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History of Osteopathy

Andrew Taylor Still, M.D., founder of Osteopathy

Andrew Taylor Still, M.D. was born in Virginia in 1828, the son of an itinerant Methodist preacher who supported his family by farming and the practice of medicine. Six years later, Still’s father moved the family to Tennessee to accept the position of a circuit preacher. Still’s early education was typical of rural schooling of the time where a large dose of discipline was served up with a little bit of reading, writing, and arithmetic. He also attended a local academy but several times in his early years his education was interrupted when his father was transferred to various parts of the Midwest. In 1837, his family moved to Missouri and later to the Kansas territory in 1851 where his father was stationed as a missionary to the Shawnee Indians. It is generally believed that between 1842 and 1848 Still had a formal uninterrupted education.

Andrew remained behind in Missouri, married in 1849, and continued to work his farm and began a family. In 1853, Andrew, his wife, and two children joined his parents at the Wakarusa Mission in Kansas where he assisted his father during a cholera epidemic. Andrew also helped his father and brothers with the family farm caring for the crops and livestock. He assisted his father in both his ministerial and medical duties as well as assisting in the religious revival camp meetings his father held. It was during the time spent with his father tending to the religious and medical needs of Native Americans that Still decided to take up the practice of medicine under the guidance of his father. One of Still’s brothers also trained under his father and later went to a medical school but it is unclear whether Andrew was offered the same opportunity.

Andrew Still studied the current texts on anatomy, physiology, pathology, surgery, and materia medica. This was the standard of conventional medical education for the rural American physician of the day. Early on, Still was well aware of the limitations of the materia medica of his day with the almost total preoccupation of allopathic medicine with symptoms and their suppression. The understanding of disease was crude at best and based on vague notions of “physiological tension” which needed to be relieved by puking, purging, blood letting and heroic doses of morphine, opium, alcohol and mercury. The early Dr. Still tolerated these short-comings but began to publicly voice his doubts about the current therapies. For his studies of anatomy and pathology, Still obtained the Shawnee chief’s permission and studied the corpses he exhumed from Indian burial grounds.

Still was elected to the Kansas Territorial Legislature and was active in the Kansas free state movement. In 1859 his wife died. She had previously lost two children in infancy and left Andrew with four children. In 1860, Still married his second wife and shortly thereafter joined the fight against slavery by enlisting in the Union Army and was assigned to the 9th Kansas Cavalry, Company F, where he served as a hospital steward. After being released in 1862, he returned home and organized his own command as a commissioned captain. He later transferred to the 21st Kansas militia and given the rank of major. Still served as an army surgeon and sustained spinal and abdominal injuries. His field instruments remain to this day displayed at the Smithsonian Institute in Washington, D.C.

In 1864, home from the war and disgusted with all the killing, Still’s life was further shaken when three children from his first marriage died from spinal meningitis. Shortly thereafter a child from his second marriage succumbed to pneumonia. Still had attended the Kansas City School of Physicians and Surgeons after the end of the Civil War but had become so disgusted with the teaching there that he left without returning for his diploma. During the years 1865 to 1870 Still gradually reestablished his medical practice relying on a system of manipulation and spinal reflexes that he devised to treat all types of conditions. The birth of three healthy children and the living he was able to scrape together from farming and his medical practice provided some glimmer of hope for the future. Despite his therapeutic successes he was viewed as a medical heretic, a grave robber, and a “crazy crank” because of his unorthodox views, long hours of solitary study and casual dress. His methods obtained results that were not otherwise explainable so his practice was viewed as the work of the devil by local Methodist preachers. For three months during 1873 Still was stricken with a lung infection which left him near death. Upon his recovery and the birth of another child he decided to leave his family and set up a practice in Kirksville, Missouri. There he saved many lives during an epidemic of infectious diarrhea, totally without the use of drugs. However, despite this success his reputation as an eccentric followed him and he was shunned by most until he cured a prominent Presbyterian minister’s crippled daughter.

The birth of Osteopathy

In 1874 he announced to the world the founding of his new medical science which he called Osteopathy. This new school of medical thought was conceived as a reformation or improvement of conventional medicine, not an alternative system. Thereafter, his practice grew and he was able to send for his family. In 1875, he was stricken with typhoid and for the next three years was mostly confined to bed. His wife and children worked to keep the family going and in 1878, emaciated and aged by his illness, the “Old Doctor”, as he was now known, slowly returned to his medical practice. During the 1880’s he continued to refine his science and made several attempts to train others. Although he and others doubted whether osteopathy could be taught, Still awaited the return of his two sons from their service in the Army whom he hoped would carry on his work which he intended to do through the establishment of an osteopathic school. During this time patients flocked from all over America for his treatment. Hotels were built in the town of Kirksville to house the many hopeless patients who arrived daily for help and several railroad companies advertised their train service to Kirksville. On November 1, 1892 the American School of Osteopathy was opened. This first class of eleven students consisted of former patients, family friends and five of Still’s children. The forward thinking Still admitted five women to the first class and was later reported to have said that he thought women made better osteopaths than men. Still was assisted in his teaching by William Smith, M.D. an 1889 graduate of the University of Edinburgh. After one year, Still determined that for the most part his experiment at teaching osteopathy was a failure. He issued certificates but beseeched the graduates to return for another year of instruction. Some did not return. However, in 1893, Still did receive some confirmation that his method could be learned when two of his son’s accepted an invitation to practice in Minnesota and saved many lives during a black diphtheria epidemic. Dr. Smith left Kirksville with his osteopathic diploma so some of the teaching was now done by Jenette Hubbard Bolles, one of Still’s best students. Graduation for the returning first class was held on March 4, 1894. Slowly, the curriculum improved , more and better students graduated and an infirmary was built in 1895 and in that year Still and his students had performed thirty thousand osteopathic treatments. By the late 1890’s his school, infirmary and new surgical hospital were increasingly successful both academically and financially. This allowed Still to remove himself from the daily administration of these institutions and concentrate on further study and writing. He continued some direct patient care and taught his philosophical principles to his students whom he affectionately called his “children”, leaving the instruction of anatomy, physiology, biochemistry, histology and clinical practice to his hand- picked faculty.

Although Still authored many articles and four books, one of which was his autobiography, the philosophical and historical basis for his work is difficult to trace. We know from his autobiography that on June 22, 1874 at 10:00 a.m., Still had an epiphany of sorts. He describes it as “being shot in the dome of reason” and from that point on he severed his ties to conventional medicine. Still never fully described what this transformation was like and the sources of his philosophy are not obvious. Historians have come to at least a partial understanding by placing Still’s life and work in the context of his times. Osteopathy is a naturalistic, vitalistic, holistic and drugless approach to health and disease. It is based on the idea that man is not a collection of parts but a synthetic whole imbued with spirit. A totality not reducible to the some of its parts. The body functions as a total unit and possesses self-healing and self-regulating mechanisms. Osteopathy maintains that there is a reciprocal relationship between structure and function. Namely, that an alteration in structure (the musculoskelatal system) through injury will result in a change in function (an internal organ) and hence disease. Likewise, a diseased internal organ will result in an alteration in the musculoskelatal system. The osteopathic physician, by his or her intimate knowledge of living anatomy can recognize, even on subtle levels, these deviations from normal and by the application of various manual maneuvers restore the structure and function and assist the inherent self healing powers of the body.

In the 1870’s, in America, this holistic perspective was heresy. Still’s early life provided many unfortunate opportunities to witness the shortcomings of conventional medicine. He lost his first wife and six children to infectious diseases of one kind or another. He saw the impotency of medical care during his service as an Army field surgeon and when he cared for Native Americans during epidemics. He had pneumonia for three months and took three years to recover from typhoid. Still was an astute observer. He spent many hours alone studying anatomy both from books and cadavers. Still was a natural born healer who revealed to one of his students toward the end of his life that he was able to see the human aura, the human energy field. In many ways osteopathy was Still’s unique synthesis of his personal experience and several major intellectual and philosophical movements making their way across America during his life time. The pseudo-sciences of Phenology, Spiritualism and Mesmerism theorized the existence of the flow of certain healing and self-regulating electromagnetic and spirit-like fluids in the body and these concepts were incorporated in Still’s notion of the healing effects of an unimpeded flow of blood. Osteopathic manipulation could relieve the restrictions to the free flow of blood and nerve power by removing the bony dislocations and muscle contractions. Still, an amateur inventor, was fascinated with machines and had a near-perfect knowledge of human anatomy from his many years of self study. He viewed disease as an effect of the various derangement’s from the anatomical perfection intended by God, the Divine Architect.

Still was most influenced by Herbert Spencer, a nineteenth century British philosopher who coined the term “ evolution” and influenced the thinking of Charles Darwin. In Still’s philosophy of osteopathy one can find many of Spencer’s ideas – the concepts of cause and effect, the relationship between structure and function, the holistic nature of man and the interrelatedness of parts. The influence of these movements on Still’s philosophy is best illustrated by the way he advertised himself before coining a name for his new science. At various times he called himself a “magnetic healer” and a “lightening bonesetter” and some of his therapeutic maneuvers resembled those use by British bonesetters and magnetic physicians of his time. Andrew Taylor Still died on December 12, 1917 from the effects of a stroke he had sustained three years earlier.

Osteopathy after Still

The history of osteopathy to this point is in many ways the personal history of the Still family. However, the history of Osteopathy over the next eighty years is intimately intertwined with the unfolding of American economic, sociological, political and philosophical thought. As osteopathy grew, political and legislative battles were fought and won. Today, in all fifty states osteopathic licensure is equivalent to that of conventional physicians. Organized osteopathy had to battle the powerful American Medical Association which sought to maintain its monopolistic hold on American Medicine. Denied the right to serve as physicians in the military and other government jobs, the osteopathic profession lobbied hard for inclusion. It wasn’t until the Vietnam War that osteopaths were allowed to serve their country as physicians. Today there are 26 osteopathic colleges. Some are state supported schools where faculty and facilities are shared with allopathic students. Osteopathic physicians can practice in all medical and surgical specialties through osteopathic or allopathic board certification. Osteopaths now serve in all branches of the military and government health service organizations. The curriculum at osteopathic schools is identical to its allopathic counterpart with the exception that D.O.s learn osteopathic philosophy and manipulation.

However, with equality comes paradox. As the osteopathic curriculum improved over the years it became more like conventional medicine. Even during Still’s lifetime the early osteopathic colleges began teaching drug therapy. Today there are approximately 70,000 osteopathic physicians in the U.S. yet only about 2,000 osteopaths practice the original healing art with some osteopaths using manipulation as an adjunct to their conventional practices. Yet the original osteopathic concept is powerful and has made a lasting impression on medicine throughout the world. Osteopathic and conventional basic science research has validated and confirmed many of Still’s original ideas. Today even the conventional medical world has many manual medicine societies and the specialties of Physiatry and Rehabilitation Medicine benefit from much of Still’s pioneering work.

Starting in the 1970’s a quiet world-wide revolution has taken place. Disillusioned by the expense and the impersonal nature of the high tech, crisis management, conventional medical model, many around the world are seeking out alternatives. Interest in natural methods such as homeopathy, acupuncture, and herbal medicine is enjoying a universal renewal and Osteopathy stands in the center of this renaissance. Although the concept of a vital energy or life-force has existed for thousands of years in various cultures, in modern Western culture Osteopathy represents the foundation of many “body work” therapies such as Rolfing, Chiropractic, and Naturopathic manipulation. For instance, Daniel David Palmer, a magnetic healer from Davenport, Iowa came to Kirksville in 1893 to be treated by Still. After several treatments he returned home and two years later announced his discovery of a manipulative healing method called chiropractic. In recent years Cranial-Sacral Therapy has arrived on the scene. This is merely the rewording of Osteopathy and includes insights derived from the work of one of Still’s most brilliant students, William Garner Sutherland, D.O.. Sutherland extended osteopathic principles to the study of the cranium and developed a diagnostic and therapeutic modality involving motion of the bones of the cranium and manipulation of the subtle flow of energy in the body. This technique is now being taught by some to massage therapists and physical therapists without the benefit of the complete medical training so crucial to osteopathic work. The osteopathic concept has also spread world wide. There are colleges in England, Canada and Europe. To date, 32 countries have granted osteopathic physicians unlimited practice privileges with an additional 9 countries granting privileges limited to manipulation.

As we stand on the threshold of a new millennium, it is unclear what course medicine will take. Governments throughout the world struggle with health care delivery issues and increasingly people are seeking a kind of medicine which acknowledges the whole person – physical, mental and spiritual. Whether we will have a collection of various approaches that each person must chose from or whether there will be a synthesis of natural science based approaches such as conventional allopathic medicine and holistic approaches remains to be seen. One thing is clear from the history of osteopathy — the osteopathic physician will be very well placed for the challenges confronting the world in the years ahead.

 

(from Dr. Masiello’s published article:  Osteopathy, in The Illustrated Encyclopedia of Body-Mind Disciplines, Nancy Allison, ed., Rosen Publishing Group, New York, 1999)