Osteopathic History

The Founder

The founder of the osteopathic profession was Andrew Taylor Still (1828-1917). Like most American physicians of his time, he learned medicine by apprenticeship, reading, and his own anatomic dissections, probably with a course of lectures from a long-defunct Kansas City medical school. In addition to practicing medicine, he farmed, fought in the Civil War on the side of the Union, and served briefly in the Kansas Free-State Legislature.

After losing members of his own family to spinal meningitis in 1864, his longtime dissatisfaction with the “heroics” methods of orthodox medicine intensified his search for a better way. He searched by studying, thinking, and examining the anatomy of cadavers obtained from Indian burial grounds.

In 1874 Still attempted to present his findings at Baker University but he could not get a hearing. Further he was rejected from the church on the basis that only Christ was allowed to heal by laying on of hands. His description of that experience makes it clear that the “laying on of hands” was therapeutic manipulation.

Late in 1875 Still moved from Kansas to Kirksville, Missouri, where he spent the rest of his life.

Osteopathy

The term Osteopathy was coined by Still in about 1889. The story is told that when challenged because this word was not in the dictionary, Still replied “We are going to put it there.” The word became for Still and his followers a symbol for medical reform, for a science that would refocus medicine on “the perfect works of the Creator.” Osteopathy worked with and facilitated the natural machinery of the body for normal and reparative function and did not work against it, as seemed to be the case with purgatives, emetics, bloodletting, and addictive drugs.

Osteopathic Schools

The first successful osteopathic school, the American School of Osteopathy, was chartered in May 1892 and opened that Fall with a class of about 21 men and women, including members of Still’s family and other local people. The goal, as stated in the revised (1894) charter for the school, was “to improve our present system of surgery, obstetrics, and treatment of diseases generally, and to place the same on a more rational and scientific basis, and to impart information to the medical profession….” The charter would have permitted granting of the MD degree, but Still insisted on a distinctive recognition for graduates, DO, for Diplomate in Osteopathy (later Doctor of Osteopathy). The growth of both clinic and school was spectacular. The town of Kirksville prospered and came to regard Still, who once was ridiculed, as a citizen of immense importance. His statue even stands in the town square.

Licensure

The first legislative recognition of osteopathic practice came from Vermont in 1896, where graduates of the American School of Osteopathy, Kirksville, were accorded the right to practice in the state. Missouri has a successful bill signed into law in March 1897. By 1901 every state had some form of legislation: at least registration, with a diploma from an accepted school, or a state examination of some type. When the Missouri board began to function in 1903, the first certificate it issued was to A.T.Still.

A final dramatic chapter in the American licensing story came when the California Osteopathic Association agreed in 1961 to merge with the California Medical Association, and the College of Osteopathic Physicians and Surgeons, Los Angeles, became the California College of Medicine. Consenting DOs were given MD degrees as a preparation for a referendum approved by voters in 1962, which discontinued licensure of DOs in the state. After a long legal battle that culminated in a 1974 decision by the California Supreme Court that licensure of Dos must be resumed. A new college was chartered in that state, and professional continuity was restored.

By the end of the 20th century, in every state as well as in a number of foreign countries, it was possible to be licensed for unlimited practice.

Organization

The American Osteopathic Association (AOA) was formed at Kirksville under the name “American Association for the Advancement of Osteopathy” in 1897. Its present name was adopted in 1901. The AOA seeks to protect and raise standards for education and practice of DOs. The AOA has become the regulatory group. State and local osteopathic organizations have grown up to serve physicians in their own localities. The AOA remains the umbrella group that recognizes and coordinates their efforts on behalf of the profession. The AOA itself has many important functions. Through its bureaus, councils, and committees, it is the osteopathic accrediting organization for undergraduate, graduate, and continuing medical education and for health care facilities. It certifies specialists in all fields, through a network of specialty boards, including a board recognizing special proficiency in osteopathic manipulative medicine. Research grants and related projects, as well as educational meetings, are arranged through the AOA bureaus and councils.

Research

In 1907 the first organization devoted to osteopathic research began, though the first recorded osteopathic research was done almost a decade earlier. The role of the AOA in encouraging and supporting osteopathic research was vital. Study of the scientific questions raised by osteopathic practice had never been easy. For example, taking only an obvious aspect of manipulative treatment: What is a manipulative placebo? Research money has never been plentiful; a major portion of the support for osteopathic research, especially in earlier days, has come from financial contributions by DOs themselves. However, a number of significant accomplishments have been recorded.

Present and Future

Throughout its history, osteopathic clinical education has taken place in primary care settings: community hospitals and clinics. The profession has supported very few academic medical centers. This disadvantage, by the 1900s, became an advantage because of the profession’s success in producing primary care physicians including many willing to work in underserved communities. Whereas students trained in academic medical centers tend to have as role models only subspecialists, and clinical contacts tend to be the types of cases referred to a tertiary medical center, osteopathic students have continued to have regular contact with community clinics and hospitals and to have many faculty role models among primary care physicians.

A recent mechanism has been established for an osteopathic board to certify both MDs and DOs in proficiency in osteopathic manual medicine. The process assumes additional studies by MDs not educated in osteopathic institutions.

Throughout the medical profession in general, there is continued emphasis on preventative care and health maintenance. This reemerging trend is also in line with traditional osteopathic values.

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