HELP! Something is deeply wrong with Anatomy!

Something is deeply wrong with Anatomy,

Thus if Osteopathy is really Anatomy, Anatomy and once more Anatomy, then we could be in it,  like knee deep ! …---… / …---… / …---… !

… _ _ _ …(Morse code for SOS, alike Titanic SOS, not ABBA’s)…---...

Fast we are sinking!!!!!

Ok, enough ‘Drama Queen’ theatrics , it is not really the Titanic, but we are sinking and the icy cold water is approaching the professions waistline rapidly, and in my personal experience…

That is usually the most disagreeable part when getting in icy cold waters of Lake Huron.

If this would be an ‘SS Edmund Fitzgerald’ case, it would not even be necessary to make a distress call, but it is not, I think, …too late, I hope

As long as there is life and the gales and waves are not too extreme there might be hope…

But as our Canadian friend Gordon Lightfoot so rightly describes in his song “the wreck of the Edmund Fitzgerald”:

“When the skies of November turn gloomy”

“When the gales of November came slashing in ”

“When afternoon came it was freezing rain”

“In the face of a hurricane west wind”

That is the feel…and if you have ever been - or - live in the vicinity of the great Lakes in North America, you know what these sinister verses really mean….it is very scary…

A feel that is not good, not good at all…

Thus let us ride that horse…

(This one is for you Barbara S., don’t surrender!)

There are many possible way’s to approach the actual Anatomy’s condition as response to the …---… feel:

·     as quantitative study versus

·     a qualitative study, or

·     as historic study, and

·     as philosophic study…or

·     just plain out, like a tracker - whack the bushes with a big stick and see what comes out of it.

My natural, would incline for the last procedure, which is an almost sensuous skill in writing, balancing on the fine cord of aggressive brutal whacking and courteous agreeable civil revelations. BUT

Since I don’t know you personally, my sincerely meant dear reader and maybe ‘brother in arms’ for health and nature, I’ll go for the mix of everything as to everybody get’s some, according to their personal taste… moreover what is really not your taste you can skip it, just ignore it…

Be mild, I am just a worried, usually clumsy, messenger out of the African bush, Belgian Plains, Anatomical dissection rooms and Osteopathic world, who lifted up his eyes from the dissection microscope as the feel of the icy cold water raised lap-wards…

This article is in memory, with deep gratitude, to an Anatomist, who spoke these dramatic words, in his opening speech of 1899, to the “Congres d’Anatomie’ of the famous ‘Association des Anatomistes’ in Paris:

“Le niveau des connaissances anatomique, des étudiants de Médecine, est déplorable...”

In English: “The level of anatomical knowledge of the medical students is lamentable…”

These were the words of Trolard Paulin back then, in 1899 (Comptes Rendus de l’Association des Anatomistes, Paris 1899)

I stumbled on this while doing a literature research on the epidural space, because I found the descriptions in the books and atlases very inconsistent (back in the early eighties), and as I was going to dissect 48 lumbar spines for my research I wanted to have a consistent idea of how to proceed and get a feel for the unknown environment where I was going to dig, elbow deep into, so to speak.

Then this sentence in an article hit me, sledgehammer wise, straight in the face: “Although clinically important, the lumbar epidural space is inconsistently described in textbooks of both anatomy and anaesthetics” Parkin I.G. 1985 and that was written almost a century after Trolard’s speech…

Thus I felt quite disheartened on one side, but even so it was on the other side a kick on the right spot that made me start different things that I still cling to today:

·     Collect old and new anatomy books

·     Study them comparatively so not only in depth but also crosswise and

·     Become aware that there was something huge happening in the Hierarchy and Chronology of Anatomy as a science, and it has not stopped, it is still going on today as I write

·     Become aware that I had to study History and anatomical history to have an understanding of the environment in which the system ‘Anatomy’ was changing

·     Finally realize that anatomy genuinely was the result of something happening on a deeper level: Phylogenies and Ontogenesis, and then the functional life story and that the experiences of what I was dissecting and studying under the dissection microscope (Which I have not stopped since 1984) was just a hold still moment of a continuous process of change…

At the same time I was reading into A.T. Still’s books, and realized he was actually seeing Anatomy even much bigger than I was aware of…. And when I realized what he meant with the word FORM, a brave new world opened to me, and that is still going…

By it’s presence, a FORM reflects its developmental history and demonstrates its potency for change in the future.

Form is not the moronized ‘structure and function’ of the 1953 Kirksville Consensus Declaration, it is a process:

Structure and its behaviours through all dimensions as one whole; or Anatomy and Physiology in all their Dimensions as well as their proper history.

After all these years orbiting around and diving deep into the subject to go orbiting again, this is the outcome:

I am not going to recap the history of Anatomy and dissection because that would ask for a few telephone directories like the yellow pages but essentially:

“Ana - tomei” comes from the old Greek: and means literally ‘to cut into pieces’

Meaning the foundation of the science of Anatomy: is dissection. (Full stop)

As a Prosector myself since 1986, thus anatomist, I always say to the wary students that a good anatomist is a handy, knife-skilful moron, that describes what he sees, while doing his careful knife work. So go and do make your own experience, but walk softly and carry a big stick. (Go precautiously and know , as much as possible , what others have shared in anatomy) And that is exactly what Anatomy and Morphology used to be; and still should be in my opinion.

The reason why I use the description: 'that a good anatomist is a handy, knife-skilful moron, that describes what he sees, while doing his careful knife work.' is to lower for some of the students the overwhelming uncertainty and shock and awe when they are confronted for a first time with a cadaver and sometimes culturally have secretly the feeling of de-sacrating it (secretly but you see it in their eyes and expression), as well as the overwhelming privilege and equal big fear to go inside the intricate complexity of nature's work, stopped by the embalmment. As prosector anatomist, accompanying them as backup on their journey, I want them them to relax a bit and not see it as a insurmountable mountain to ascend but go into the exploration with an open respectful discoverers mind...That is the why these people gave their mortal remains for science...That is also why our departments just motto is: 'Here death is pleased to come to help to Life.'

Now the problem is that you can only recognize what you know...You see what your brain wants you to see...and thus...

Some anatomists were artists like Leonardo, some had more fantasy than others (an endless list difficult to pick one) , some were more skilled observers ( also a big list), some copied shamelessly from others without understanding or reasoning by themselves (here I wanted to put Fascia - Serge but he is not anatomist so I don’t name him), some where slicing it that far up they created a new fantasy world (Fiber Stecco and matrix Sharky are very trendy in that category right now, victims of the infinite regress delusion but the list is very long too) and so on…

The biggest danger in unaware dissection is that by cutting with your scalpel you can create new structures that obviously are not really there ...you just created them... Idem by the intention with which you observe....

The best known classic example of this is the fascia lata or iliofibular tract for instance.

If you take one component out of a complex mix, in principle you are doing the same thing, a fascia is not fibers nor matrix...it is a highly complex adaptive system which in its most simplified description has 4 intensly interacting components...and please:

I am not confronting people but fundamental principles and the ideas that sprout out of it, don’t misunderstand my intention here.

Alike in any human group the adage stays true: ‘in every type of water you find several kind of fish’

Anatomy stands no exception here.

But a big one emerges out of the big pond: Andreas Vesalius Bruxellensis (Andries van Wesel), a Flemish Belgian from my region. His book “De Corporis Humana Fabrica” threw a stone in the pond literally. (The fabric of the human body)

He was important because he gave anatomy the description method that is still in use today. The ignominious not over-see-able triads of everything, for every first year anatomy student:

what where how?

What is it / how does it lie / Where on the body is it / and its orientation or side

For example: Nervus Cutaneus Femoris Lateralis = Nerve / superficial - under the skin / on the femoral part of the leg / on the outside.

A sound and clear orientation and observation exercise, that started a habit that was not so sound; as I already mentioned in a previous article with the kidney’s as example.

Fact is, we as anatomists chose, certainly for that particular case, the arrantly wrong reference frame by habit, and if we are, not aware enough and flexible enough in our minds, we are not even keen-sighted enough to be come aware of it. 

Right in time for my favorite quote of another famous outdoorsman Teddy Roosevelt (US president):

"The cast-iron quality of the official mind was shown by the rigid application of certain rules, but which in time of stress became damaging due to lack of flexibility."

Note to self:  

·     Cast iron is excellent for stoves and cooking pots, not the mind and

·     It is a bad idea to take as reference frame exactly that what is going to be the most growing-moving and thus unstable reference system ever.

·     Stop trying to push or pull kidneys, not good… not good at all… bad idea, very bad (In Tweet I must sound like Donald now)

This arrant bad choice in reference frame makes the observations based on it as well as, the thereby derived convictions very wobbly, and when they are expressed or written sound like gibberish… 

https://www.dhirubhai.net/pulse/natural-versus-normal-stills-work-coincidence-crucial-max-girardin)

The ‘bloody Belgian country man’ of mine chiseled in stone the nasty habit of using the skeleton as reference frame, on which everyone hangs the rest of the structures, alike an old wet raincoat on a coat hanger, and as such

he instigated the mental divide of the FORM into separate pieces, systems and subsystems, even further than it was already. The big infinite regress disease leading to the infinite regress delusion.

The final push into, this nasty similar direction of doing by habit, without reflection or reasoning was given in 1801, by Xavier Bichat, who defined the four tissues in histology…when actually there is only two, as oncology demonstrates adamantly. (But that is whole other story, in another dimension but the same principle at work)

An interesting detail, that you can investigate if you want, comes directly from the Religion Wars that devastated Europe for almost 300 years, coffee and lunch breaks included (short moments of relative peace). 

The main excuse to exercise the worst villainies to each other was the reactions to the Reformation against the stickiness of Roman Catholicism. Same book but different interpretations and what and how to do with it, (Catholicism and Protestantism) and as top the overflying all-covering curse of convinced Fundamentalist Monotheism.

What do I mean?

The all-covering curse of convinced Fundamentalist Monotheism: When you are really fundamentally convinced of having the sole righteous image and interpretation of the ‘Big-one from upstairs’ or ‘imaginary friend’, every other opinion, wisdom or consciousness is per definition wrong … and they all tried truthfully to convince one another of that, by merrily exterminating each other on regular occasions, with tons of collateral damage for the environmental populations… (When an army past through a range of 50 km around their passage was looted and cleaned violently definitely) And you think that war makes a lot of collateral damage today? Think again. The HORROR has not really changed, just more sophistication…surgical strikes…Think again.

Anyway back to the cleaner individual cutting into pieces or ‘ana-tomei’, long story short, the extremely Catholic Jesuit (soldiers of Jesus) University of the Sorbonne in Paris, developed a proper French terminology for anatomy, as to evict the pestilential influence of others, not so righteous publications, in their conviction. Ridicule? Unnecessary jingoism?

Not really.

I agree in those day’s jingoism was a homo “?Sapiens?” sign of the times, as it still is a tradition today sadly enough; and a preposterous attempt to isolate themselves mentally and philosophically from the outside world, but every bad, even arrantly bad cloud has a silver lining as we’ll see. (Mental as physical walls don’t function as originally intentioned)

So the European world (where science and its modern development is happening at that time) on the level of anatomy is divided in two: two ways (languages and terminologies) of describing and naming what they see, when they dissect.

Now the science of anatomy is going its two ways (Latin and French terminology and way of observing) merrily, steadily and with much eager enthusiasm towards ANATOMY'S apex or top.

The culmination of the science of anatomy is a period that lies somewhere between the 1800’s and First World War. Afterwards it spirals down like a Messerschmitt shot by a Spitfire during the Battle of Britain. (My Father flew one of does in the Belgian Air Force just after the War, and as a kid I liked them, especially the sound of the Roll’s Royce engine, it roared like a dinosaur....Gosh I loved those planes)

Why does anatomy spirals down? As often this is a series of apparently fantastic well-meant coincidences, all with the best of intentions that turn out south, deep south like Antartic south …icy cold water bad…SS Edmund Fitzgerald bad…Donald Tweet BAD BAD BAD

Two major trajectories reinforce each other (Like the meeting of the waters in Ireland) and the emergences with their unintended consequences are to the detriment of Anatomy, reasoning and even medicine.

The first culprit is the advancement of the scientific method and the discovery and disclosures as consequence in almost every possible branch of biology and medicine.

The second one is the urge to implement new stuff as fast as possible, as to feel modern, at the cutting edge and lacking to take the consequence of that decision….

Strange formulation? Here is the long track: The discoveries are indeed huge, and the urge to implement them is obvious, as alike in the business world, Universities battle for funds or money thus must stay on the top, cutting edge…logical from a capitalist viewpoint in a identical society or environment. Even here it is a game of financial selection not natural: but survival of the fittest...in a perverse environment that carries consequences for the type of selection....

The problem arises and increases with the overshoot.

When you want to push all the new stuff into a MD’s education, molecular biology, statics science, pharmaceutical science, genetics, pathology, immunology, imaging technology etc etc etc and that all these branches are increasing their size increasingly too, every passing year…

There are but few possibilities: or you increase the education time (like doubling it) or you throw stuff out of the curricula.

The latter was clearly chosen, and by that choice, the reasoning for a big part followed the same way out… ALLAS INFINITE REGRESSION....(if you don't understand this look it up it is even on misses Wikipedia -who alike Misses Google knows everything isn't it?)

Medical science in the 1800’s was mostly anatomy, a little physiology as it was developing, and observational pathology as well as some simple pharmaceutics and surgery - obstetrics. But the major was Anatomy (actually Morphology) and all the rest was more or less based upon that major.

Where do you think they threw stuff out? Yeah right!

The major, Morphology was pruned down diligently to anatomy and then, as not to change a winning horse, they continued to amputate anatomy…. I experienced it myself in our Alma Mater, we ( The Morphologicum boys) were working as prosectors in the department of Experimental anatomy (formerly the department of Morphology) and in the eighties as the curriculum was getting to crammed, our Professor was told to eliminate 10% at his own choice out of the Anatomic curriculum (This happened around 1987 1988 if my memory is correct). Looking at the Anatomical literature, this was a commonly often-repeated exercise, repetitively done in the last two centuries. Do you start to understand why our website is www.morphologicum.org ?

It would not be dramatic, if they had maintained the knowledge in the books, and just taught less matter or/or hours. But Capitalism and Modernism also works its way through the publishing sector, so it disappeared out of the books too. Out of the eye = out of the heart and finally completely forgotten.

And there the strong French jingoism and traditionalism demonstrated its silver lining. In the French anatomy the same process went on, but much slower. Probably because of the fact that their terminology of structures was directly connected to the name of the discoverer, and as such it was disrespectful to throw stuff out because it was in their minds really connected to a person, a once famous renown anatomist. But alas the French finally submitted to the worldwide trend somewhere end eighties begin nineties of last century. 

The Gray’s anatomy, used to be the exception to the rule for a long time, until somewhere after the 38th edition, or 39th edition, now it has been amputated as the rest, such a shame…makes my anatomist's heart bleed

The old Gray’s anatomy had maintained longer than many, as the French, a systemic or more morphological approach. But on popular - consumerist demand the publisher finally gave in and it plunged too.

One of the consequences of this dreary principle at work is easy to get if you read VOMIT: Victim Of Medical (or Modern) Imaging (or Investigational) Technology, This term was first coined by Richard Hayward in 2003 in the British Medical Journal (BMJ 2003; 326: 1273, 7 June)

Are you getting depressed yet or just some chronic fatigue signs suddenly hitting in?

Brother better watch out for the skin deep...(This is from the Stranglers not me, but their lyrics fit this mood)

Feel it, acknowledge it (it can be a motivational force) and let then the resilience of Life insufflate you again, and remember: “…every bad, even arrantly bad cloud has a silver lining”

What is the silver lining?

Osteopathy is ‘per se’ an individual profession and experience, so the silver lining is also individual… you can still get the anatomy books in second hand bookshops …usually relatively cheap… I have anatomy books I bought for one image in them, or one description in them….

If your cash flow is low, many of them are digitalized and often open for free download…. Get into action before we meet the fate of the SS Edmund Fitzgerald

DIG ON…. An osteopath is a lifelong student… and mostly

“Never surrender, but die in the last ditch. This is a war not for conquest, popularity, or power. It is an aggressive campaign for love, truth, and humanity”

From the the border of the plains of Flemish Brabant Belgium, sincerely yours  Max

Evost in action, pictures of this year, I am the fat guy on the left and solely answerable for what is in this article, if you like it, it comes from us both, if you dislike it it is me, myself and I the fat guy. Sincerely yours Brother and Sisters.