From its small beginnings in the last years of the nineteenth century to the present time there has been a dynamic growth in osteopathy in all its spheres—education, research and practice. In the U.S.A there are in the region of 20,000 fully licensed osteopathic physicians currently in practice. Their training is in all respects equal to that received by medical students in terms of content, standards and requirements.
The emphasis in the osteopathic colleges has, over the years, been towards producing osteopathic practitioners who could practice comprehensive medicine, using orthodox methods as well as the unique osteopathic approach. This has tended to result in a number of osteopathic physicians becoming indistinguishable from orthodox doctors, and many have found it easier to practice ‘straight’ medicine rather than to employ the methods uniquely associated with osteopathy.
As a result of this trend a group of practitioners dedicated to the preservation and dissemination of the essential fundamentals of osteopathy formed, in 1937, the Academy of Applied Osteopathy. This organization, through its efforts, has been responsible for a resurgence of interest amongst the new generations of practitioners in the methods and philosophy of the original osteopathic pioneers. The Year Books of the Academy provide a treasure-house of information and inspiration for the profession.
It should not be thought, though, that the osteopathic profession has been slavishly tied to the pronouncements of Dr Still. Indeed, as early as 1918, Dr Michael Lane D.O. wrote: ‘Many osteopaths, while revering the founder of the new system, have seemed to feel that because Still was right in his grand principles of disease and its therapy, that therefore he should not have been wrong in anything he said about the body and its work in health and disease. But such osteopaths are short-sighted and unwise. If Dr Still had been right in all his theories he would not have not been human.’
In the U.K., where osteopathy has had a very different history from that in the U.S.A., writers and teachers have tried to hold on to the essentials of Still’s teaching whilst also being aware of his shortcomings. In 1954 the eminent British osteopath, S. Webster-Jones, describing in a lecture the case of the child with dysentery who Still had treated, said: ‘It would be only too easy to ridicule Still’s approach to this case, and his idea of moving heat from one part of the body to another. Discredit Still’s ideas on physiology, diet, medical diagnosis, as you will, actually they led him back to his patient as a whole, to seek in his body the cause of his illness and to try to remove it. They led him away from that overstudy of local pathology and preoccupation with local and systemic diseases that has led to over-specialization in orthodox medicine, which has had the effect that the patient is often forgotten in the study of disease.’
Osteopathic Colleges in the U.S.A.
In the U.S.A. all states licence graduates of the twelve Colleges, and they are at liberty to practice unlimited medicine after seven years training. The twelve colleges are:
- Chicago College of Osteopathic Medicine.
- College of Osteopathic Medicine and Surgery, Des Moines, Iowa.
- Kansas City College of Osteopathic Medicine.
- Kirksville College of Osteopathic Medicine.
- Michigan State University College of Osteopathic Medicine.
- Ohio University College of Osteopathic Medicine.
- Oklahoma College of Osteopathic Medicine and Surgery.
- Philadelphia College of Osteopathic Medicine.
- Texas College of Osteopathic Medicine.
- West Virginia School of Osteopathic Medicine.
- New York College of Osteopathic Medicine.
- New Jersey School of Osteopathic Medicine.
New colleges are in the process of development in Maine and California. As the names indicate, there are a number of osteopathic colleges which are part of major University campuses. As also indicated, many teach surgery as an integral part of Osteopathic training.
There are, in the U.S.A., a variety of speciality groups including Anaesthesiology, General Practice, Internal Medicine, Neurology and Psychiatry, Nuclear Medicine, Obstetrics and Gynaecology, Ophthaemology and Otorhinolaryngology, Pathology, Paediatrics, Proctology, Radiology, Rehabilitation Medicine, Surgery etc. In all these specialist fields there are skilled physicians approaching their individual areas of disease or dysfunction from an osteopathic viewpoint. The growth in numbers of practitioners and colleges has been paralled by the development of osteopathic hospitals, of which there are hundreds in the U.S.A.
With more and more graduates, with the highest academic qualifications, and the constant voice of the Academy of Applied Osteopathy to remind them of their unique heritage, the ‘Old doctor’s’ proteges would seem to have established themselves in the country of osteopathy’s birth.
The Situation in the U.K.
In the U.K. osteopaths practice under common law. There is no legislation governing the right to practice or the scope of practice. Anyone with or without training may establish a practice and style themselves as an osteopath and use the initials D.O. (which in the U.K. stand for Diploma of Osteopathy). There are three colleges offering four year courses (full time) in osteopathy in the U.K. No surgery or pharmacology are taught as subjects for students in the U.K. (where a more limited approach to the health problems of the patient exists than in the U.S.A.).
The British colleges are (in order of seniority):
- The British School of Osteopathy, whose graduates style themselves ‘Registered Osteopaths’ and use the initials M.R.O.
- The British College of Osteopathy and Naturopathy, whose graduates style themselves ‘Registered Naturopaths and Osteopaths’ and use the initials M.B.N.O.A.
- Ecole Européene d’Osteopathie, whose graduates style themselves ‘Members of the Society of Osteopaths’ and use the initials M.S.O.
Apart from these colleges, all of which attract discretionary grants from local authorities, there are a number of colleges and schools, offering part-time and correspondence courses. There is also The London School of Osteopathy which offers a one year post graduate course to qualified medical practitioners.
The rivalry, and lack of co-operation, between the various osteopathic groups in the U.K. until fairly recently would be laughable were it not so sad. Of the estimated three thousand practicing osteopaths in the U.K., no more than 600 are graduates of full-time colleges. The remainder may have had some or no training, and whilst some of these practitioners are skillful, they patently do not have the background knowledge of anatomy and physiology possessed by the more adequately trained practitioners.
A further area of discord results from the strict code of ethics insisted upon by the associations governing the graduates of the full time colleges. Among the rules affecting these practitioners is a prohibition on advertising in any shape or form. The less well qualified osteopaths, who are not elligible for membership of the three main organizations (whose members are identified by the letters M.R.O., M.B.N.O.A., or M.S.O.) can, and do, advertise. The College of Osteopaths, which offers a five-year part-time training also forbids its graduates (M.C.D.) from advertising. Outnumbered by their less well-qualified colleagues it might have been expected that fully trained osteopaths would have aimed for a degree of unity in order to try to persuade government to legislate on the unhappy state of the profession. Instead, for many years, open hostility has existed between the three organizations, who would miss no opportunity to denigrate each other. Force of circumstances has led to a degree of co-operation being discussed, with regard, for example, to joint representation in the face of various legislative developments. One of these involves strict controls over the use of x-ray equipment, in an effort to minimize people’s exposure to radiation. Desirable as this is, it has been necessary for osteopaths to attempt to ensure that their interests were taken into account in the formulation of the proposed laws. Obviously the expenses of legal advice and of a parliamentary agent are better shared, rather than duplicated by all the interested parties.
The prospect of this sort of co-operation has led to wider discussion between the three major osteopathic organizations and it is through such talks that future joint approaches to government might come. The flood of new, partly trained or untrained, practitioners has also concentrated the minds of those practitioners and their representatives who have had full time training. A united front is the only way that government agencies will be persuaded to act to sort out the current disorganized state of affairs. There have been two main attempts towards this end. The first in 1935 was initiated in the House of Lords, who appointed a select committee to look into the whole question of osteopathic recognition. At that time it was decided that the educational establishments of the day, and the profession as a whole, were too disorganized to warrent registration.
There was sympathy for the cause, but the profession was virtually told to put its house in order. To a large extent it has, insofar as it can. If the three full-time colleges and their associated organizations were to come together and seek registration it would probably succeed. However, the problem would still be, what was to be done with the 2,500 practitioners who do no fall into the category of having had a four year fulltime training? This, and the rivalry between the three organizations, was the main reason for the failure of the second attempt at legislation. In 1976 Mrs Joyce Butler M. P. presented a bill to parliament under the Ten-minute rule. In her speech to the House she stated (from Hansard report, 7 April 1976):
There is a growing interest among the general public, and even within the medical profession, in various less orthodox medical procedures, of which osteopathy, or treatment by manipulation, is probably the best known. The interest often comes from practical experience of the success of such treatment when more usual methods have failed. Some of it is also undoubteldy a reaction against excessive drug therapy and a search for more natural methods of treatment.
She concluded by saying:
With the growing public interest in this form of treatment it is important that it should be performed by adequately trained and experienced practitioners and that the public should be protected from those practicing skills based on home study ‘quickie’ courses and the like, or people who may put glossy but worthless diplomas on their walls. In this country there are two training colleges for osteopathy, The British College of Naturopathy and Osteopathy and The British School of Osteopathy. Both have a full four-year course and strict entry requirements. These are recognized for student grants by the Inner London Education Authority and others. There is also the London College of Osteopathy which gives a one year course of training, to doctors. These colleges have their own private register which intending patients can consult.
The bill which I am seeking leave to introduce proposes that there should be a statutory register of all osteopaths who have followed such a recognized course of study for a required period. The Bill will set this out in greater detail and will, I believe, be an important contribution to the status and expansion of a very important profession. It will at the same time give additional protection to the public. They can be certain that the practitioner they consult is fully qualified if his name is on this register. It is a simple and limited measure which I hope the House will approve.
Because of a failure on the part of the osteopathic organizations to agree to the proposed legislation, or to promote any common policy, the Bill was withdrawn, despite receiving an unapposed first reading. The positive results of this attempt include the fact that no opposition to the Bill was forthcoming either in or out of parliament. An editorial in the General Practitioner questioned whether the Bill went far enough, stating that a register, without legislation forbidding unqualified osteopaths from practicing, would be insufficient. The movement towards registration will continue as the profession comes together to present a united and valid claim.
The practice of osteopathy in the U.K. is usually within a more limited range than that practiced in the U.S.A. The majority of patients attending British osteopaths are suffering from obvious musculo-skeletal conditions (muscles, joints, ligaments etc.) more usually affecting the spinal column. In recent years the attitude of orthodoxy has changed dramatically. It is no longer a punishable offence for an M.D. to co-operate with an osteopath or to recommend osteopathic treatment, after decisions to this effect by the Ethical Committee of the General Medical Council. Consultant Radiographers have been given free choice as to whether or not to take, and report on, x-ray pictures for osteopath’s patients. There are now osteopaths working alongside medical practitioners in the same institutions.
All this would have been impossible as recently as 1970. Public recognition of the value of osteopathic treatment has resulted in an enormous increase in the numbers of patients seeking their assistance. Many practitioners believe that osteopathic care should be freely available through the National Health Service, and if this could be organized it would greatly relieve general practitioners and hospitals. Although, since most osteopaths are already overworked, it is hard to know how they would cope. The saving in lost time to industry would be enormous; already many factories and businesses refer injured workers to osteopaths, and gladly pay their fees in the knowledge that the worker will be fit weeks earlier than otherwise. Many people cannot afford to pay for treatment, but if they live in London they can attend one of a number of clinics, such as those attached to the major colleges, where treatment is available at low cost.
Osteopathic care is more than the correction of joint problems, it is also a system of preventive medicine. By normalizing spinal and joint dysfunction before it has produced obvious symptoms, a great deal of potential trouble can be avoided. Thus, many people visit osteopaths for regular maintenance treatment and this includes assessment of young children during their vital formative years.