Honouring to a Master and a Friend

By Pierre-Marie GAGEY

     Da Cunha kept definitively silent on November first, 2000 in Lisbon after more than a year of lucidity occupied with speaking despite all about the passion of his career. He had even organised his swan song which should have taken place on November 17 and 18, 2000: "il Curso Post-Graduado de Posturologia Clinica"…
     To speak was as registered in his genome when he was born on July 25, 1928 at Viseu, Casa do Cruzeiro, descendant of a lineage of noble Portuguese persons, jurists and humanists, more skilful to handle the verb that the sword. And we enjoyed teasing him on his insatiable appetite of word!
One evening of congress in Amsterdam where we dined in an Indonesian restaurant, our small group was seized with surprise: Martins Da Cunha did not say a word! Questions fused under cape around the table: what happens? We never ever saw that... Da Cunha says nothing! It was simply Indonesian hot peppers, which had been right of his eloquence from the very beginning of the dinner! But they were strong, we must recognise it!
     This strong verb, Da Cunha put it in the service of Posturology, which became step by step the second passion of its life. At the beginning of his medical studies, one did not speak about posture in the Faculty and when Da Cunha went to Angola to organise the service of physical medicine and rehabilitation of the military hospital of Luanda (1963-1965) his eyes were not yet awakened at this new glance on patients.
     But in his return to Lisbon, by waiting for a new post, he replaced the doctor Carpinteiro and this Portuguese doctor, specialist of physical medicine, opened his eyes, Da Cunha recognised it formally. His patients suffering from low back pain, Carpinteiro saw them quite gangling and Da Cunha discovered that it was true. Carpinteiro prescribed to his patients a whole series of physical exercises to put back them right, upright, and Da Cunha noticed that it worked! To find a beautiful appearance thanks to postural reprogrammation (fig.1) and to no longer suffer, went together! What a miracle. But also which question! How was the morphology, so connected to nociception?
     From this time, one can say that Da Cunha is lived by an almost fervent thirst to understand. He begins study trips almost everywhere in Europe and in America, to Pr. Guttman in Ailsbury, Pr. Trueta in Oxford, Dr Chodera at Queen Mary hospital of Rohampton, Dr Garcia in Madrid, Pr Cesarani in Milan, Rabishong in Montpelier, Brodin in Stockholm, Baron in Paris, Hamonet in Créteil, Sherwood in Houston, Chantraine in Geneva, Sibilla in Milan, Berthoz at the Collège de France. Everywhere it remains the time necessary for him to understand the answers, partial, to his questions. Sometimes, he returns even several following years to better understand, as to saint-Anne with Baron.

FIG. 1 - Reproduction of a prescription of postural reprogrammation, drawn by Da Cunha himself. Nine exercises are schematised there:
1: Sat on a low seat, straight back without support, left foot heightened by 20 centimetres, work plan tilted to 22 ° to read, 60 ° for the screen of computer (At the top and to the left).
2: Up against an angle of wall, head, shoulders and buttocks pushed against this angle, feet spread from the wall and parallels, to tip over pelvis until the lumbar vertebra contact the angle of the wall. (To the left)
3: Up, parallel feet, the right behind, the left-handler forward, the hands on a file of chair, to tip over the pelvis forward, to pull shoulders behind, head behind and bent, lower jaw propelled forward, to expire between the tight teeth. (Lower and more in the centre)
4: Lying flat on one's face, a pillow under ankles. (Below)
5: Lying flat on one's face, head to the left and tilted towards feet, back rounded, right thigh bent on the pelvis, right knee, elbow and hand in extension, left thigh, knee, elbow and hand bent. (Below to the right)
6: Lying on one's back, left knee bent, right hand under the nape of the neck. (To the right a little higher)
7: Lying on one' s back, feet on the ground, knees bent, hands under the nape of the neck, lower jaw propelled forwards, the incisors in contact, to breathe profoundly by the nose, to expire between the tight teeth (To the right, in the middle)
8: Squatting, feet spread and parallels, heels contacting ground, to hold balance sticking to a piece of furniture. (In the centre)
9: Lying on one' s back, feet and legs on a chair; 5 minutes, hands crossed on the breast, 5 minutes hands under the nape of the neck

     It is at sainte-Anne hospice that I met him for the first time, without understanding anything about the reasons why he came to see us. At this time, we worked about dizziness of head-injured patients and he came to show us quite a lot of slides from patients suffering from low back pain, more or less rickety. By what, indeed, could it concern us? And he too had his twisted patients wear prisms, besides postural reprogrammation. And he said that he cured them this way. Really this Da Cunha was difficult to catch!
     It is only years later that I understood all these links that Da Cunha had established between all the dysfunction of the postural system, around the upright posture and around its symbolic meaning: the patients have, either some difficulties, or some pain when they try to stand upright quiet, and echoes of this incapacity can resound very profoundly in their psyche. He called that the " Syndrome of Postural Deficiency" ( SPD) and we go on doing the same.
     I was not the only one to follow this pioneer of Posturology with difficulty. One recounts that in the service of Ophthalmology of Professor Ribeiro da Silva at Santa Maria hospital, Lisbon, at a certain time, an ophthalmologist tore Da Cunha's letters and threw them to the dustbin even without reading them, irritated not to be able to get with him. That's why Orlando Alves Da Silva met Da Cunha in June 1977, charged by his boss to restore bridges.
     As this ophthalmologist was kind enough to tell us these first meetings, I shall leave him speak: " I suggested to Da Cunha seeing together one of his patients and he agreed. During the exam Da Cunha explained me that his patients had a strange way to look at, and, while speaking, he moved from one side to another in the room, irritated to have difficulties to clarify his thought. By listening him and by trying to understand him, I looked at his patient. Then, almost accidentally, I noticed that the patient looked at Da Cunha in a strange way: he turned his eyes when Da Cunha went to the left, but he turned his head when Da Cunha went on the opposite site. A small light sprang then in my spirit, I decided to look what took place in the synoptophore and, miracles of the miracles, by looking to the left, the patient saw quite the whole test cards but by looking to the right a part of test cards missed.... Some months later was established that a precise relationship exists between support foot and pseudo-scotoma. Then, I pointed out to Da Cunha that one could not continue speaking only about left or right foot of support, because there were also mixed supports, more numerous than both others did.
     This year, Baron came to Portugal; he showed us that a prism, external base, put in front of the left eye of one of our patients, was able of resolving his incapacity of convergence. And we verified that this prism was effective in the very precise situation of pure left foot of support, and not in other situations. What urged us to discover the efficiency of oblique axis prisms and, more generally, to fix relationships between axis of prisms and support foot and pseudo-scotome, and eye that had to wear the prism. Without the enthusiasm of Da Cunha, it is necessary to recognise it, I would have miss all these relations. "
     Then Da Cunha searched the relationship of the autonomous nervous system with the postural system by a whole series of investigations of variations of facial thermography, blood pressure, heart frequency, and encephalic circulation...under the effects of postural manipulations. He also tried to clarify the morphological observation of postural patients by rachis stereometry, and to study their scotomes by computerised campimetry. On the other hand, he was rather blurred with the stabilometry! Well, he had bought a platform, but the data processing, the statistics, were not so convenient for her. His clinician glance was brilliant and he did not need to trouble himself with machines to know what suffered from his patients. While we discuss still criteria of definition of support foot, without having managed until now to agree between all of us, he indicated it at first glance without any hesitance. We did not understand how he managed and he did not succeed to explain it to us. It was so evident for his eyes! But he did realise that people around him did not understand all his intuitions and he suffered from it in his last years, he had the feeling that he would bring with him in his last silence far too many secrets, which he would have liked sharing.
     I would not like to end this affectionate honouring to Da Cunha without turning me to the one that accompanied him throughout his life. When one meets a big man, it is necessary to look for the woman who allowed him to reach the plenitude of his dimension, and, indeed, she deserves being thanked.

Home page