and rickets should in time be eradicated, given reasonable State facilities. In the prevention of tuberculosis nothing is more important than the provision of milk free from tubercle bacilli. Until the menace of cattle affected with tubercle is removed, one of the chief origins of infection will persist. The etiology of rickets is sufficiently known to merit some organized method of control. Recent investigations with regard to vitamine have served to confirm the belief that it is largely a dietetic disease intensified by insanitary conditions. With a better education of the student as to the origin of deformities, many of the dangers of rickets would be eradicated, such as the evils of superincumbent body-weight as applied to soft bone.
Orthopaedic surgery is largely the surgery of the extremities, and the aim of the surgeon is the removal of disability. He effects this by a scientific application of the lessons to be learnt from anatomy, physiology, pathology and mechanics. In his reconstructive efforts he places the restoration of form as secondary to the restoration of function. (R. Jo.)
ORZESZKO (or ORSZESZKO), ELIZA (1842-1910) , Polish novelist (see 20.343), died in 1910.
OSLER, SIR WILLIAM, 1ST BART. (1849-1919), British physician and professor of medicine, was born at Bond Head, Can., July 12 1849, the son of the Rev. F. L. Osier, a missionary. He was educated at Trinity College School, Port Hope, Trinity University, Toronto, and McGill University, Montreal, where in 1872 he took his degree of M.D. He then went to Europe and studied medicine in London, Leipzig and Vienna,' afterwards returning to Canada, where he was appointed in 1874 pro- fessor of medicine at McGill University. From 1884 to 1889 Osier was professor of clinical medicine in the university of Pennsylvania, and from 1889 to 1904 professor of medicine at Johns Hopkins University; it was during this period in the United States that his international reputation was made. In 1905 he was appointed regius professor of medicine at Ox- ford. In this position he greatly developed the medical school at Oxford, and used all his influence towards the furtherance of advanced research. While at Oxford he served as a curator of the Bodleian library, as a delegate of the University Press, and as one of the Radcliffe trustees. He was created a baronet in 1911, and died at Oxford Dec. 29 1919. Sir William Osier was not only a great medical consultant, and one of the wisest advisers of his day on practical affairs of all sorts, but was the author of many medical works, of which the most important, The Principles and Practice of Medicine (1892, latest ed. 1916), has been trans- lated into many foreign languages.
OSTEND (see 20.356). Pop. (1914) 43,196. The extensive harbour and dock works, begun in 1900, were practically completed before the war, and 1,795 vessels of 1,155,000 aggregate tonnage entered the port in 1913. Ostend was occupied by the Germans from Oct. 15 1914 to Oct. 17 1918. The entrance channel to the harbour and to the Grand Canal connecting with Bruges and Ghent was blocked to all craft except the smallest submarines by the sinking of the " Vindictive " on the night of May 9-10 1918. During the occupation over 2,000 bombs were dropped on the town; 400 of the inhabitants were killed and several hundred injured, and 1,250 houses were either destroyed or damaged.
OSTEOPATHY. According to its advocates, osteopathy is that system of the healing art which regards the structural integrity and adjustment of the mechanism of the body as the most important single factor in maintaining the organism in health, in contrast to the older systems which regard the chemical intake of the body as the most important factor. In other words, osteop- athy is based on the recognition of the human body as a vital mechanism, a living machine, which, given wholesome physical and mental environment, good food, proper exercise, pure air and pure water, will be healthy, that is, will function properly, so long as all the cells and parts of that vital mechanism are in nor- mal adjustment. Osteopathy teaches that structural derange- ment of the body is the predisposing cause of disease. It causes functional perversion of the vascular and nervous systems, weakening the nutritional processes and lowering the powers of resistance of the body; on the one hand, producing congestion, either general or local, active or passive; on the other, depriving tissues of an adequate blood and lymph supply. This perversion impairs the rebuilding of cells after waste due to active functioning and retards the elimination of waste products through body drainage, thus making the body unable to withstand climatic changes or unhygienic and insanitary surroundings, and offer- ing a hospitable medium for the invasion and propagation of pathogenic germs. For example, as Dr. Still, the founder of osteopathy (see below), said, " A disturbed artery marks the beginning to the hour and minute when disease begins to sow its seeds of destruction in the human body. The rule of the artery must be absolute, universal and unobstructed, or disease will be the result."
If a machine is complete in its structure, and the structural rela- tion of all its parts is perfect, it performs its function perfectly; if, however, it is not " plumb," if some of its parts are ill-adjusted, if friction is increased, it will not function properly it will not perform its proper work. So it is with the human body. If the structural relations of the various cells, tissues and organs of this vital mecha- nism are in perfect harmony, and if there is an unobstructed supply of blood, lymph and nerve to all these cells and tissues, then the pur- poses for which these cells, tissues and organs are designed will be carried out ; but if the structure is perverted in any manner the func- tioning also will be perverted. Integrity of mechanical structure determines the normality of functioning. That this structural per- version is the basic cause of functional disturbance or disease is a distinctive and fundamental principle of osteopathy.
Centuries old is the idea that man is a machine, and that his oper- ations are dependent upon mechanical laws; but to Dr. A. T. Still is due the honour of recognizing the unity of the body and the law that any derangement of its mechanical structure is followed by disordered functioning or disease, and that the vital mechanism possesses the auto-protective power to restore normality of function, without pharmaceutical, chemical, electrical, or any other extraneous and artificial stimulation, as soon as complete alignment and adjustment of such derangements have been made. These structural derangements of the body are technically called " lesions." A lesion is defined as " any structural perversion which by pressure (or irritation) produces or maintains functional perversion." All the tissues of the body are subject to such perversions. They are produced by both external and internal forces. External causes are mechanical violence, such as falls, blows, strains, ill-fitting clothing and the like, and changes of temperature. Internal causes are postural influences, abuse of function, and nutritional disturbances.
A gross, frequent, palpable and easily distinguishable lesion is that of the sacro-iliac articulation. It is highly productive of functional perversions of the sciatic nerve, pelvic viscera, and the body equilibrium. Before Dr. Still's founding of osteopathy in 1874, anatomists described this as an immovable joint. He demonstrated the opposite by recognizing it as a movable joint, and correcting its derangements. This disturbance was among his first citations and teachings as an example of the osteopathic lesion. Only within the past two decades have other schools of medical practice recognized that this articulation is subject to this lesion and its resulting pathological disturbances. The more frequent, and consequently the more important, lesions are those of the bony, muscular and ligamentotts tissues. Owing to their intimate mechanical relation with the nervous and vascular systems, particularly the vasomotors which control the rate of blood-flow, these tissues along the area of the spinal column are those most subject to lesions of far-reaching influence. Clinical experience also proves that a large majority of lesions are found in the spinal region. Hence the importance of maintaining the integrity of this area, both as a prophylactic and as a curative measure. And nowhere is it of such supreme importance as with children, subject as they are to the thousand-and-one stresses and strains of tumbling about from morning to night. Osteopathy teaches that nothing will contribute so much to the health of children as to see that they are examined every few months for the purpose of detecting lesions, just as they have their teeth examined by the dentist to detect lesions there. As contributive factors in the etiology of disease, osteopathy recognizes germs, abuse of function, unhygienic and insanitary surroundings, climate, etc.
Osteopathic diagnosis has but one aim, to find the cause. It includes the complete examination of the whole body and its excretions, especially the articulations and alignments of the vertebrae, ribs and pelvis. Symptoms are noted, and all chemical, microscopic, hygienic, sanitary, and other findings are studied to aid in determining the existing conditions of tissue, viscera and function. Of supreme importance, however, is the physical examination to discover existing mechanical tissue lesions. In this respect osteopathy stands alone among schools of medicine.
Osteopathic therapeutics has but one aim, to remove the cause. This may require the employment of one or more of many means. It may, and it usually does, consist in the specific manipulative removal of the lesion or structural perversion, by effecting tissue adjustments, which free the remedial anti-toxic and auto-protective resources of the organism itself; or it may consist in correcting hygienic, dietetic, environmental and psychic conditions; or in the application of operative surgery for fractures, lacerations, and the removal of abnormal growths or organs so diseased as to be danger-
