Osteopathy is a system of medicine that is distinct in a philosophical approach to patient care in health and in sickness. Doctors of osteopathic medicine (DOs) are fully-recognized physicians licensed to practice medicine in any of the recognized specialties in the United States and in Canada, as well as some other countries of the world. Osteopathic practitioners in other parts of the world may or may not be physicians, but they also adhere to a patient-centered approach that utilizes osteopathic manipulation.

Osteopathy began in the middle of the United States in the State of Missouri by an itinerant physician, Andrew Taylor Still. Dr. Still was trained under the then-common system of apprenticeship and was licensed to practice medicine. He became increasingly discouraged with the ways in which typical allopathic medicine was practiced in the mid-19th century: lack of antisepsis; amputations; bloodletting; alcohol, opiate, heavy metal, and other dangerous medications; disease-focused treatments; and other unproven interventions. Dr. Still first expressed his frustrations and made a break from traditional medical practice on June 22, 1874, after having experienced personal losses with the deaths of several of his children and his first wife to disease.

He reasoned that physicians should focus on the patient and facilitate the inherent adaptive, self-healing, and defensive mechanisms of the individual. Eschewing the typical approaches, his chief tool to accomplish his medical interventions was the use of manipulative techniques. By 1892, he had such success that he established a medical school, the American School of Osteopathy, in Kirksville, Missouri. Among his first students were former patients, family members, and allopathic physicians who were also frustrated with the typical heroic medical practices of the day. Dr. Still was permitted to grant an MD degree under the school’s original charter that was granted by the State of Missouri, but he wanted to break with traditional practices, and so he chose to name his new approach “osteopathy” or osteopathic medicine.

Because manipulation was to be the primary tool, practitioners would have a “feeling for the bone.” Five women were among the inaugural class of students at his two-room building. The number of students and the physical size of the school rapidly grew as well as the number of schools developed by his followers. The initial satellites were established primarily throughout the Midwest of the United States and included colleges established in major cities such as Los Angeles, Des Moines, Kansas City, Philadelphia, and Chicago. An early graduate, J. Martin Littlejohn, returned to his native United Kingdom and established osteopathy in England. From there, it spread to the European continent, although it was primarily practiced by nonphysicians there.

The philosophical principles of osteopathy, although clarified over the last 100 years, have remained mostly unchanged:

1. Structure and Function are interrelated

   1. Normal

      1. Structure governs Function

      2. Function modifies Structure

   2. Abnormal

      1. Abnormal Structure results in Abnormal Function

      2. Abnormal Function results in Abnormal Structure

2. The Person (Body) is a Unit and is composed of an

   1. Interaction of different systems

      1. Neurological

      2. Dermatological

      3. Musculoskeletal

      4. Hematological

      5. Cardiovascular

      6. Pulmonary

      7. Gastrointestinal

      8. Genitourinary

      9. Endocrine

      10. Immunological

      11. Behavioral/Psychological

   2. Mind, Body, Spirit connections

      1. All of the components interact and influence each other

      2. There is sometimes difficulty separating what is cause or effect

3. The body has an inherent ability to

   1. Regulate itself

      1. Normal

         1. Maintain systems

      2. Abnormal

         1. Altered regulation

   2. Adapt to changes that occur

      1. Normal

         1. React to small alterations in environments

            • External

            • Internal

      2. Abnormal

         1. Poor adaptation

         2. Inappropriate reaction

   3. Compensate when regulation and adaptation cannot occur or inadequately occur:

      1. To inherent or developed inadequacies

         1. Normal

            • Congenital malformations

            • Genetic

            • Functional inadequacies

         2. Abnormal

            • Overcompensation

            • Undercompensation

            • Maintenance of adaptation past usefulness

   4. Repair itself when damaged

      1. Normal

         1. Tissue repair

      2. Abnormal

         1. Scar formations

         2. Adhesions

   5. Defend against dangers from within and without

      1. Normal

         1. Internal derangements

            • Abnormal cell formation (i.e., cancerous cells)

         2. External invasions

      2. Abnormal

         1. Inappropriate reaction to irritants

            • Recognition of host elements as “enemy” (i.e., autoimmune disease)

4. Disease/Dysfunction of the body

   1. Is the interaction of the

      1. Host (person)

      2. Activating event

         1. Endogenous

         2. Exogenous

   2. Disease occurs when the body is

      1. Overwhelmed

      2. Underprepared

5. Rational treatment is based on the above principles

   1. Treatment decision is based on proper

      1. History

      2. Examination

      3. Experience

      4. Knowledge

   2. The function of the physician is to

      1. Facilitate the body’s inherent capacities

      2. Minimize effects of disease

         1. Endogenous alterations

         2. Exogenous threats

Osteopathy was not immediately accepted within the United States and was often referred to as a cult and its practitioners as “quacks.” Although several American presidents, politicians, writers, artists, and others were supporters, legislation permitting the practice as physicians was slow in evolving. Early reviews supported by the American Medical Association (AMA) and other entities, such as the Flexner report, indicated that the osteopathic medical schools were deficient because of the relative dearth of pharmacology, or material medica as it was called in the late 19th and early 20th centuries, that was taught. Although the curriculum initially included surgery and obstetrics, Dr. Still limited the amount of pharmacology that was taught. He exhorted his followers to “keep it pure.” However, shortly after his death in 1917, the curriculum at the surviving osteopathic medical schools developed ways to meet the requirements that were perceived as deficient. Gradually, the requirements and duration of the curriculum matched that of the typical MD medical schools.

The road to acceptance of the “parallel and distinctive” osteopathic medical profession was often rocky. In early times, some osteopathic physicians were prosecuted for illegally practicing medicine, sometimes successfully. Regulations initiated to secure recognition in the armed services occurred in the early part of the 20th century, but it was not until the mid-1960s that DOs were commissioned as officer physicians. Lack of hospital privileges and exclusionary directives from the AMA barring MDs from cooperating with osteopaths in any manner further limited training and practice opportunities. However, by the late 1950s, DOs had established their own hospitals and the AMA had dropped its objections to the recognition of DOs as physicians, if they rejected adherence to their historical and philosophical roots.

The California Medical Association and the California Osteopathic Association entered into secret negotiations. Legislation was introduced in that state to allow the licensed osteopathic physicians to attend a weekend seminar, pay a $65 fee, and exchange their DO degrees for state-granted MD diplomas. Over 2,000 DOs took this option. Simultaneously, the two medical societies merged and the College of Osteopathic Physicians and Surgeons converted to a state college of allopathic medicine. Students who entered anticipating graduating with a DO degree would become MDs. The legislation also restricted licensing any new osteopathic physicians within the state and would eliminate the osteopathic medical board once the absolute number of licensed DOs fell below a specified number. Rather than being the beginning of a nationwide series of assimilations, this event became the rallying nexus for maintaining a separate medical profession. Many of the remaining DOs within California who objected to the transition formed a core group which fought for restoration. The legislation was determined to be unconstitutional in 1974 and a new college of osteopathic medicine was established by the end of that decade.

Gradually, the number of osteopathic medical schools and graduates increased from the initial few to 25 in 2007 and nearly 60,000 osteopathic physicians in practice in the United States. Many practice alongside MDs as well as obtain their pre- and postgraduate training in the same hospital settings. It is sometimes difficult to see the distinction between the two types of physician practitioners. Some do not look upon themselves as different. The curricular difference in the schools continues: all osteopathic students are instructed in osteopathic principles, philosophy, and practices. MD physicians of the current era apparently have no stated objection to the philosophy although some concerns may persist as to the practice of manipulation. Some of the reluctance may be with a relative lack of evidence as to the benefit and some may still have concerns as to the safety. Primarily, as a therapeutic intervention, manipulation is known to be safe.

SEE ALSO:

• Allopathy; Homeopathy; Naturopathy.