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Special Communication  |   January 2014
A Degree of Difference: The Origins of Osteopathy and First Use of the “DO” Designation
Norman Gevitz, PhD
Author Notes
  • Address correspondence to Norman Gevitz, PhD, Senior Vice President, Academic Affairs, A.T. Still University, 800 W Jefferson St, Kirksville, MO 63501-1443. E-mail: ngevitz@atsu.edu  
Article Information
Emergency Medicine / Being a DO
Special Communication   |   January 2014
A Degree of Difference: The Origins of Osteopathy and First Use of the “DO” Designation
The Journal of the American Osteopathic Association, January 2014, Vol. 114, 30-40. doi:10.7556/jaoa.2014.005
The Journal of the American Osteopathic Association, January 2014, Vol. 114, 30-40. doi:10.7556/jaoa.2014.005
Abstract

This article is the first installment in a series of 6 articles on the history of and controversies related to the DO degree. Four questions about the origins of osteopathy and the initial use of the DO designation will be addressed in this particular article. First, did Andrew Taylor Still earn an MD diploma?—he being invariably described as an MD in current osteopathic periodical literature. Second, what was the importance of “magnetic healing” in the evolution of Still's thought? Third, how did the principles and practice of “bonesetting” complete his new system? Finally, when did he originate the term osteopathy and first devise and employ the DO designation? Future articles will examine episodically the history of the DO degree from Still's establishment of the American School of Osteopathy in 1892 up through to the present debate over its significance and value.

Andrew Taylor Still embedded his Autobiography (1897) with entertaining allusions, parables, tall tales, and allegories to explain to a lay audience the basic philosophy and principles of his new form of healing.1 However, for the modern scholar, reading Still's autobiography can be an exercise in frustration. He was neither a dispassionate nor an accurate chronicler of his life, particularly with respect to how he evolved his system of healing, what books and periodicals he read, and who may have influenced him, as well as what he called his practice at different stages of his intellectual and career development.2 Indeed, when Still speaks of the critical years when he was evolving his distinctive approach, he often substitutes metaphor for hard facts. For example, the term osteopathy was a development of the late 1880s or even 1890, yet unabashedly he declares in one his most famous pronouncements, “On June 22d, 1874, I flung to the breeze the banner of Osteopathy.”1(p108) Not only does he use a term that he had not invented at that time, but throughout his book he offers varying information and interpretation as to what he had “discovered” on that particular day. 
To paint a factually based portrait of the development of osteopathy and the origins of the DO designation, it is absolutely necessary to seek out and publish other sources of documentary evidence irrespective of whether, at times, the resulting portrait is consistent with Still's own varying accounts. In this article, the first installment in a series of 6 articles, and based on new research, I will address 4 questions about the origins of osteopathy and the initial use of the DO designation. First, did Still earn an MD diploma?—He being invariably described as an MD in current osteopathic periodical literature. Second, how did Still turn to “magnetic healing” and what was its importance to the evolution of osteopathy? Third, how did he transform himself into a bonesetter? Finally, when did he originate the term osteopathy and first employ the DO designation? Future articles will examine episodically the history of the DO designation from Still's establishment of the American School of Osteopathy in 1892 up through to the present. 
A.T. Still—MD?
There can be little quarrel with Still's assertion that from the early to mid-1850s and for upwards of 20 years, he practiced medicine in Kansas as an orthodox physician, and he was so regarded by other physicians and his patients. Still studied medicine under the direction of his minister-physician father, Abram. He read medical texts and exhumed Indian corpses to further his anatomical knowledge.1 There was no system of medical licensure when he lived in Kansas, nor was there a requirement or an expectation that one must have a medical school diploma to be considered qualified to practice.3 
Still was purposefully vague over the years about his medical training. In his Autobiography, Still first says, “I will omit my later schooling and medical training.”1(p59) Then, speaking of the period before the Civil War he says of his exhumation of Indian corpses,
 

In the quiet of the frontier, surrounded by nature, I prosecuted my study of anatomy with more zeal and more satisfactory results than I had at college…I sat down to my desk on the prairie to study over what I had learned at medical schools.1(pp96-97)

E.R. Booth, PhD, DO, the profession's most reliable early historian, makes no claim of Still's medical school attendance in the first edition of his History of Osteopathy (1905).4 Arthur Hildreth, DO, perhaps the closest of Still's early followers, makes no direct argument about his putative medical school education in The Lengthening Shadow of Andrew Taylor Still (1938).5 
Nevertheless, Hildreth included a remarkable recollection in his book. He printed an undated letter by George Mahan, a prominent lawyer who was the prosecuting attorney in Hannibal, Missouri, when Still, in the early 1880s, was charged with practicing medicine without a license. In 1874 Missouri passed a law requiring that all resident medical practitioners possess a medical school diploma from a reputable school to be licensed and registered in the county in which they practiced.6,7 When Still arrived in Macon, Missouri, late in 1874, hoping to locate there, this law was being enforced. Despite the fact that he could produce no diploma and he was not eligible to be exempted from its provisions by being a resident practitioner in the county for the previous 10 years, Still nevertheless managed to get registered as a physician in Macon County. Very likely, this was made possible through the intercession of his brother E.C. Still, a surgeon who had lived and practiced in Macon for decades.5 Yet, despite his registration as a physician in Macon, Still had no legal protection in Hannibal, which was located in a different county. If Still could not produce a diploma, he could be fined and barred from further practice there. 
Still's trial was memorable to Mahan many decades later not only because of the defendant's eventual prominence but also because of the unusual nature of how it proceeded. Because Still had no money to hire an attorney, he pleaded with Mahan to allow him and the complaining local physician to present their own respective positions to the court without lawyers arguing the case. Mahan acceded to Still's request but remained in court as an eyewitness to what transpired. According to Mahan,
 

Dr. Still explained to the Court that he had graduated from a southern school, had lost his diploma and during the Civil War the school had been burned down so he could not obtain a duplicate, and hence was not able to obtain a license.5(p12)

After hearing both sides, the jury acquitted Still and he continued to practice intermittently in Hannibal.5 In 1883, Still was registered as a physician in Adair County where Kirksville is situated, doing so just before a new, more restrictive medical practice act was to go into effect.5-7 
The issue of Still's putative medical school diploma came up once again in a court case tried in 1899. The Secretary of the Kentucky Board of Health testified that he came to Kirksville in 1896 to inspect the American School of Osteopathy. He testified that during his visit he met with Still, who “told him that he was a graduate of one of the old Kansas City schools, and that he graduated in the ‘40s, but that Dr. Still could not give the name of his alma mater, nor the year in which he graduated.”8(p93) 
The issue of Still's putative formal medical education was again raised in 1907 when Edward Bok, the prominent editor of Ladies Home Journal and himself an osteopathic patient, sent Still a letter inviting him to contribute an article on how he discovered osteopathy. In the first draft of this article he wrote, “Early in the Sixties, I took a course of instruction in the Kansas City School of Physicians and Surgeons, studying such branches as were taught in the Medical schools of that day.”9 Unhappy with the first draft, Bok sent it back to Still calling on him to make a number of changes—none having anything to do with his medical school education. Nevertheless, in his first revision of the draft article, Still made a significant addition. He now declared,
 

In regard to the school which I attended at Kansas City, I would say, that I passed all of the examinations, but on account of the great amount of whiskey being used, there being always a demijohn about the place, also the opium and morphine and other drugs. This was so thoroughly disgusting to me that I lost all desire to graduate and receive a diploma.9

This revised draft, however, was not sent in, and in the final copy that was eventually printed, the original language of the first draft pertaining to Still's medical school attendance was retained.10 
When the Ladies Home Journal article was published, Still's claim that he attended medical school in Kansas City before his service in the Civil War was met with incredulity by some in the osteopathic profession. Henry Bunting, DO, MD, a veteran newspaper man, American School of Osteopathy graduate, and now the editor of the independent monthly journal The Osteopathic Physician, responded to a reader's request to know “if A.T. Still ever was a real doctor” by writing George Laughlin, DO, Still's son-in-law. Laughlin spoke directly with Still and in replying to Bunting noted,
 

The ‘Old Doctor’ tells me he attended the Kansas City College of Physicians and Surgeons during the winter of 1865 and 1866. This was right after the close of the war. He attended there one full term and finished up the work, but did not get his diploma.11(p8)

 
There are 2 fundamental difficulties with this response. First, Still had now changed the story that he attended a Kansas City college from “the beginning” of the Civil War to directly “after” the Civil War. The Civil War was a defining period of time for Still—indeed for anyone who was involved in that conflict. How could he forget whether he had attended medical school before, during, or after the war? The second difficulty is that the documentary record of medical education in Kansas City is clear on dates. Both the Kansas City Medical College and the College of Physicians and Surgeons of Kansas City were established in 1869—years after Still said he attended.12 
Frankly, whether Still earned a medical school diploma or not makes very little difference in weighing his actual and tangible accomplishments in developing his own system of practice and creating the osteopathic profession. However, his lack of a medical degree does have relevance with respect to 3 further questions to be addressed in this series of articles, namely: Which professional degrees should be awarded by osteopathic schools? How should osteopathic practitioners identify themselves? And which degree designations should be advertised and displayed by osteopathic physicians? 
It is important to note that currently it is the American Osteopathic Association's policy to identify the founder of osteopathy in all publications as “Andrew Taylor Still, MD, DO.” Nonetheless, this practice of characterizing him as MD is problematic in 2 respects: First, this policy does not reflect the historical record as he did not possess an MD diploma. Second, current American Osteopathic Association policy is inconsistent with the Association's own long-standing legal position that the designation “MD” is not a title meant to identify anyone who is licensed as a physician and surgeon—but rather signifies the awarding of a particular type of earned diploma, which, most importantly, is not interchangeable with the DO diploma. It is also important to note that the founder most often signed his later articles, correspondence, and legal documents as “Dr. A.T. Still,” “A.T. Still,” or simply “Pap” without appending any degree whatsoever. 
A.T. Still, Magnetic Healer
Still may have doubted the value of drugs even prior to the Civil War; however, it was a personal tragedy, the death of 3 of his children in 1864 due to spinal meningitis despite the best efforts of fellow physicians, that put him on a path toward finding a better way of understanding the causes of disease and a safer and more efficacious means of cure.1,2 Most readers of Still's autobiography—without any other independent knowledge—might readily conceive that the development of osteopathy was linear. Still's interest in farm machinery led him to the belief that man is a machine, which led him to look at mechanical derangements of the body as causes, which resulted in him adopting a mechanical approach (ie, manual treatment as the principal treatment in correcting these derangements). The actual story, however, is more complicated and nuanced—and Still's constructed narrative in his autobiography is just as remarkable for what information he left out of his tale. 
When Andrew Taylor Still arrived in Kirksville, Missouri, he placed the following advertisement in the March 11, 1875, edition of a local paper—the North Missouri Register:
 

AT 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 p.m. with an intermission of one hour from 12 p.m. to 1 p.m.2(p16),13

This ad was printed repeatedly during the next few months. In his Autobiography, Still makes no mention of having previously identifying himself to the public as a “magnetic healer.” Instead he used his pen to steadfastly deny that magnetic healing or other forms of alternative practice, had anything to do with osteopathy—a claim that is not accurate.1,2 Thus, without the benefit of his being forthcoming about himself, we must ask and answer 3 additional questions: How was Still drawn to magnetic healing? What were the principles and practices of magnetic healing? And finally, what role did magnetic healing play in the evolution of osteopathy? 
Still's attraction to magnetic healing was inextricably tied to his evolving religious beliefs. Although raised in the Methodist Church, Still became a spiritualist. Spiritualism was the belief that the living can communicate with the dead. However, American spiritualists went dangerously further and harshly attacked organized religion and characterized established churches and the Bible as impediments to social reform.14 The social consequences of adhering to these radical religious views can be found in a letter co-signed by Still and published January 9, 1875—just 2 months prior to his arrival in Kirksville. It was sent from Baldwin, Kansas—then Still's home—asking for supplies to relieve the distressed people of his town whose crops had been destroyed by a grasshopper invasion. The letter was published in a nationally distributed spiritualist journal entitled the Banner of Light. (Could the title of this journal be the inspiration for the “Banner of Osteopathy,” which Still said that he had flung to the breeze a little over 6 months prior to this correspondence?) The contents of this letter are most instructive:
 

There are a few workers here [spiritualists] but we are looked upon as ‘crazy’ and worse than infidels' and any calamity that may fall upon us is construed to be the just judgment of God, for our daring to think and act for ourselves.15(p8)

This letter by the Baldwin spiritualist circle puts into much clearer and far more understandable context Still's claim in his autobiography that it was the espousing of his new system of healing that was responsible chiefly for getting him “read out” of (or excommunicated from) the local Methodist Church. This letter provides compelling evidence that it was not Still's new type of medical practice, per se, that was the basis for his dismissal—it was his heretical religious beliefs. Similarly, the reason why he could not give a public presentation of his newly adopted ideas on healing at Baker University—which he also recounts in his autobiography—was not explicitly because his medical philosophy challenged orthodox medicine but because Baker University was a Methodist School and surely its administration would not want to provide a stage for one who held such heretical religious views or had been “read out” from the Church. 
Still retained his adopted faith and in 1903 attended an Iowa spiritualist convention.16 Leading American spiritualist authors embraced an independent but compatible set of ideas—magnetic healing—which Still also found most appealing and later publically espoused. The so-called father of American spiritualism was Andrew Jackson Davis.17 Davis authored numerous books, including the multi-volume series entitled The Great Harmonia, which was published in the early 1850s. Because Still does not tell us what he specifically read in these formative years, it is impossible to unequivocally state that he read or was familiar with the first volume of Davis' work, which was entitled The Physician.18 However, anyone familiar with Still's writings can appreciate the similarities between several of Davis' arguments and the philosophical and medical views of osteopathy's founder. 
Davis conceived of “Nature” as a “mighty and Magnificent Machine, and the Divine Mind as the omnipotent and omniscient Artisan.”18(p20) Perfect health, he declared, is “that state where the immortal spirit is circulating harmoniously through every organ, tissue, and ramification, of the organism.”18(p43) Disease, then, “is caused or created by a constitutional disturbance in the circulation of the spiritual principle.”18(p110) Clearly, it is but a very short leap from Davis' free and unobstructed flow of spirit to Still's “rule of the artery”—or the free and unobstructed flow of the blood. Furthermore, Davis waxed rhapsodic about the body's ability to produce the chemicals it needs as well as the body's capacity to heal itself. Davis also argued that physicians were usually mistaken in how they managed their patients' problems, noting that the general practice of treating effects instead of causes is erroneous. As for drugs, he declared, “I am impressed that medicine never cured a disorder in the human body.”18(p234) Drugs were nothing but harmful. Indeed, Davis continued, “medicines penetrate, imprison, and partially murder, some of the weakest or most susceptible organs of the body.”18(p237) In frustration, Davis sighed, “O, that patients could place the same unbounded, submissive, child-like confidence in the in-dwelling Divinity of nature, that they place in their physicians!”18(p237) 
Davis employed a variety of means—including magnetism and electricity—to restore “harmony.” However, physical manipulation—except in asthma—played no role in his overall treatment regimen.18 Nevertheless, several of Davis' followers, also espousing magnetic healing and writing in the 1860s and early 1870s, emphasized the use of the hands in the treatment of illness. Warren Felt Evans devoted several chapters of his book Mental Medicine (1873) to manipulation. He wrote,
 

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, and of sympathy, applied here, by friction combined with gentle pressure, is a singularly efficient remedy for the morbid condition of the internal organs.19(p109)

In his book Vital Magnetism the Life-Fountain (1874), Edwin Dwight Babbitt argued that spinal manipulation could cure convulsions, apoplexy, sunstroke, headache, muscular complaints, common rheumatism, and paralysis.20 Simply put, Still's later claim that osteopathy had nothing in common with magnetic healing was denying the obvious. 
By the end of 1874, Still had been read out of the Baldwin church. He was now considered by many townspeople to be a pariah in both religion and medicine. His crops had been devastated by the grasshoppers, and he and his family were facing economic ruin. It was time for him to move. He visited his brother in Macon, Missouri, and tried to establish a practice there but found that the local populace was not receptive to his ideas. From Macon, he travelled approximately 35 miles directly north (on what is now route 63) to Kirksville, the capital of Adair County, Missouri. Kirksville had no shortage of physicians, although no practitioner in town appears to have espoused ideas or had a treatment approach similar to that of Still. However, a little over 60 miles due north past Kirksville (on that same route 63) at the next medium-sized town—Ottumwa, Iowa—lived the most famous “magnetic healer” of the Midwest—Paul Caster—who had called Ottumwa home since 1869.21 
Undoubtedly, Still had heard of him through his circulars or by word of mouth. Barely literate, Caster discovered he had a special God-given talent of healing through his hands. Chronically ill patients throughout the Midwest and elsewhere travelled to Ottumwa to receive his ministrations, making it a Mecca for invalids. In 1871, due to the demand for his services from out-of-towners, Caster built a large “magnetic” infirmary and hotel consisting of 98 rooms that catered to his clients. In 1876, the Banner of Light published a glowing account of his activities, noting “he has a wagon load of crutches, canes, and various kinds of metallic skeletons (surgical appliances) from which he has rescued his patients and sent them home without them.”22(p110) Once in as bad a financial situation as Still now was, Caster had become a wealthy man. Caster's success as a “magnetic healer” may have provided Still with inspiration and hope as to what he might accomplish. Indeed, upon arriving in Kirksville, Still, along with 2 business associates, announced they would soon “build an infirmary.”23(p129) 
Given their geographic proximity, could there have been communication or a relationship between these 2 “magnetic healers?” A short biographical sketch of Caster published in 1899 was later used for a biographical notice of him that appeared in a 1914 history of Wapello County, where Ottumwa is situated.21,24 Appended to this latter publication's reproduction of the earlier bio is a new paragraph which makes the claim that Caster treated Still as a patient, that the latter adopted “his preceptor's system,” and that Caster encouraged Still to establish his own practice.24(p238) There is no known documentary or collaborating evidence that supports these assertions. Unless such evidence materializes, this claim of Caster's direct influence on Still appears to be an example of local “boosterism”—designed to elevate the importance and legacy of a hometown celebrity who, more than 30 years after his death in 1881, was becoming forgotten. In 1895, an unsigned contribution to the Journal of Osteopathy took notice of Paul Caster, and observed that one important difference between he and Still was that, where the former thought his abilities were “a gift” and thus could not be taught, Still believed that his principles and methods constituted a science and thus could be transmitted to others. As a consequence, the contributor to the Journal astutely noted, Still's name, unlike that of Caster's, would be perpetuated.25 
A.T. Still—Lightning Bonesetter
When Still arrived in Kirksville by January 1875, he found “three or four thinking people” who welcomed him.1 In the prior year a small group of townspeople founded a spiritualist circle, and Still soon developed close friendships with members of this group who encouraged his practice.23 Precisely what type of manipulative procedures Still used under the rubric of “magnetic healing” is unclear, and his patients give varying accounts. Speaking of his unsuccessful effort to establish an infirmary when he first arrived, one Kirksville resident is quoted by Booth as referring to Still's then practice as “massage treatment,”2(p28) which would be consistent with the “frictions” and “rubbings” employed by other magnetic healers, including Paul Caster.19,20,22 
By the early 1880s, Still's practice became less focused on “rubbing” and more centered on the techniques of bone setting—a form of manipulative practice generally limited to the field of orthopedics. Bonesetters were either self-trained or the art was passed down from one family member to another. In addition to reducing dislocations, bonesetters also manipulated painful and diseased joints, thinking these conditions were caused by a “bone out of place.” Physicians ridiculed bonesetters' crude diagnoses and dismissed their claim that such treatments were of any value. Nevertheless, some patients with restricted joint mobility that remained unrelieved after treatment by formally trained orthopedists reported benefit after manipulation administered by such practitioners.2 In 1871, Dr Wharton Hood, a university-trained surgeon, authored a book published in both England and the United States based on his experience 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.”26(p4) Hood noted that while bonesetters' activities were usually limited to manipulating the extremities, they were also treating people who were “complaining of a ‘crick,’ or pain, or weakness in the back”26(p145) and “these applicants are cured by movements of flexion and extension, coupled with pressure upon any painful spot.”26(p146) 
The most well-known American bonesetters were the Sweet family who practiced in New England for nearly 200 years.27 In 1843 Waterman Sweet published a book entitled Views of Anatomy and Practice of Natural Bonesetting by a Mechanical Process Different From All Book Knowledge, which provided insight to his craft.28 This slim volume was in part a “how-to” book; the rest was a series of glowing testimonials by Sweet's patients. Sweet assured his readers that those…
 

…who may peruse and understand my brief views of Bone-Setting, and…by strict attention in following my advice, may in some degree be their own Bone-Setters, who have confidence to undertake and try to operate sufficient to see, and by experience gain self-confidence and the confidence of others.28(p iii)

In point of fact, Sweet was not very forthcoming in describing his techniques. However, the philosophy underlying his practice is most instructive. Sweet declared,
 

Without the aid of medicine, regular circulation assists the absorbent vessels to carry off the refuse of the blood, to keep it pure; but when an accident occurs, it obstructs the circulation of blood—blood and ligaments and nerves, and often muscles, which causes pain and soreness in the parts.28(p35)

Sweet then describes what happens when a bone becomes out of place. “In cases of dislocation of the shoulder or hip, it impedes the circulations, and cannot be restored entire without an operation and reduction of the joints to their original places, which gives ease and rest again.”28(p35) The marked similarity of several passages in Sweet's book with Still's later writings was first documented in 1916 by Norman D. Mattison, MD, DO.29 There is no evidence, however, that Still was familiar with or read Sweet's book; he may have learned these techniques by watching another practitioner or through an empirical process of trial and error as did many so-called natural bonesetters. 
Sometime after 1880, he began to advertise himself as “Dr. A. T. Still, the Lightning Bonesetter.” In an early business card, he listed headache, heart disease, facial and arm paralysis, lumbago, sciatica, rheumatism, and varicose veins as ailments that his ministrations could successfully treat.2,30 Soon afterwards, he was treating hip dislocations. One eyewitness noted that he would leave Kirksville on his visits to other parts of Missouri, distribute upwards of a thousand handbills,
 

after which he would give an exhibition of setting hips; probably on the public square, in a spring wagon or an old 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 some one with a severe headache or some disease that he could cure quickly and demonstrate before the anxious crowd.4(p32)

Still started building a reputation across the state. By the late 1880s, his scheduled trips to various towns in western Missouri caused considerable local excitement. In Eldorado Springs, he had to reserve 16 rooms to treat the crowd that had gathered. People reportedly came from upwards of 150 miles away, complete with tents, in anticipation of a long wait. Still had become a charismatic figure.2,4 
From the mid-1880s onward, Still began employing his sons. Harry Still was just 17 years old when after reading anatomy and physiology with his father accompanied “the old doctor” to Hannibal in 1884-1885 “to assist him in the practice of his new profession.”4(p57) Harry later claimed that “for nearly two years he and I did all the work.”4(p57) Harry's brothers—Charles and Herman—later joined him in assisting their father. Soon, A.T. realized that the 4 of them were unable to meet the growing patient demand. With others wishing to learn, Still took on 3 apprentices, who paid him to teach them what he knew.1 
The first was James O. Hatten whom Booth declared “probably saw more of Dr. Still's early work than any one else except his sons.”4(p61) Hatten recalled,
 

In the spring of 1887 I made arrangement to study his theory of bone-setting, so called at that time…. I traveled on the road with him and had the opportunity of seeing thousands of cases of all kinds and varieties treated…. He would always have something new to explain. He would give his lecture on his discoveries and explain his theory and make it so simple that anyone could understand it.4(p61)

A second apprentice was W.H. Wilderson, who first met Still in Nevada, Missouri, in 1890.4 Still does not mention Wilderson by name in his autobiography but gives a vivid portrait of his initial credentials as well as his own approach to teaching. Wilderson's education, said Still, “was very limited, and in fact he was ignorant of the human body. I told him he must get Gray's anatomy, begin with the bones, and complete a knowledge of anatomy before he could be of any help to me.” Still explained to Wilderson that if his own success was a gift, “it was a gift of hard study, of all my life, and the result of brain-work put in on standard authors of anatomy.” Still recalled that Wilderson's head…
 

…was not quite as hard as a bull's, for in about twelve months I got a few ideas in his untrained mind, after which he began to travel with me. He was a blank to begin with, but in the course of time I made him a fairly good operator.1(p145)

The third apprentice was a former patient named Marcus Ward, whom Still described as…
 

…a lightning-rod peddler whom I had cured of asthma. He too became wild to go with me and study. He was very ignorant, but so thankful for his cure of asthma that he was willing to learn the ‘Great Science’ if I would take his promise to pay me one hundred dollars some time.1(pp145-146)

 
A.T. Still, DO
Given the type of conditions he usually treated, Still was likely considered by most of his patients to be a very talented but otherwise conventional bonesetter. The vast majority of his clients had chronic musculoskeletal complaints, and his explanation for his success, namely that the patients had “a bone out of place,” which he put back in alignment, constituted a traditional cause and effect argument that he used repeatedly. However, over time, Still's limited but growing experience with other types of complaints that were not so easily associated with the musculoskeletal system led him to believe he had discovered a new, more general understanding of health and disease. In his autobiography, Still relates what he considered to be an important case in his intellectual development. “An Irish lady…had asthma in a bad form, though she had only come to be treated for the pain in her shoulder.” He discovered, “she had a section of upper vertebrae out of line, and stopping the pain I set the spine and a few ribs. In about a month, she came back to see me without any pain or trace of asthma.”1(pp115-116) He noted, “This was my first case of asthma treated in the new way and it started me on a new train of thought.”1(p116) 
Subsequently, whatever the condition with which patients presented, Still would studiously examine their spines, even in visceral diseases, and when he did so, he often found hot spots and congested areas, which he assumed was evidence of a structural derangement. He associated this spinal derangement with problems elsewhere in the body and specifically addressed his treatment to restoring the alignment of the vertebrae and ribs. To his satisfaction, a large percentage of his patients reported improvement after his use of procedures directed at the spine, irrespective of the type of presenting complaint. This success led him to believe he had originated something new and something revolutionary. To explain his results, Still fused elements of the principles of both magnetic healing and bone setting into a single coherent doctrine. The effects of many diseases, as magnetic healing stressed, were due to the obstruction or imbalance of the fluids, but this state of affairs was caused by misplaced bones, particularly of the spinal column, which interfered with nerve supply regulating blood flow. At this point—whenever this was—Still had given birth to his own distinctive system.2 He could now say that he had “flung to the breeze” the banner of whatever it was that he would ultimately call his new approach. He knew that the term lightning bonesetting—although aptly descriptive of his treatment methods—would not suffice for a name of his new and revolutionary philosophy of healing. But what, he asked himself, should he call it? 
We do not know when Still originated the term osteopathy. In his biography of the founder, Hildreth claims that Still had used the term “in the early eighties” when he first explained to him “his new theory of disease.”5(p4) However, this recollection contradicts a much earlier statement Hildreth made wherein he notes that Still had not named his system before 1885.4 According to Hatten, Still continued to refer to his “theory of bone setting” in the spring of 1887 when he first met him.4(p61) Wilderson stated that as late as 1890, Still “gave no name to the treatment, other than to call it ‘bone setting,’ or the relief of disease by manipulation.”4(p62) Indeed, Still's first public announcement of the new name for his system does not occur before the beginning of 1891.31 
In his published and unpublished writings, Still gives varying accounts of the process by which he fashioned the term “osteopathy.” One narrative published in Booth's book has become a standard version and if read closely provides a nod to a hitherto unrecognized influence on the naming process. Still notes, “I listened to all who thought I ought to name my science, so I began to think over names, such as Allopathy, Hydropathy, Homeopathy, and other names”4(p65) (author's emphasis). He continues,
 

[A]s I was in Kansas when the name Osawatomie was coined, by taking the first part of the word Osage, and the last part of Pottawattamie, and the new word coined represented two tribes of Indians, I concluded I would start out with the word os (bone) and the word pathology, and press them into one word—Osteopathy.4(p65)

Recognizing that this name had its naysayers even among his own followers, Still defiantly concluded his story by declaring, “I wanted to call my science Osteopathy, and I did not care what Greek scholars said about it.”4(p65) 
The phrase “other names” in the aforementioned quotation is highlighted because it now seems likely that Still was directly or indirectly influenced in this naming process by a competitor (or colleague) in town. In 1883, a “Dr. C.D. Henry” moved to Kirksville from nearby Milan, Missouri. His new residence and office were located 2 blocks northeast of the town square, not far from Still's home.32 Henry announced in the Kirksville newspaper, the Weekly Graphic, that he “treats all acute and chronic diseases. Chronic diseases a specialty.”33 Henry proclaimed he was an exponent of “vitapathy” and took out large ads promoting not only himself but the system he followed.23,34 
Henry was a graduate of the “American Health College” in Cincinnati, Ohio, established in 1874 by the founder of vitapathy—John Bunyan Campbell.35 Though Campbell touted vitapathy as his original idea, much of its philosophy and practices are liberally drawn from the writings of the aforementioned Andrew Jackson Davis.18,35 Campbell taught his students that through a combination of natural agencies including air, light, electricity, baths, and vital magnetism, the life force, or vita, could be imparted or restored to the sick.36 
Henry, like Still, was a spiritualist, and given their very close geographical proximity, their similar religious views, and their shared healing background, they were doubtless aware of each other and perhaps interacted.37 Still's motivation to originate his own “pathy” may have been stimulated by Henry's presence in town, although the latter left in 1886, before Still had likely named his own system.38 A greater influence on Still than the name of the system under which Henry practiced may have been the odd designation appended to his name in his newspaper ads. Allopathic, homeopathic, hydropathic, eclectic, and physiomedical colleges all bestowed MD degrees upon their graduates—but Campbell, the founder of vitapathy, awarded instead a distinctive degree to his graduates—the “V.D.” which stood for “vitapathic doctor” or “doctor of vitapathy.”35,36 Thus, during the mid-1880s, when Still was evolving his own system, there was a precedent in Kirksville for practicing the healing arts under a novel type of diploma or degree. 
On January 1, 1891, Still gave what he billed as the “first annual address to the pupils of Osteopathy,” which was published 2 weeks later in the Weekly Graphic.31 In this article, he referred to himself as “A.T. Still, DO”—the first known public use of this unusual designation. Concurrently, this was the first time he publically used the term “osteopathy” to describe his philosophy and practice. Looking at the small group of apprentices and his sons attending his talk, Still joked, “You can be counted on the fingers of one hand,” and reflected, “one year ago one thumb was enough, as the writer…was all there was of the school and its pupils.” Still sounded optimistic and foresaw a great educational enterprise ahead. He observed that since he began his teaching, “applications have been legion to become pupils of this grand school.”31 He saw a pivotal role for his sons and other apprentices in the near future, hyperbolically declaring, “At an early day you will have to fill the chairs of professors of the greatest institution that ever had a place on earth. Its name is and will be Osteopathy.”31(p2) 
Andrew Taylor Still's use of the designation “D.O.” to describe himself in this address—some 16 months before he obtained the first charter to establish a formal school—the American School of Osteopathy—and approximately 22 months before actual instruction under this charter began, tells us that by the beginning of 1891 he had already decided what type of diploma or degree he wanted to bestow upon his eventual graduates of this new science of osteopathy. Nevertheless, as we shall explore in the next article in this series, the type of school he wished to establish, what this new science of osteopathy embraced as subject matter, and what he wanted the DO designation to represent, were still to be determined. 
   Financial Disclosures: None reported.
 
References
Still AT. Autobiography. Kirksville, MO: Published by the Author; 1897.
Gevitz N. The DOs: Osteopathic Medicine in America. 2nd ed. Baltimore, MD: The Johns Hopkins University Press; 2004
Bonner T. The Kansas Doctor. Lawrence: University of Kansas Press; 1959.
Booth ER. History of Osteopathy and Twentieth-Century Medical Practice. Cincinnati, OH: Press of Jennings and Graham; 1905.
Hildreth AG. The Lengthening Shadow of Dr. Andrew Taylor Still. Kirksville, MO: The Journal Printing Co; 1938.
Baker SL. Physician licensure laws in the United States, 1865-1915. J Hist Med Allied Sci. 1984;39(2):173-197. [CrossRef] [PubMed]
Goodwin EJ. A History of Medicine in Missouri. St Louis, MO: W.L. Smith; 1905.
Toney SB. Decision on Osteopathy: Harry Nelson, plaintiff, vs. State Board of Health, defendant, in Jefferson Circuit Court, Law and Equity Division. JAMA. 1900;34(2):86-94. [CrossRef]
Ladies Home Journal—Article and Correspondence. Andrew Taylor Still Papers. 1908;Nos. 2009.10.74-83. Located at: Museum of Osteopathic Medicine, Kirksville, MO.
Still AT. How I Came to Originate Osteopathy. Ladies Home Journal. 1908;25(Jan):25,48.
Bunting HS. Asks if A.T. Still ever was a real doctor. Osteopathic Physician. 1909;15(1):8.
Whitney C. Kansas City, Missouri: Its History and People, 1808-1908. Vol 1. Chicago, IL: The S.J. Clarke Publishing Co; 1908:475.
North Missouri Register. March 11 , 1875;1.
Carroll BE. Spiritualism in Antebellum America. Bloomington: Indiana University Press; 1997.
Banner of Light. January 9 , 1875:8.
Bennett F, Bush I. Dr. A.T. Still's visit to the spiritualists' meeting at Clinton, Iowa. Bull Axis Atlas Clubs. 1903;4(1):3-6.
Delp RW. Andrew Jackson Davis: prophet of American spiritualism. J Am Hist. 1967;54(1):43-57. [CrossRef]
Davis AJ. The Physician. Boston, MA: Benjamin Mussey; 1853. The Great Harmonia; vol 1.
Evans WF. Mental Medicine: A Theoretical and Practical Treatise on Medical Psychology. Boston, MA: Carter & Pettee; 1873.
Babbitt ED. Vital Magnetism the Life-Fountain. New York, NY: Published by the author; 1874.
Gue BF. Biographies and Portraits of the Progressive Men of Iowa: Leaders in Business, Politics and the Professions Together With an Original and Authentic History of the State. Des Moines, IA: Conaway & Shaw; 1899:423-424.
Chase W., Caster Paul, the healer. Banner of Light. February 5 , 1876. Reprinted in Mack J. Healing by Laying-On of Hands. London, UK: James Burns; 1879:109-111.
Trowbridge C. Andrew Taylor Still, 1828-1917. Kirksville, MO: Thomas Jefferson University Press; 1991.
Waterman HL, ed. History of Wapello County Iowa. Vol 1. Chicago, IL: The S.J. Clarke Publishing Co; 1914:236-238.
Caster Paul. J Osteopathy. 1895;1(12):5.
Hood WP. On Bonesetting (So-called) and Its Relation to the Treatment of Joints Crippled by Injury, Rheumatism, Inflammation, &c &c. London, UK: MacMillan and Co; 1871.
Joy RT. The natural bonesetters with special reference to the Sweet family of Rhode Island: a study of an early phase of orthopedics. Bull Hist Med. 1954;28(5):416-441. [PubMed]
Sweet W. Views of Anatomy and Practice of Natural Bonesetting by a Mechanical Process Different From All Book Knowledge. Schenectady, NY: I Riggs; 1843.
Mattison ND. Bonesetting and its modern revival. NY Med J. 1916;104( July 15 ):103-107.
Dr. A.T. Still business card. Andrew Taylor Still Papers. No. 2009.10.961 5A&B. Located at: Museum of Osteopathic Medicine, Kirksville, MO.
Annual address delivered by A.T. Still, D.O., to the students of osteopathy. Weekly Graphic. January 16 , 1891:2.
Graphics. Weekly Graphic. September 28 , 1883:2.
Dr. C.D. Henry, V. D. [advertisement]. Weekly Graphic. August 21 , 1885:3.
Vitapathy: the dawn of health and happiness [advertisement]. Weekly Graphic. February 27 , 1885:4.
Haller JS. Cincinnati's Notorious Charlatan, John Bunyan Campbell. Queen City Heritage. 1997;55(summer):21-39.
Campbell JB. Spirit Vitapathy. Cincinnati, OH: H. Watkin; 1891.
A wedding party. Weekly Graphic. May 13 , 1881:3.
Graphics. Weekly Graphic. October 29 , 1886:3.