Baltimore: Johns Hopkins Univ. Press, In the second edition of The DOs: Osteopathic Medicine in America, Norman Gevitz extends and updates his assessment of the relationship between osteopathic physicians, their allopathic colleagues, and American society. The second edition continues to chronicle in detail a historical basis from the osteopathic perspective as to its favorable relationship with the American public and its adversarial one with their allopathic colleagues. As he did in the first edition , Gevitz draws a clear portrait of the founding philosophy and the founder, Dr.
Andrew T. Still was trained in orthodox medicine before the Civil War. He spent most of his training in an apprenticeship under a local doctor with didactic work for an unknown period of time in Kansas City. His faith in the orthodox medicine of the time faltered with the death of three of his children from meningitis after the war. Faith-based philosophy and open-mindedness led to his success as a physician and his ability to found the first American College of Osteopathy in Clearly, the 21st-century osteopath has an inferiority complex, but even though the "orthodox" medical image and majority culture has maintained its dominance as mainstream medicine in America through breathtaking medical discoveries and great science, American capitalist culture, which thrives on choice, has rejected the notion that alternative medicine is quackery.
Some of them were hopeless. He lacked only a proper designation. William Smith — , a thirty-year-old Scottish physician who was in town on a business trip. Smith had been trained at Edinburgh and had studied for several additional years on the Continent; his background was in stark contrast to that of the self-taught country doctor. Some held college degrees, others had nothing more than a common school education. Still was a natural philosopher rather than an academician.
Students had to pick up what knowledge they could by listening to his extended metaphors and his sometimes rambling commentary. One of his followers declared: He rose to the lofty heights of his conceptions of life, health, disease and medicine by the purest of intuition. You load your car with everything necessary to sustain life and start off in the right direction.
So far so good. But in case you are side-tracked some where, and so long delayed in reaching the desired point that your stock of provision is spoiled. If complete starvation is not the result, your friends will be at least poorly nourished. In center, holding cane, is Dr. Still; on other side of skeleton is Dr.
William Smith. As a horse needs strength instead of a spur to enable him to carry a heavy load, so a man needs freedom in all parts of his machinery with the power that comes from the perfection in his body, in order to accomplish the highest work of which he is capable. Remember the company you have kept before coming here. You come to me with eyes big from belladonna, back and limbs stiff from plaster casts—you have been treated and dismissed as incurable by all kinds of doctors before coming to us, and if we help you at all—we do more than others have done.
No homeopathic practice with its sugar coated pills, must be allowed to stain or pollute our spotless name. Osteopathy asks not the aid of anything else. All it asks is a thorough knowledge of the unerring laws that govern its practice and the rest is yours. Was Nature ever intoxicated? The St. To and fro there surges a throng of ailing humanity sincere in purpose as the Eastern devotee who kneels at the tomb of Mohammed.
But the results accomplished are not visionary or fanciful, they are real and practical. Average issue circulation rose from several hundred in to more than 18, two-years later. There was the laboring man, the business man, and the professional man; there was the working girl, and the society favorite; there was the anxious husband with the invalid wife, the loving mother with her crippled child; there were scores on crutches and in invalid chairs; there were others who were compelled to depend on strong arms and tender hands.
Barker was a Methodist minister from Kansas who had fallen from a train, severely wrenching his neck; he subsequently developed sore eyes and ultimately became blind. Barker claimed to have seen oculists in three states before coming to Kirksville. I felt like toppling over at every step. Christian, the wife of a Baptist preacher, brought her seven-year-old son, who had suffered for three years from what had been diagnosed by two physicians as hip joint disease.
They were at once reduced without weights, braces, plaster of Paris, or any other paraphernalia; and now the boy is able to go anywhere on crutches, without his brace, feels no pain, the abscesses having disappeared, and will soon be well again. Blocker of Dark County, Ohio, was only bothered by an occasional pain in his ankle. Asked by a reporter if he believed in miracles, Mr. Greenwood, linked osteopathy to the aspirations of Midwestern populism. Would you call that class legislation? A monopoly of free gospel certainly. Then is not our medical class legislation as bad?
I hold that if medicine is a science that no legislation is necessary to uphold or protect it. If it is not a science the challenge is open to the world to disprove it. Louis by the improbably coincidental name of A. He argued that every cult, regardless of its methods, professes cures. Osteopathy was simply no different from Christian Science, magnetic healing, and the water of Lourdes. As to osteopathic theory, it was entirely invalid. Do our studied research in pathology and therapeutics go for naught? Strange is it not that of the thousands of skeletons carefully examined that frequent examples of misplaced bones have not been discovered, if such truly is the cause of all disease?
We see patients daily recovering from sickness and disease in whom no effort has been made to reduce misplaced bones, showing that the causus morbi did not lie in that direction. Then let him inquire of the patients who tell him in their stories, how many doctors had declared their recovery impossible, and then, and not until then, let him make up his mind as to whether or not osteopathy is a fraud, its practitioners humbugs and its supporters liars. To pay such an army of liars would consume the capital of the state.
If they are hysterical why did not their doctors cure them? The osteopath would not be required to pass any test or attend classes for any set length of time. All of this went for naught. Indeed, there was little Still or his followers could say to justify what then constituted osteopathic education and standards. From through , three classes had graduated. The length of training varied from nine to eighteen months and consisted of lectures in anatomy, osteopathic principles and technique. Still believed other subjects were unnecessary.
Anatomy, in his view, was the sole medical certainty. There was no need to bother with the theories and speculations of other branches of medicine. This time, the DOs did not face an executive veto. Bells rang and whistles blew. Anything that would make a big noise went.
Within a few years there were seven hundred full-time students in attendance. Among those he found to assist Smith and himself were C. Proctor — , a university graduate who also held a DO; Charles Hazzard — , a university graduate who also held a DO; Carl McConnell — , who after earning his osteopathic diploma received an MD at a homeopathic school; and the three Littlejohn brothers: J.
Whereas Still had built his system largely upon the principles and practices of magnetic healing and bonesetting, his new faculty relied upon more reputable sources of knowledge. In ancient Greece, frictions—a form of massage—were employed to treat a wide range of ailments. Although rediscovered during the Renaissance, it took a minor position in therapy compared to drugging.
What Is a Doctor of Osteopathic Medicine, and Should You See One?
However, over the course of the next several centuries it would be promoted by a host of distinguished physicians including Gerald von Swieten —72 , who advocated manipulation as a general measure to increase blood circulation. Later in the century, S. Weir Mitchell , as a result of his Civil War hospital experience, relied on manipulation to treat many traumatic nerve and muscle injuries and by was including it when treating neurasthenia, hysteria, and locomotor ataxia. Pardington migraine; and A.
Eccles , constipation. George H. Although the success of massage in treating a number of disorders went virtually unchallenged by other practitioners, it failed to be integrated alongside materia medica in the standard medical school curricula. This attitude did not necessarily apply to other countries. Hundreds of articles and many books on this system were published during the latter half of the nineteenth century.
It also follows that osteopathy must generally work more quickly and easily than massage in such cases as the latter could reach, and that it must succeed in a large class of cases beyond the power of these manual systems, since to this class belong so many disease conditions depending upon some removable obstruction not noticed by them. In addition, advocates of these two systems provided them with experimental evidence of how manipulation had cured.
Zubludowski, for example, found that massage increased electrical contractility of the muscles; Hopadze showed how it sped assimilation of food; Golz provided evidence that it aided the circulation of blood; Mitchell reported that it could produce an increase in red blood cells; and von Mosengeil found that manipulation promoted lymphatic absorption. To this question they found a partial answer in neurophysiology.
In a Scottish physician, Thomas Brown, wrote an article in which he argued that pain about an internal organ could be caused by a disturbed vertebra that shared a common nerve supply. To treat this type of pain, said Hilton, one must only treat the spine, which he did with rest and restriction of mobility. Martin Littlejohn argued by analogy that if referred pain could be produced by displaced vertebrae other remote symptoms, as Still argued, could be caused by them as well. Furthermore, many contemporary scientists speculated that the nerves had a trophic function—that is, they would directly supply nutrients to body tissues—so it followed that a disturbance of a spinal nerve could materially weaken the organ it supplied.
Brown-Sequard — If, for example, a patient was suffering from a bad case of indigestion and there was no discoverable disturbance in segmentally related vertebrae, one could nevertheless relieve the condition by treating the relevant centers. Still ignored the contradiction. His faculty, however, preferred to face the problem more directly. Each of them accepted the existence and etiological role of microorganisms.
If, as they believed, these structural lesions produced derangement of physiologic functions, it would follow that in their presence the body would automatically be put into a state of lowered resistance. Under these assumptions, osteopathic procedures seemed entirely applicable and necessary. A directory published in listing graduates shows Under such sponsorship the osteopath was formally introduced to the entire community. The system was new and in many areas unheard of. Often the term osteopathy was a handicap; quite a few prospective patients took it to mean that DOs thought all ailments were due to diseased bones or that they only treated fractures and dislocations.
He remained adamant. I asked her if she had put the same question to [her last physician] that she had put to me. She replied that she had not. It took me another hour to explain the difference between osteopathy and Christianity. For one patient I had to insulate the table, as they think this is some form of magnetic treatment. They were afraid to tell of their relief.
Several of them published descriptions that were eloquently worded and simple to understand. As a violin or engine needed tuning or adjustment every so often, so also did the human body. Many are the diseases entirely beyond the reach of the medical attendant that promptly surrender to the ability and the knowledge of the osteopath. In other words, there is not a single thing that medical men can surpass osteopaths in except. Its theory is most reasonable. But it has a practical side as well as a reasonable theory. Most DOs agreed with Dr. Evans, who observed: The over sanguine osteopath who advertises, writes, and talks constantly about cases that are remarkable for the rapidity with which they have yielded to the osteopathic treatment does himself and the profession an injustice.
People are led to expect miracles. It is wise to explain to them that it will take time to eliminate poisonous drugs from their system and to induce healthy normal action in torpid organs that have long been dependent upon extraneous stimulation. It is far better to impress this upon them than to tell wonderful stories— no matter how true—of marvelous cures effected in one or two treatments. By the latter method the patient is led to expect the same results in his own case and may be disappointed, for nature, though sure, is sometimes slow. If, on the other hand, more is accomplished than promised, osteopathy has won a friend that will never falter in allegiance to our system.
One problem generated by this arrangement was that patients expected as many sessions within the month as possible, regardless of their ailment. As a result, it became a matter of custom to administer no more than three treatments per week per client. So-and-so goes to Dr. In a week the patient is so prostrated by the frequent treatment that she is glad to admit she cannot stand so much osteopathy. It is all I can do to get her three times a week which is as much as anyone can stand without becoming debilitated. Mason Pressly and O. It is results that tell.
Each issue of the Journal would also contain notices by many DOs of their change of address, often from town to town. For them, osteopathy was not a sure-paying proposition, and not a few dropped out of practice altogether. Some regarded DOs as harmless quacks whose clienteles would patronize any new healer who happened to arrive in town. If the latter went quietly about his or her own business, there was usually small chance of confrontation. However, the osteopath who arrived in town with much fanfare, making extravagant claims regarding his or her own skill while intimating that the MDs were in league with the undertakers, was simply asking to be prosecuted.
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Whenever arrests did take place, the DOs would maintain that jealousy and fear were the prime motivating factors. Once they had begun to prove they were superior doctors, their argument ran, the MDs in selfdefense would have to do all they could to get rid of them. When he arrived in he found himself in the midst of an epidemic of what had been diagnosed by local doctors as diphtheria. Though his experience to date had been with chronic disorders, Still was soon called upon to treat a victim.
After his patient made a rapid recovery following conscientious applications of manipulative treatments to the neck, shoulders, and head, Still was asked to care for upwards of seventy children with reportedly only one fatality as a result. The State Board of Health, despite his apparent success, authorized his arrest for practicing without a license. In Harry Nelson, DO, who had been practicing in Louisville for about a year, became tired of the threats issued by the Kentucky Board of Health that he had better leave town or prepare himself for incarceration.
Nelson would be dangerous to the health, limbs, and lives of those citizens who might be treated by him in most instances. The following year he brought his case to the Court of Appeals, which reversed the original decision and granted a permanent injunction against the board from preventing any DO from engaging in his profession.
MD representatives argued that the term medicine as found in the various healing arts statutes should be construed in its widest possible sense, while the DOs maintained that it meant the practice of administering drugs—and nothing more. Physicians in and nearby the town of Chelsea had become upset over the activities of Dr. This prompted the Vermont Medical Association to call upon the legislature for relief. A number of them, including the lieutenant governor, were most pleased.
Our family physician advised its immediate removal assuring me that nothing but the knife could remedy the evil, and stating that it would soon assume a malignant form if not removed without delay. It was a great shock to my nervous system, and I had not recovered from it, when the same trouble appeared in my left breast.
I had heard meantime of osteopathy and resolved to try it before again submitting to the knife. I went to Kirksville and was completely cured in six weeks time. My own eyes saw and my own hands felt the obstruction that caused the trouble in both cases, and I knew very well that the knife was never necessary.
Osteopathy has clearly proven its right to recognition in the healing of cases heretofore declared only curable by the knife, and it is only right that its supporters should sustain its claim. After hearing her dramatic story and her rebuttals of some of the arguments put forward by the MDs, the legislature passed the measure, and the governor, another osteopathic patient, happily signed it. It stands between me and my body and tells me what kind of doctor I must employ. I know how Adam felt in the Garden of Eden about the prohibited apple.
Nevertheless, in addition to Vermont and North Dakota, thirteen other states had by established laws regulating the new system—Missouri , Michigan , Iowa , South Dakota , Illinois , Tennessee , Montana , Kansas , California , Indiana , Nebraska , Wisconsin , and Connecticut By , of the estimated four thousand DOs in practice, approximately one-half were graduates of these other schools.
Entrance standards were nominal. Some colleges, following the American School, limited their instruction to several months of anatomy, osteopathic diagnosis, and therapy, while others took it upon themselves to increase the time necessary for graduation as well as the number of subjects covered. The teaching staff of these schools was small, generally between three and ten professors depending on the number of students enrolled. In some cases a majority of the instructors did not possess a DO degree or have any previous osteopathic training.
MDs who wanted to learn something of osteophathic techniques as an adjunct to their own practice were pressed into teaching some subjects in lieu of part or the whole of their tuition fee. In almost all cases, MDs, whether they served on the faculty or not, were automatically given advanced standing, allowing them to complete the requirements for their diploma in approximately half the normal time. There is increasing demand for it. No student properly equipped has made a failure of it.
The supply is short. This opens up a highway to success. Since they were then denied entrance to all but a handful of regular medical schools, here was an alternative method of becoming a doctor. In addition to citing the alleged quality of their respective facilities, equipment, and staff, many focused on the environmental conditions of the city in which their school was located.
Brought to Kirksville on a stretcher in , Ward looked to Still for relief from a severe asthmatic condition. After he was restored to health, Ward entered into a business arrangement with his benefactor to learn his methods. Within months after the college opened, however, the two had a falling out, and eventually Ward left town. He relocated in Ohio, enrolling in the medical department of the University of Cincinnati. After obtaining his MD degree there in , Ward moved back to Kirksville.
There, with the help of local businessmen who believed the town was large enough for two osteopathic institutions, he established the Columbian School. Columbian students were therefore taught the principles of drug therapy along with other subjects now found in the expanded American School of Osteopathy curriculum. After they completed their twenty-month course and received the DO degree, they could enroll for another year of medical and surgical training, upon completion of which they would be granted the MD.
This he left to his friends and associates.
In February of , a small group of American School of Osteopathy alumni met in Kirksville and decided to establish a national organization for this purpose. Graduates of other schools were then invited to take part in the planning, and by April they had collectively launched the American Association for the Advancement of Osteopathy, which was renamed and restructured as the American Osteopathic Association AOA four years later.
To protect autonomy, it fought for independent boards of registration and examination. Early lobbying campaigns had usually been conducted by individuals speaking for only one segment of the emerging movement, leading to situations such as that in Vermont, which had extended practice rights only to graduates of the American School. This lack of unanimity often resulted in a poorly constructed compromise or no law at all. Several of the early practice acts placed the regulation of osteopathy under the jurisdiction of existing state medical boards.
In some states a DO was added to these agencies; in others no representation was granted. Although osteopaths would be examined alongside MDs, taking the same written tests in such subjects as anatomy, physiology, and chemistry, they were exempted from answering questions concerning materia medica or therapeutics.
In a few states this arrangement seemed to work out satisfactorily for the DOs, as they found they could do nearly as well as the allopaths in passing examinations and becoming licensed. In Iowa, for example, the legislature granted the medical board the power of accrediting osteopathic schools, with only graduates from approved institutions becoming eligible for licensure.
After a cursory look at their catalogs, the board rejected all osteopathic colleges, thereby preventing any DO from legitimately practicing in the state and thus circumventing the intent of the lawmakers. These individuals, once they had been appointed, would be responsible for testing DO candidates, negotiating reciprocity agreements with other boards, and disciplining errant practitioners. Frequently the societies faced a hard struggle. During the s and s, when medical practice acts were being reintroduced, several states granted the allopaths, homeopaths, and eclectics separate boards.
Some states addressed these problems by abolishing this system and placing representatives of each sect upon a single, allencompassing board, where they all kept a watchful eye on one another. Every inch of progress made by our profession since its discovery has been contested by them. And after securing representation upon their boards, what is our position? Are we loved any more by them? No, we are still at a disadvantage because they overwhelm us in numbers and ours being unwelcome company, we need not expect many favors.
Certainly we shall receive no help to reach out and grasp greater and better things such as must and will come to us with the right kind of encouragement and conditions. In , of the thirty-nine states that had passed osteopathic practice laws, seventeen provided for independent boards. From E. Booth, History of Osteopathy Accordingly, the profession won for itself a considerable degree of autonomy and legal security. Certain competitive activities— such as cutting tuition, stealing students, and shortening the time necessary to earn a diploma—were working to their mutual detriment.
To stop these practices, each member of the ACO pledged to adhere to clear guidelines covering admissions, attendance, tuition, transfers, and advertising methods and to offer a mandatory two-year course. One of the critical areas of concern was the length of time needed to train and graduate DOs. Certainly the two-year curriculum of twenty months looked meager beside the four-year, thirty-six month program offered by almost all allopathic institutions. Some believed that laboratory instruction was relatively unimportant. This argument was skillfully answered by Dr. Martin Littlejohn, who, along with his brothers, had left Kirksville in to establish a school in Chicago.
They did succeed, but theirs was a struggle to evolve their knowledge as they advanced. To the busy practitioner, this is no easy matter. There was concern that the new requirement might accelerate this trend. Curiously, the greatest objections were raised by the most solvent of the colleges. The younger Still pleaded for an optional rather than mandatory threeyear course, but the AOA rejected the request. However, they did by a narrow margin decide to give Kirksville an additional twelve-month grace period.
This emboldened all of them to initiate an optional fouryear course. In the Philadelphia school, spurred by recently enacted requirements for college registration in key states like New York, made the extra year compulsory for new matriculants. By all graduates of approved osteopathic colleges had received instruction equivalent in length to that of their MD counterparts.
Its staff recognized that for the JAOA to become a truly professional publication, the quality of its articles on practice, particularly those based on actual case histories, would have to rise above the level then prevalent. Do they know what they fail to cure? This effort, it was thought, not only would be good experience for the average DO, but would also help to support osteopathic claims. While most of these printed cases were described without the needless bluster, self-advertising, and harangues against the MDs, serious qualitative problems in the reports remained.
Only a small number of examples where manipulation was found to be ineffective were included. Though these supplements were not meant for distribution to patients, most DOs had no desire to appear as anything less than successful before their peers either. In a given condition, for example asthma, one DO would have found lesions along the cervical spine, another in the dorsal area, while a third would have located them in the lumbar region; and each would announce positive results by manipulating only where the lesions had been palpated.
Still Research Institute. However, their evidence supporting causal relationships was less than compelling. However, as the number of new DOs increased, it became common for two or more to serve a relatively small town. In such communities, particularly where osteopaths and allopaths competed for limited health dollars, price wars and instances of character assassination took place.
These occurrences made osteopathy appear as something other than a lofty calling—an impression furthered by those DOs who engaged in indiscriminate advertising. This document, based in part upon the code of the American Medical Association, emphasized cooperation rather than competition. Ministers and schoolteachers received special reduced rates, while the poor were to be treated for free. A physician ought not to take care of or treat a patient who has recently been under the care of another osteopathic physician, in the same illness, except in the case of a sudden emergency, or in consultation with the physician previously in attendance or when that physician has relinquished the case or has been dismissed in due form.
Unethical advertising was also denounced in this document, and later the AOA published a list of what it found to be the most offensive practices. One type of promotion which was looked upon with great favor was the lay-oriented osteopathic health journal, such as the one established by Dr. Henry Stanhope Bunting — Working as a reporter for a Chicago newspaper, Bunting was sent off to Kirksville in the mids to write a story on Still and his movement.
Impressed with what he found, he soon returned to enroll. After graduating with his DO degree in , he settled again in Chicago, where he started a practice and took night classes at a medical college to further his education. In the busy Dr. Bunting introduced two continuing monthly publications; the Osteopathic Physician, for the practitioner only, dedicated to voicing all sides of every professional controversy; and Osteopathic Health, which was aimed exclusively at the general public.
Compared to previous lay literature, OH, as it was commonly called, contained little in the hard-sell vein. Instead, there were broad discussions of the philosophy, principles, and practice of osteopathy. Bunting, who maintained an avid interest in advertising theory and wrote a textbook on the subject, believed that the most effective means of getting the attention of people was via the underplayed message.
As each of these and other new advertising ventures demonstrated their value in generating new business, the desire for and use of more questionable methods greatly diminished. For those members of the AOA who were unwilling to abide voluntarily by the provisions of the code of ethics, disciplinary action became necessary.
Every year the Board of Trustees investigated alleged misconduct, suspending or expelling those found guilty of serious violations from the ranks of the association. However, not all osteopaths sought membership in the AOA. In only 51 percent of the approximately 6, DOs belonged.
In , 57 percent of roughly 7, practitioners were in the fold. Therefore, although instances of disreputable behavior would continue to be a problem for the movement, organized osteopathy had established the basic institutional mechanisms for dealing with unethical practitioners. At best, it would be a struggle of many weary months. Most of those so contacted wrote back that they would henceforth reject such ads, and in the committee reported to the AOA Board of Trustees that there remained only one magazine of any sizable circulation that refused to honor their request.
Quite a different problem, however, was presented by those individuals practicing what appeared to many to be osteopathy under a different name. The most numerous of these were the exponents of chiropractic, founded by Daniel David Palmer — According to Palmer the principles of this system were fashioned by him in , while he was making a living as a magnetic healer in Davenport, Iowa. Reasoning that a displaced vertebra was responsible, Palmer manipulated the spinal segment into its proper position, and the janitor announced that his hearing had returned.
Initially he found few followers, training only 15 students through In he was convicted of practicing medicine without a license and was sentenced to spend six months in jail. During his incarceration, his school was taken over by his son, Bartlett Joshua Palmer — The two were better known as BJ and DD. Bitter feelings between the two remained strong. DD died a few months later, with some of his followers convinced that his death was a consequence of his injuries. For those who could not appear in person, a correspondence course was instituted.
Unlike those with fake DO diplomas, however, chiropractors claimed that they were not pretending to be osteopaths and were therefore innocent of any offense. In court they cited a number of differences between the two systems. The DOs, they pointed out, commonly adjusted several vertebrae to treat a given disorder; they invariably adjusted but one. The technique also varied. Osteopathic manipulations were based on the lever principle, namely, the application of pressure on one part of the body to overcome resistance in motion elsewhere.
The most common chiropractic procedure of the era had the client lying prone with little, if any support below the spine. In court, when DO witnesses were called to the stand, they would often testify that this method was crude and dangerous and would not be employed in osteopathic practice. With respect to the element of danger, the defendants were only too glad to present patients who had been so treated, attesting to the safety of such maneuvers.
As a result of these tactics, they generally won acquittal. Each required for licensure an eighteen-month course of personal instruction at a duly chartered college. By twenty other states had similar statutes. Thus, while the DOs, through the AOA, had made considerable progress in obtaining some professional recognition insofar as certain measures of organization, autonomy, socioeconomic status, and education were concerned, they nevertheless could not prevent the rise of others who could more inexpensively and quickly produce practitioners capitalizing upon the therapeutic modality that was the central feature of the osteopathic system.
Vying for the support of the majority of practitioners were two distinct groups. This, after all, was the same approach that Still had successfully employed to permit crippled people to throw away their crutches and other chronically ill individuals to lead a more normal life. Lesion osteopaths argued against the inclusion of these areas of practice, principally on the grounds that the DO could not be expected to perform two or more different roles as well as one.
If patients were in need of a surgeon or an accoucheur, they could easily be referred to an MD specialist. The broad osteopath saw this reasoning as short-sighted.
They maintained that if osteopathy was to rank with allopathy, homeopathy, and eclecticism, it was imperative that it provide the same range of services to its clients as they did. However, available evidence strongly suggests that he originally wanted to add these subjects,1 and once they were integrated in he gave them his full support.
In he wrote that his students were to be taught all operative surgery commonly performed in rural areas and were to become knowledgeable in the handling of obstetrical cases. At the time Booth undertook his survey in all the institutions he visited were conducting classes in obstetrics and gynecology and in surgery. For the —9 academic year, the Kirksville, Chicago, Philadelphia, and Los Angeles colleges offered a combined average of hours of instruction in these areas.
Before comparatively few DOs performed surgery other than setting fractures and closing minor wounds. The paucity of opportunities for education in surgery, combined with restrictive state licensing laws for osteopathic surgeons, made this area of practice relatively unattractive. Courtesy of Philadelphia College of Osteopathic Medicine.
A few osteopaths in this era did specialize in surgery or obstetrics, and most of them employed manipulative therapy in their practice, believing that this modality gave them a decided advantage over their MD counterparts. In obstetrics, strictly osteopathic procedures were thought to shorten the duration of labor, lessen the pain, prevent mastitis, and secure a more rapid convalescence of the patient.
She noted similar differences in multiparae deliveries. Soon after Still instituted this protocol, a dramatic decline in the rate of postsurgical pneumonia was recorded among his patients. Instead of having a temperature of , pulse , respiration In Frank Young, DO, MD, then at the American School, wrote a textbook entitled Surgery from an Osteopathic Standpoint in which he cautioned against manipulation of patients with ankylosis, dermatitis, hernia, skin ulcers, glanders, cysts, osteomyelitis, scurvy, gangrene, and septicemia.
In succeeding years others expanded the list. Still believed his system to be complete. His graduates could deal with a wide range of ailments and conditions and could utilize all the modalities he felt essential to general practice. To cure disease the abnormal parts must be adjusted to the normal, therefore other methods that are entirely different in principle have no place in the osteopathic system.
People in looking at it from a distance might mistake the tail for a kite. They, the people, are very likely to call osteopathy anything else but what it is anyway. Is it, can it be possible, that some of us are helping them to do this? Smith spoke of the use of the colon tube. I have interviewed a number of Kirksville graduates in Minneapolis and St. Paul and I have listened to their talk pertaining to this matter but I have never yet learned any purely manipulative method which will invariably move feces in the colon. And if it was one who was near and dear to me above everything else that Dr.
Smith was called to treat, and some hot water and the colon tube would save that life, and he refrained from using them in order to stand by osteopathy, I would not think of him as being much less than a murderer. Young never studied under Dr. He got his osteopathy second hand. It may be just as good, but when he asserts that osteopathy as taught by Dr.
Still and those men [he instructed] failed, not that he failed in order to substantiate his position. I have heard one or two argue that it makes no difference whatever one uses as food provided his vertebrae, ribs, etc. It would be quite laughable, if it were not so serious to hear such narrowmindedness. If their proposition were true, medical knowledge prior to the discovery of osteopathy amounted to naught. They do not seem to realize that it was through medical knowledge already existing that osteopathy was developed.
It is just such people as this that harm us more before the medical world and public more than anything else. Given a lack of policy directive, it was left to individual schools and practitioners to decide their own course. In the ensuing years the lesionists were encouraged by the discarding or avoidance of some adjuncts by most of their colleagues; however, sentiment had clearly shifted towards the position of the broad osteopaths on others.
Despite that the same principles put for- EXPANDING THE SCOPE 75 ward in the adjuncts controversy were relevant here—the freedom of the practitioner to choose any modality thought helpful in the management of a given disorder and the right of the schools to teach what they desired—the symbolic meaning of chemical and biological agents to the pioneers of the movement made this a lengthier and more painful matter to settle. The last third of the nineteenth century was marked by several momentous changes in the practice of orthodox medicine.
With each passing year an increasing percentage of regular physicians came to rely on a smaller number of drugs in less heroic doses for those conditions in which pharmaceuticals seemed indicated. Still, for the most part, was unimpressed by these advances, believing that the chemical and biological tools employed by the MDs were often toxic to the body, as well as being vile and disgusting.
One might conceivably eliminate symptoms through such modalities, but not the underlying cause, namely, structural lesions. Finally, whatever the alleged usefulness of these agents, osteopathy was always equal to the task. Their additional training and experience had convinced them that some of these tools had proven their worth and there was no valid reason for not using them in patient management.
If a client was suffering from gout, it made sense to them to both manipulate and administer colchicine. Similarly, in malaria, why not adjust the spine and give quinine together? In this fashion, the sufferer would receive the best of both systems. Still did not think much of this view.
He ought to be put it a class by himself and no doubt will be if he attempts to practice osteopathy and medicine combined. Medicine and osteopathy as therapeutical agencies have nothing in common either theoretically or practically, and only an inconsistent physician will attempt to practice both. Osteopathy does not need to be bolstered up by the use of any therapeutical knowledge to be learned at any medical school. Each state association should adopt such rules as will require the resignation of all two-faced practitioners and prevent them from being taken in hereafter.
Osteopaths cannot afford to compromise their position in regard to drug medication and should bar from their association all mixers and their ilk, who honor neither the profession of osteopathy nor medicine. Hinckle, DO, MD, to resign. In an eloquent reply he wrote: Being a physician and not a sectarian practitioner I am heir to and privileged to make use of any and all therapeutic measures which the accumulated knowledge of centuries has shown to be of value, or which future learning may place within my reach regardless of its source or character. Every physician must decide from his own experience and from the experience of others as to the relative value of the curative measures at hand and on the breadth of his learning, the accuracy of his judgment and his freedom to choose will decide his stature as a physician.
As membership in your society can therefore be purchased only at the price of intellectual liberty, I hereby present you with my resignation preferring rather the glorious isolation of unfettered thoughts and activities than the company of those who are slaves to creed and dogma. In Frank Furry, DO, MD, then vice-president of the AOA, told his colleagues of his own dilemma in a poignant account of caring for his daughter, who had contracted diphtheria.
I had kept myself reasonably well posted on the serum therapy. I chose osteopathy straight and we fought it out on that line and lost. No internal medication was used, excepting a hypodermic injection of strychnine to support the heart during the intubation process at the last. The specialist who performed the intubation. Furthermore, it appeared to them that even more instruction in these modalities would have to be given, whether they liked it or not, if their graduates were to secure greater legal privileges insofar as surgery and obstetrics were concerned.
In Illinois, for example, the medical act allowed for the granting of two types of licenses, one for a physician and surgeon and the other for a drugless practitioner. Such approval required the inclusion of a complete course in materia medica. Supporters of the Chicago school tried to change the law, but repeatedly failed. It then applied for recognition but was turned down on the grounds that the subject was not adequately taught. The Littlejohns sued the board but eventually lost their case, whereupon ownership of the institution was transferred and the course was dropped.
The Los Angles School therefore made the necessary changes and thus became approved by the composite California Medical Board. Both Philadelphia and Boston offered optional courses on materia medica which did not appear in their annual catalogs.
The DOs: Osteopathic Medicine in America by Norman Gevitz
Henry Bunting, publisher of the journal Osteopathic Physician, listed a number of orthodox remedies and hypothetical situations for his colleagues to consider: If you had an elderly patient whose body was eaten out with malignant cancer, dying by inches, would you yield to her entreaties and give her morphine?
If you had a son who was a cretin would you give him thyroid extract? If your child had diphtheria would you use antitoxin? If bitten by a mad dog would you yourself take the Pasteur treatment? If you had a patient bleeding to death would you blanche the wound with adrenaline? Would you use pumpkin seed to expel a tapeworm?
Would you give an anemic organized iron? If you had a syphilitic patient would you use mercury or salvarsan or anything else now used to help that condition? The enemy has broken through the picket. Shall we permit the osteopathic profession to be enslaved to the medical truth? Although this action seemed to signal the dawn of a new era for the movement, a rather extraordinary chain of events occurred soon afterwards which temporarily restored the lesionists to power.
With the profession then seeking additional evidence with which to pressure Congress to allow its members to serve in the military medical corps, a campaign to gather and publish statistics was launched and given wide publicity in the Osteopathic Physician and JAOA. Of 6, pneumonia reports, there were only fatalities a With sentiments towards biological and chemical agents diminishing, those DOs who supported the resolution and Oregon amendment reasserted themselves.
Nevertheless, once the initial wave of renewed enthusiasm had passed, dissatisfaction with the new AOA policy became evident. The broad osteopaths, ending a discreet period of silence, again took the offensive, blasting away at what they felt was the intellectual vacuousness of the AOA position. However, many practitioners seemed more upset by the adverse effect the policy had on their efforts to obtain favorable laws.
Many legislators refused to budge from their long-held view that before they would seriously consider their requests, the DOs would have to demonstrate that they received the same breadth of undergraduate training as did the MDs. This meant teaching the use of all generally recognized preventive and therapeutic measures. In , due to strong student pressure, administrators of the Chicago College announced that it would once again attempt to meet legislative demands by adding a comprehensive course in materia medica to the curriculum.
In July , members of the board met with representatives of the Associated Colleges of Osteopathy and hammered out another compromise. What this would include was not made explicit; nevertheless, it was thought that the title would satisfy the lawmakers. At the turn of the century medical education in the United States was noted for its disparities. Most existing boards of registration and examination either did not have the power to set meaningful standards for the colleges or had declined to do so. In order to determine the actual situation in the colleges, the AMA Board of Trustees the following year authorized the council to undertake a complete on-site survey and to rate all MD-granting schools.
Although the grading was reportedly lenient, only 82 were given Class A, or ap- proved, ranking; 46 were placed on Class B, or probation, and 32 were designated as Class C, or unapproved. Many colleges were thus motivated to begin making needed improvements, and others simply shut their doors. Between and , the number of MD-granting institutions decreased by Though Flexner found some colleges upholding what he considered to be satisfactory standards, these constituted a decided minority.
With respect to matriculation, only one of four was insisting upon either a high school diploma or liberal arts college credit as the minimum prerequisite for admission; the remainder were permitting even the barely literate to enroll. First, he urged that all proprietary schools be closed down. Since the United States then had far more MDs per , people than in the industrialized European nations, it was unlikely that the loss of these institutions and their graduates would lead to a physician shortage.
He further recommended that each surviving college become an integral component of a major university, thus ensuring higher academic standards. Since tuition fees could cover only a fraction of the expenses necessary to support an adequate program, other sources of income had to be cultivated.
Now in a position to mobilize public opinion, the various groups committed to change went forward in their efforts to accelerate the progress already being made. First, the number of schools steadily dropped. Commercial and otherwise weak institutions were forced out of business as more state boards accepted the continually updated ratings of the Council on Medical Education. In the council ruled that all incoming students had to have completed two years of college work. As of , 83 percent of all matriculants exceeded this minimum, while 49 percent enrolled with a baccalaureate degree.
During the —35 and — 36 academic years, 55 percent of the total income of all medical schools was raised through taxes, public and private general university funds, and philanthropy. These advances helped spur considerable progress on the postdoctoral level. From then through the mids, standards for internships were regularly strengthened as this additional year of training became all but obligatory. These changes, along with those on the predoctoral level, would provide the American people with a more uniform corps of highly skilled MDs.
It was found he was treating even adenoids and appendicitis. Therefore, it was clear that osteopaths at least this one were diagnosing the same diseases which physicians were called upon to treat, therefore osteopaths should have the same training in fundamentals. Flexner argued: Whatever his notions on the subject of treatment, the osteopath needs to be trained to recognize disease and to differentiate one disease from another quite as carefully as any other medical practitioner.
Whether they use drugs or do not use them, whether some use them while others do not does not affect this fundamental question. All physicians summoned to see the sick are confronted with precisely the same crisis: a body out of order. No matter what remedial measures they include—medical, surgical, manipulative—they must ascertain what is the trouble.
There is only one way to do that. The osteopaths admit it when they teach physiology, pathology, chemistry, microscopy. This pattern characterized the other basic sciences as well. At Philadelphia it happens to be in a dark cellar. At Kirksville, a fair sized room is devoted to pathology and bacteriology; the huge classes are divided into bands of 32, each of which gets a six weeks course following the directions of a rigid syllabus, under a teacher who is himself a student.
Clinical instruction fared no better. And these for the most part he begins to see only. Outpatient contact was similarly restricted. Each of the colleges operated a pay clinic that was staffed by the faculty, in which student participation seems to have been limited to the care of charity cases. The instruction furnished for this sum is inexpensive and worthless. Not a single full time teacher is found in any of them. If sincere its votaries would be engaged in critically building it up.
They are doing nothing of the kind.
Reform, they believed, would have to be slow. With respect to preprofessional education, the AOA Board of Trustees in stipulated that henceforth each school must maintain an entrance standard of no less than a high school diploma or its equivalent to keep its accreditation rating. However, no attempt was immediately made to enforce this provision, and it was not until the early s that all the schools appeared to be fully complying. Most DOs sided with Dr. As many of these disappointed students came from farms and small towns, the standard had the indirect effect of causing a decline in the percentage of recent MD graduates deciding to locate in sparsely populated areas.
They received no direct tax support, no general university funds, and, in comparison with MD institutions, little outside philanthropy. In reportedly 92 percent of the gross receipts of all the colleges was secured from tuition fees alone. In the Los Angeles College moved to a new campus, where three large buildings were erected over the next decade.
The colleges added a mandatory fourth year, introduced a graded curriculum, and integrated the teaching of biological and chemical agents into the course of study. As a result, in its promotional literature the profession could boast that in terms of subjects presented and time devoted to them, MD and DO schools were equivalent.