History of Osteopathy
Still played an active military and political role in the American Civil War on the side of the opponents of slavery. His fate took a decisive turn in 1864, after his return from the war. Three of his children died within a few days during an epidemic of meningitis. Shortly after, a fourth child died of pneumonia, even though he had consulted the best doctors and preachers in the area. Still was so disappointed that he abandoned “heroic medicine” and all religious institutions, in the attempt to find a better form of medicine. He started to take an interest in the spiritual movements of his time: American transcendentalism, phrenology, mesmerism, magnetism, and also bone setting, as practised by the medicine men of the Shawnee Indians.
Still also attentively studied highly complex philosophical treatises, such as those written by Herbert Spencer, the founder of evolutionary theory, and current developments in European medicine. In this period,he also acquired knowledge of mechanics and electricity. Still's open mind towards spiritualism was particularly controversial. Seances, an Indian medium and his later membership in a freemason lodge all bear witness to his broad interest in this area too. However, few of his critics were prepared to acknowledge that, however eccentric his behaviour was, he applied what were for the period the strictest scientific standards. Everything that could be implemented in practice and which appeared to be of use to his patients was integrated into his osteopathic system and the rest was rejected - totally independent of current fashions, expert opinions, traditions or specialized literature. Still thus embodied the ideal of a neutral empiricist.
The Osteopathic Philosophy
The result of Still’s long and intensive search was the discovery of a new medical philosophy - osteopathy, whose date of birth he describes to be 22 June 1874. This was centred on the perfect creation as the expression and work of an unnameable higher power. The individual structures and the functional connections both within and between them were subject to harmonious laws. Still also applied this conviction to man. He developed the concept of the triune man - the triply differentiated unity of man - with the unity of body, spirit and soul. He recognised this as creation’s perfect self-healing mechanism. The optimal function of “God’s pharmacy” therefore essentially depends on the supply and removal of nervous energy, blood and lymph, to and from the body. If these pathways are blocked, this hinders the self-healing mechanism and the corresponding organs become sick. Still regarded the spinal column as the centre of peripheral supply and this is why he looked for displaced vertebral bodies in most diseases, even internal diseases. He assumed that malposition of the vertebral bodies inhibited the function of surrounding nerves and vessels and attempted to reposition them specifically by gentle manipulations. Manipulation of a bone (Greek: osteon) assured supply and removal, the self-healing mechanism could become active again and there was a positive effect on the disease (Greek: pathos).
Still regarded treatment with drugs as proof of a lack of confidence in the powers of nature and categorically rejected this, just as he rejected premature surgery. According to Still, the osteopath was simply a mechanic with complex ideas and the perfect creation was the healer. As a consequence, the osteopath was never directly responsible for the cure, but was simply the intermediary between the patient and the freely acting creation.
In the mid-1870s in Kirksville, Missouri, Still finally obtained the recognition he deserved for his extraordinary dexterity, his enormous general scientific knowledge, his intense spiritual experience of life and his dogged ambition. Because of the enormous success of his treatments and his exceptional ability to use his immense general knowledge to recognise functional interconnections with no effort, his reputation as “wonder healer” spread rapidly. Encouraged by his patients and even some doctors, at the age of 64 Still finally founded the first osteopathy training school in the world, the American School of Osteopathy (ASO) in Kirksville in 1892. The triumphant march of osteopathy had begun.
In 1910, the American Medical Association initiated a state investigation of all medical training centres in America. This was intended to guarantee further financial support only for those candidates which fulfilled specific criteria in the evaluation. The standards of the medical universities - including pharmacy and pharmacology - were used as the basis. The so-called Flexner Report resulted in almost all osteopathy colleges distancing themselves increasingly from Still’s original concept to guarantee their economic survival. Therefore, most osteopaths in the USA now regard manual techniques as being of little importance. What was even more unfortunate was that the central concept of the triune man - with the conviction of a perfect self-healing mechanism subordinate to a spiritual power - was expelled from osteopathy. Thus osteopathy drifted more and more towards allopathic medicine.
Still’s Later Years
At the turn of the century, Still returned to his favourite occupations: observing nature, internal development and social exchange of opinions. Although he was revered by this students and patients, his faculty became increasingly alienated from “the old doctor.” In particular, they had no sympathy for his stubborn refusal of any sort of medication and his resumption of research in spiritualism. Still was not distracted and continued his studies and his attempts to fathom the mysteries of osteopathy free of prejudice. In 1917, more than 50 years after the start of his career as a simple country doctor, Still died. He had discovered one of the most important medical philosophies in the history of mankind, osteopathy, centred on the triune man as part of a perfect creation.
(1865-1947) A Sparkling Intellect
John Martin Littlejohn was born in Glasgow on 15 February 1865 as the son of a parson. John Martin was a sickly but highly intelligent young man who was eager for knowledge. Although his parents’ house was bitterly poor, there was active interest in humanities and this led him to study languages at Coleraine Academy in Northern Ireland when he was only 16. After completing his study of theology at Glasgow University, he went to Northern Ireland as a parson in 1886, but returned shortly afterwards to Glasgow. He passed exams and was awarded prizes in law, theology, medicine, philosophy and sociology.
In 1886/87, he gave his first lectures. The harsh climate and his constitution had turned him into an introverted and uncouth, but brilliant and widely educated analyst. At this period he started to suffer from bleeding in the neck and this forced him to seek a change of climate. This was the abrupt end to a splendid university career.
In 1892, he emigrated to America with his brothers James and William and continued his studies at Columbia University in New York. Because of his exceptional achievements, he soon became head of Amity College in College Springs, Iowa. However, his symptoms did not improve and this led to his fateful meeting in 1895 in Kirksville with Dr. Still. Even a single treatment led to marked improvement. As Still urgently needed qualified teachers for his American School of Osteopathy after its foundation in 1892, he offered Littlejohn the position of teacher in physiology. Littlejohn was deeply impressed by Still’s natural concept of osteopathy and accepted the offer. He started work in 1897, registered as student one year later and became dean of the school in the same year.
However there was soon bitter conflict within the faculty. Still’s disciples regarded the anatomical approach to osteopathy as holy. Littlejohn and his brothers thought that this was too simple. They regarded physiology - which was more complex - as being the kernel of osteopathy. But it was also a timeless conflict: academically trained doctors against practically orientated osteopaths. To make matters worse, Littlejohn fell in love with his teacher’s vivacious daughter, Blanche Still. His well-intentioned presents of lexica fell on stony ground and he was rejected. When, in addition to that, he was displaced as dean, the break with the ASO was conclusive. He moved to Chicago with his brothers, who had accompanied him from Glasgow, and founded the Chicago College of Osteopathy there in 1900. Teaching in theoretical subjects was extended and physiology was established as a central subject. The school flourished, in spite of the critical attitude of the conservative American Osteopathic Association and developed into one of the most important scientific sources of early osteopathy. It is thought that Littlejohn, who had been married by then and was highly sensitive to political developments, foresaw the disastrous effects that the Flexner Report (as mentioned above) would have for the independence of osteopathy in the USA. This may be why he preferred to start again in England.
In 1913, Littlejohn and his family, which now numbered eight, moved to Bagger Hall near London and John Martin started with “hospital work” and “instruction” while war was still raging. In 1917, he founded the British School of Osteopathy in London and the Journal of Osteopathy, finally laying the foundations for osteopathy in Europe. However, in England too he had to ward off the attacks of the British Osteopathic Association and the British Medical Association. Just as with the consequences of the Flexner Report, a BMA campaign led in 1935 to a parliamentary bill. Osteopathy was refused official recognition. The Second World War did the rest and the BSO soon shrunk to a small clinic. Littlejohn, the most important representative of osteopathy apart from Still, died in 1947 in Bagger Hall. If Still represents the body and soul of osteopathy, John Martin Littlejohn was certainly its intellect. He extended the physiological concept, laying an important foundation for its later triumphal march in America. European osteopathy in its present form would not be conceivable without him.
William Garner Sutherland (1873-1954)
Born in rural Portage County, Wisconsin, like Still, Sutherland was permanently influenced by the simple and agricultural character of life in the Midwest. One experience influenced him particularly. Sutherland’s father got his children to plant potatoes in a bed in the garden and then harvest them later. After they had apparently found all potatoes during the harvest, the father instructed them to dig again and repeat the search – “Dig on!” – and they found even more potatoes. Even the third attempt was successful. This meticulous and obstinate digging for hidden goals had a lasting effect on Sutherland’s later research on skull bones, as he familiarised himself with the smallest anatomical details in order to fathom their functional significance. “Dig on!” – the search for the invisible – was to become the motive of his life. Sutherland earned his first money as printer’s boy at the Blunt Advocate. He soon proved himself and was promoted to foreman in 1890. In 1893, he went to Fayette, Iowa, to attend the Upper Iowa University. He then returned to the newspaper and finally became the publisher of the Daily Herald in Austin, Minnesota. Whilst in this position in 1898, he heard of Dr. Still and osteopathy. In the same year, he registered at the American School of Osteopathy and completed his training in 1900. One way he supported himself as student was by editing the texts of his physiology teacher, Dr. Littlejohn, who was also Sutherland’s fellow student. This is an interesting detail, as Littlejohn was then already writing about the movements of the skull.
“Like the Gills . . .”
Towards the end of his training, the young Sutherland was looking at the sutures of the individual skull bones of a disarticulated skull and he suddenly thought: “This looks like the gills of a fish”. He predicted breath-like motion in the sutures and, during the subsequent decades, attempted to disprove his hypothesis by daring experiments on himself (!). As this was not successful, he transferred the concept of traditional osteopathy to skull bones, developed advanced and extremely fine techniques, thus founding the concept of cranial osteopathy. It should also be mentioned that Charlotte Weaver DO, who had also studied at the ASO (1912), had already published some important articles on skull motility before Sutherland’s first work, The Cranial Bowl (1939), so that it is conceivable that she influenced him to some extent.
After more than two decades of cranial research, Sutherland, normally a quiet man, decided to try his luck with his professional colleagues under a false name at the start of the 1930s. He used the Minnesota Osteopathic Journal as a forum to explain for the first time the basic ideas of his concept, which did not yet include PRM. The reactions to his column differed widely, ranging from vehement rejection to honest encouragement to perform additional research in this area. Because of the increasing interest of a small group of osteopaths, in 1939 Sutherland published the small book mentioned above, The Cranial Bowl, in which he summarised the results of 40 years of research on a few pages.
In spite of the restrained response, he continued to extend his studies of cranial osteopathy. In the mid 1940s he surprised his colleagues again with a revolutionary innovation: Initially in a restrained manner, but then increasingly openly, he started explaining the terms “liquid light”, “potency” and “primary respiratory mechanism” (PRM) in his seminars, in the context of the well-known biblical expression, “the breath of life.” In this connection, he was probably lastingly influenced by the American philosopher and artist Walter Russell, just as Still in his time had been influenced by the English philosopher Herbert Spencer. Sutherland’s open mention of and emphasis on spirituality shows that he was totally in the tradition of his revered teacher, as Still had throughout his life regarded metaphysical elements as a natural component of the triply differentiated unity of man. Moreover and with this background, Sutherland repeatedly and emphatically stated that craniosacral osteopathy should be regarded as an integral component of traditional osteopathy and was not under any circumstances to be seen as an independent form of treatment. Sutherland died in 1954 as one of the most respected members of his profession. Craniosacral osteopathy is regarded as one of the major pillars of osteopathy, even though PRM has not yet been proved.
Osteopathy in Europe
As it is impossible to render the total history of osteopathy in Europe, we will restrict ourselves to describing the two most important countries in this area: England and France. All important impulses in the other countries are directly or indirectly connected to initiatives from America or these two countries.
In 1898, John Martin Littlejohn was the first osteopath to touch European soil. He was followed almost immediately by Dr. William Smith, the first ASO anatomy teacher and also a senior member of its faculty. After Littlejohn and his family had finally emigrated from America to England in 1913, he started the British School of Osteopathy in London in 1917 - the first training centre for osteopathy in Europe. Some American osteopaths had previously set up practices, particularly in Scotland and England. It was nevertheless Littlejohn’s merit that it was now, for the first time, possible for Europeans to learn the art of osteopathy on their own continent. Littlejohn also founded the Journal of Osteopathy, the first official scientific forum for European osteopathy. He also made intensive efforts to achieve professional recognition for osteopathy in England. As in America, the medical associations resisted these efforts and, in contrast to America, equal recognition has not yet been achieved - even though legal protection for osteopathy was awarded in 2000.
1. The Medical Route
Dr. Robert Lavezzari (1886-1977) was instructed by Florence Gair, one of Still’s pupils, and went to Paris in 1936, where he declared himself for osteopathy in 1949. Before then, doctors had been trained as osteopaths in America or had gone to the London College of Osteopathy.
2. The English Route
In 1950, the physiotherapist Paul Gény, together with the English osteopath Thomas G. Dummer, founded the l’École française d’Ostéopathie. The aim was to offer even non-doctors the chance to learn osteopathic art. From there, this concept was also introduced into Switzerland under the name of Etiopathy. It was also Gény who looked after the students who wanted to complete their training at the British College of Naturopathy and Osteopathy and the osteopathic clinic in Maidstone (later: European School of Osteopathy). Most French osteopaths now choose this training and have organised themselves in the Association Française des Ostéopathes.
3. The French Route
In accordance with the wish of his deceased teacher, Sutherland’s pupil Harold Magoun Sr., together with Viola Fryman and Thomas Schooley, instructed nine doctors or physiotherapists in Paris in 1964 in the art of cranial osteopathy. The instruction took place in the practice of Rene Quéguiner, who, together with Francis Peyralade, shortly afterwards organised a society to support the spread of cranial osteopathy within France. Parallel to this, Denis Brooks instructed the founder of the l’Association de Thérapie Manuelle, Bob Bénichou.
In contrast to the USA, highly qualified osteopaths, such as Littlejohn in England or Gény in France, were forbidden to perform surgery, prescribe drugs or to assist in child birth. This inevitably led to osteopathy developing in two directions. While the non-medically qualified osteopaths in Europe were compelled to concentrate on their manual techniques and improve these techniques continuously, the osteopaths in America undertook scientific research over a broad area, particularly in increasing the precision of surgical methods. If the origins of visceral techniques are in Europe (Barral and Weisschenk), minimally invasive and tissue sparing surgical techniques and important neurophysiological results are due to American initiatives (Korr, Denslow). Still’s traditional holistic osteopathy with the central concept of the triune represents a symbiosis of these two approaches. The situation became even more complicated when European doctors arbitrarily mixed manual therapeutic and chiropractic elements and reduced their complexity to make them more suitable for every day work. The osteopath as intermediary was replaced by a local manipulator, working in a one dimensional manner, tending to restore the old hierarchy in which the therapist was simply “a pair of hands.” In the context of the historical quarrel between doctors and non-doctors, all this has led to osteopathy becoming a plaything between the lobbies. Reconciliation may appear utopian at the moment, but is the only way and the most important challenge for all participants to develop osteopathy’s full potential - for the good of the patient.