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Discover Unpublished Writings From A Pioneer In Osteopathy
Over six decades of teachings of osteopathic principles and practices.
In this second volume of The Collected Papers of Viola M. Frymann, DO, editors Hollis H. King, PhD, DO, and Raymond J. Hruby, DO, MS, present a collection of recently uncovered lectures transcribed from recordings of live presentations Dr. Frymann gave across the US and in England in the 1970s and 1980s.
With lecture topics ranging from the trauma of birth to the process of death, from osteopathic lesion to the cranial concept, this collection highlights Dr. Frymann’s passions and influence in osteopathic and dental circles. It also provides a rare opportunity to immerse oneself in the unique perspective and expert knowledge of one of the osteopathic profession’s most beloved and influential figures.
As Dr. King notes in his editor’s forward, “Taken together, The Collected Papers of Viola M. Frymann, DO, constitute an excellent discourse on osteopathic philosophy second only to that of Andrew Taylor Still, founder of Osteopathy.”
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Gain deep insight into the beauty of osteopathic medicine through the teachings and practice of one of the most respected osteopathic physicians the profession and the world has ever known. A new collection of Dr. Frymann’s works, with new topics, not previously published. A perfect supplement and complement to volume I of her published papers. If you are looking to expand your clinical knowledge and acumen, and want to expand you knowledge of osteopathic philosophy, principles and practice, and gain insight as to how to apply this knowledge in your own daily life and practice...This book is for you.
This book contains many previously unpublished lectures that will give you deep insight into: Dr. Frymann’s philosophy of osteopathic medicine; how she envision osteopathy’s principles and practices; many examples of her application of these principles and practices into clinical practice. Co-edited by two well-known osteopathic physicians who spent decades learning from and teaching with Dr. Frymann, and experiencing her knowledge and wisdom in real time. They continue to promote Dr. Frymann’s legacy by writing, teaching and practicing the philosophy, principles and practice applications learned from Dr. Frymann over decades of experience with her.
Dr. Hollis H. King, DO, PhD, FAAO, FCA is a graduate of Texas College of Osteopathic Medicine, Fort Worth, TX . He is board certified in Family Medicine/OMT from the American Osteopathic Board of Family Physicians and certified with Special Proficiency in Osteopathic Manipulative Medicine from the American Osteopathic Board of Neuromusculoskeletal Medicine. He is a Founding Diplomate of the American Board of Holistic and Integrative Medicine. His postdoctoral training was at Dallas Memorial Hospital, Dallas, TX. His internship was at the VA Hospital & Univ. of Kentucky Medical School, Lexington, KY. His Ph.D. in Clinical Psychology is from Trinity University, San Antonio, TX. He is a Fellow of and Past-President of the American Academy of Osteopathy. He is a Fellow of the Osteopathic Cranial Academy. Dr. King is currently a Clinical Professor of Family Medicine at the University of California San Diego School of Medicine. He also has a private practice at Osteopathic Center San Diego. His memberships include: AOA, AAO, OCA.
Dr. Raymond J. Hruby, DO, MS, FAAO (Dist) is a graduate of the College of Osteopathic Medicine and Surgery in Des Moines, Iowa. He is board certified in Family Medicine/OMT by the American Board of Osteopathic Family Practice and Osteopathic Manipulative Medicine by the American Osteopathic Board on Special Proficiency in Osteopathic Manipulative Medicine. Dr. Hruby completed a traditional internship at Osteopathic Hospital of Maine, Portland, ME and was in private practice for sixteen years. Retired as professor and chair of the Department of Osteopathic Manipulative Medicine at COMP, he continues consulting with the school’s Department of NMM/OMM on teaching, research, curriculum analysis and development, new faculty mentorships and Predoctoral OMM Fellows. He is involved with WUHS’s Interprofessional Education program, and lectures part-time in the Graduate School of Basic Medical Sciences, among others. He is a fellow of the American Academy of Osteopathy and a member of the American Osteopathic Association, American Academy of Osteopathy, American College of Osteopathic Family Practitioners, Osteopathic Cranial Academy, Osteopathic Physicians and Surgeons of California, Memberships: AOA, AAO. ACOFP, OCA, OPSC. Cranial proficiency (OCA).
TABLE OF CONTENTS
v On Behalf Of Osteopathy's Promise to Children
vii Acknowledgments
ix Editor's Foreword
xi Co-editor's Foreword
xiii Preface
1 Research
2 Slow Rhythmic Oscillations Within the Human Cranium: Phenomenology, Origin, and Informational Significance (2001)
10 Physiological Background of the Cranial Rhythmic Impulse and the Primary Respiratory Mechanism (2003)
23 The Osteopathic Approach to the Child With a Seizure Disorder (2005)
31 Life as a Medical Student
32 Introduction to Osteopathic Concepts (1981)
41 To be a Physician (1981)
48 Address to Students (1986)
53 British School of Osteopathy
54 Structure and Function-Motion (1982)
62 Whiplash: High-Velocity Impact and Twisting Injury (1982)
71 The Musculoskeletal System: There Is More to It Than You Might Think (1982)
85 Pediatric Experience
86 The Consequences of Being Born (1982)
94 An Osteopathic Approach to Children With Learning Disabilities (1982) Evaluation and Treatment of 101 Visual Dysfunction: An Osteopathic Approach (1997)
181 The Cranial Concept
182 Applying the Principles of the Primary Respiratory Mechanism (1976, 1977, 1978)
194 Initiating the Practice of Osteopathy in the Cranial Field: Personal Experiences (1980)
200 The Cerebrospinal Fluid (1979)
209 Reciprocal Tension Membrane (1976)
215 Respiration (1979)
221 Cerebrospinal Fluid Motion (1988)
226 Understanding the Structure and Vitality of Motion (1976, 1978, 1979)
239 The Potency (1981)
244 V-Spread and Compression of the Fourth Ventricle: Effects and Technique (1979)
251 Complementary Disciplines for Osteopathic Practice
252 Nutrition (1978)
262 Osteopathy and Myofunctional Therapy (1978)
275 Osteopathy and Energy Medicine (1979)
283 Osteopathic Treatment for Common Conditions
284 Influenza and Pneumonia (1981)
288 Common Cold, Sinusitis, and Otitis Media (1981)
295 Osteopathic Approach to the Allergic Patient (1981)
303 For Dentists
304 Osteopathy for Dentists: Basic Concepts (1979)
311 Osteopathy for Dentists: History and Application (1976)
316 Objectives of Treatment (1979)
322 Temporomandibular Joint (1981)
333 Primary Respiratory Mechanism (1978)
337 End of Life and Biodynamic Energies
338 In Preparation (1982)
344 Death (1978)
353 Whole-Person Treatment: End of Life and Healing Experiences in my Osteopathic Practice (1978, 1979)
360 Challenges at the Beginning and End of Life: Palliative Care, Healing, and Intuition (1978)
372 Thoughts on the Physician-Patient Dynamic: Energy transmission and Blocks to Healing (1979)
381 Biodynamic Force and Creative Palpation (2001)
389 New Beginnings for DOs in California
390 Interview with Michael A. Seffinger, DO (2002)
417 Figures
EDITOR'S FOREWORD
A Passion for Osteopathy
Viola M. Frymann, DO, FAAO, FCA
July 18, 1921-January 23, 2016
Retired December 2011 from the Osteopathic Center for Children
Education:
1944 - Medical Degree: M.B., B.S. University of London, The Royal Colleges M.R.C.S., L.R.C.P
1945 - Medical Internship: Royal London Homeopathic Hospital
1948 - Doctor of Osteopathy: College of Osteopathic Physicians and Surgeons Los Angeles
Dr Frymann has created a legacy to osteopathy in her total body of work, clinical practice, teaching, research, and writing. She never set out to do anything but be a clinician, but circumstances compelled her to action in all these areas. The inspiration she received by taking the basic cranial course from William Garner Sutherland, DO, in 1952 laid the groundwork for her teaching in courses on osteopathy in the cranial field (OCF, now officially referred to by the osteopathic profession as osteopathic cranial manipulative medicine, or OCMM) and her iconic work with children and the establishment of the Osteopathic Center for Children. Dr Frymann's research was borne out of her perceived need to verify the basic principles of OCF/OCMM because, as she said, "no one else was doing it."
In the first volume of collected works, the title acknowledged her legacy to children. However, Dr Frymann was first and foremost an osteopath in the tradition of the profession's founder, Andrew Taylor Still. It is my observation that Dr Frymann was first and foremost about osteopathy, with pediatric osteopathy a very close second. She was indeed an osteopathic physician and practiced osteopathic medicine, to use the preferred terminology of the modern-day osteopathic medical profession. However, in this second volume of papers, as in the first, Dr Frymann preferentially uses the traditional term osteopathy to describe both the philosophy and clinical practice that was osteopathic manipulative treatment.
In The Collected Papers of Viola M. Frymann, DO: Legacy of Osteopathy to Children, all of the papers were reprinted from other publications or were in manuscript form ready for submission for publication. Very little editing of content was necessary. In The Collected Papers of Viola M. Frymann, DO, Volume 2 : Legacy to 0steopathy, virtually all of the manuscripts were transcriptions from recorded lectures she had given, "with the exception of the three reprinted research publications. Raymond J. Hruby, DO, MS, FAAO (Dist), and I made a great deal of effort to take the typewritten hardcopies of the transcriptions through the optical character recognition process to produce editable documents that appear in this publication. Without Dr Hruby's, able assistance, this project would not have been completed before Dr Frymann's 100th, birthday in 2021. It likely that Dr Frymann intended some future publication(s) based on the transcriptions these lectures. When I was on the faculty of the College of Osteopathic Medicine of the Pacific and simultaneously on the staff of the Osteopathic Center the Children in the late 1980s, l remember that Dr Frymann was paying a secretary to transcribe numerous cassette tape recordings of her lectures. The transcriptions were stored in a box and packed away and not rediscovered until after Dr. Frymann passed away. We discovered more than 70 lectures in her storage area. By combining similar content and eliminating others because of their incomplete nature, 45 lectures are included in this volume.
We were able able to locate Dr Frymann's slide collection and identify most of the images that she used in her presentations. Unfortunately, over the years, the quality of most of her 35mm slides degraded, but I believe we have been able to reproduce most of the slide images into print-worthy form. Many of the sides are cited in multiple papers, so we have one section in the book for these images, numbered sequentially from the first time an image is cited. The exception to this approach is the reprinting of the 3 research papers, which have their images embedded in the original publication.
The editing process was detailed and utilized the excellent work of a professional editor who worked for The Journal of the American Osteopathic Association for 14 years. Audrey Lusher’s contribution to the general readability of the papers and the accuracy of citations and footnotes in the papers in this collection is at the highest level of editorial professionalism. Ms Lusher’s deciphering and organization of the numerous sections of questions and answers resulted in much greater readability than appeared in the original transcriptions.
We created a summary for each section that describe the nature of the content beyond the simple titles. Several of the chapter titles in Volume 2 are similar or identical to titles in Volume 1. However, there are significant differences in the content to make each paper sufficient to stand alone. The discerning reader will see the value added as she develops the clinical and philosophical points in each paper.
Taken together, The Collected Papers of Viola M. Frymann, DO, constitute an excellent discourse on osteopathic philosophy second only to that of Andrew Taylor Still, founder of Osteopathy. She shared a spiritual perspective similar to that of Dr. Still himself, with writings on the “spiritual” aspects of health care. The osteopathic medica profession, in its desire to be viewed as “mainstream” has not emphasized these writings on the part of Dr. Still, and they are rarely mentioned today. Any physician or layperson with an interest in medical philosophy and the holistic body-mind-spirit perspective will find Dr. Frymann’s writings intriguing, but osteopaths and osteopathic physicians in particular will recognize her writings on spiritual matters as highly consistent with the sayings of Dr. Still reported in the literature.
-Hollis H. King, DO, PhD, FAAO, FCA
CO-EDITOR'S FOREWORD
In 1998, the American Academy of Osteopath) published The Collected Papers of Viola M. Frymann DO: Legacy of Osteopathy to Children. It represented one part of the immense impact Dr Frymann had on the osteopathic profession through her lifelong, unflagging efforts in education, research, leadership, and service to her patient. This second volume of papers represents a continued effort to reflect the lengthening shadow of Dr Frymann in the world of osteopathic medicine, both nationally and internationally.
Like the first volume, this second book was and is the brainchild of Hollis H. King, DO, FAAO, FCA. The reader "will immediately see his dedication, passion, and perseverance in the project that resulted in the publication of this work. I was honored and humbled when Dr King asked me to co-edit this collection with him. I was the recipient of many years' of Dr Frymann's teaching and mentorship. I was privileged to be able to interact with her on a personal level and to have her trust and confidence to treat some of her patients on occasions when she was away teaching or attending to other important work for the osteopathic profession. For many years, Dr Frymann honored me by asking me to be a faculty member at her continuing education courses. I quickly accepted Dr King's request, as it was a perfect and unique opportunity for me to give something back to Dr Frymann for the knowledge, wisdom, mentorship, and insight that she willingly shared with me for so many years.
It is indeed an understatement to say that the task of producing this volume of Dr Frymann's papers was monumental. Many of the papers in this book come from transcriptions (transcribed from audio recordings using a typewriter) of lectures she gave during her courses and invited presentations she gave to various groups and organizations around the world over many years. A number of these documents contained corrections and additional notes in the margins in Dr Frymann's own handwriting. Digitizing these files and preparing them for publication was challenging but also extremely enlightening and rewarding. Other tasks included searching the archives of Dr Frymann's papers for supporting documents, finding images to help illustrate some of the topics spoken of in these papers, and looking up citations for references given during these presentations. A lot of work, yes, but I think I can speak for both Dr King and myself when I say that this was also a golden opportunity for us to learn even more about Dr Frymann's personality, spirit, thought process, and knowledge of osteopathy. As a result, the work was not really work at all, but instead, it was a most joyful and rewarding experience.
Y first experience with Dr Frymann was in 1979 when I took my first course in osteopathic cranial manipulative medicine, or OCMM (then called osteopathy in the cranial field). Dr Frymann was one of many stellar faculty members at this course, but for me, she was particularly impressive. After hearing her lectures and experiencing her hands-on teaching, I knew I needed to learn much more from her. As soon as I could, I attended a 5-day tutorial entitled “The Expanding Osteopathic Concept” at her office in La Jolla, California. Little did I know that this would be the first of many course experiences I would have with Dr. Frymann over a span of nearly 35 years.
At this course, I met an extraordinary osteopathic physician who introduced me to a whole new way of looking at osteopathic medicine and of applying its principles and tenets in teaching and in clinical practice. Never before had I met someone who could quote the words of Andrew Taylor Still, William G. Sutherland and other pioneering DOs. I soon comprehended that Dr. Frymann’s courses were not just sessions to teach more osteopathic manipulative techniques. She showed me how to utilize the anatomy and physiology I had learned in school to formulate an osteopathic critical thinking process that helped me get he to the root cause of the patient's problem and to formulate a clear and rational treatment plan to address the problem in the most optimal fashion possible.
Dr Frymann passed away in 2016. After her memorial service, I was fortunate to be standing next to the minister as he knelt next to a mall area cut out of the ground of the Memorial Lawn outside the church where he gently placed Dr Frymann's ashes. It was a clear, sunny day, and there was a gentle, cool breeze blowing in from the ocean over La Jolla Cove. In the breeze, some of the ashes swirled up from that small opening in the earth. It was then that I knew that Dr Frymann's spirit would never be in the ground but would always be alive and with us. Her legacy, the mark she made on the world, is eternal. This second volume of her papers only helps to serve as proof of that.
- Raymond J. Hruby, DO, MS, FAAO (Dist)
PREFACE
Viola M. Frymann, DO, FAAO, FCA
Reprinted from The Collected Papers of Viola M. Frymann, DO: Legacy of Osteopathy to Children
I came to California to study osteopathy, upon which my family had totally depended since I was 4 years of age. Through the care of a dynamic exponent of these methods, a sick father and a puny child found health. Thus, I knew the potential of this practice.
But the profession in California, unbeknownst to me, was already on a secret destructive road to annihilation. I soon realized that if I were to find what I came for, I must search for myself. My first study resulted in an essay for the Academy of Applied Osteopathy 1948 contest on the role of the osteopathic lesion in cardiac pathology. The following year I was challenged to explore the role of the osteopathic lesion in functional and organic renal pathology. The library at tje College of Osteopathic Physicians and Surgeons had become my resource.
It was the repeated reference of a patient to the work of Thomas Schooley, DO, who had successfully treated her headaches, that sent me with great trepidation to attend a course in Denver on the very controversial subject of osteopathy in the cranial field. William Garner Sutherland gave the first lecture, and it was on the vomiting of the newborn. He described the trauma of birth and the resulting distortion of the occiput that would compromise the vagus nerve. A quick and simple technique would, he declared, promptly solve the problem. I had recently lost a baby witl1 uncontrollable vomiting despite everything that had been recommended. I could scarcely believe what I had just heard. It was too logical, too simple. But my baby had had a hard labor and was born with a distorted head. I had to find out whether tl1is theory was true. With but a few weeks of experience with tl1is cranial osteopathy, I persuaded the local osteopathic hospital to let me examine newborn babies. With the naivete of a neophyte, I was confronted with a devastating inadequacy of palpatory skills. A workshop in palpation was then developed with the assistance of the writing of the renowned professor of the piano, Tobias Matthay, and the discovery that the skill of manipulating piano keys to produce real music had much in common with the technique of osteopathic palpatory diagnosis and treatment. Only after the palpatory education was I ready to formulate conclusions concerning newborn babies.
This was the era of skepticism. Unless you can demonstrate in the research laboratory and record on a graph that cranial bones move, the PhDs of the osteopathic profession vehemently declared, there is no validity to this concept. Another patient came to my assistance. F. George Steele, who was a pioneer in the early development of the computer, workdays accepted this challenge, and for several on years we labored together evening after evening when our workdays were concluded, when suddenly on May30, 1968, the cranial rhythmic impulse was recorded on the oscillograph. There was great rejoicing and a new avenue of essential osteopathic research was about to open.
The wonderful early student of Sutherland, Rollin Becker, DO, used to tell me, "by our patients we are taught." It was another patient who introduced me to a pioneer in the field of learning difficulties of children, Amorita Treganza, OD. In fact, she and I grew together in this field and published a joint paper in 1973. Harold Magoun Sr. DO, FAAO, another early student of Sutherland and a prodigious worker in furthering osteopathy in the cranial field, challenged me with the question, “What is different in the crania of children with learning disabilities?” I had no idea of the answer, but I did have hundreds of records from which I could discover the etiology of learning problems.
A telephone call in 1976, from Eugene Dyer, DDS, a professor of dentistry at the USC School of Dentistry, demanded an 8-hour seminar for the dentists on temporomandibular joint (TMJ) dysfunction! I tried to convince him that all I knew about the TMJ could be said in 15 minutes, but he would not take "No" for an answer. Once again the needed patient arrived. As I sat with a mother giving me the history of her daughter I was fascinated by the devious motions of her jaw as she talked. "Do you have a problem?" I asked. Her response described her intolerable pain and dysfunction in both TMJ's following the forceful clenching of her teeth during a very difficult labor. She now became my patient and hence my teacher in preparation for this dental seminar. This seminar opened the door to the dental profession. Dentists began to realize they were influencing more than teeth: the teeth were outgrowths of bones that articulated directly or indirectly with all the bones of the head which in turn were related to the whole patient. Furthermore, Osteopathy in the Cranial Field could profoundly improve malocclusions; orthodontists discovered that their work could be profoundly enhanced if they had the opportunity to consult and work with the osteopathic physician.
In 1978 California opened the College of Osteopathic Medicine of the Pacific. It was not my intention to join any college faculty, but by January of 1979, Philip Pumerantz, PhD, the President challenged me to provide the introduction in osteopathic principles and practice that I had promoted over so many years. Seven years followed of commuting 500 miles per week and maintaining a private practice while developing a department osteopathic principles and practice at the college. A curriculum was developed, handouts to enhance it were created, and certain issues relative to practice were addressed. One of our first students to be selected an undergraduate teaching fellow in osteopathic principles and practice was receiving his education on scholarship from the US Air Force. He was refused the I-year deferment in order to fulfill his fellowship. I sought advice from osteopathic physicians both within and retired from the Air Force in order to prepare compelling document explaining why this extra education in osteopathic principles and practice would provide a flight surgeon with added skills of great value to the health of air force personnel in general and fliers in particular. This document ascended the ladder of the medical officers of the Air Force to the desk of the Surgeon General, but it was to no avail ... except that I learned important clinical material in the process.
Prevention is an important aspect of osteopathic practice. An article was formulated to stimulate the thinking reasoning process and to raise critical questions to influence a philosophy of practice.
For the 21st anniversary of the California state association, Osteopathic Physicians and Surgeons of California requested an article on the profession for their commemorative issue. A vision for the future was written. I described a center for the osteopathic care of children where the problems resulting from the trauma of birth would be recognized and corrected, where prevention would be paramount and would enable children to grow into healthy, happy, productive citizens. A grandfather read this newly published article while I treated his grandson. “I want to give you a check,” he said. When I inquired what for, he pointed to the article and said, “for this, what is it called?” It was only a vision, but in conclusion it stated, “This is osteopathy’s promise to children.” Unwittingly, the vision was validated and Osteopathy’s Promise to Children was established.
Our students m COMP (College of Osteopathic Medicine of the Pacific) needed clinical rotations. Our practice in La Jolla had focused on the problems of children since 1962. With the generous help of the Irene Anderson Foundation, a comprehensive remodeling operation was performed, and the Osteopathic Center for Children, a teaching affiliate of the College of Osteopathic Medicine in Pomona, was founded in 1982.
Another research project was now of possible, namely the outcome of the osteopathic management of children with neurologic developmental problems. In cooperation n with Peter Springall, PhD, a neurologic developmentalist, a developmental profile was developed and used to evaluate a child's developmental status before, during and after the osteopathic treatment program. Significant progress in response to such care was now demonstrated and documented in the literature.
In conclusion, reading the articles in this book that were written when I was seeking answers may now be recognized as the learning experiences I needed, and will I trust, meet the unfolding osteopathic needs of the readers.