Manipulative methods as part of medical treatment are known to date back to earliest times. Hippocrates wrote of their value. Throughout medical history manual methods have been used, but almost always with a view to the correction of gross structural problems such as dislocations or spinal deformities. The methods used were empirical and often extremely forceful, with a minimum of scientific rationale to support their use. The same can be said for much of medical practice, until the end of the nineteenth century. Heroic drugging and bleeding were the methods most frequently used in order to bludgeon the body back to a semblance of health.
There have been a number of medical reformers who saw the folly of attacking the apparent disease process, or more often the symptoms of it, rather than seeking and eliminating causes. Among these were the celebrated Dutch physician Hermann Boerhaave (1669-1738), and the great English doctor and teacher, Thomas Sydenham. They stressed the vital importance, in the Hippocratic tradition, of placing the study of the patient at the heart of medicine rather than emphasizing the disease process.
Andrew Taylor Still
In a different age and out of a very different culture there emerged a man who wrestled with the same problems and who came to a practical solution. Andrew Taylor Still was born in 1828 in Jonesburgh, Virginia. His father Rev Abram Still, of the Methodist Episcopal Church, was both preacher and doctor to his flock. This was not an unusual combination at this time in frontier America. When Andrew was six the family moved to Tennesee, where he attended elementary school. Three years later the family moved again to Northern Missouri, Abram Still having been appointed as Methodist missionary in the area. There Andrew attended a typical frontier school.
During this period Andrew displayed a great interest in the natural environment. With his father’s aid he studied and observed nature. He found great beauty and order in the world, marred only by the constant presence of disease and death. He was horrified by the havoc caused by the common diseases of the day, such as smallpox, cholera and meningitis. He was sensitive to the inadequacies of current medical methods in dealing with these diseases.
Andrew Taylor Still M.D. (1828-1917), Founder of Osteopathy
When Andrew was sixteen the family moved again, this time to Kansas where his father had been appointed missionary to the Shawnee Indians. At the age of eighteen Andrew Still married. In 1857 he was elected to the Kansas legislature where he promoted the anti-slavery cause. His wife died in 1859 leaving him with three young children, and he remarried in 1860. His medical training began when he was able to help and learn from his father, and other practicing doctors of medicine. At this time medical schools were few in the U.S.A. and the preceptor method of training was usual. Before the civil war he attended the College of Physicians and Surgeons in Kansas City, but before completing the course he enlisted in the army. During the civil war he served as a surgeon and rose to the rank of major.
Following the war he continued to study the nature of health and disease. He found current theory and practice inadequate and in his autobiography he states: ‘I was in the practice of medicine and had been for several years. I treated my patients as other doctors did. Some of them got well, and some of them died. Others, both young and old, got sick and got well again without the assistance of the medical doctor’. He studied the human body in detail, its structure and the relationship between structure and function. He became convinced that only through an understanding of this relationship could an understanding be achieved of the malfunctions of the body, i.e. disease.
In 1864 an epidemic of meningitis struck the Missouri frontier. Thousands died, including his three children. It was his helplessness during this tragedy that drove him on in his studies. ‘Not until my heart had been torn and lacerated with grief and affliction,’ he wrote, ‘could I fully realize the inefficacy of drugs. Some may say that I should suffer in order that good might come, but I feel that my grief came through gross ignorance on the part of the medical profession.’
This experience crystallized his dissatisfaction with the current empirical methods of medical treatment of disease. He sought a philosophy upon which to base his practice which would not vary with every new wind of doctrine or experiment, but which would have a scientific basis. This he sought at a time when modern science and methods of research were unknown, and he devoted himself to the study and analysis of all the existing knowledge available to him. On 29 August 1874 he was registered as a practicing physician in Macon county, Missouri.
Shortly after this he announced the results of his years of study. He stated three fundamental principles upon which he would base his practice of medicine. These were:
- The body produces its own healing substances
- Health is dependent upon structural integrity
- Perverted structure is a fundamental cause of disease.
Besides these principles he also originated a system of manipulation. Basing his philosophy of practice upon these principles he proceeded to correlate manipulative therapy with other methods, then used by doctors, such as drugs and surgery. In many instances he found that the use of manipulative methods made drugs and operations unnecessary. The concepts and theories were proved in his clinical experience. He developed the art of manipulative therapy, based on his knowledge of human anatomy, physiology and chemistry and, above all, on his new found discovery of the vital inter-relationship between the structure of the body and its function.
An Early Case
One early case illustrates his approach at this time, and also shows the fairly primitive knowledge of the way the body functions that was prevalent at that time. Despite this obstacle Andrew Taylor Still was able to evolve and construct a theory and a practical system of therapeutics which worked then, as it does now, because it recognized and was based upon natural laws. In his autobiography he describes the case of a child with dysentery:
I placed my hand on the back of the little fellow in the region of the lumbar and found it very warm, even hot, while the abdomen was cold. My only thought was to help . . . and little dreamed I was to make a discovery that would bless future generations. I thought it strange that the back was so hot and the belly so cold; then the neck and the back of his head were very warm and the face, forehead and nose cold. I began to reason, for I then knew very little about flux (dysentery), more than the fact that it killed old and young and was worse in warm weather. I did not know how to reason on diseases because all the authorities I had met could not get their eyes off the effects to turn them to the cause. I knew that a person had a spinal cord but little of its use. I began to work at the base of the brain and thought that by pressing and rubbing I could push some of the heat to the cold places. While doing so, I found rigid and loose places in the child’s whole spine, while the lumbar region was in a very congested condition. I worked for a few minutes on that philosophy and then told the mother to report to me the next day. She came early next morning to report that the child was well. I had seventeen severe cases of flux in a few days and cured them all without drugs.
As we shall see in later chapters, spinal manipulation is used with great benefit in many infectious diseases.
At the time Dr Still was living in Kirksville, Missouri, and his fame spread rapidly, and patients came to him from all over America. He found that by careful palpation, i.,e. examination by feeling the surface of the body, he could ascertain abnormalities, and by careful manipulation he could often restore normal function. In many cases he found that he was able to achieve beneficial results, where previously he had failed. He records success with cases of pneumonia, asthma and many acute and chronic ailments. Osteopathy, to Still, meant diagnosis followed by specific manual techniques applied spontaneously until he felt the desired changes in the tissues or joints on which he was working. He did not apply manipulation as a remedy for symptoms as such, but regarded himself as a mechanic of the living body, restoring or encouraging its natural powers of recovery.
The case of the child with dysentery illustrates how the idea evolved. Starting with the idea of moving heat from one part of the body to another he used his hands on the child’s spine, felt abnormalities and proceeded to normalize these, with good effect. By trial and error he found that similar abnormal structural changes existed in many conditions and from these simple beginnings grew a new science.
The facts have not changed, such abnormalities are still to be found in most spines. We do, however, have more of an idea as to what the physiological and pathological implications of these areas are. They used to be called osteopathic lesions, and a great deal of vitriolic, not to say hysterical, attacks on the very idea of their existence, have been made by medical writers. The current osteopathic terminology labels these ‘lesions’ as ‘areas of somatic dysfunction’, and later we shall examine in more detail their significance.
Still’s gifts as a skilled manipulator and healer are well documented. There was a celebrated case in which he reduced a dislocated elbow in minutes after four physicians had failed, even with the patient under anaesthesia. His contribution to the healing art was to offer an alternative to the heavy drugging of orthodox medicine of that time. He also conceived the basic theories of his new approach and developed and originated the manipulative skills without any outside aid. A man of brilliance and dedication, he stubbornly persisted in his work, despite enormous opposition from the medical establishment.
In considering his contribution, it is as well to realize that medical knowledge as we know it today was in its infancy. Antiseptic surgery was only just being introduced by Lister against conservative opposition. It was another twenty years before radiography was introduced, and the germ theory of Pasteur had only been established some ten years previously. It was in this dark age that Still worked out a practical system of structural therapeutics that has never been invalidated by later discoveries. Still emphasized the importance of the musculoskeletal system as a major factor in disease processes; he recognized the body structure as an important source of derangement. It was therefore also a major avenue for the application of therapy designed to assist natural defences and to repair and restore physiological adaptive functions. The result of this view is to distinguish the patient from his ailment and to recognize finally that only by understanding the attributes of health can the disease process be studied and corrected.
In order to cope with the demands of some of his fellow doctors, Still trained them in his theories and techniques. This led ultimately to the founding of the first College of Osteopathy in Kirksville, in 1892. He based his school upon the fundamental principles of the osteopathic concept and included in its teachings all available methods which were useful in the care of the sick. Sixteen men and three women graduated from this first Osteopathic College in 1894. From that small beginning the growth of the profession has, against great odds, been staggering. Today there are twelve osteopathic schools in the U.S.A. Some are part of major university campuses, and between them they graduate some one thousand new osteopaths annually, after seven years of training, which includes a full orthodox medical training, as well as the specialized osteopathic theories and methods.
Graduates enjoy all the rights and privileges enjoyed by graduates of medical schools. But, as we shall see in the following chapter, this position is not the case in other countries where osteopathy has yet to realize its true potential. Dr Still was an eccentric individualist who lived through a storm of abuse from the medical fraternity to the age of 89. When ‘the old Doctor’ died in 1917 there were more than five thousand osteopathic physicians practicing in the U.S.A.