This page tells the story of osteopathy from early 19th century USA to present day NZ.
Andrew Taylor Still
Andrew Taylor Still
Andrew Taylor Still was born in Lee County, Virginia on 6th August 1828, the third of nine children born to Abram and Martha Still. Abram was an itinerant Methodist preacher, farmer and doctor. Six years later, Abram moved the family to Tennessee to accept the position of a circuit preacher and in 1837 they moved to Missouri, a journey of over 700 miles, taking 7 weeks with 6 children in two covered wagons and six horses. At the age of ten, Andrew suffered from frequent headaches with nausea. He constructed a rope swing between two trees, eight to ten inches off the ground. He lay down using the rope for a swinging pillow. He wrote, "I lay stretched on my back, with my neck across the rope. Soon I became easy and went to sleep, got up in a little while with headache all gone." He later quipped that this was the first osteopathic treatment. He continued to use this ‘treatment’ successfully every time he had a headache. As a young frontiersman, Andrew became very expert with the rifle and hunted deer, turkeys, eagles, hawks, wild geese, wildcats, and foxes. He was a good judge of dogs, and quoted as an authority on the subject.
When he was 18 Andrew wanted to enlist in the army to fight in the war between the United States and Mexico, but Abram refused to let him go, saying that he was too young. In 1849 Andrew married Mary Margaret Vaughn. Andrew’s primary occupation was farming. He ploughed 60 acres of land and planted corn. On 4th July 1849 a hail storm destroyed the crop. It was a disaster and the family was financially decimated. Andrew taught at the local school that autumn and winter for $15 per month and began to study medicine with his father. Andrew and Mary's first children are born in 1849 and 1852. In 1851 Abram was posted to run the Wakarusa Shawnee Mission in the Kansas territory. Part of the reason for the posting was to get him out of Missouri, a pro-slavery state where Abram's strong anti-slavery sermons were getting an increasingly hostile reception. Andrew and his brothers helped Abram with the family farm, whilst Andrew also helped him with his preaching, teaching and doctoring. Andrew and his family was to live in Kansas for the next 22 years. In 1853 Andrew served in John Fremont’s expedition that set off from Kansas City to find a central route for the transcontinental railroad, through Colorado, Utah and Nevada to California, crossing the Rocky Mountains. Bad weather in Utah forced the expedition to turn back.
Andrew was active in the abolition movement and a friend of the anti-slavery leaders John Brown and James H. Lane. He became deeply involved in the fight over whether Kansas would be admitted to the Union as a slave state or a free state. The Kansas–Nebraska Act of 1854 provided that the settlers in those two territories would decide the question for themselves. Civil war raged in Kansas as both sides tried to gain control of the territorial government. In October 1857, Andrew was elected to represent Douglas and Johnson counties in the Kansas territorial legislature. Andrew and his brothers took up arms in the cause and participated in the Bleeding Kansas battles (between the pro and anti-slavery citizens). By August 1858, a free-state constitution had been passed; Kansas was admitted to the Union as a free state on January 29, 1861. Andrew would serve a total of five years in the Kansas legislature. Andrew and his family were among the founders of Baker University, the first 4-year university in the state of Kansas. Abram was a commissioner, Andrew and two brothers donated land and helped build the university. The university later refused to let Andrew present his ideas about osteopathy, which he found hurtful. In 1859 Mary Margaret died two months after giving birth. The baby had lived only five days. She had previously lost another child in infancy. She left Andrew with four children. In 1860, Andrew married his second wife, Mary Elvira Turner. They were together until she passed away 50 years later.
From 1861-1864 Andrew fought in the Civil War on the side of the Union Army. He served his entire military career in Kansas, in several different militia units. Andrew was refused a commission as a surgeon due to his lack of formal training, so he enlisted as a hospital steward with the rank of sergeant. Normally hospital stewards were selected for training from the enlisted men in the hospital corps. They were given a basic training in sanitation, pharmacy, medicine and surgery and their duties included being in charge of hospital stores, dispensing medicines and having general charge of the sick in the absence of the medical officers. Andrew was exempt from this training because of his prior medical training from his father, and his medical experience. A hospital steward could expect to be promoted to an officer and surgeon with experience. Andrew stated in his autobiography that whilst he was nominally a hospital steward was in reality a de-facto surgeon. After his first militia unit was disbanded Andrew wished to be an infantry officer. He organised a new militia, was promoted to the rank of Captain and ultimately achieved the rank of Major. Andrew fought in the Battle of Westport, during which he suffered an inguinal hernia.
After he returned from the war, Andrew and his wife Mary Elvira repeatedly petitioned the US government for Andrew to receive a pension based upon the injury (the hernia) he received in the Civil War, which made him unable to do hard physical work, such as farming. However, because the Kansas Militia was not officially sworn in to the Union Army, their requests were denied. Andrews earnings were very low, and the family suffered many hardships. Andrews' faith in medicine was shaken when, within two weeks, three of his children from his first marriage died of meningitis, and two weeks later a child from his second marriage died of pneumonia. Andrew with his medical knowledge could do nothing to help them. In 1867 Abram died at age 71 of pneumonia. Andrew was very close to his father and this death was a great loss. Three children were then born in close succession. In 1870 Andrew enrolled for a short course in medicine at the College of Physicians and Surgeons in Kansas City, though there is no record of his graduation. Some believe that he had extensive arguments with the faculty and dropped out. In 1873 Andrew was seriously ill with a lung infection for three months. After his recovery another child was born.
Andrew had an epiphany on 22nd June 1874 - he saw the body as an intricate machine which if free from displacements, derangements and contractures, nourished and cared for, will perform the functions for which it was intended, having within itself the power to manufacture and prepare all chemicals, materials and forces needed to regain its normal equilibrium and run smoothly to a useful old age. In September 1874 Andrew performed what he later called his first osteopathic treatment (although he wouldn't call it that until 1885), treating for no fee a poor boy he saw in the street with his lower body covered with blood. In Andrews’ own words: “My first case was of bloody flux (haemorrhagic gastroenteritis) in a little boy of about four summers. I didn't know what caused the flux, except that it affected young and old alike and was common in summer. I knew that a person had a spinal cord, but really I knew little, if anything, of its use. I had read in anatomy that the upper portion of the body was supplied with motor nerves from the front side of the spinal cord, and that the back side of the cord gave off the sensory nerves, but that gave no very great clue to what to do for flux. I placed my hand on the back of the little fellow, in the region of the lumbar, which was very warm, even hot, while the abdomen was cold. I began work at the base of the brain, and thought by pressure and rubbing I could push some of the hot to the cold places. While so doing I found rigid and loose places in the muscles and ligaments of the whole spine, while the lumbar was in a very congested condition. I worked for a few minutes on that philosophy, and told the mother to report to me the next day, and if I could do anything more for her boy I would cheerfully do so. She came early next morning with the news that her child was well. Flux was in a large percent of the families of Macon. My home at that time was still in Baldwin, Kansas, and I was only visiting in Macon. The lady whose child I had cured brought many people with their sick children to me for treatment. As nearly as I can remember, I had seventeen severe cases of flux in a few days, and cured them all without drugs.”
Soon after, Andrew was publicly "read out" (or formally removed) from the Methodist Church by the minister in Baldwin, Kansas. Because of his "laying on of hands", Andrew was accused of trying to emulate Jesus Christ and was labelled an agent of the devil. His practice dropped off rapidly. He was socially and professionally ostracized, became financially destitute, and was ultimately forced to move his family to Macon, Missouri. From that time he called himself a "magnetic healer". Shortly after he moved alone to Kirksville, Missouri and after three months sent for his family to join him. Kirksville at that time had a population of 6000. In 1876, he was stricken with typhoid and for six months was confined to bed. From 1880 until 1885 Andrew called himself a "Lightning Bone Setter" traveling from town to town in rural Missouri. He used to treat people in the street for all manor of diseases solely using lightening bone setting, and was known as the "tramp doctor", sleeping wherever he could find a bed. He was away from his wife and children for months at a time. In 1885, on the advice of his friend, the Scottish doctor William (Bob) Smith, Andrew changed the name of his healing art from lightening bone setter to osteopathy, from the Greek "osteon" for bone and "pathos" for suffering. In 1886 Bob Smith helped Andrew set up his first clinic in Kirksville and Andrew stopped travelling. Andrew continued to refine osteopathy. He described the principals of osteopathy as: structure governs function, the medicine chest within, the rule of the artery reigns supreme and the body is a unit. Although he and others doubted whether osteopathy could be taught, he made several attempts to train others. Andrew hoped that his two sons would carry on his work through the establishment of a school of osteopathy, so he waited for their return from service in the army. During this time patients flocked from all over America for his treatment. Hotels were built in the town of Kirksville to house the many patients who arrived daily for help.
On 1st November 1892 Andrew opened the American School of Osteopathy (later renamed the Kirksville College of Osteopathic Medicine, and now part of the AT Still University) in a two roomed timber framed building. Bill Smith taught anatomy and some chemistry and physiology. This first class consisted of five women and sixteen men, including former patients, family friends, three of Andrew’s children and his brother. At the time women were barred from US medical schools.
The first ASO building in 1892
The ASO in 1897
The first graduation was in 1894. Andrew wished his graduates to be general practitioners, caring for patients with a wide variety of health problems, able to perform surgery, and deliver babies. The state of Missouri was willing to grant him a charter for awarding the MD degree, but he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree. An infirmary was opened in January 1896 and in that year Andrew and his students had performed thirty thousand osteopathic treatments. Andrew sanctioned the use of anaesthetics and antiseptics. By the late 1890’s his school, infirmary and new surgical hospital were increasingly successful both academically and financially. In 1897 two wings were added to the infirmary that more than tripled the size of the original building. The Wabash Railroad Company had to increase the number of passenger trains running to Kirksville to four a day to accommodate the 400 people traveling to the ASO every day for treatment. By 1902 the ASO was graduating 300 students a year. Andrew Taylor Still died on 12th December 1917 from the effects of a stroke he had sustained three years earlier.
Some of the Major Influences on Andrew Taylor Still
Still was influenced by the intellectual and philosophical movements making their way across America during his life time such as transcendentalism, phrenology, natural hygiene, homoeopathy, magnetic healing, spiritualism and mesmerism and also by Hippocrates's doctrine where all illness was seen as the result of an imbalance in the body of four humours. The therapeutic approach was based on "the healing power of nature" ("vis medicatrix naturae"), the body containing within itself the power to rebalance the four humours and heal itself. He studied the English philosopher Herbert Spencer, who developed a theory of evolution before Darwin and wrote about a wide range of subjects, including ethics, religion, anthropology, economics, political theory, philosophy, biology, sociology, and psychology. In later years Still was a Freemason.
Still, was fascinated with machines, and was an amateur inventor. He assembled and operated a steam-powered saw mill when he helped build Baker University. He invented a wheat harvesting machine, but his idea was stolen by a visiting sales representative, who put it into production. In 1871 he invented and marketed a centrifugal butter churn. Some of his inventions were related to the practice of osteopathy, such as the patient brace, a simple device designed to keep patients from falling off the narrow treatment table during vigorous manipulations. In 1910 he patented a smokeless coal furnace, though he had difficulty producing a full-sized working model. Heartbroken by Mary Elvira's death in May 1910 he did not pursue the matter further. He was fascinated by human mechanics and had an excellent knowledge of anatomy. Still said: "An osteopath is only a human engineer, who should understand all the laws governing his engine and thereby master disease." Still, as a boy, scrutinised the muscles, nerves and bones of the animals he hunted. Later, as a young doctor he dug up Indian graves to study the skeletons. For years he carried one or two bones in each of his pockets and often a whole sackful over his shoulder. He wondered about their mechanics and how they influenced health and disease. He saw that the nerves that control the body branched off from the spinal column through small holes between the vertebrae. He became convinced the minor dislocations or subluxations, which he called "osteopathic lesions" could cause disease. He said: "all diseases are mere effects, the cause being a partial or complete failure of the nerves to properly conduct the fluids of life".
Still was an intuitive thinker who spoke in florid allegories, was dogmatic, evangelical, kind, humorous and generous. He was venerated by his early followers as an infallible font of truth. He continued to dress as a 'tramp doctor', even as principal of the ASO. Many of his ideas were years ahead of their time. Still never believed that drugs apart from anaesthetics and antiseptics had any value. At the time that Still learned medicine form his father, Louis Pasteur had yet to discover, in 1861, that micro-organisms cause infectious diseases, and it wasn't until 1865 that Joseph Lister invented anti-sepsis. Common medical treatments at that time included vomiting, purging, blood-letting and heroic doses of opium, morphine, arsenic, and calomel (a mercury based drug which rotted the teeth, gums, and cheeks of the patient), and often did more harm than good and didn't prevent three of his children dying from meningitis. He correctly recognised that the muscular and skeletal systems are important to the body's health. His belief in the self-healing powers of the body is similar to modern theories. His idea of the "osteopathic lesion" (now called "somatic dysfunction") has been supported by research by Korr and Denslow on how a facilitated segment can act as a neurological lens contributing to disease. Osteopaths today do not believe that "somatic dysfunction" can be the sole cause of disease, but that it can be a contributing factor, and that treatment of "somatic dysfunction" can be an adjunct to conventional medical treatment to hasten recovery.
Osteopathy in the USA after Still
In the early 20th century, osteopathy in the United States moved closer to mainstream medicine. The first state to pass laws giving those with a D.O. degree the same legal privilege to practice medicine as those with an M.D. degree was California in 1901, the last was Nebraska in 1989. In 1962, in California, the AMA tried to eliminate the practice of osteopathic medicine in the state. In 1974, the California Supreme Court ruled that licensing of DOs in that state must be resumed, and as of 2012, there were 6,368 D.O.s practicing in California. Osteopathic physicians are licensed to perform surgery and prescribe medications, and are taught to practice medicine with a patient-centered, holistic approach, emphasising the role of the primary care physician within the health care system plus osteopathic manipulative therapy (OMT) as an adjunctive measure to other biomedical interventions for a number of disorders and diseases. There are currently 29 osteopathic medical schools in the United States, offering education at 37 locations. As of 2011, there are approximately 78,000 osteopathic physicians in the U.S., but only about 2,000 of those practice OMT as their sole modality. (90% of manipulative therapy in the US is administered by chiropractors, of which there are 49,000). A 2001 survey of osteopathic physicians found that more than 50% of the respondents used OMT on less than 5% of their patients. The survey indicates that osteopathic physicians have become more like M.D. physicians in every respect —few perform OMT, and most prescribe drugs or suggest surgery as a first line of treatment. Osteopathic physicians are unevenly distributed in the United States. The states with the highest concentration are Oklahoma, Iowa, and Michigan where osteopathic physicians comprise 17-20% of physicians, and the lowest concentrations of DO's are Louisiana, Massachusetts and Vermont where only 1–3% of physicians have an osteopathic medical degree. Public awareness of osteopathic medicine likewise varies widely in different regions. U.S. trained DOs are currently able to practice in 45 countries with full medical rights, including New Zealand and the United Kingdom, but not in Australia or the Republic of Ireland. The United States does not have any colleges training non-physician osteopaths, and osteopaths trained in other countries are not permitted to practice in the U.S.
Cranial osteopathy or “Osteopathy in the Cranial Field' involves the osteopath applying the principals of osteopathy to a very subtle, rhythmical motion that is present in all body tissues, but felt most strongly in the cranial bones and sacrum (the part of the spine within the pelvis). This is called the 'Involuntary Motion' or the 'Cranial Rhythm' or the 'Primary Respiratory Mechanism'. Primary because it underlies all of life's processes. Respiratory as it moves through the body and gives rise to the breath. Mechanism because it is a system composed of many parts that together create a whole which is greater than the sum of those parts.It is thought that there is a rhythmic fluctuation in the cerebro-spinal fluid, which is within the ventricles of the brain, and between the brain, spinal cord and the meninges. The meninges surround the brain and spinal cord and the strong outer layer connects to the cranial and spinal nerves, which in turn connects to the fascia (the connective tissue that surrounds and connects every tissue and organ of the body). The movement is of very small amplitude, therefore it takes practitioners with a very finely developed sense of touch to feel it. This rhythm was first described in 1929 by William G. Sutherland DO.
Cranial osteopathy is usually learned as a post-graduate study, such as those taught by the Sutherland Cranial Teaching Foundation. Cranial osteopathy is not practised by all osteopaths, and there is controversy about cranial osteopathy within the profession. An osteopath called John E. Upledger DO researched cranial osteopathy at the Michigan State University from 1975 to 1983 and developed his own treatment style which he called craniosacral therapy and is taught by the Upledger Institute, largely to non-osteopaths. Osteopaths who use cranial or indirect techniques call themselves cranial osteopaths. Cranial osteopaths refer to conventional osteopaths as structural osteopaths.
Osteopathy in the Rest of the World
Dr John Martin Littlejohn, a Scotsman, was the first professor of physiology at the ASO and also dean of the ASO. He established the Chicago College of Osteopathy in 1900. Teaching in theoretical subjects was extended and physiology was established as a central subject. The school flourished and developed into one of the most important scientific sources of early osteopathy. In 1913 Littlejohn returned to the UK and and in 1917 established the British School of Osteopathywhere he taught until he passed away in 1947. He developed a theory of spinal mechanics, published many papers, and wrote two textbooks.
Until the 1960's, all osteopathy schools worldwide taught osteopathic diagnosis based primarily on structural alignment and theories of spinal mechanics formulated by pioneers such as Littlejohn and Fryette. In the 1960's Hugh Middleton of the BSO started a new approach based primarily on assessing the function of all joints and tissues of the musculo-skeletal system and correcting any dysfunction. Normal mechanical function leads to normal physiology and hence helps eliminate pathology (disease). It also became standard practice to identify the tissues causing symptoms, the pathology of those tissues, the pre-disposing factors, precipitating factors and maintaining factors. These factors include not only neurological, muscular and skeletal factors, but also the patients home, work and social environment, psychology, old injuries etc. This more holistic approach is very effective and is also more acceptable to regulators and other health professionals. In the 1970's Laurie Hartman of the BSO developed a way of performing high velocity thrust manipulations with minimal leverages. Since the 1980's he has taught his techniques and the functional approach to other UK osteopathic colleges. These are now taught at all British, New Zealand and Australian schools of osteopathy except for one small UK school.
Over time more osteopathic schools were started in the UK, Australia and New Zealand, and more recently in other countries. Osteopathy courses in New Zealand, Australia and the UK are rigorously science based and teach a non-surgical, non-pharmaceutical approach based on the updated principals of osteopathy. Their graduates are primary care practitioners who see themselves as manual medicine or neuromusculoskeletal (NMS) specialists, complementary to all systems of medicine. They spend considerably more time training in osteopathic diagnosis and technique than their US counterparts, in addition to the study of anatomy, physiology, pathology, embryology, neurology, paediatrics, orthopaedics, rheumatology and psychology to a similar standard as medical schools. Some medical doctors undertake a postgraduate training in osteopathy.
Courses in osteopathy are currently offered by ten universities and colleges in Britain, eight in Canada, seven in France, five in Germany, three in Belgium, Russia, Spain and Australia (RMIT, Victoria University and Southern Cross University), two in Finland, Netherlands, Switzerland, and Argentina, and one in New Zealand (UNITEC), Austria, Chile, Ireland, Italy, Norway, Poland, Sweden and South Korea. A new course is scheduled to start in Christchurch (New Zealand) in 2018. The qualifications conferred vary widely, and include: certificates, diplomas, bachelors degrees, masters degrees and Doctor of Philosophy (PhD).
The first full time training in New Zealand started at UNITEC in 1999 (there was a previous part-time course in New Zealand taught by the Osteopathic College of NZ, the last cohort graduating in 1997). The UNITEC training includes a Bachelor of Applied Science (Human Biology) and a Master of Osteopathy. There is currently 35 students in the first year of the bachelors course and 20 in the final year of the masters. Prior to 2004 most osteopaths on first registration in New Zealand were trained in the UK, with a few from Australia and until 1998 from the part-time training. Now most new registrants are NZ trained. As of 1 July 2016 there are 466 practicing osteopaths in New Zealand, of which 214 are New Zealand graduates, 199 are UK graduates, 38 are Australian graduates, and 15 'others'.
Since 2003 all osteopaths in New Zealand have been regulated by the Health Practitioners Competence Assurance Act 2003 (HPCAA), the same law that regulates all health professionals, including medical doctors. The Osteopathic Council of New Zealand (OCNZ) was instituted by the HPCAA to regulate the osteopathic profession. Council members are appointed by the Minister of Health. It is illegal for anyone who is not registered with the OCNZ and holding a current Practicing Certificate to call themselves an osteopath.
The "UK Back Pain Exercise And Manipulation Trial" trial published in the British Medical Journal has proven that manipulative treatment (osteopathy, chiropractic and physiotherapy) is usually more effective than GP care (largely the prescription of medication and advice) or exercises prescribed by an expert physios. Also in the United Kingdom, the National Institute for Excellence in Health Care recommends osteopathy for the treatment of persistent lower back pain. Osteopathic research is published in the peer reviewed International Journal of Osteopathic Medicine and the Journal of the American Osteopathic Association. Also, the Osteopathic Research Web publishes both peer reviewed research and research done by osteopathic students as part of their diploma thesis or Masters thesis. For a summary of research and evidence see the Osteopathy Australia website. In New Zealand the Osteopathic Council of New Zealand funded Dr Carl Scarrott of the University of Canterbury to analyse ACC data. His research is published in four parts under "The Statistical Analysis of Manual Therapists Funded by ACC". Please click on the links below to download PDF files of this research:
Multiple Profession Claims.PDF
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Initial Referrals and Aspects of ‘Patient Journey’.PDF
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Market Analysis by Provider and Injury Type with Trend Analysis.PDF
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Philip Bayliss, Registered Osteopath, 43 Thames Street, St Albans, Christchurch, NZ. ☎️03 356 1353