected back into your touch
and feel. The first step in developing this
depth of feel and touch is to reevaluate the
patient from the third problem standpoint,
just what does the patient’s body want to tell
you? Take the patient’s story and opinion and
set it aside, take your opinion and diagnosis
and set it aside, then let the patient’s body
give you its opinion. Place your hands and
fingers on the patient in the area of his com-
 DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION -- BECKER
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 po-
tency 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.
Webster’s dictionary defines potency as
“the state or quality of being potent, or the
degree of this; power; strength”. (2) It defines
potent as “able to control or influence: having
authority or power”. (3) We have heard for years
that the body has within itself all the factors
with which to maintain health and to heal itself
in case of disease or trauma. This statement
is basically true. The body has the capacity
to express health through this inherent potency
and it has the capacity to maintain compensatory
mechanisms in response to trauma or disease
through variant potencies. At the very core of
total health there is a potency within the human
body manifesting it in health. At the very core
of every traumatic or disease condition within
the human body is a potency manifesting its
interrelationship with the body in trauma or
disease. It is up to us to learn to feel this
potency. It is relatively easy to feel the
tensions and stresses of trauma and disease as
they are manifesting this pattern of trauma or
disease. But within these manifesting elements
there is a potency that is “able to control or
influence: having authority or power”. It centers
the disturbance. It can be sensed and read by
a feeling touch.
To bring the idea of what it means to feel
potency within a given problem let us consider
something outside of ourselves and describe it
to demonstrate the power within potency. Let
us consider the hurricane Carla which struck
35
All Rights Reserved American Academy of Osteopathy®
Texas in the fall of 1961.
Why a hurricane to describe potency?
Because the principles and manifestations of a
hurricane can, in my opinion, be shown to be
very similar in analogy to the principles and
manifestations of disease and trauma within the
human body. The eye of the hurricane carries
the potency or power for the whole storm, the
spirals of the high winds feeding into the eye
manifest the destructiveness of the storm. The
eye of the hurricane carries the pattern for the
whole storm. Any change in the eye automati-
cally changes the spiralling effects of the winds
feeding into the eye and thus the pattern of the
storm. Witness the next hurricane that follow-
ed 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 po-
tency “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 15
knots per hour until she neared the land surface
where she met resistance and came to a halt off
the coast of Texas. She sat there for 12 to 18
hours. The tremendous winds in her spirals
pounded the coast hour after hour with blinding
rain at 100 plus miles per hour intensity.
Finally, she moved inland and the edge of the
eye had winds clocked at a maximum of 173
miles per hour and heavy rain. Imagine being
bombarded by rain drops travelling at that speed.
As the eye touched the coast, the winds ceased
and all was still during the time that it took for
the 30 mile diameter of the eye to travel 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 over all
capacity of such a storm, while the winds were
100 miles per hour at the coast, we in Dallas
were experiencing winds up to 30 to 40 miles
per hour from the east 400 miles north of the
 ACADEMY OF APPLIED OSTEOPATHY -- 1963 YEAR BQOK
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 evacu-
ated 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, tele-
vision 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 Carla’s existence, those scientists who flew
in the B-29s were able to literally know and
and experience the high winds in the spirals and
the potency of the eye of the hurricane. It was
a physical awareness to them. It was an aware-
ness to those who were in the direct path of the
eye as it crossed the state of Texas, first the
winds, then the stillness of the eye, then the
following winds from the opposite direction
36
All Rights Reserved American Academy of Osteopathy®
after the passage of the eye. Men trained to
understand mechanisms of this type of storm
can know the various factors within the storm
pattern by the interpretation of their own senses
in addition to that information given to them by
the instruments they are watching. They know
when they are in the eye or in the periphery of
the spirals. They can feel it with their whole
being.
Thus it seems logical to me that the
physician can train his touch to recognize and
accept the fact that within every trauma or
disease pattern there is an “eye” within or
without his patient, which has within it a
potency to manifest this traumatic or disease
condition. It is a point of stillness within that
focus. It is invisible, to be sure, but it can be
perceived by the trained discerning touch of the
physician. How do I know? I have been aware
of this potency hundreds of times. This is
something that has to be learned by personal
experience. It was forced upon me by learning
to read structure-function within the patients
who brought their problems to me. I became
aware of this area of stillness centering the
trauma or disease. Slowly over a long period
of time, knowledge and understanding came as
to why it existed and its part in the traumatic or
disease picture. I observed through the years
that when any change took place in the area of
stillness there was manifest a whole new change
in the trauma or disease pattern. Like the eye
of the hurricane that closed in the storm off the
New England coast, it was no longer a hurricane.
If any change had taken place in the eye of
Carla before she hit the Texas coastline, her
entire pattern of spirals, the intensity of her
winds and other factors would have modified
to meet the change in the potency within the
eye : Thus I slowly learned to add this diagnostic
insight to my armamentarium until it has become
a day to day experience with every new patient
as well as with those I am seeing over a period
of time. It was by deliberately taking the
patient’s opinion and setting it aside, taking my
diagnosis and setting it aside, and going to the
structure-function of the anatomical-physiologi-
cal mechanisms of the patient’s body that I was
able to acquire this knowledge. This is not
something that I have discovered. It exists of
itself. It merely asks acceptance of its existence
and time to develop a sense of touch and 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 one’s experience. It is a
self-taught process.
 DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION -- BECKER
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 rais-
ing or moving something; “hence, a means of
exerting influence, pressure, etc. (4) Dr. W. G.
G. Sutherland in describing the fulcrum in
relationship to the two halves of the tentorium
cerebelli and falx cerebri stated, “The Fulcrum
(the junction of the falx cerebri and tentqrium
cerebelli at the straight sinus) is the still-
leverage junction over and through which the
three sickles function physiologically in the
maintenance of balance in the cranial membran-
eous 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 move-
ments of the storm and the potency or stillness
of the eye of the hurricane. This was something
they could feel during the flight, could report,
and interpret. The physician must bring this
principle down to a much finer degree of use
than that of the whole body. He must set up a
still-leverage mechanism with which he can
feel the stress and tension in the tissues under
his hands and fingers and find the potency or
area of stillness within that area of stress. He
does this by placing his hand or hands near the
area in which the patient is experiencing
difficulties and then establishes a fulcrum with
his elbow, his forearm, his crossed fingers, or
any other part of him that is convenient to his
comfort. From this fulcrum, his fingers become
the end of a lever that can note the changes
taking place within the body. His fulcrum
point can be shifted from time to time to adapt
to changes within the body, yet remaining
still in its leverage functioning.
Touch
In placing the hands and fingers on the
tissues under examination, do so with the idea
37
All Rights Reserved American Academy of Osteopathy®
that the fingers can mold themselves to the
patient’s body. It is a gentle contact yet one
with firmness and authority. To borrow a
descriptive analysis from Dr. Sutherland, “It
is necessary to develop fingers with brain cells
in their tips, fingers capable of feeling
thinking, seeing. Therefore first instruct the
fingers how to feel, how to think, how to see,
and then let them touch. There must be a
‘finger-feel’, a ‘finger-thought’, a ‘finger-
sight”’ (5) with which to read the functions and
dysfunctions of the body. The mechanisms of
the body and their potencies are always in
action and can be felt with a thinking, feeling,
seeing touch that in time becomes a knowing
touch. It is like getting onto a moving train.
The train continues in motion and action as I
get on it, analyze the roughness of the road
bed, the side sway around the curves, its
relative speed, and then get off the train
while it continues in action. So it is with the
problems within the patient. I move in on a
living mechanism that continues to function, I
make my diagnosis, administer my treatment,
and leave the mechanisms continuing their ever
changing patterns. My touch is think-deep,
see-deep, feel-deep and yet does not limit or
lock the structure-function of the tissues I am
examining.
I can go another step in developing my
touch, Through the still-point at the fulcrum
and the depths of my finger-touch, I can develop
knowledgeable awareness of potency and
structure-function in tissues within the patient's
body. This awareness goes beyond the physical
sensations of the physician’s five senses. This
is not what I feel with my finger-touch. That
would be my opinion. Instead this is what the
patient’s body is reporting through my fulcrum
and finger-touch. This is awareness. This is
a “listening” finger-touch. This is the patient’s
body’s opinion. This is knowledge gained from
the patient’s body, not mere information.
I can control the gentle yet firm contact of
my hands and fingers by the manner in which I
establish a fulcrum from which I will develop
this touch. Establish a fulcrum to provide a
working point from which to operate and evaluate
the case and yet let it be free enough to allow it
to shift, while maintaining still-leverage
functioning, to adapt to the changing needs from
within the mechanisms under examination. Try
examining a hyperactive child and you will see
the need for a shifting fulcrum and hand-finger
lever, not only within the child’s mechanisms
but also for the child itself. The hand and
finger contact can be light and gentle, yet it
 ACADEMY OF APPLIED OSTEOPATHY -- 1963 YEAR BOOK
can be observed that increasing the amount of
pressure at the fulcrum automatically increases
the depth of palpatory touch at the end of the
lever, the hand and fingers; decreasing the
pressure automatically decreases the depth of
palpatory touch at the end of the lever. Thus
with knowing fingers and the use of the fulcrum
I become aware of potency within my patient.
Thus I can modify my touch to meet the various
needs of the kinetic energies expressed by the
manifesting anatomical-physiological mechanisms
and their potencies. Every patient is different
and each patient is different each time he comes
in for attention. The work continuously builds
the physician’s fund of knowledge and insight.
For example, a patient comes in with a
low back problem. With the patient supine upon
the table, it is possible for the physician to sit
beside the patient and to place his hand under
the sacrum with the finger tips extended upward
so their contacts are on the lower back. By
leaning comfortably on his elbow, the physician
establishes a fulcrum from which to read the
changes taking place in the back. The patient
may flex his knees with his feet on the table,
if it is more comfortable for him to do so. The
physician’s other hand can be brought from the
side and placed under the lower back. The
fulcrum for this contact can be the edge of the
table against the forearm or the elbow on the
physician’s knee. By applying a modest
increase of pressure at the fulcrum to cause a
slight degree of compression through the sacrum
towards the head, he will initiate the kinetic
energy that will allow the structure-function of
the stress area to begin its pattern to be re-
flected 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
38
All Rights Reserved American Academy of Osteopathy®
within the anatomical-physiological units.
Another example would be a sick liver in
a case of hepatitis. With the patient supine,
the physician can sit comfortably beside the
patient, place one hand under the lower rib
cage on the right side beneath the liver. Then
he can place the elbow or forearm of that hand
on his own knee. Thus he has his fulcrum
point on his knee or thigh and his examining
fingers under the sick organ. The other hand
can be placed on the rib cage above the liver
and the elbow or forearm placed on some point
that is comfortable to maintain its contact.
Thus he will have the sick organ between his
examining hands. By reading from these double
fulcrums, he will be able to note 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 examina-
tions 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 relation-
ship to the falciform ligament, and its venous
and lymphatic drainage to begin to open and
function, he will know that this is a case of
hepatitis that has reversed its pathological
state and is returning to normal. All of these
changes are perceptible to the discerning touch
from the fulcrums he establishes to examine
this organ.
Application
The application of the principle of the
fulcrum is as varied as the list of complaints
that walk into the physician’s office. Each
case calls for its own application. The patterns
of setting up a fulcrum or fulcrums from which
the examining fingers can study the problem are
an individual development each physician must
make for himself. The physician must know
anatomy and physiology and as much function-
structure that accompanies anatomical-physio-
logical units as is possible. With the develop-
ment of this type of touch through fulcrum points
into and through the structure-function patterns
manifesting their changes under his hands, this
 DIAGNOSTIC TOUCH: ITS PRINCIPLES AND APPLICATION -- BECKER
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 estab-
lish 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 appli-
cable 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 mater-
ial. It will localize the specific lobe of the
lung that is sick in lobar pneumonia. It will
locate the strains and stresses of the musculo-
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 pre-
sent in his machinery. He takes his wires, his
transistors, his printed circuits, his vacuum
tubes and strings these things together to pro-
duce 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 in-
tended to call it electricity in the sense that it
corresponds to the electrical energy the engineer
uses. It is a form of energy that is in the living
39
All Rights Reserved American Academy of Osteopathy®
body and as such can be used by the understand-
ing physician to determine function-structure
within the anatomical-physiological units of the
body. What is this potency? No one knows.
Nor is it necessary to know, anymore than the
engineer has to know what electricity is before
he puts it to use. The physician can learn to
recognize this potency, accept its presence, and
use it for diagnosis and treatment. As was said
early in this paper, at the very core of total
health there is a potency within the human body
manifesting itself in health. At the very core of
every traumatic or disease condition within the
human body is a potency manifesting its 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 remanifest itself.
This paper is a statement of principles
and methods whereby to apply those principles
in the diagnosis of health, disease and trauma.
It is not a paper to describe manipulative pro-
cedures. The power and authority inherent
within the potencies and the structure-function-
ing 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 ap-
plication of force from without and that we will
be able to control that leverage with much great-
er 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-physiolo-
gical mechanisms with their potencies will re-
solve 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
 ACADEMY OF APPLIED OSTEOPATHY -- 1963 YEAR BOOK

is only necessary to contact them and let them
speak for themselves. It is possible to make ‘a
diagnosis in less than ten minutes. The average
patient that comes in with a problem does not
require that he be minutely examined from head
to toe. He comes in with a complaint in a
specific area. It is possible to go to that area
and make an examination that will give the
information you need to explain to him why he is
having his difficulties. Of course, this may be
only a small portion of the interrelated total
picture of his problem but it is a beginning from
which to go to other areas and finally to bring
the complete diagnosis into focus. Herein is
where the physician’s knowledge of anatomy and
physiology plays an important role. He is able
to correlate his knowledge with his sense of
touch and to trace the pattern of the disability
and dysfunctioning until the whole diagnosis is
clarified in his thinking. Subsequent office
calls will add more insight until he is able to
use his knowledge to understand the past history
of the dysfunction, its present status, and pro-
ject 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 accomplish-
ed. New strains feel like new strains. Their
time-clock can be correspondingly charted. The
same applies in disease conditions. It is pro-
ductive work. There is something new to be
learned each time you apply it. It is also work
that opens many doors for better understanding
only to discover that opening those doors
exposes more doors to open.

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

40

All Rights Reserved American Academy of Osteopathy®