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Fascia

In the first chapter of Still’s seminal work appears a very short but profound paragraph entitled ‘fascia’. Still’s comment that “the fascia is the ground in which all causes of death do the destruction of life” despite its absolutism sign posts an area of study that is only now being fully explored, so ahead of his time was the founder of his profession.

Fascia is now being hailed as an independent organ, whose complexity and importance to the organism as a whole is unsurpassed.

International Fascia Research Congress defines fascia as the dynamic mesenchymal tissue that unites every cell in the body and allows for fluid and tissue movement. Far from being just a band or sheet of connective tissue beneath the skin that attaches, stabilises, encloses, and separating muscles and other internal organs – fascia is the uniting element that allow the body to work as a whole organism.

This is where Still philosophy maintains it integrity, Still propounds that the body works as a single unit – and if the fascia is the uniting element, then it is fair to propose that it is the ground where all the causes of death do their destructive work, as they would undermine the unity of the whole. It is of course a bit excessive to say disease lives purely in the fascia, however if we see it as poetic licence aimed to inspire researchers and students alike it is truly prophetic.

People interested in further contemplation of the subject I append the fascinating youtube video “Strolling under the skin” for your edification.

Principles

Midway through the first chapter Still reveals his underlying position, he is essentially a mechanist who encourages his students to become “master mechanics’ skilled at “adjusting the engines of life’.  He compares his extended version of anatomy to an ‘engineer’s hand book’ and defines the job of the osteopath to “go no farther than to adjust the abnormal condition, in which you find the afflicted. Nature will do the rest.”

Criticism of a mechanistic approach abound; how can a system as adaptive, dynamic and incomprehensibly complex as the human being be understood as purely mechanical? Its possible but the underlying notions of certainty can not be sustained. Complex systems provide us with probable outcomes not certain outcomes and this is where modern clinical science and fundamental osteopath diverge. There is no absolute treatment or answer to any complaint – there are probable outcomes to probable diagnoses; and there are a multitude of confounding environmental, physiological and psychological factors that often skew outcomes. However endeavouring to comprehend the complex human system in a functional way is primary to any approach and Still is right to point that out.

The Osteopath an Artist

In a very short chapter Still promotes the need for medical practitioners to have a thorough and profound anatomical knowledge, a knowledge he believed that in the medicos of the time had “become sloppy and haphazard’. He wants his new practitioners to be anatomical artists whose anatomical knowledge was so ingrained that they held a picture of all the bodily structures in their minds. Later in the text Still makes it clear that physiological, histology, biochemistry and pathology should be considered branches of anatomy.

This of course begs the question – how good is the anatomical knowledge of our medical practitioners now? Does Still’s critique that it is sloppy and haphazard is hold true.

Sadly as recently as 2015 the British College of Surgeon (RCS) revealed they could not fill their training places with medical graduates because not enough of them met the minimum standard for anatomical knowledge. According to Turney writing in the RCS Annals in 2007 anatomical knowledge in the medical profession as been on the decline for the last 30 years.

Whether Osteopaths’ anatomical knowledge is of a higher standard is a moot point. Certainly at we had access to a wet labs and I was taught anatomy, physiology, histology, embryology, biomechanics and advanced visceral anatomy during my time at university. I believe Dr Raymond Blaich Osteopath in doing his pHd on this very topic and I eagerly await his results.

Chapter 3 – Method of reasoning

Still’s disregard for the allopathic medical industry of the time is so profound that he claims to have “obtained a mental divorce from them”. So having divorced himself from the generally accepted medical practice of the time, Still determines to undertake two distinct pathways to establish his new medical practice – Osteopathy. The first being an exacting study of the structures and functions of the human body, and the second to use reason to establish the very principles that explain the underlying and unchanging nature of the function of those structures.

In this way Still establishes himself as both empiricist and rationalist, thus combining the major competing schools of philosophical thought at that time, much as Emmanuel Kant was endeavouring to do in the world of ethics. In short bringing deontological thought to the primarily experimentally based utilitarian practice of medicine.

Still postulated that if we could establish through empirical facts the functional nature of the human body we could derive unchanging principles and a rational base for all treatment and management. This is arguably what makes Osteopaths different for every other forms of western medicine and is the very focus of this seminal text as will become clear as we progress through the work.

“The student of any philosophy succeeds best by the more simple methods of reasoning. We reason for needed knowledge only, and should try and start out with as many known facts as possible. If we would reason on diseases of the organs of the head, neck, abdomen or pelvis, we must first know where these organs are, how and from what arteries the eye, ear, or tongue is fed.”

Chapter 2

God and experience as the only source

In a very short section Still claims the only authors of his text are God and himself (his experience). This is because it would be “very foolish” to look for instruction or advice from any medical writers of a science as they know nothing of – the science of Osteopathy.

This statement is of course inadequate – no one wakes up one morning and starts providing a complex new form of philosophy and medicine that involves cracking people’s necks without precedents and influences. And there are many – in fact the practice of bone setting is even depicted in Egyptian hieroglyphs.  The English written tradition of bone setting reaches back into the 1600s and is well documented. Perhaps more interestingly the American indians, notably the Sioux, also practiced bone setting and Still does admit to having discussed health matters with JB Abbott and Indian agent.

I digress, what is important is to recollect that this is a philosophical text – so the philosophical precedents for Osteopathy also require investigation. Linking medicine and philosophical method was fundamental to ancient Greek medicine, so in this Still in the inheritor of a very long rational tradition.

Who exactly influenced Still isn’t clear in this text and as that is the focus of these blogs I will not dig further but to say the second chapter creates more questions than answers.

National Osteopathic Conference -Auckland 2017 presentation slide produced by Dr Iain Bell.

Iain is a Musculoskeletal Physician who graduated from Otago in 1990 (with distinction), and holds post graduate Diplomas in Musculoskeletal Medicine and Sports Medicine, FRNZCGP, and FAFMM. He is currently completing a Masters in Health Science (Pain and Pain Management). 

The science is in – you don’t need bit of plastic in your mouth or some other weird contraptions; chances are you just need to sing to get a good nights sleep.
And if like me you think a dying raven makes more tuneful noises – sing in the shower, sing in the car (if your’e alone).
“Sing. Sing a song. Make it simple; to last your whole life long
Don’t worry if it not good enough for anybody else to hear, just sing…sing a song”