Dr. A. T. Still’s Treating Chair

Jamie Archer,  B(Ost), PGCert Applied Anatomy

A while ago a patient who works as a joiner and welder asked me if it would be possible for me to design a chair that would traction the spine when sitting comfortably at home and he would make it. I replied that it was not a chair that needed inventing but encouragement to stop people spending long hours sitting, often in very poor positions. 

A chair would only encourage people to sit longer, treating the symptom and not the cause. There are many devices out there that will traction the spine; some effective and some that belong back in the medieval age. I told him that the point is not to instil bad habits but advise patients on how to improve their health.

This conversation however did get me thinking about a chair that I had seen a picture of many times. Being fortunate to own several original volumes of the Journal of Osteopathy from 1900-1904 I had regularly seen the advert for ‘Dr Still’s Treating Chair’ (Figure 1).

Figure 1: Dr A.T. Stills Treating Chair. (Advertisements 1902) Reproduced with kind permission of the Still National Osteopathic Museum

I had also come across papers relating to the chair on a recent visit to Kirksville. Intrigued by this invention I did a little research to find out more; how it worked and why none seem to exist today.

Dr Still was constantly instructing his students and graduates to be specific in their treatments, even in the early days there were those who practiced the so called ‘general treatment’. These treatments were known as the shot-gun approach, that is, manipulate everything and you can be sure that you may have corrected something. These kinds of operators were referred to by Still as ‘engine wipers’. In the Journal of Osteopathy, Fred W Gage (1901) states that many operators in the field would consult Dr Still for treatment who were:

‘all complaining from injuries by stooping and lifting while treating’.

(Gage, 1901, p.68)

There was a danger that in order to make things easier for themselves operators would be tempted by adjuncts or resort to less specific approaches in their treatments (a factor that still exists today).  

A.T. Still of course, knew how labour intensive and difficult osteopathic treatment could be remembering the early days when he would treat his patient in all manner of places and positions such as on a goods box, against a tree or door casing, on the ground or floor depending on what was most convenient or best suited the needs of the case.

He began to think of ways to make practice less intense on the operator but no less specific. As we know he was, amongst other things, an inventor and had already produced a uterine spoon, a treatment table used by many operators, as well as an osteopathic swing (figure 2).

Figure 2: Dr Still’s inventions (Professional cards, 1900) Reproduced with kind permission of the Still National Osteopathic Museum

However, these did not meet all the requirements and it was later admitted that the operator had not been given adequate consideration when designing or constructing the table or swing. With this in mind A.T Still began to plan a device that would both save labour as well as get results.  

The Old Doctor considered that lesions of the spine and ribs were best detected when the patient was in a sitting position and therefore best treated in many cases with the patient sitting. After days and nights spent in thought and study his plans took the form of a treating chair. Drawings in Dr Still’s notebooks thought to be early representations of the chair are held at the Still National Osteopathic Museum, Kirksville. The chair made its appearance in July, 1900. Gage (1901) gives the following description:

‘This chair is made from a stool about thirty inches high, the top of which is eighteen or twenty inches in diameter with an iron back made on angles to fit the spine. Upon this back plays a slide which extends out each side to about the angles of the ribs, by adjusting the slides some seventeen or more specific points are made between the first dorsal and the fifth lumbar, thereby allowing the operator to move any vertebra or rib in this region. On the chair muscles may be easily relaxed and ribs and vertebra set without so much preliminary work as heretofore. All who have seen the chair think it fills a long felt osteopathic want and that it will do all that is claimed for’

(Gage, (1901), pp.68-69).

A one-page article in the Journal of Osteopathy (September, 1901,) goes on to say that the chair:

‘places the patient at a convenient height so that stooping over is avoided. The raised part on the top of the stool prevents the patient from sliding forward or to either side, the tuberischii fitting on each side of the elevation thus the patient’s own weight holds him solidly on the chair. The two pads on the back are about an inch and one half apart and fit snugly on each side of the spine. The pads are constructed on a cross bar that slides up and down on the back part of the chair, thus the sliding portion can be placed over any part of the spine. The back part of the chair is made so as to accommodate the normal curve of the spine’. 

(Dr A.T Still’s Treating Chair (Anon., 1901), p.303)

The article goes on to say that the movements for certain lesions will not be given in the text as the operator after some practice will be able to devise their own. It states that the chair is now being used by quite a large number of practitioners and all have reported that they are very pleased with it.

Born in 1874, Dr Guy Dudley Hulett was a famous early osteopathic pioneer. He held the post of ‘Assistant in Theory and Practice of Osteopathy’ at Kirksville in the early 1900s.  Coming from a family of osteopaths he began his osteopathic studies in the fall of 1898. He is reported as having a special advantage of an ‘intimate association with the Old Doctor throughout his entire course’ (Faculty of American School of Osteopathy (Anon., 1900), p.126).

Dr Hulett wrote an excellent text ‘The Principles of Osteopathy’ first published in 1903, and running into several editions. In the third edition, 1905, there are found several references to Dr Still’s chair. Dr Hulett gives a description of the chair similar to the one above as well as describing certain techniques:

 ‘with the adjustable piece at the point of lesion and the physician in front or behind, the shoulders are grasped and by a figure of eight movement the body is rotated, the only moveable part of the body being that above the fulcrum, the remainder being held by the pressure against the latter and downward upon the stool. In this treatment the spine above the fulcrum represents the lever arm, the ‘breaking’ occurring more or less entirely at the fulcrum. By sliding the moveable part up or down each of the involved vertebrae may be acted upon’

(Hulett, 1905, p 281).

The ‘breaking up’ treatment is not to be confused as being a high velocity thrust technique but more rotational and articulatory in character designed to try and overcome rigidity by stretching the thickened ligamentous and connective tissues, thus encouraging them to yield. Hulett (1905) agrees with Dr Still that little importance is to be attached to the sounds made during treatment as they can be produced easily in most individuals.  

A much-used technique at the time was the knee fulcrum, where the patient was usually sitting; the operator in most cases behind the patient with their knee on the lesioned area acting as a fulcrum. Then by the movement of the shoulders the patient is rotated and articulated around this fixed point.

This is a valuable and underrated technique that requires great skill, but poorly performed can result in distress and damage. This may have been the case in the early days as Hulett (1905) states in regard to Dr Still’s chair:

‘owning to the interference presented by the arms of the standard supporting the moveable fulcrum, there is little possibility of drawing the patient too far posteriorly and hence doing harm’

(Hulett 1905, p.281)

In discussing rib lesions, Hulett (1905) again mentions Dr Still’s chair:

‘with its sliding fulcrum, additional advantages are gained. The patient sits, the fulcrum rests against the angles on each side of the spine and a fixed point is therefore gained. Then with appropriate movement of the arms or body standing in front or behind, the ribs are quite satisfactory under control. Standing in front the thumbs may be inserted so as to grasp the pectoral muscles on either side. Then by lifting and rotating, the ribs may be quite easily adjusted’

(Hulett, 1905, p.305).

Further reference to Dr Stills chair is made by Ashmore (1915) in her book when discussing techniques in the treatment of rib lesions. The technique is referred to as the A.T.S Chair Movement.

When considering pelvic lesions A.T. Still according to Hulett (1905) argues with reason that in most cases the treatment of sacral and inominate lesions may be simplified into one or two methods designed to make use of the fact that many times the sacrum has been driven downward between the iliac structures. Hulett gives Still’s analogy of freeing a wedge that has been driven into a log, being easier to withdraw it by a side-to-side movement rather than just a straight traction force.

This treatment can be performed on Dr Still’s chair. Thus, with the inominate bone/s fixed, the body can be lifted and moved from side to side with some rotation, gently withdrawing the wedged shaped sacrum and releasing it from its strained condition.

As you may imagine I was excited to see this chair that the Old Doctor had invented having only read about it and seen it in pictures. Although at one time one of these chairs was to be found in all treatment rooms at the A.T Still Infirmary I was to discover not one exists today.

Faced with this disappointment the decision was made that there was only one thing for it and that was to make one. So, with just old black and white pictures, the above descriptions and my own osteopathic technical knowledge, my friend and I after several attempts managed to recreate and bring back to life Dr A. T Still’s treating chair. (Figure 3).

But why are these chairs not in use today or at least exist?

Well the answer firstly may lie in the design. The legs of the original stool were made from wood as can be seen in the original photographs. The first observation my joiner friend made when seeing the picture was that many would have just fallen to pieces after continued use especially as the chair was reported to be particularly useful for heavy patients. This along with repeated strong leverages may have slowly weakened the chair eventually leading to structural failure.

Secondly and perhaps more likely was that rather than the invention leading to more specific work as Dr Still had hoped, it in fact led to operators no longer thinking about the treatment making it less specific. Although Dr Still made it clear from the start that the chair was not to be used in place of accurate examination, diagnosis and manual work but merely as an aid to treatment, it may have been that this chair under some operators removed all the above and they proceeded to give the unfavourable routine general treatment, but on the chair. Indeed, Dr Still may have already been having his doubts from the beginning as George W Riley (Hildreth,1938) explains in a personnel tribute to Dr Still:

One day I met Dr Still just inside the front entrance of the college building and he said, ‘New York,’ that was always his term of greeting me, ‘come with me’.

He led the way to a room I think on the garret floor, and there he showed me a treatment chair he was building. He explained that he was trying to build a chair that possibly might be helpful in the correction of vertebral and rib lesions. He asked my opinion of it and I told him it did not appeal to me as a very effective device.

The Old Doctor agreed and then added, ‘Riley, there is nothing that can beat the hands for correcting lesions’.

Such an observation, such an estimate as that, from such an authority, should cause every osteopathic physician to give it some very careful thought. No matter how perfect nor how marvellous a piece of mechanism you may have, it is never the less a mechanical device and as such can never take the place of that matchless combination of brain and skilled hands, hands that know well both the normal and the abnormal, that sense the resistance of lesions and enable the brain to control the amount of force to be applied, the exact direction, and the exact moment for its application in the correction of lesions.

As he expressed it in his Autobiography, ‘An intelligent head will soon learn that a soft hand and a gentle move is the hand and head that get the desired result’

(Hildreth, 1938, p.420).

Even today new devices, contraptions, equipment and adjuncts are coming onto the market which only serve to remove the fundamental principle of osteopathy from treatment; the adjustment of the body by the use of the osteopath’s hands. 

Dr Still may have realised that his device was in fact more of a hindrance than help and was removing the delicate palpatory and manual work needed in osteopathic treatment with operators using it as a convenient short cut. As a result, this may have caused him to discontinue the production of his invention.   

With this and the high possibility of the chairs falling to pieces they just disappeared. What ever the reason, this device shows us that Dr Still our discoverer, was constantly striving, thinking, reasoning and testing, never being satisfied.

The subject that he gave us was Osteopathy enough to fill a lifetime of learning. The chair now stands proudly in my office as a piece of osteopathic history and as a testament to his skill. It is used in certain cases but only as the Old Doctor advised, as an aid to my treatment.

References

Advertisements, (1902). Dr A.T. Still’s Treating Chair. [advert] The Journal of Osteopathy. July, p. XII.

Ashmore, E., (1915). Osteopathic Mechanics A Text Book. Kirksville, MO. Journal Printing Company,

Faculty of American School of Osteopathy Session of 1900-01, (Anon., 1900), The Journal of Osteopathy, August, Vol VII, (No.3) p.126.

Gage, F.W, (1901), After Thoughts, The Journal of Osteopathy. March, pp. 68-69.

Hildreth, A.G. (1938), The Lengthening Shadow of Dr Andrew Taylor Still, Kirksville, MO. Journal Printing Company,

Hulett, G.D, (1905), A Textbook of the Principles of Osteopathy, 3^rd ed, Kirksville, MO. Journal Printing Company,

Professional Cards, (1900). Swinging or Suspension Device. [advert] The Journal of Osteopathy. August, Vol VII, (No.3) p. III.

 Dr A.T. Still’s Treating Chair, (Anon., 1901), The Journal of Osteopathy, September, p.303.

Special thanks to Jason Haxton, Director of The Still National Osteopathic Museum and Barbara Magers at The Still National Osteopathic Museum, Kirksville, Missouri, USA.