The DOs: Osteopathic Medicine in America, 2nd Ed.

1. Andrew Taylor Still

Like other medical prophets or revolutionaries, the founder of osteopathy, Andrew Taylor Still, sought recognition as a completely original thinker. In his autobiography, Still maintained that the precepts of his approach came to him in a single moment of inspiration, that no contemporary belief system or practice significantly influenced his theory that most diseases were directly or indirectly caused by vertebral displacements and that elimination of the latter through spinal manipulation would remove symptoms of pathology elsewhere in the body. Although his followers and others later modified this unlikely interpretation of the profession’s origin, they did not go far enough in identifying the intellectual currents that had shaped his thought.

Still was born on August 6, 1828, in Jonesville, Virginia, the third of nine children. His father Abram, had served as a Methodist preacher but at the time of Andrew’s birth was supporting his wife, Martha, and their offspring by farming and practicing medicine. However, in 1834, when Andrew was six, Abram once again heard the call, sold his land for the then considerable sum of $900, and moved his family to New Market, Tennessee, where he had received an appointment to preach.1

In the early decades of the nineteenth century, the Methodist Church in the United States sent its ministers to follow the steady westward march of the population, making each one responsible for a large geographical area known as a circuit. Often, after spending a few years in one location, a preacher would be transferred, so that he might face a new challenge elsewhere.2

Of these country clerics, Horace Bushnell wryly noted that they were “admirably adapted, as regards their mode of action to the new west—a kind of light artillery that God has organized to pursue and overtake the fugitives that flee into the wilderness from his presence. The new settler reaches the ground to be occupied, and by the next week, he is likely to find the circuit crossing by his door and to hear the voice of one crying in the wilderness ‘The kingdom of God is come nigh unto you.’”3

Andrew’s first schooling came in Jonesville at the hands of a man named Vandenburgh. “He looked wise while he was resting from his duties,” Andrew recalled, “which were to thrash boys and girls, big and little, from 7 am. to 6 p.m. with a few lessons in spelling, reading, writing, grammar, and arithmetic … [pardoning] our many sins with the ‘sparing rod.’” At New Market, Andrew attended classes with his older brothers at an academy called the Holston College. This institution, much to their relief, was conducted by a man “of high culture, a head full of brains, without any trace of brute in his work.” In 1837 Reverend Still was transferred to Macon County in northern Missouri, and for two years Andrew’s studies were suspended until his father was able to find a regular tutor. From Macon County, the family moved to Schuyler County, and again there was an interruption. But from 1842 through 1848, when he was twenty, it appears, Andrew continuously pursued a formal education.4

The family of a circuit rider led an especially rough life on the frontier. There were the periodic moves, and Reverend Still was called away from home on his religious work several times a year for intervals lasting as long as six weeks. The salary provided him by the church was insufficient to provide for his large brood, and Reverend Still had to supplement the preaching income with earnings from his farm and medical practice. As a child Andrew devoted much of his time to chores such as caring for the crops and livestock. He much preferred hunting. On occasion he traveled with his father on ministerial rounds and participated in the camp meetings that the Reverend Still helped lead. At these religious revivals songs were sung, prayers were offered, and conversions were made. The keynote was enthusiasm. In describing this phenomenon, William Sweet, in his history of American Methodism, observed, “The revival in many instances was accompanied by certain peculiar bodily exercises, such as jerking, rolling, barking, dancing, and falling. The falling exercise was the most common, and frequently at these great meetings scores, even hundreds were on the ground, many lying for a considerable length of time either entirely unconscious or semi-conscious. The ‘jerks’ were also common, though affecting different persons in different ways. Sometimes the head would be affected, twisting it rapidly to the right and left; sometimes it would seize the limbs, sometimes the whole body.”5 In retrospect, it is surprising that these events did not then give Andrew the idea that anatomical displacement was the predisposing cause of most diseases.

In 1851 Abram received yet another appointment, this time to the Kansas Territory as missionary to the Shawnee Indians. For the time being Andrew remained behind, married, and began working a farm of his own. Two years and two children later, however, he and his family joined his parents at the Wakarusa Mission. It was here that Andrew decided on medicine as a career and began to study and practice under the tutelage of his father. When the territory was officially opened up to settlement soon afterwards, the Stills headed for Baldwin, about twenty miles southeast of Lawrence.

This area became a focus of the national debate over slavery. In 1854 Senator Stephen Douglas of Illinois, seeking to open up the frontier to commerce, introduced legislation organizing the land west of Missouri and Iowa as one territory. Southerners opposed the idea because they believed this proposed geopolitical entity would eventually be admitted as a Free State, thereby altering the existing balance of power in Congress. To win southern support, Douglas amended his bill, calling for the creation of two territories—Kansas and Nebraska—and for the repeal of the Missouri Compromise of 1820, which forbade slavery north of the thirty-sixth parallel. Under the Douglas plan citizens of each territory would decide for themselves whether or not they wanted “the peculiar institution.” Over considerable northern objection the bill narrowly passed, and President Pierce signed it.6

The result was chaos, as settlers representing both sides of the issue poured into eastern Kansas. In November 1854, an election was held to choose a delegate to Congress. Hundreds of proslavery Missourians crossed the border to vote and were successful in selecting one of their own. The next March, they returned and elected a legislature that promptly enacted a slave code. Following this string of setbacks, the abolitionist forces in the area began to rally. Among them was Andrew Still, who became a lieutenant to the movement’s leader, James Lane. In 1857 Still was elected to the quasi-legal Free Kansas Legislature, which passed its own set of laws and organized the people to vote down the existing constitution.7 After three years of continuing political debate, as well as intermittent bloodshed, Kansas was finally admitted to the Union as a Free State just prior to the beginning of the Civil War.

At the outbreak of the national conflict Still enlisted in the northern cause and was assigned to the 9th Kansas Cavalry, Company F, as a hospital steward; he was responsible for the procurement of drugs and other medical supplies. In April 1862, after being released from this service, he returned home, organized his own command, and was commissioned Captain. Later Still was transferred to the 21st Kansas Militia with the rank of Major. In 1864 he saw action in the successful drive against Confederate forces advancing upon Kansas City.8

“During the hottest period of the fight,” he recalled, “a musketball passed through the lapels of my vest, carrying away a pair of gloves I had stuck in the bosom of it. Another minie-ball passed through the back of my coat, just above the buttons making an entry and exit almost six inches apart. Had the rebels known how close they were to shooting osteopathy, perhaps they would not have been so careless.”9 This battle marked the end of Still’s military career. Returning to Baldwin, he resumed his fledgling career as an orthodox physician.

Still and Midcentury Medical Practice

American medicine in the 1850s and 1860s was generally characterized by poorly trained practitioners employing harsh therapies to combat disease entities they understood insufficiently. Before the Civil War the great majority of physicians had never attended a medical school; they either had been trained through the apprenticeship system or were engaging in practice without benefit of any formal background.10

The apprenticeship, which could last three or more years, afforded the student a pragmatic education. After reading anatomy and physiology with a preceptor, the trainee learned how to diagnose, how to compound and administer drugs, and how to perform common minor surgical procedures. The qualifications of the preceptor were not standardized and instruction was usually poor, given the paucity of adequately trained physicians, mainly those who had received their education abroad. Nevertheless, the system itself was quite popular, providing the teacher with a dependable income and a cheap source of labor from the student, who in turn received the knowledge necessary to practice medicine according to public expectations. 11

After serving an apprenticeship the student could elect to enroll in one of the growing number of medical colleges springing up in the country. The aim of these institutions was to supplement the training already received with formal lectures and demonstrations. Initially, instruction in these schools was brief, consisting of one term four to six months in length taken in two successive years, the second term being merely a repetition of the subject matter assigned in the first. The quality of education in such colleges was not good. As they existed to make a profit for their stockholders, their expenditures for equipment, facilities, and instructors were relatively modest.

When A. T. Still began his career in 1854, his medical education consisted of work performed at his father’s side and the study of a number of texts in anatomy, physiology, surgery, and materia medica.12 His first patients were the Shawnee. “I soon learned to speak their tongue,” he reminisced, “and gave them such drugs as white men used, cured most of the cases I met, and was well received.” The Indians also constituted the source of his continuing education in anatomy and pathology, as he made occasional nighttime raids into their burial grounds to disinter corpses for dissection. Still noted that, although his conscience was troubled over this, at least his subjects never complained.13 During the Civil War, Still may have received further training and experience in treating trauma as well as camp diseases. Andrew maintained that his duties far exceeded those subsumed under his title of hospital steward.14 Late in life, Still also claimed he had gone to medical school. An article published under his name in the Ladies Home Journal but actually penned by his grandnephew, declared that he had attended a medical college in Kansas City prior to the Civil War. After this article appeared, the question of what his formal medical education had included was directly posed to Still. He answered that he had attended the Kansas City college just after the war, in the winter of 1865 and 1866 but had stayed just for one term since he was so disgusted with the training. This answer raises more questions, because the first documented medical school in Kansas City did not open its doors until 1869. No records have been found to establish whether Still, in fact, actually attended.15

Medical thought and practice in these years was highly speculative and largely empirical. Most American physicians believed that disease was due to organic decomposition, climate, heredity, and mechanical injuries. The germ theory, which had lost favor in the first half of the century, was just beginning to be revived. More than cause, the practitioner was preoccupied with effects. Many physicians thought of disease as the sum total of symptoms and reasoned that the faster each was removed (the temperature lowered, pulse restored to normal, bowels evacuated, or stomach purged), the more rapid the patient’s recovery would be. Those disorders bearing common attributes tended to be treated by similar or identical methods, serving only to encourage the use of panaceas such as bloodletting.

Playing an instrumental role in this trend was Benjamin Rush (1745 a 1813), a signer of the Declaration of Independence and perhaps the most influential American physician of his time. Rush believed that the basis of all disease was physiological tension, particularly of the veins and arteries. In his treatment of this condition, he found the drawing of blood most effective. In fact, bleeding the patient for an acute illness became his practice and teaching, and in later years he even claimed that often the only equipment the physician needed for house calls was the lancet.16 The results of moderate bloodletting were dramatic and seemed palliative: a sudden drop in temperature, profuse sweating, and a sense of calm. Some practitioners believed that utmost benefits were achieved when patients were bled to unconsciousness. Although the theory upon which Rush based his practice was discredited shortly after his death, bloodletting, which was conscientiously performed by the majority of orthodox physicians in America, remained a popular treatment for yellow fever, cholera, typhoid, typhus, smallpox, croup, and enteritis until the 1850s."

Another widely employed panacea was calomel, a mercury compound that acted as a powerful cathartic. So popular was this remedy in the midnineteenth century that it was commonly referred to as “the Samson of the materia medica.”18 Since most physicians felt that in treating internal ailments a cleansing of the system was desirable, calomel was often prescribed and not infrequently administered in conjunction with bloodletting. In large doses it was responsible for some dangerous side effects. As Guenther Risse has noted:

Within a few days after ingestion, severe stomatitis with excessive salivation appeared. Patients had ulcerated lips, cheeks, and tongue, soreness and inflammation of the gums, plus loosening and frequent loss of teeth. Some unfortunate children died with perforation of their cheeks, bucal gangrene, and osteomyelitis of the maxillary bones. Generally there was a gastric pain associated with vomiting and gastrointestinal cramps after ingestion of the calomel. In some cases bloody diarrhea occurred which was ascribed to the disease… The larger doses were considered to have a so-called sedative effect, no doubt because of the more severe systemic consequences of the mercurial poisoning.19

Because the drug would not readily pass from body tissue, several years of even intermittent use would produce a cumulative reaction. Still recalled that when he was about fourteen years old he was salivated with mercury which loosened his teeth eventually making him use a partial set of dentures. “I lived in a day,” he recalled, “when people had no more intelligence than to make cinnabar of my jawbone.”20

In addition to calomel other toxic pharmaceuticals of dubious value, such as arsenic, antimony, tartar emetic, lobelia, strychnine, and belladonna, were generally employed. A small number of truly useful agents were available in this era: quinine for malaria, colchicine for gout, opium for pain, and digitalis for dropsy. But each was utilized in the treatment of a host of other ailments, for which their introduction was either of no assistance or even harmful.21

Such symptomatic management was not accepted by all orthodox physicians. As early as 1835 Jacob Bigelow introduced the concept of the “selflimiting disease,” which he defined as “one which received limits from its own nature and not from foreign influences; one which after it has obtained [a] foothold in the system, cannot in the present state of our knowledge be eradicated or abridged by art.”22 Through a careful study of the drastic, or what he commonly called “heroic” measures then in use, Bigelow concluded that none significantly improved the patient’s chances for recovery. Though the article that announced his beliefs received favorable notices in the medical press, the reaction of many of Bigelow’s contemporaries was indifference. Depletive measures continued to be employed.

In 1860 Oliver Wendell Holmes, Sr., MD, declared in frustration, “If the whole materia medica as now used could be sunk to the bottom of the sea, it would be all the better for mankind—and all the worse for the fishes.”23 Holmes subsequently became the object of severe criticism, as did others who attacked the prevailing practices. In 1863, when William Hammond, MD, the surgeon general of the United States, issued an order removing both calomel and tartar emetic from the Union Army supply table, the doctors revolted. Hammond was blasted by the medical societies and his directive was never enforced.24 Though physicians could appreciate the arguments in favor of the concept of self-limiting diseases, it was not practical for them to follow the logic of this approach. Many felt it was their role to act; their patients’ expectations were other than to have them sit by passively, simply watching and waiting.

In the early Kansas years malaria was probably the leading cause of adult mortality. Though the benefits of quinine were widely known to the first generation of settlers, the drug was quite expensive and often difficult to secure. Also decimating the population was smallpox. Many Kansans doubted the efficacy of vaccination, which had been popularized by Edward Jenner (1749–1823), and never bothered to submit to the procedure. Some feared that vaccination was dangerous and would only spread the disease. Other scourges for which there were no effective therapies—typhoid fever, pneumonia, scarlet fever, typhus, dysentery, and meningitis—were all frequent visitors to the pioneers’ homes." In treating clients suffering from these and other conditions, Still employed such generally accepted drugs as castor oil, gamboge, aloes, lobelia, quinine, and soap pills. Though he may, as he said, have harbored some doubts about their relative value at the beginning of his practice, this did not stop him from prescribing them.26 Only when tragedy struck his own household in the spring of 1864 did Still begin seriously to question the practice of regular medicine. “War,” he wrote, “had left my family unharmed; but when the dark wings of spinal meningitis hovered over the land, it seemed to select my loved ones for its prey.” Following the interdiction against treating one’s own close relatives, Still summoned nearby physicians, who took immediate charge. He recalled the scene:

Day and night they nursed and cared for my sick and administered their most trustworthy remedies, but all to no purpose. The loved ones sank lower and lower… God knows I believed they did what they thought was for the best. They never neglected their patients and they dosed and added to and changed doses, hoping to hit upon that which would defeat the enemy; but it was of no avail. It was when I stood gazing upon three members ofmy family… all dead from the disease of spinal meningitis that I propounded to myself the serious questions “In sickness had God left man in a world of guessing? Guess what is the matter? What to give and guess the result?”27

While Still would not abandon orthodox medicine per se for another ten years, this personal loss inspired him to evaluate various alternative systems of practice which had already arisen. “Like Columbus,” he said,

“I trimmed my sail and launched my craft as an explorer.”28

Alternative Medical Systems

Several vastly different medical movements arose in America beginning in the nineteenth century.29 The first significant challenge to orthodox medicine in America was led by Samuel Thomson (1769–1843), a crude, self-educated individual who postulated that all disease was due to the body’s inability to maintain its natural heat. As therapy he rejected bloodletting and calomel, employing instead botanical remedies that caused the patient to sweat and vomit. Thomson attacked the legitimacy and integrity of the medical profession on several grounds, arguing that the motive of regular physicians was often to obtain a larger fee by prolonging illness, that formal education was an unnecessary prerequisite to practice, and that licensing laws passed on the grounds of protecting the public against “quacks” were only the means by which one group could monopolize the healing arts. Though they were ridiculed by orthodox doctors, Thomson’s attacks appealed to many Americans in the age of Jackson, when the virtues of the common man were extolled and the according of special privilege to anyone was frowned upon.30

Thomson, however, was not loathe to obtain his own special privilege, securing a patent on his system of medicine and selling family rights for its use at $20 apiece under a slogan stating that every man could be his own doctor. Mobilized by Thomson into “friendly societies,” his followers lobbied intensively in state legislatures against existing licensing laws that restricted medical practice to orthodox physicians. By the 1840s almost all of these statutes had been repealed, amended, or otherwise made ineffective. This meant that anyone could practice medicine practically anywhere in the country without fear of being prosecuted, a situation that lasted for several decades.31

A distinctly different and more intellectual threat to the medical establishment was presented by homeopathy, which was adopted by thousands of educated physicians in the United States who had been trained in the orthodox tradition. This movement was originally launched in Germany by Samuel Hahnemann (1755–1843), an erudite university graduate who, like Thomson, opposed the standard remedies then in use. In the 1790s Hahnemann began performing experiments on himself, recording the physiological reactions produced by various drugs. The first drug he tested was cinchona bark, from which quinine is derived. He found that if he ingested it while perfectly healthy, his body would manifest several of the symptoms of malaria. This led him to conclude that the drug best able to cure a given disease was the one that produced most of its symptoms in a well person. Other agents were tested by Hahnemann and his followers, who found the use of such homeopathic or “like cures like” remedies most effective, especially when administered in extremely small amounts.32

The homeopaths developed their own comprehensive materia medica and offered their system as a substitute for the practices of orthodox doctors, whom they labeled allopatbs. The allopath, declared Hahnemann, was one who would offer treatments that produced completely opposite effects of the disease when administered in health. In subsequent decades, however, the term allopatb lost its original signification and became a convenient label used by all alternative medical movements in describing “regular” or “orthodox” physicians.33

The rapid growth of homeopathy can be easily understood. Its followers did not administer toxic levels of the standard pharmaceuticals of the day, nor did they employ bloodletting. Thus, patients had only to bear the disease, not the treatment as well. Even Holmes, its arch critic, who would deny any physiological efficacy of infinitesimal doses, would nevertheless note that homeopathy “taught us a lesson of the healing faculty of nature which was needed, and for which many of us have made proper acknowledgments.”4

Before 1860 most American homeopaths were educated in regular medical colleges and learned the Hahnemannian system following graduation. After the Civil War, practicing homeopaths were increasingly expelled from the American Medical Association and orthodox societies and institutions. As a result, they built their own schools and hospitals. The instruction in these colleges was as complete as that in allopathic schools of the day, the two differing only in the content of their materia medica and their approach to patient care. Based on his analysis, William Rothstein concluded that the facilities, staff, and clinical opportunities available in most homeopathic institutions were equivalent to those found in their orthodox counterparts.35

Due partly to the increasing popularity of homeopathy, a schism occurred within the Thomsonian ranks. When the founder wanted to restrict his followers’ therapeutic armamentarium to the drugs he used and opposed any formal medical training, several of his more sophisticated supporters could not agree. They wished to experiment with all available botanicals as well as any other agent that held promise. Under the leadership of Wooster Beach (1794–1868), this group arose and opened their own colleges, eventually adopting the name eclecticism to describe their desire to shun all restrictive tenets or principles. In actual practice, however, the eclectics, who rejected most drugs of mineral origin and substituted resinous medicinals for the regulars’ alkaloid pharmaceuticals, did so purely on dogmatic grounds. As for the schools they established before and after the Civil War, most were academically poor, and the physicians they produced were not as well trained as those graduating from their competitors’ colleges.36

Whatever their respective strengths or shortcomings, unorthodox practitioners flourished as the century progressed. At their apex, they collectively represented approximately 15 percent of the entire physician population; the homeopaths were located principally in the cities and the eclectics mostly in rural areas.37 It is difficult to establish how much influence these systems had on the practices of regular physicians, who soon abandoned their heroic measures, but certainly their success in attracting a sizable number of patients gave pause to many in the orthodox ranks.

In studying these reform movements, Still came to the realization that they generally offered a less harmful regimen to their patients than did the regulars. However, he concluded that they were just as empirical and ineffective. “First I tried the ability of drugs as taught and administered by allopathy,” he once observed, “then noticed closely the effect from the schools of eclecticism and homeopathy. I concluded all was a conglomerate mess of conjectures and experiments on the ignorant sick man from the crown to the heel. I learned that a king was just as ignorant of the nature of disease as was his coachman, and the coachman no wiser than his dog.”38 The central issue in medicine, he would maintain, was not which drug to use and in what dosage, but whether drugging itself was a scientific form of therapy.

No less important was his moral concern. Being a Methodist, Still abstained from alcohol.39 After the war he asked himself, If drinking is sinful, should drugs be classified any differently? “I was not long in discovering,” he reflected, “that we had habits, customs, and traditions no better than slavery in its worst days and far more tyrannical.” For this he laid the blame on the physician, proclaiming the cause to be ignorance in “our schools of medicine.” He observed, “I found that he who gave the first persuasive dose was also an example of the same habit of dosing and drinking himself, and was a staggering form of humanity wound hopelessly tight in the serpent’s coil.”40 Increasingly convinced that internal medication of any kind was immoral as well as invalid, Still would continue his explorations in a different direction.

Drug-less Substitutes

This was an era in which a number of drugless systems appeared and gained some degree of success in drawing adherents. An early entry was the “popular health movement,” led by Sylvester Graham (1794–1851), a temperance speaker who in the 1830s began to lecture against gluttony, improper dress, sexual permissiveness, and medicines, while arguing in favor of bathing, fresh air, exercise, and alterations to diet. Graham maintained that man was heading toward physical degeneration by not living according to the dictates of Nature’s laws. Some of his arguments appeared most reasonable. Bathing in this period was not regularly practiced, the common diet was unbalanced, and clothing for women was unnecessarily restraining. Although the farmer was constantly exposed to sunlight, fresh air, and exercise, the commercial and leisure classes were not; indeed, many believed such a life to be unwholesome or demeaning. On the other hand, much of Graham’s advice, notably his ramblings on the supposed evils of too frequent sexual encounters, was based upon what one biographer has called a “sublimated Puritanism.”41

In 1839 he published a collection of lectures which became a best seller. Graham claimed that following the principles outlined in his book would make drugs and physicians unnecessary. First, adherents would be less likely to get sick; second, if they did fall ill, they would not be as severely affected; and third, by allowing their bodies’ natural self-restorative powers to operate, they would recover more quickly." Graham ruled out certain “unhealthy” foods: meats, fresh milk, eggs, coffee, tea, and pastries. His substitutes were invariably bland and tasteless; the best known of these was a cracker that still bears his name, originally designed to curb not only one’s hunger but also one’s sexual appetite. Graham’s critics were quick to point out that his ultimate goal seemed to be to take enjoyment out of not only the kitchen but the bedroom as well.

Though Graham argued that his system was all inclusive, a number of his followers were among those who soon began to frequent the offices of another group of drugless practitioners, the hydropaths. An Austrian peasant by the name of Victor Priessnitz (1799–1851) had discovered that cold water seemed quite effective in treating many of the chronic ills of both man and beast, most notably gout and rheumatism. Within a short time his approach caused a small sensation in Europe, and several sanitaria were opened on the Continent for the teaching and practice of his methods.

Hydropathy was exported to America in the 1840s. Proponents founded two medical schools, and by the mid-185 Os at least twenty-seven spas were in business, mostly in rural areas of the East and Midwest, where the water was believed to be the purest. The cure primarily consisted of drinking the precious fluid as well as enveloping one’s body in it. According to Marshall Legan, “A sheet of cotton or linen dipped in cold water was spread on several thick woolen blankets… Over the whole was thrown a feather bed, and the patient remained in his cocoon from twentyfive minutes to several hours, depending upon the seriousness of his condition and his ability to work up a good perspiration. Next the victim was unswathed and cold water was poured over him, or he was immersed in a cold bath and finally briskly rubbed dry.”45 Quite clearly, “heroic” therapy could be practiced by drugless healers as well.44

Still’s familiarity with Graham’s notions and hydropathy can be traced to his early manhood, when a utopian colony following a combination of these ideas was established near the Shawnee Mission.45 This experimental community did not last long, but while it existed the Reverend Still had to be called on several occasions to care for those not responding to, or suffering from, the regimen. Undoubtedly Andrew was not especially impressed then or later with these methods. Yet Still came to believe that the drugless approach was the right one. It was only a matter of seeking out a system that could provide a more logical basis for reliable diagnosis and efficacious treatment. Towards this end, Still would find considerable guidance in the principles and practices of magnetic healing.

In 1774 Franz Mesmer (1734–1815), an Austrian physician, postulated that an invisible universal magnetic fluid flowed throughout the body and that too much or not enough in either a part or the whole was one major cause of disease, particularly nervous disorders. The only rational course of treatment, therefore, was to restore the fluid to its proper balance. This could be accomplished by making passes over the body with magnets or his hands. Mesmer was not the first to heal through the use of touching; rather he was the first to fashion this approach into a coherent system of medical practice.46

Many of his early cures through this method were greatly publicized, and soon he was attracting patients from all across Austria. His success there was short-lived, however, as pressure from the medical community of his native Vienna forced his departure for Paris. In the French capital, Mesmer’s practices became more irregular. Instead of seeing clients separately and discreetly, he formed groups and ministered to several patients at once. Often he employed a huge indoor tub with extended “magnetized” rods. Those gathered would bathe together, placing the afflicted parts of their bodies against the metal protrusions, until Mesmer materialized. While an orchestra played solemn music, he entered the room dressed in a flowing, lilac-colored robe and touched his patients as he passed. This was designed to bring each individual to a near seizurelike state, which, according to Mesmer, was often necessary to achieve catharsis. The tub was not his only healing site. Clients would also be treated outdoors, under “magnetized” trees or beside “magnetized” rocks.47

In 1784, as Mesmer’s practice gained popularity, two special commissions were created to investigate the relative merits of his claims. One of these groups was appointed by the French Academy of Sciences and included in its ranks Benjamin Franklin, Jean Sylvan Bailly, and Antoine Lavoisier. This committee declared that a “magnetic fluid” did not exist, that Mesmer’s cures were only the result of suggestion, and that the morals of women undergoing such treatment were being threatened. In an induced seizure, they argued, females could become easy targets for seduction.“48 With the appearance of this study, Mesmer’s personal influence waned. Some of his followers, believing his basic principles to be valid, abandoned the tub and other questionable procedures and continued the attempt to gain respectability. In succeeding decades, they made progress. In 1831 a somewhat favorable report on the subject was issued by the French Academy of Medicine, and backhanded support came later, in the writings of James Braid (1795–1860) on what was eventually called hypnosis.”49

Magnetic healing was brought to the United States in 1836 by Charles Poyen (d: 1844), who gave a series of public lectures in Boston and took on a number of students, training them in massage and other methods then thought to be useful in restoring fluid balance.50 Poyen’s activities helped stimulate considerable interest in magnetic healing, and though his stay in America was relatively brief, the seed he planted was soon able to sprout without him.51 One of those who allegedly heard Poyen lecture was Phineas Parkhurst Quimby (1802–65), who afterwards established a practice consisting largely of verbal suggestions combined with light stroking of the body. Though Quimby’s writings were not published until after his death, he was an influential figure during his lifetime, serving as physician, teacher, and inspiration to Mary Baker Eddy (1821–1910), the founder of Christian Science. Quimby’s ideas also constituted the intellectual fountainhead for the loose confederation of religious groups known as “New Thought.”52

The best-known magnetic healer prior to the Civil War was Andrew Jackson Davis (1826–1910), who was also the leading American exponent of spiritualism.53 In the first volume of his massive tome, The Great Har mania (1850), Davis sought to combine both belief systems. Conceiving of the body as a machine, he maintained that health was simply the harmonious interaction of all man’s parts in carrying out their respective functions. This was due to the free and unobstructed flow of “spirit.” Any diminution or imbalance of this “fluid” would cause disease. Like others before him, Davis placed emphasis on healing with his hands. Of particular interest is his management of asthma, which consisted in part of vigorous rubbing along the spinal column.54 While this type of treatment constituted but a small feature of Davis’s practice, later magnetic healers, perhaps influenced by the attention given the spine by such orthodox European physician researchers as Charles Bell (1774–1842), Francois Magendie (1783–1855), and Marshall Hall (1790–1857), made extensive use of manipulation. One of these was Warren Felt Evans (1817–89), whose name is most often associated with “Mind Cure.”55 In his book entitled Mental Medicine (1872), which went through fifteen printings, Evans noted, “By the friction of the hand along the spinal column, an invigorating, life-giving influence is imparted to all the organs within the cavity of the trunk. The hand of kindness, of purity, of sympathy, applied here by friction combined with gentle pressure, is a singularly effective remedy for the morbid condition of the internal organs. It is a medicine that is always pleasant to take.”56

These sentiments were echoed in the book Vital Magnetism (1874), written by another popular healer, Edwin Dwight Babbitt (1828–1905). He specifically mentioned convulsions, apoplexy, sunstroke, headache, muscular complaints, common rheumatism, and paralysis as disorders capable of cure through spinal treatments.57 It is not known whether Still read these works by Davis, Evans, and Babbitt; however, he was well aware of their message. A letter cosigned by him to the editors of the Banner of Light indicates that he was a reader of that journal, which was oriented toward spiritualism and magnetic healing and published articles and advertisements by those practitioners within its pages.58

Though Still never embraced all of the ideas of such contemporaries, a number of the central tenets of magnetic healing made a strong impression on him: the metaphor of a man as a divinely ordained machine; health as the harmonious interaction of all the body’s parts and the unobstructed flow of fluid; and, of course, the use of spinal manipulation. His most significant departure from them would be over the nature of the fluid. While for the remainder of his life he spoke obliquely of the physiological role of magnetic energy, it was free flow of blood, he believed, that constituted the key to health.59 “I proclaimed,” he later wrote, “that a disturbed artery marked the beginning to an hour and a minute when disease began to sow its seeds of destruction in the human body. That in no case could this be done without a broken or suspended current of arterial blood itself. He who wished to successfully solve the problem of disease or deformity of any kind in every case without exception would find one or more obstructions in some artery or vein.”60

In June of 1874, Still severed his ties to regular medicine, an action that shocked his community. Many of his friends and relatives, in response to his odd theories and particularly his “laying on of hands,” questioned his sanity. The local minister, seeing him as an agent of the devil, had him “read out” of the Methodist Church. Still asked for permission to explain his practice at nearby Baker University, a school he had helped establish, but the privilege was denied.61 Effectively ostracized in Baldwin, Still traveled to Macon, Missouri, to visit a brother and see if public acceptance of his newly adopted ideas and methods would be any better there. It was not. After staying a few months, treating but a small number of patients, he moved on to Kirksville, situated in northeast Missouri, where, to his surprise, “three or four thinking people” actually welcomed him.62 The city then had a population of eighteen hundred and was the commercial capital of Adair County, which had a total of some thirteen thousand inhabitants. In a local paper, the North Missouri Register, he advertised himself: “A. T. STILL, MAGNETIC HEALER, Rooms in Reid’s building, South Side Square, over Chinn’s store. Office hours—Wednesday’s, Thursday’s, Friday’s, and Saturday’s from 9 a.m. to 5 pm. with an intermission of one hour from 12 pm. to 1 pm.”63 Though his practice in this new locale was not successful at first, he was comforted that there was no organized harassment by either the clergy or the local physicians. Still was also able to go about his business without serious interference from the state. In August 1874, while in Macon, he registered with the county clerk as a physician and surgeon, thereby protecting himself from prosecution for practicing without a license.64 As a result of the initial tolerance he had been shown in Kirksville, he moved his family there the following May.

In the fall of 1876 Still contracted typhoid fever, the effects of which made him an invalid for more than six months. After he fully recovered, Still realized that his local clientele would be too small to support his loved ones as well as pay off the debts incurred during his illness. In desperation he applied for a federal army pension but was turned down, since his service in the Civil War had been entirely with state militias.65 With few Kirksville patients, it was necessary to expand his population base. Still became an itinerant practitioner. He traveled for extended periods to several communities throughout the state, while his wife and children remained in Kirksville. For the next few years Still’s earnings barely kept pace with his expenses. On various occasions his relatives offered to help him out financially if he would return to orthodox medicine, but he adamantly re fused.66

The Lightning Bonesetter

Sometime during the 1870s Still became interested in bonesetting, another form of manipulative practice generally limited to the field of orthopedics. In deciding to learn these techniques, he may have hoped to be able to treat a wider range of disorders, thus giving him the potential of substantially increasing his patient load and his income.

Bonesetters were an ancient if not respectable group of healers. In England they had enjoyed a relatively unfettered practice among the common people, who could not afford a regular physician and who often had difficulty locating one willing to treat them. However, bonesetters could also count on the patronage of members of the upper classes, including royalty. It was widely believed that their particular talent was passed down from one family member to another and was therefore a gift that transcended formal book learning.67

In addition to reducing dislocations, bonesetters also manipulated painful and diseased joints, thinking that these conditions were also caused by a “bone out of place.” Physicians ridiculed their crude diagnoses and dismissed their claim that such treatment was of any value. Nevertheless, some patients with restricted joint mobility that remained unrelieved after treatment by trained orthopedists apparently benefited from manipulative therapy administered by such “quacks.” Some physicians assumed that these clients were only hysterics, or that the patient and the bonesetter were in collusion to embarrass the doctor in charge; but in 1867 Sir James Paget, himself a most distinguished surgeon, startled his colleagues by announcing that he believed there were joint maladies that bonesetters, regardless of the inaccurate diagnoses, were able to cure and that only through a searching investigation of their techniques could the relative value of such treatment be fully understood. “Few of you,” he admonished his educated brethren, “are likely to practice without having a bonesetter for a rival and if he can cure a case which you have failed to cure, his fortune may be made and yours marred.”68

In 1871 Dr. Wharton Hood, an acquaintance of Paget, published a book in England and the United States based upon his experiences as a bonesetter’s apprentice. As he described it, the bonesetter’s technique constituted “the art of overcoming by sudden flexion or extension, any impediments to the free motion of joints that may be left behind after the subsidence of the early symptoms of disease or injury.” The conditions for which Hood believed this type of treatment useful were: cases of stiffness, pain, and adhesion following fractures and sprains of one or more of the bones forming a joint; rheumatic or gouty joints; displaced cartilage; subluxations of the bones of the carpus and tarsus; displaced tendons; hysterical joints; and ganglionic swellings.69 However, he cautioned that bonesetting was only successful where the ability of joints to rotate had not already been permanently destroyed.

Hood noted that, while most bonesetters’ activities were limited to manipulating the extremities, they were also treating people who were “complaining of a ‘crick’ or pain, or weakness in the back, usually consequent upon some injury or undue exertion, and … these applicants are cured by movements of flexion and extension, coupled with pressure upon any painful spot.” Often during these maneuvers a “popping” or “clicking” sound would be emitted by the spinal joints, which many times convinced the patient that a cure of the problem had been effected.70

Bonesetters had been found in America since the colonial era; the most prominent practitioners were the Sweet family, who held forth in the New England area for nearly two hundred years.71 How widespread such manipulators were elsewhere in the country is unclear. One physician in 1884 estimated that in every city in the United States there were “individuals claiming mysterious and magical powers of curing disease, setting bones, and relieving pain by the immediate application of their hands.”72

It is not known how Still learned to become the “lightning bonesetter” he would throughout the 1880s advertise himself to be. Though he could have come across Hood’s book, it seems more likely that his knowledge was derived from observing the work of another practitioner in the field.73 However he learned these methods, Still soon afterwards made an important discovery, namely, that the sudden flexion and extension procedures peculiar to this art were not limited to orthopedic problems and that they constituted a more reliable means of healing than simply rubbing the spine. He would later recount this story from about 1880: “An Irish lady … had asthma in bad form, though she had only come to be treated for the pain in her shoulder. I found she had a section of upper vertebrae out of line, and I stopped the pain by adjusting the spine and a few ribs. In about a month, she came back to see me without any pain or trace of asthma… This was my first case of asthma treated in the new way and it started me on a new train of thought.”7“r Soon he was handling headache, heart disease, facial and arm paralysis, lumbago, sciatica, rheumatism, varicose veins, and an increasing variety of other chronic ailments, all by manipulating vertebrae back into their”proper position." In accounting for his success, Still would synthesize some of the major components of magnetic healing and bonesetting into one unified doctrine. The effects of disease, as the former said, were due to the obstruction or imbalance of the fluids, but this in turn was caused by misplaced bones, particularly of the spinal column which interfered with nerve supply regulating blood flow. Still had given birth to his own distinctive system.

In the next decade Still traveled across Missouri touting his new approach. According to one eyewitness:

Sometimes he would leave Kirksville with barely enough money to pay carfare and go to some town with a bundle of probably a thousand [hand] bills, get them scattered, after which he would give an exhibition of setting hips, probably on a public square, in a spring wagon or ox-cart. Of course, he would be looked upon as some mysterious being, crazy, or at least daffy; but with his intuitive insight, he would pick out a cripple, or someone with a severe headache or some disease that would cure quickly, and demonstrate before the anxious crowds."

Often, Still had a difficult time getting his ideas across to potential clients. He saturated his speeches with an odd collection of metaphors, parables, and allegories which left many listeners bewildered.76 His unusual attire—a rumpled suit, a slouch hat, his pants tucked inelegantly in his boots—caused some to look rather than listen. Many times he could be seen on the streets clenching a long wooden staff he used as a walking stick while toting a sackful of bones over his shoulder. Not surprisingly, such behavior led people to decide that he was either an eccentric genius or a deranged old man. Nevertheless, as one follower noted, “the impression left was usually a good one.”

One or more of his sons would often travel with him and assist in treatment. I-larry Still later observed:

I believe I would be safe in saying that the six months we practiced in Hannibal [winter 1884–1885] we accumulated a dray load of plaster of paris casts, crutches, and all classes of surgical appliances [no longer needed by patients]. We went from Hannibal to Nevada, Missouri where the state insane asylum is located. Here we made fully a hundred cures… I remember one interesting case. The lady had been in the asylum for several years. It seemed she had lost her mind suddenly while playing a piano. Father examined her neck and found a lesion of the atlas. In less time than I have taken in telling, the girl was as rational as ever. Strange to say, the first thing she said was “Where is my piano and music?” She was anxious to finish the piece she had started playing three years before.“77

Such unusual recoveries gradually spread the “lightning bonesetter’s” reputation. By the late 1880s his scheduled trips to various towns would cause considerable local excitement. In Eldorado Springs he had to reserve sixteen rooms to treat the crowds that had gathered. People reportedly came to Nevada City from upwards of 150 miles away, complete with tents in anticipation of a long wait.78 Still had become a charismatic figure.

Paradoxically, it was only after he had obtained notoriety elsewhere that the people of Kirksville began to patronize him in large numbers. One incident in particular helped change his image. The young daughter of the town’s Presbyterian minister, J. K. Mitchell, had for some unreported reason lost her ability to walk. Mrs. Mitchell, after her child had been treated without apparent benefit by other local physicians, in desperation asked her husband to allow Still to make an examination. The clergyman adamantly refused. Nevertheless, while her husband was away on an extended trip, the child’s mother called for Still, who proceeded to adjust the girl’s spine. Men Mitchell returned home his daughter walked down the stairs to greet him. The good pastor thereafter sang praises to Dr. Still’s name, and the social barriers that had long prevented “the lightning bonesetter” from treating “decent folk” were lowered.79

As a result of his newfound respectability, Still decided to make Kirksville his permanent base of operations. In 1889 he established an infirmary. Soon patients from great distances were seeking him out. “It was a problem,” said one follower, “how best to take care of the people that were flocking to him… Many of those who came were pronounced hopeless by other physicians. Some of them were hopeless. But he was able to cure enough … to keep adding to his reputation and his fame which extended into ever widening circles.”80

His success convinced Still that he had discovered a new science of healing. He lacked only a proper designation. “I began to think over names such as allopathy, hydropathy [and] homeopathy,” he recalled. Eventually this led to “start out with the word 0: (bone) and the word pathology, and press them into one word—osteopathy.”81



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