The Old Doctor

Doctor Still was a man with many skills. As a teenager growing up in Virginia in the 1830s and 40s, he was an avid and able hunter, his catch providing not only dinner for the family but also dissecting material to satisfy his growing curiosity about the body and its workings. Rural life was for the self-reliant and Still learned about farming and building early on. Later qualifying in medicine, he was enlisted as a surgeon during the American civil war.

Unsatisfied with the efforts of his student's to convey the meaning of his new science in the written word, Still became an author. Although not a sophisticated writer, Still had a way with words, and a bluff, droll turn of phrase. His observations on osteopathy and learning liberally employ hunting, agricultural, engineering and military metaphors. In his writing he was a philosopher, a humorist, an eccentric. He devotes an entire chapter of one of his works to ear wax, as he was convinced that it had hitherto unrecognised and important physiological significance – it was produced by the brain to lubricate the nerves, he supposed.

In life Still was an original, and a man with a mission. His mind focussed by the failure of chemical drugs to save his children, he aimed single-mindedly and single-handedly to establish a new and better medical system. His hatred of drugs was matched only by his firm faith in the wisdom of nature. He “unfurled the banner of osteopathy to the wind” in 1874, and founded the first school of osteopathy in Kirksville, Missouri, in 1892. Interspersed were years of itinerant practice, experimenting and developing his method and his ideas.

Still’s idea was simple, intuitive and profound. He had found out for himself as a youngster that mechanical effects could cure physical symptoms (in that case resting the back of his neck against a swing seat to ease a headache). He had marvelled at the intricate machine-like make up of the musculo-skeletal system in the animals he dissected, and observed how each part seemed designed perfectly for its role. (Structure governs function, he was later to state). He had come to the conclusion from medical experience that the body possessed an inherent healing mechanism. He reasoned that this might become compromised by mechanical derangements and that manipulation could restore the anatomy to its functional state.

But Still was an absolutist. He did not just say mechanical derangement was a possible cause of pathology, but the underlying cause of all pathology. He believed that a detailed knowledge of anatomy and “the knife of reason” were the fundamental tools needed to cure any ill.

“The osteopath must learn that his first lesson is anatomy, his last lesson is anatomy, and all his lessons are anatomy”

In Still’s world the existence and the ultimate wisdom of the Creator were fundamental. Often, he refers to the “master mechanic”. Often he invokes the wisdom of nature, and one wonders whether God and nature were not intimately intertwined in Still’s mind. Often he reasons that disease would not exist in a perfect body – perfect from a mechanical point of view that is – nature would not have been so foolish. Still, evidently, new or thought little of his contemporaries Mendel and Darwin.

Still’s world also was dominated by mechanistic thought, and a fascination with advances in technology, which was of course largely mechanical in those days – the Victorian age back in Britain. Thought processes were linear, with a desire to search for and find one clean and clear cut line between one cause and one effect, like a rod connecting a piston to a crank.
Engineering is guided by physics, in which Newtonian variety the workings of the universe were described by laws. This requirement to seek and find natural laws expanded to other fields, such was their success in physics and such was the success of physics. Thus was the need expressed again and again by Still, to regard the human machine in terms of immutable “natural laws”, and illness in terms of their not having been observed.

Still was driven to build a scientific medical system, but his idea of science was very different from our modern way of science. He used the word to countermand the empiricism of the medicine of the day, which he abhored. To the Old Doctor, “science” meant the rigorous use of rational thought. He often stated that we must reason from the given facts, by which he largely meant the anatomy before us.

But his reason depended upon something which he thought were facts, but were actually articles of faith – his osteopathic principle that the deep cause of all illness was to be found in abnormal anatomy. In fact Still’s relationship with factual reality often tended to be of the kind, I think, therefore it is (apologies to Descartes). In one paragraph, for example, he muses on the cause of “bilious fever”:

Science does not yet know the cause. What if the diaphragm blocked venous return to the thorax? Surely the liver would suffer. Since my osteopathic principles are absolute, and they must be right in all cases, the case is proved! Bilious fever is caused by a disorder of the diaphragm. (Apologies to Still).

The aetiology of all disease was expressed in one of Still’s best known aphorisms: The rule of the artery is supreme. Health depended upon the arterial blood supply as well as unimpeded venous drainage, lymph flow, nerve activity, and cerebrospinal fluid flow. If any of these were impeded by a “dislocated” bone or muscle, illness would soon follow. Still was about 100 years ahead of his time in the importance he placed on the fascia, the “hunting ground” where to find the origin of disease as well as its cure.

A brilliant anatomist, Still’s knowledge physiology was less solid, but spiced up with wild guesswork: the lymph vessels were filled by lymph directly from the cerebrospinal fluid; fever was produced by heat from nerve electricity, and served to transform wastes into gas; food was transformed into gas in order to be digested and assimilated by the body, the lungs (“the clouds of the body”) were the body’s major source of water. Very soon at Kirksville, Still installed a physiology teacher by the name of Littlejohn.

There is little record of the technique of Still, as he never described it. By the available accounts it was simple. Many treatments were effected with the patient seated or on foot, and he invented his technique on the spot according to necessity and circumstances. He made use of articulation, leverages and thrusts. He often spent much time on soft tissue work, even several sessions, before attempting bony adjustment. He states in one of his works that the osteopath is “no lightening bone setter”, yet one of his original business cards recently came to light claiming to be just that! He scorned general non-specific massage (“engine wiping”) and did not believe in the least necessary: “Find it, fix it, then leave it alone”.

What balance can we draw? On the positive side we can say that Still insisted that his medicine must be based on reason, that he recognised the importance of the somatic component of disease, that he would accept no dogma nor adhere to any orthodoxy, that he abounded in original thought, that he recognised no limits, that he was an enthusiast.

"The explorer for truth must first declare his independence of all obligations or brotherhoods of any kind whatsoever". (A.T. Still)

Against this must be set the clear fact that his reasoning was limited by the paradigms of his time: mechanistic thought, absolutism, unifactorialism, and that his vision was at times tunnelled by the sheer force of his belief.

However Dr Still's basic premise, that the body's macro-structure and it's dynamic relations are fundamental to the deep workings of physiology, was ahead of it's time and is supported by recent findings in modern science. Still recognised that his new system was in its infancy and would develop enormously in the years after his death, and so it has scientifically and technically. But despite the relative simplicity of the original idea and methods, they have provided the main contribution to many manipulators’ work, with quite remarkable success.

My favourite of his aphorisms is the one I believe expresses best the essence of the success of manipulation as a treatment. The saying is his simplest: “Movement is life”.

What's in a name?

“Manus et Mens” is latin and translates as “hand and mind”. In osteopathy we use the hand and the mind to help our patients. We use our heart, too, but this is not a peculiar characteristic of our trade, as all healers of all stripes whether conventional or unorthodox, should use their hearts.

“Manus et Mens” conjures alchemical images of learned men working matter with their hands to the end of engendering something new and very special. Here we could add the “spirit” to the hand and the mind, and in the healing arts too, this is an essential ingredient. Renewed health is a very special thing, to be treasured.

But the name of my blog must not be too long, and "hand and mind" seems to me to be the particular essence of osteopathy.

Manus et Mens is a space for me to present more personal and perhaps less structured thoughts than are published on my website, reflections about myself, about what I do, about health, and about our place in the world. Most of you reading it will be patients or prospective patients I should imagine, so the content will be chosen particularly to interest or be of use to that kind of readership.

Who am I?

We are all enormously complex loci of density in the energetic fabric, thrown kicking and screaming into the world as we know it, and across the universe we can only attempt to imagine, so the few biographical details which follow are obviously a little reductionist, but they are a start. Some of all the rest no doubt will become apparent as (and if) this blog proceeds.

Born: 1961

Education:

• BSc (First class honours) Biology / Food Science & Nutrition, 1983.
• Diploma in Acupunture, 1990.
• Diploma in Osteopathy, 1993.
• Diploma in Naturopathy, 1994.
• BSc Osteopathy, 1999.

Professional CV:

• Teacher, 1984 – 1988.
• Director of Language School, 1989 - 1993.
• Osteopath and Natural Health Practitioner, 1994 – Present.
• Registered with the General Osteopathic Council (UK) since 1999.
• Registered with the Registro de los Osteopatas de España since 2006.

After graduating the first thing on my mind was to leave the UK, a decision I do not regret. I am enormously lucky to live in the Mediterranean sun for half the year on the strange and lovely island of Ibiza, and to spend an equal amount of time in the North of Italy near some of the world’s most beautiful mountains.

If I had to define myself by my work and my work by a guiding set of principles, I would say I am an osteopath, although I use various tools to an osteopath’s end.