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

2. The Missouri Mecca

Having named his new system of medicine, Still decided it was time to share his discovery with others. In 1892 he opened the American School of Osteopathy, charging his students $500 for several months of personal instruction. Upon completion of the specified course, students were awarded a certificate stating they were “diplomats in osteopathy,” or DOs. Within six years, the school changed the title on the certificate and bestowed on new graduates the degree Doctor of Osteopathy.

A few months before his first classes were to begin, Still had the good fortune to meet Dr. William Smith (1862–1912), a thirty-year-old Scottish physician who was in town on a business trip. Smith had been trained at Edinburgh and had studied for several additional years on the Continent; his background was in stark contrast to that of the self-taught country doctor.1 After hearing Still spoken of as the “d–d quack” by a local regular physician, he decided to investigate osteopathy on his own. “I sat entranced,” Smith wrote a few years later of his first encounter with Still. “The theories he introduced were so novel, so contrary to all I had read or heard that I failed to follow his reasoning. Arguments as to their impossibility were simply met with one statement: ‘But it is so; there are no “ifs” and “ands” about it, I do what I tell you and the people get well.’”2 After visiting several boarding houses around town and seeing the results that had been obtained under such care, Smith became convinced that something of value was being imparted. As he wanted to learn more, Smith accepted Still’s offer to teach him everything he knew; in return, the young doctor would serve as an instructor in Still’s proposed school.

On October 3, 1892, classes began, with upwards of twenty-one students, men and women, enrolling at the beginning or during the first several weeks of the course. The ages of the students ranged from eighteen to sixty-five. Some held college degrees, others had nothing more than a common school education. All of them, however, had been direct or indirect beneficiaries of Still’s ministrations. Each morning for four months Smith drilled the group in anatomy without the benefit of a cadaver upon which to demonstrate. This problem was compensated for in part by his lecturing, which, according to one of his students, “was of such an impressionable type that one who listened to him could virtually look into the human body with his mind’s eye and see all its numerous functions.”3 Smith’s role was also symbolic. As one early student shrewdly noted, “‘Bill’ furnished the ‘front.’ He ‘looked good’ to the people and inspired confidence in infant osteopathy.”4

Following their daily anatomy lessons, students spent the afternoons in the infirmary with the “old doctor,” as he was affectionately called. Still was a natural philosopher rather than an academician. Students had to pick up what knowledge they could by listening to his extended metaphors and his sometimes rambling commentary. One of his followers declared:

He rose to the lofty heights of his conceptions of life, health, disease and medicine by the purest of intuition. He wiped the slate of knowledge, as it were, of much if not most of the accepted, accredited teachings of the day, not only in the field of medicine, but also in science, religion, ethics, politics, and endeavored to begin his thinking upon any and every subject with the new data of pure forms, built out of his imagination, with little regard or discomfort if his excursions took him sheer in the face of every accepted belief and profession.5

“The human body,” Still told his students, “is a machine run by the unseen force called life, and that it may be run harmoniously it is necessary that there be liberty of blood, nerves, and arteries from their generating point to their destination.” He then illustrated the significance of this basic principle with a colorful analogy:

Suppose in far distant California there is a colony of people depending upon your coming in person with a load of produce to keep them from starving. You load your car with everything necessary to sustain life and start off in the right direction. So far so good. But in case you are side-tracked some where, and so long delayed in reaching the desired point that your stock of provision is spoiled. If complete starvation is not the result, your friends will be at least poorly nourished. So if the supply channels of the body be obstructed, and the life-giving currents do not reach their destination full freighted with health corpuscles, then disease sets in.6

Given such circumstances the osteopath would “remove the obstruction by the application of the unerring laws of science, and the ability of the artery for doing the necessary work will follow. As a horse needs strength instead of a spur to enable him to carry a heavy load, so a man needs freedom in all parts of his machinery with the power that comes from the perfection in his body, in order to accomplish the highest work of which he is capable.”7

The highlight of the students’ day was watching him operate. According to one, “We would hold the patients in position while Dr. Still … worked upon them, explaining to us as he treated why he gave this movement in one place, and a different movement in another. He would tell us what it would mean to the nerves from that particular region if muscles were ‘tied up’ or a bone was out of line.” In diagnosing these conditions, a student explained, Still taught “that we should place the patient on his side and then pass our hands carefully over the spinal column from the base of the spine, noting temperature changes as we went along. Should there be a lesion along the spine, where nerves may be disturbed, it would easily be detected through an abnormal coldness or hotness of the tissue at that point.”8

Students often had the opportunity to observe the progress of patients over an extended period of time, because the afflicted usually agreed to remain in Kirksville for a minimum of one month. “Remember,” Still told his clients,

when many of you come to me you are not the most choice kind of patients. Remember the company you have kept before coming here. You have been with doctors who blister you, puke you, physic your toenails loose, fill your sides and limbs with truck from hypodermic syringes. You come to me with eyes big from belladonna, back and limbs stiff from plaster casts–you have been treated and dismissed as incurable by all kinds of doctors before coming to us, and if we help you at all–we do more than others have done.9

While in Kirksville each supplicant had to obey the interdiction against the use of liquor. “We do not wish to treat habitual whiskey tubs,” Still declared. “This rule must be strictly obeyed by all patients, and those who feel they cannot conform to it had better stay away.” Internal medications were taboo as well: “No system of allopathy, with its fatal drugs should e’er be permitted to enter our doors. No homeopathic practice with its sugar coated pills, must be allowed to stain or pollute our spotless name… Osteopathy asks not the aid of anything else. It can ‘paddle its own canoe’ and perform its works within itself when understood. All it asks is a thorough knowledge of the unerring laws that govern its practice and the rest is yours.” Still left no doubt that he considered alcohol and other drugs a moral evil. Indeed, often his crusade centered more on them than on the benefits of manipulation: “Was God ever drunk? Was Nature ever intoxicated?” He once estimated that 90 percent of his work involved overcoming the effects of such poisons upon the body.10 If one had faith in the wisdom and completeness of God’s design, Still maintained, one had to see that the use of drugs was not just immoral, it was unnecessary as well.

The Word Spreads

Throughout Missouri and elsewhere, more people were beginning to learn of Still’s activities from sensationalized newspaper accounts. The St.

Louis Democrat called Kirksville “the great Mecca for invalids, particularly those suffering from bone disease, dislocations, and similar afflictions. To and fro there surges a throng of ailing humanity sincere in purpose as the Eastern devotee who kneels at the tomb of Mohammed. But the results accomplished are not visionary or fanciful, they are real and practical. Marvelous even unto the miraculous are some of the cures and yet they are all treated in a natural and scientific manner.” The Des Moines Daily News noted in its columns that Still was “performing remarkable cures in a very simple way,” while the Nebraska Daily Call declared that osteopathy had deservedly “won a substantial claim to the confidence of all classes of invalids.” Some reporters told their readers that they had arrived in Kirksville hardened skeptics but left true believers. One Iowa journalist confessed, “It was an experience for the correspondent which removed from his mind every vestige of incredulity to the truth of these innumerable testimonials favorable to osteopathy and the eminent doctor.” The editor of the Bet/Jany (Illinois) Eclyo even submitted himself for treatment and later told his readers, “If you have an ailment which our doctors cannot successfully treat we advise you to go to Kirksville and be cured.11

All of these and other favorable stories were subsequently reprinted in a monthly tabloid Still published called the journal of Osteopathy, which was mailed to friends and relatives of patients in Kirksville and to local papers throughout the Midwest. Average issue circulation rose from several hundred in 1894 to more than 18,000 two-years later.12 With this publicity greatly increasing the number of patients, the railroads scheduled more trains through the town to accommodate the traffic and established special reduced-rate fares for those who required shuttle service. Entrepreneurs built new hotels, and boarding houses flourished. Storekeepers were pleased to find that their shops were constantly crowded. Seemingly everyone in town was prospering from Still’s work.

Still’s representatives met each train that pulled into the station, greeting clients, arranging accommodations, and setting up appointments with his staff. One reporter noted of the infirmary:

Everything is managed as smooth as clockwork… The almost constant ringing of electric bells announcing that room so and so is ready for another patient, the great discipline with which patients take their positions near the doors of the operating rooms when their turn is “next,” the incessant click of the typewriter as it wades through the immense correspondence, the frequent

“helloing” at the telephone, and the general counting room appearance of the business office, impress the visitor that besides an understanding of the human mechanism and laws of health, a thoroughly organized business system is required to do the great amount of work accomplished daily by this wonderful institution. There are now over five hundred patients and when it is remembered that treatment is given each patient from one to three times a week, it is not difficult to understand that the ten operators are kept moving." Of those who came to the infirmary, one journalist observed:

Almost every phase of society, nearly every section of the country, and certainly quite, if not all the ills to which human flesh is heir, were represented. There was the laboring man, the business man, and the professional man; there was the working girl, and the society favorite; there was the anxious husband with the invalid wife, the loving mother with her crippled child; there were scores on crutches and in invalid chairs; there were others who were compelled to depend on strong arms and tender hands. One thing they possessed in common, and that was a beaming countenance that indicated confidence, an expectancy, if not already a realization of a bettered condition.14

Contemporary accounts indicate that the majority of incoming patients were suffering from chronic, noninfectious disorders. In a sample of forty-nine patients cited in one issue of the journal of Osteopathy, ten were diagnosed as having some form of joint dysfunction, seven a nervous disorder, six asthma, five partial or complete loss of sight, hearing, or voice, three bowel difficulties, and the remainder had other long-term health problems.15 One enterprising patient took a survey of 109 fellow sufferers. Of these, 61 percent reported having some form of “spinal complaint”; the second most common problem was bone or joint maladies of the extremities. A different point of view was provided by a reporter from Godey’s Magazine, who wrote, “From my own observation I think that a majority of the patients were afflicted with nervous trouble and paralysis.”16

Many clients were willing to discuss their cases openly and give testimonials to the newspapers. F. H. Barker was a Methodist minister from Kansas who had fallen from a train, severely wrenching his neck; he subsequently developed sore eyes and ultimately became blind. Barker claimed to have seen oculists in three states before coming to Kirksville. After undergoing treatment at the infirmary for five weeks he reported that he had no more pain and that his eyesight was almost normal. R. W. Neeley of Franklin, Kentucky, developed a serious case of “heart disease with nervous prostration.” “When I landed in Kirksville,” he told the press, “I could not walk across the room without holding to chairs. I felt like toppling over at every step. From the very first treatment I began improving, and can’t express it better than to say I feel like a young colt in a clover field on a bright spring morning.” Mrs. J. T. Christian, the wife of a Baptist preacher, brought her seven-year-old son, who had suffered for three years from what had been diagnosed by two physicians as hip joint disease. According to the newspaper account, “As soon as he was placed on the operating table here a partial dislocation of the hip and spine were discovered. They were at once reduced without weights, braces, plaster of Paris, or any other paraphernalia; and now the boy is able to go anywhere on crutches, without his brace, feels no pain, the abscesses having disappeared, and will soon be well again.” After being treated for several weeks for a chronic case of sciatica, J. W Blocker of Dark County, Ohio, was only bothered by an occasional pain in his ankle. Mr. English from Quincy, Illinois, had been deprived of the full use of his right leg and arm and other parts of the body by what was diagnosed as a “spinal affection.” After treatment he was walking without crutch or cane. Asked by a reporter if he believed in miracles, Mr. English replied, “Not often, but I am a firm believer in osteopathy.”l7 Perhaps the most publicized early case was that of the son of US. senator Joseph Foraker (R-Ohio), who was sent to Kirksville with what had already been diagnosed as “valvular disease of the heart.” As his physicians had given up any hope for the child’s survival, there seemed little to lose by trying Still; and indeed, under his care, the symptoms of the condition gradually disappeared. Because of the national attention given the Foraker child, several among the political and economic elite came to Kirksville and then further spread osteopathy’s good name.18

In the Legislature

The events taking place in Kirksville did not escape the attention of the Missouri State Medical Association, which determined to put a stop to them. The association’s first action appears to have been taken as early as 1889, when it pushed through the legislature an amendment to the existing healing arts law which read, “Any person who shall by writing or printing or any other method publicly profess to cure or treat diseases, injuries, or deformities by manipulation or other expedient, shall pay to the state a license of $100 a month.” This, however, was unenforced.19 Later, in

1893, after Still had secured his school charter and begun teaching his first class, the regular physicians, in cooperation with the homeopathic and eclectic medical societies, introduced a bill into the House rendering it necessary for those practicing osteopathy to be graduates of a reputable medical school. Apprised in advance of this move, Still’s students and patients began a petition drive that was active throughout the state. Hundreds of protesting letters and telegrams poured into the lawmakers’ offices, leading to the defeat of the bill by a wide margin.20

After winning this battle Still and his followers went on the offensive, seeking specific legislation that would guarantee the legal right of DOs to practice within Missouri’s borders. One of Still’s legal advisors, P. F. Greenwood, linked osteopathy to the aspirations of Midwestern populism. In reference to the three established schools of medicine, Greenwood drew a religious analogy: “Suppose Baptists, Methodists, and Cumberland Presbyterians were the only recognized churches to save souls in this state and we were assured the legislature intended to rid the people of the Commonwealth from the doctrines and teachings of heretics? Would you call that class legislation? A monopoly of free gospel certainly. Then is not our medical class legislation as bad? I hold that if medicine is a science that no legislation is necessary to uphold or protect it.” Greenwood continued his defense of osteopathy by stating, “it is a science, and all it asks is an equal chance in the race of life. If it is not a science the challenge is open to the world to disprove it. It asks but one favor and that is the modification and change of the unfair medical laws of this state.”21

Leading the medical opposition was a prominent orthopedic specialist from St. Louis by the improbably coincidental name of A. J. Steele. He argued that every cult, regardless of its methods, professes cures. Osteopathy was simply no different from Christian Science, magnetic healing, and the water of Lourdes. As to osteopathic theory, it was entirely invalid. Steele pointedly asked:

Is the honest, scientific work of educated men and acute observers of the past ages down to the present to be thus ruthlessly set aside? Do our studied research in pathology and therapeutics go for naught? Strange is it not that of the thousands of skeletons carefully examined that frequent examples of misplaced bones have not been discovered, if such truly is the cause of all disease? We see patients daily recovering from sickness and disease in whom no effort has been made to reduce misplaced bones, showing that the census morbi did not lie in that direction. Per contra, we have had cases where dislocation and deformity did exist, for example of the spine, and neither organic nor special disease followed–the soft parts accommodating themselves to the displaced bones and the normal functions being well performed.22

Some osteopathic followers responded by challenging this critic’s competence, claiming that a number of his unsuccessfully treated patients had come to Kirksville only to return home free of their affliction.23 William Smith, however, admitted that there was due cause for the skepticism of his fellow MDs.

If a man, a physician, comes to Kirksville and hears what he will hear and tries to reason it out on the basis of what he learned in medical school, there is only one conclusion to which he can come: that osteopathy is a fraud and a delusion, a gigantic humbug which is taking from the pockets of the sick and afflicted th0usands of dollars monthly. BUT, if the enquirer will just approach the matter as though he knew nothing (and after four years experience of osteopathy let me tell any doctor that he knows very little), take nothing for granted, accept no statement for or against osteopathy; but just interview a dozen patients and accept them as reasonable men and women and not as hysterical persons, half-fitted for the lunatic asylum, nor utter and gratuitous liars, he is BOUND as an honest man to come to the conclusion as I did that there are still some things in the healing art which are not known to the medical profession. Let him examine further and he will find results obtained quite impossible under treatment with medicine. Then let him inquire of the patients who tell him in their stories, how many doctors had declared their recovery impossible, and then, and not until then, let him make up his mind as to whether or not osteopathy is a fraud, its practitioners humbugs and its supporters liars. If all these persons claiming to be benefited are liars where can the profit come from in running the business? To pay such an army of liars would consume the capital of the state. If they are hysterical why did not their doctors cure them.324

Despite vigorous medical opposition, the legislature ultimately voted in favor of the osteopathy bill. This measure called for DO graduates to present their diplomas for registration to their county clerk, who in turn would issue a certificate making them eligible to treat disease through the hands. The osteopath would not be required to pass any test or attend classes for any set length of time.

All of this went for naught. When the proposed law reached the desk of Governor William Stone he vetoed it on the grounds that osteopathic practitioners were insufficiently educated. “Medicine is a science,” he declared. “A judicious practice of it requires a good general and fundamental education, and a thorough knowledge of all the departments of medicine: anatomy, physiology, chemistry, pathology, therapeutics, practice, etc.”25 In other words, if osteopathy wanted equal treatment under the law, it had to conform to the academic scope adhered to by other practitioners of the healing art.

The bill’s advocates excoriated Stone, but the substance of his objections went unanswered. Indeed, there was little Still or his followers could say to justify what then constituted osteopathic education and standards. From 1892 through 1896, three classes had graduated. The length of training varied from nine to eighteen months and consisted of lectures in anatomy, osteopathic principles and technique. Still believed other subjects were unnecessary. Once, he stormed into class, raced to the blackboard, and wrote on it in large letters “NO PHYSIOLOGY” and then left the room. Anatomy, in his view, was the sole medical certainty. There was no need to bother with the theories and speculations of other branches of medicine.26 The first charter of the American School of Osteopathy and early board meetings show that Still wanted to include surgery as well as obstetrics as part of the curriculum, but at that time these subjects had not been introduced.27

Stone’s veto and the urgings of Smith and others who had argued that the DOs training was incomplete finally convinced Still that he had to make changes. By the end of 1896 he had formally lengthened the course of study to four terms of five months each, and at dedication ceremonies of a new college building he announced, “I am now prepared to teach anatomy, physiology, surgery, theory and practice, also midwifery in that form that has proven itself to be an honor to the profession.”28 Several months later the school published a more detailed course outline that also included histology, chemistry, urinalysis, toxicology, pathology, and symptomatology." Thereafter Still’s supporters maintained that every subject covered in a standard medical college, with the exception of materia medica, was taught at the American School of Osteopathy.

After Still had thus complied with the governor’s major objections, his followers revised their bill and resubmitted it to the legislature, which speedily passed it. This time, the DOs did not face an executive veto. In the interim, Stone had left office; and his successor, Lon Stephens, an osteopathic patient, gladly signed the measure into law on March 3, 1897.30 When word reached Kirksville, pandemonium reigned while the entire population set aside a day for celebration. “The morning was ushered in,” according to one newspaper account, “by the firing of anvils in honor of Governor Stephens, the legislature, Dr. Still and everybody connected with the fight. Bells rang and whistles blew. Anything that would make a big noise went. Residences, stores, shops were decorated, the big osteopathy building was covered with flags and bunting inside and out, and the whole city donned its best fourth of July attire.”31 As students marched down the streets they cheered:

Rah! Rah! Rah!

Missouri passed the bill

for AT Still

Good-bye Pill

We are the people

of Kirksville.32

The New Faculty

The passage of this law brought more matriculants, now confident that their time and money would not be wasted. VV1thin a few years there were seven hundred full-time students in attendance.33 This growth, coupled with the expansion in the curriculum, forced Still in 1897 and 1898 to engage additional teachers. Among those he found to assist Smith and himself were C. W Proctor (1859–1949), holder of a PhD in chemistry; Charles Hazzard (1871–1938), a university graduate who also held a DO; Carl McConnell (1874–1939), who after earning his osteopathic diploma received an MD at a homeopathic school; and the three Littlejohn brothers: J. Martin (1865–1947), president of Amity College in Iowa, who had law and divinity degrees from the University of Glasgow and a PhD in political science from Columbia; James (1869–1947), who held both an MD and a master’s degree in chemistry from Glasgow; and David (1876–1955), who earned an MD degree from a Michigan medical school. All of these new faculty either had benefited personally from osteopathy or had a close relative or friend who had.

Although this group remained intact for a comparatively brief period, its effect upon the development and course of the movement was significant. Whereas Still had built his system largely upon the principles and practices of magnetic healing and bonesetting, his new faculty relied upon more reputable sources of knowledge.34 Joint manipulation had a lengthy orthodox tradition, and others before Still had postulated that disturbances or displacements of vertebrae could cause symptoms elsewhere in the body.

In ancient Greece, frictions–a form of massage–were employed to treat a wide range of ailments. Some of the Hippocratic writings deal extensively with the subject, one work noting that “the physician must understand many things and frictions not the least of all … for frictions can bind a joint that is too loose, and loosen a joint that is too rigid.” In later centuries manipulation was practiced by Roman healers, but when the Empire declined, the art all but disappeared in Europe. Although rediscovered during the Renaissance, it took a minor position in therapy compared to drugging. However, over the course of the next several centuries it would be promoted by a host of distinguished physicians including Gerald von Swieten (1710–72), who advocated manipulation as a general measure to increase blood circulation. “The vital powers,” he said in words that foreshadowed Still’s, “may be increased by friction to any extent without any foreign addition to the body.”35

Throughout the 1800s a small group of English and American doctors who employed massage in their practice tried to alert the medical profession to the modality’s value through a number of books and articles. William Balfour (in 1819), for example, recommended it in rheumatism and sprains; John Bacot (1822) considered it helpful in treating several surgical diseases; and William Cleoburey (1825) manipulated in cases of contracted joints and lameness from various causes. Later in the century, 8. Weir Mitchell (1872), as a result of his Civil War hospital experience, relied on manipulation to treat many traumatic nerve and muscle injuries and by 1877 was including it when treating neurasthenia, hysteria, and locomotor ataxia.36 William Murrell (1886) added constipation, poisoning, lumbago, and sciatica to the list; G. L. Pardington (1886) migraine; and A. J. Eccles (1887), constipation." The most extensive clinical research on the subject was carried out by Douglas Graham (1884), who, citing the results of fourteen hundred of his own cases as well as those handled by others, reported success in uterine disorders, hemiplegia, infantile paralysis, writer’s cramp, muscular rheumatism, sprains and joint afflictions, rheumatoid arthritis, glaucoma, and in catarrhal affections of the nose, pharynx, and larynx.38

Some advocates of massage worked on spinal complaints. George H. Taylor (1884) noted:

It has been clearly proved that the circulation of the blood, and therefore the proper nutrition of the spinal bones, are quite dependent on the flexibility of the spine, which displaces and replaces the vertebral nutritive fluids, much as the functional use of muscles secures their nutritive support. It follows that the proper therapeutics in vertebral disease is not suspension of the flexibility of the vertebrae by mechanical restraints… It has been practically demonstrated that exactly the opposite course is therapeutically indicated and that the most successful treatment of vertebral disease consists essentially in judicious use of this physical property of elasticity and flexibility.39

While their practices paralleled those used by Still, neither Taylor nor other proponents of massage gave the spine any central theoretical role in disease; nor did they focus upon vertebrae in directing their overall therapy.

Although the success of massage in treating a number of disorders went virtually unchallenged by other practitioners, it failed to be integrated alongside materia medial in the standard medical school curricula. Most American and English physicians simply felt it was beneath them to administer treatment with their hands, let alone enter a field dominated by unorthodox healers. This attitude did not necessarily apply to other countries. “French, German, and Scandinavian physicians,” Douglas Graham acidly remarked, “often apply massage themselves without any thought of compromising their dignity.”40

The popularity of manipulation in these nations was largely the result of the efforts of Peter Henry Ling (1776–1839), a fencing master who combined body mechanics and gymnastics into what was popularly called “Swedish Movements.” Ling’s procedures were designed for both prophylactic and therapeutic purposes. His exercises were divided into active and passive movements, with the latter requiring the assistance of a trained specialist who would manipulate the patient through flexion and extension procedures. Though the Swedish medical community at first dismissed Ling’s approach as being of no value, his methods nevertheless increasingly secured satisfactory results in cases where medication had been found wanting. As a consequence, a fair number of northern European physicians learned Ling’s techniques and began applying them in cases of chronic, and even acute, disease. Hundreds of articles and many books on this system were published during the latter half of the nineteenth century.41

In examining the literature on massage and Swedish Movements, Still’s new faculty recognized the similarity of the systems to osteopathy in the type of diseases successfully treated and in some of the techniques employed. However, they firmly believed that their own approach was more specific in terms of diagnosis and therapy. Charles Hazzard remarked:

Upon the whole these manual systems compare with osteopathy as does the shot gun with the rifle. They produce excellent results by the “shot gun method” of general manipulation, while osteopathy works with the definite aim of finding the obstruction to health and removing it. It is unavoidable that, if such a comparatively “hit and miss” method of massage can secure excellent results as a curative means, osteopathy, with its definiteness, must generally far exceed massage in results. It also follows that osteopathy must generally work more quickly and easily than massage in such cases as the latter could reach, and that it must succeed in a large class of cases beyond the power of these manual systems, since to this class belong so many disease conditions depending upon some removable obstruction not noticed by them.42

While emphasizing the supposed shortcomings of massage and Swedish Movements, Still’s faculty were not loathe to borrow a number of those methods’ underlying principles, particularly the importance of treating muscles and working manually to restore physiologic harmony in the absence of palpable anatomic displacement. In addition, advocates of these two systems provided them with experimental evidence of how manipulation had cured. Zubludowski, for example, found that massage increased electrical contractility of the muscles; Hopadze showed how it sped assimilation of food; Golz provided evidence that it aided the circulation of blood; Mitchell reported that it could produce an increase in red blood cells; and von Mosengeil found that manipulation promoted lymphatic absorption.43

The one area in which Swedish Movements and massage research could not materially assist the American School’s faculty was in explaining why Still and his followers were obtaining their results by focusing predominately on the spine. To this question they found a partial answer in neurophysiology. In 1828 a Scottish physician, Thomas Brown, wrote an article in which he argued that pain about an internal organ could be caused by a disturbed vertebra that shared a common nerve supply. He called this phenomenon “spinal irritation.”44 In succeeding years this theory gained currency, and a number of books dealing with the subject were published.45 One who accepted a similar principle but who did not use the term spinal irritation was the English surgeon and anatomist John Hilton (1804–78). In his popular and influential treatise Rest and Pain, first published in 1863, Hilton spoke instead of “sympathies,” which covered the relationship between visceral pain without accompanying inflammation and “sore spots” about segmentally related vertebrae. To treat this type of pain, said Hilton, one must only treat the spine, which he did with rest and restriction of mobility.46 While Still’s staff seemed only vaguely aware of the doctrine of spinal irritation, they were quite familiar with Hilton’s work and often cited his case studies in their lectures.47

Charles Hazzard and J. Martin Littlejohn argued by analogy that if referred pain could be produced by displaced vertebrae Other remote symptoms, as Still argued, could be caused by them as well. Many of the nerves originating from the spine are connected to the sympathetic ganglia, whose function is to regulate blood flow to the various organs. Furthermore, many contemporary scientists speculated that the nerves had a trophic function–that is, they would directly supply nutrients to body tissues–so it followed that a disturbance of a spinal nerve could materially weaken the organ it supplied.48

The faculty also seized upon the principle of “stimulation and inhibition” as advanced by C. E. Brown–Sequard (1817–94). In animal experimentation he had discovered that a transverse sectioning of one lateral half of the base of the brain would be followed by augmentation of the motor properties in front of the cut and by inhibition of the opposite side. A stimulus weaker than normal would then be sufficient to produce an effect in the first case, while a stronger stimulus would be necessary in the latter. This meant that an “irritation” of a given nerve not only could reduce action at one distant part, it could also increase action in another.49 Charles Hazzard, in his interpretation of Brown-Sequard’s doctrine, believed that by putting physical pressure on “vaso-motor centers” along the spinal column the osteopath could return excessive or insufficient functional activity within an organ back to normal, independent of the actual cause. If, for example, a patient was suffering from a bad case of indigestion and there was no discoverable disturbance in segmentally related vertebrae, one could nevertheless relieve the condition by treating the relevant centers.50

In addition to finding scientific evidence supporting Still’s theory, the faculty undertook the equally important task of making his ideas conform to established scientific facts, most notably the role of germs. Between 1876, when Robert Koch (1843–1910) isolated the bacteria responsible for anthrax, and the dawn of the twentieth century, the microorganisms causing fourteen different human afflictions were positively identified.51 How could these discoveries be reconciled with the doctrine that anatomical misplacement was the major cause of disease? Similarly, what possible benefit could manipulating the spine have in treating infectious disorders? Still ignored the contradiction. “I believe but very little of the germ theory,” he once declared, “and care much less.”52 All he seemed to admit to was the potential danger of germs in open wounds.

His faculty, however, preferred to face the problem more directly. Each of them accepted the existence and etiological role of microorganisms. Carl McConnell and the Littlejohns argued that while bacteriology seemed to undermine part of Still’s original theory, its sister field, immunology, clearly supported him. Germs, they hypothesized, might be the active cause of disease, but spinal displacements, or what were then being called spinal “lesions,” could be predisposing causes. If, as they believed, these structural lesions produced derangement of physiologic functions, it would follow that in their presence the body would automatically be put into a state of lowered resistance. Thus, correcting lesions shortly after they occurred would lessen the likelihood of germs’ gaining a foothold in the body. By correcting lesions after infection had struck, the body’s natural defenses could then more effectively respond to the invaders. Under these assumptions, osteopathic procedures seemed entirely applicable and necessary.53

Though he was at times disappointed and angry with his faculty because they sought to integrate the ideas of medical writers into their teaching, Still did not seriously interfere.54 As a result, their contribution to the future course of the profession was assured. While his faculty’s writings had no appreciable effect on the number of patients and students coming to the Missouri Mecca, they built osteopathy upon an intellectual base broader than the one Still was capable of constructing himself.55

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