Introduction

By the 15^th century, a formal education system had been adopted in Europe and was beginning to produce brilliant minds such as Issac Newton, Robert Boyle, and Galileo Galilei 

However, when it came to the newly established colonies in America, they had some catching up to do. During this time, children were not required to go to school, but the benefits of learning to read, write and perform arithmetic were thought to be invaluable skills.

In 1635, the first public school was opened in Boston Massachusetts.

This was a significant milestone in public education, because prior to this time, teachers taught academic skills to children out of their own homes. This institutionalization of education allowed a single teacher to teach students of all ages, within the comfort of a schoolhouse.

Just one year later, in 1636 John Harvard left his library and public estate to the department of education which resulted in the opening of the first ivy league school, known today as Harvard university.

Yale was established in 1701.

Battle of the Systems (1882-1979)

Following the conclusion of the American Civil War, in 1861, the nation was attempting to recover from the most devastating military endeavor in the nation’s brief history. However, it was not necessarily violence that claimed all these youthful lives, but rather disease asa the concepts of sanitation, nutrition, and germ theory were not well understood.

Concluding the war effort and the abolishment of slavery, the nation seemed to return to a state of solidarity and unity.

However, one individual who was directly affected during this time was Major Andrew Taylor Still, a union militia physician who served at the Battle of Big Blue and Battle of Westport.

A.T. Still, a husband and father of three children, noticed a lack of knowledge and understanding when it came to maintaining or restoring human health through heroic medicine, which was the main philosophy of the time.

Following the loss of three children to typhoid, Still embarked on a journey of healthcare knowledge by investigating bone setting and magnetic healing from Shawnee, Pawnee, Kickapoo, Cherokee, and Pottawatomie peoples (5).

In 1874, Still, proposed a new medical theory to his church but was forced to relocate to Kirksville, Missouri after being cancelled as a heretic.

However, in 1882 Still partnered with William Smith, a respected European MD who assisted him in developing the American School of Osteopathy. The opening of this institution was not to discredit, eliminate or disprove current heroic medicine practices but rather reform the art and practice of medicine to best treat the patient.

In this model, Still emphasized osteopathic manipulative therapy (OMT) to be more vital to health than Materia Medica.

Conceptually this changed the view of the body as a machine and the physician as the engineer. It is believed that the driver behind this philosophy was the high rates of deaths during childbirth, toxic heroic medicine, and blood letting procedures which claimed the life of Geroge Washington.

In 1895, the National School of Osteopathy was founded by Dr. Elmer & Helen Barber in Baxter Springs, Kansas.

This began a wave of rival schools began to adopt a larger scope of medical practice, which placed a larger emphasis on the academic topics of surgery, pharmacology, hydrotherapy, and electrotherapy. These institutions became known as BROAD osteopaths.

 This in Still’s eyes began the battle of the systems in which pure and broad osteopaths were pegged against one another.

By the beginning of the 1900’s, thirteen osteopathic schools had been established, and tensions began to arise when Major Still recognized the appearance of a philosophical split within the osteopathic profession.

During this time medical legislation began to get involved and started to crack thy legal whip on those who were accused of practicing unregulated forms of medicine.

The first attempt to legalize the practice of osteopathy was conducted in Missouri during the winter of 1895 when the bill was passed in both the senate and the house. However, the governor at the time, William J Stone, refused to sign this bill into the law.

However, two years later a new bill was proposed by Judge Edward Hugbee, a representative from Schuyler county and osteopathic medicine was officially ratified under the law on February 25^th, 1897.

In the 1900’s broad osteopaths began to experience friction from state legislation as a result of their new academic responsibilities. There predecessors, straight osteopaths, aka lesion osteopaths utilized the OMT model which exempted them from medical legislation. During this time board osteopaths had to contend with two legislative hurdles if they wished to maintain their legal standards of practicing medicine.

In 1929, a curriculum for pharmacology was approved which led to an increase in legal status upon receiving the title of DO /Osteopathic physician.

This medical philosophy would later gain recognition during World War II, when the profession filled the holes of MD’s who assisted directly on the Pacific and European theatres. It was during this time the osteopathic profession began to implement surgical intervention, pharmacological prescriptions, and the issuing of birth and death certificates.

When osteopathic physicians began functioning under their own set of licensing boards, MD’s across the United States of America began lobbying for basic science examination that would be scheduled prior to state board examinations.

This legislation served to circumvent profession specific boards and established a university standard of knowledge of science and the practice of healthcare.

In the 1930’s it was observed the MD’s possessed the highest passing rates at 88.3% while DO’s and DC’s struggled tremendously with passing rates of 54.5% and 21.9% respectively.

Shortly after this times the field of osteopathy began to divert from its foundational principles of spinal manipulation and placed larger curriculum attention to Materia medica and surgery. Some historians argued that this shift occurred in light of Major Still’s death and produced three key changes.

1. Institutional – Alterations in the social structure of colleges, hosptials, and private medical practices were largely driven by the Flexner Report.

1. Scientific – Alterations in the curriculum led to increase credit hour requirements in surgery and pharmacology.
2. Technological – Alternations in the equipment used by physicians such as spinaltor and spinal manipulation therapy were replaced by pharmacology and surgery.

A Professional Business Merger

By the end of the 1950’s there was little mention of the usage of manipulation therapy within professional research literature. During this time a survey was conducted and it was determined that only 44% osteopathic physicians who graduated between the years of 1948-1953 utilized the OMT model on more than half their patient portfolio.

This was cited to be the result of decreased training in the art of joint palpation and manipulation techniques. In addition, it was also stated that during this an increased number of partnerships were offered to osteopaths to join forces with the allopathic profession.

In 1962, the osteopathic profession reached its philosophical peak when it signed a business merger with the California Medical Association.

Discussions regarding this merger were conducted over a 19-year period and the location of California was significant because previously this state had served as a strong hold for those who held belief in Major Stills original premise of spinal manipulation.

In 1963, osteopathic physicians in the state of California would be classified as medical doctors, and a stipulation stated that they should cease to identify themselves with the osteopathic profession entirely.

This merger seemed to benefit the American Medical Association in a one-sided fashion.

The AMA viewed pure osteopaths who, still held Major Still’s belief as inferior and responsible for the decreased quality of healthcare within the state. However, in the eyes of broad osteopaths this appeared to be an easy decision or compromise, in which they could finally treat their patients, freely, and the way they see best fit.

But this loss of liberty completely altered the trajectory of alternative medicine and placed it entirely on the shoulder of the chiropractic profession, who emerged as the next main target for the AMA to contend with.

In 1984, Francis Helminski (MA/JD) published the JOURNAL of LAW and Medicine with the title of peculiar science- osteopathic medicine and law.

This manuscript served to further the gap in ones association and belief in the OMT model. Within it, it is stated “the equation of osteopathy with manipulation has plagued the movement throughout its life… It has given rise to the present myth that osteopathy began as a cult of manipulation and later somehow outgrew its origins to embrace SCIENTIFIC MEDICINE” (12,37).

Although the osteopathic profession is represented by its professional organization, the AOA, practitioners of osteopathic medicine, are recognized by the AMA as physicians with full medical qualifications (43).

Questions for the reader to consider

• Why was the merger signed by the AMA & AOA respectively?
• How did this alter the practice and philosophies of both parties?

Recapping the Legacy of A.T. Still

Moving into the 21^st century, spinal manipulation therapy has become a specialty within the study of osteopathy.

 In a recent position statement, the AMERICAN OSTEOPATHIC ASSOCIATION (AOA) directed its members to refer to themselves as osteopathic physicians who utilized osteopathic manipulative treated instead of osteopathic manipulative therapy.

I often wonder what Major Still would have to say about the evolution or progress of his medical theory that he coined in 1882.

Although critics often argue that his philosophy of medicine was skewed after orthodox medical treatments failed his family, which resulted in the death of three of his children.

Following, this military veteran became influenced by a spiritual fever, which led him to accumulate alternative knowledge and philosophies of healthcare. Throughout the battle of the systems, it is fair to assume that Stills liberal philosophy to medicine and health made conservatives uncomfortable and/or threatened.

It had been 200 years since the Salem witch trials, but it was still quite ballsy to refer to oneself as a lightning bonesetter who utilizing magnetic healing in the 1880’s.

Still remained as the figurehead of the osteopathic profession until his death in 1917.

His later years were spent teaching in attempt to preserve the OMT model, which placed spinal manipulation as an integral component of medical theory. However, following the Flexner report and introduction of the new BASIC SCIENCE EXAMINATIONS, the pure osteopathic physicians began to fade into the darkness of history.

Some argue that it was utterly eliminated with the California merger of 1962 and erased as scientific when Helmski referred to the art of spinal manipulation as primal, cultish and uneducated.

With all of our health theories under scrutiny since the SARS-CoV-2 2 pandemic maybe it is time we begin as a collective to reassess what were once referred to as best practices.

If DO’s are no longer placing emphasis on the OMT model and spinal manipulation, is there a profession currently examining or conducting research on the human spine.

Yes, we are known as chiropractors.

A Chiropractic Origin Story – Coming soon

Refrences

1. Callahan, Daryl. “A. T. Still Timeline” atstilldo.com, March 24, 2023. https://atstilldo.com/a-t-still-timeline/
2. Haldman, Scott. Principles and Practice of Chiropractic. 2005. McGraw-Hill Publishing Company. https://www.amazon.com/Principles-Practices-Chiropractic-Scott-Haldeman/dp/0071375341
3. Sherlock Holmes’ Dr Watson was ‘based on Dundee doctor’ – BBC News
4. Judge Edward Higbee (1847-1929) – Find a Grave Memorial
5. Indigenous roots of osteopathy – Lewis Mehl-Madrona, Josie A Conte, Barbara Mainguy, 2023