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Letters to the Editor  |   August 2014
A Degree of Difference: The Origins of Osteopathy and the First Use of the “DO” Designation
Author Affiliations
  • Jane Stark, MS, D.O.M.P.
    Osteopathic Manual Practitioner, Moffat, Ontario, Canada
Article Information
Being a DO
Letters to the Editor   |   August 2014
A Degree of Difference: The Origins of Osteopathy and the First Use of the “DO” Designation
The Journal of the American Osteopathic Association, August 2014, Vol. 114, 615-617. doi:10.7556/jaoa.2014.125
The Journal of the American Osteopathic Association, August 2014, Vol. 114, 615-617. doi:10.7556/jaoa.2014.125
To the Editor: 
Congratulations to Norman Gevitz, PhD, for furthering our understanding of the role that magnetic healing played in the “evolution of osteopathy” in the special communication that appeared in the January 2014 issue.1(p34) Each additional piece of substantiated insight adds to the ever-growing body of knowledge that helps the osteopathic profession better understand how Andrew Taylor Still conceived of and developed osteopathy. However, as Dr Gevitz points out, if a “factually based portrait of the development of osteopathy”1(p34) is a goal in this series of articles in The Journal of the American Osteopathic Association, then it is worth-while to examine the criteria for establishing fact in an historical inquiry. 
Recognizing that the majority of osteopathic physicians and researchers are not historiographers, several documents outlining historical method could be beneficial to this process. For an overview of the subject, Hodysh's Theory and Practice in Historical Research2 offers a variety of insights into historical methods. Christy's The Methodology of Historical Research3 offers a useful but strict guide for distinguishing fact from probability and possibility. Shafer's A Guide to Historical Method4 provides less exacting delimiters for establishing fact. Shafer also provides approaches for dealing with corroboration and contradiction in historical inquiry. Still's seemingly contradictory statements are highlighted in Dr Gevitz's article. 
Christy states that fact is established when 2 independent critically evaluated primary sources agree with each other, or when 1 independent primary source and 1 independent secondary source both are in agreement—and there are no substantive conflicting data.3 Primary and secondary sources are distinguished by whether the recorded information represents an eyewitness account or someone else's recollection of that first account.3 Tertiary sources represent information that has gone through more than 2 reporters. Still is an eyewitness to his own accounts, but someone who recounts Still's stories is a secondary source, and someone who relays an account for the third or fourth time is a tertiary source. Any purported “fact” that is based on less than Christy's criteria for establishing fact is either a possibility or a probability. Shafer is not as rigid as Christy, and instead he focuses on degrees of probability, plausibility, and certainty on the basis of such considerations as the personal state of mind of the author, the author's social circumstances, and how the author may be affected by age or illness.4(pp132-133) 
Together, Hodysh, Christy, and Shafer support that establishing fact in osteopathic history is difficult. It might be more realistic to evaluate osteopathic history in gradations of probability. Evaluation factors affecting the possibility gradient include whether the author accidently or purposefully distorted information, the time span between the event and the reporting of that event, and the intent of the statements under consideration.4(pp131-138) 
Moreover, the interpretation of historical statements requires examination through several lenses, including the original author's biases as well as the biases of the individual who is now interpreting the truthfulness and value of the original author's words.4(pp137-138) For example, Still arguably held several biases. He was patriotic, he was spiritual, and he did not want to be held accountable to the “rules of fine writing.”5(p5) Those biases are evident in the content and style of his writing. In describing Still's writing and actions, Dr Gevitz selected certain adjectives that lend themselves to criticism for their apparent subjectivity. Still is seemingly portrayed in an uncomplimentary light by the use of “entertaining”1(p30) to describe his “allusions, parables, tall tales, and allegories”; “unabashedly”1(p30) concerning how he made his famous 1874 “banner of Osteopathy” pronouncement; “putative”1(p32) regarding his memory of his medical education; and “heretical”1(p34) in relationship to his religious beliefs. 
From my perspective—which carries its own biases—Dr Gevitz's use of “entertaining” could be replaced with extensive to describe Still's allegories, and “tall tales” could be omitted. In describing Still's osteopathy pronouncement, “unabashedly” could be replaced with bravely. Still's recollection of his medical education could be described as indifferent. 
Still openly admitted in his autobiography that his “stories may appear disconnected” because he wrote from memory and that he favored stories that left “lasting impressions on my mind.”5(p5) Writing at the age of 69 years, he cast doubt on his ability to remember and record the truth. But he did not seem to intentionally conceal the truth. Rather, he admitted that he kept no personal notes of his life, and he did not want to be confined to “dates and figures.”5(p5) Therefore, it should come as no surprise that he did not chronicle, to our satisfaction, certain aspects of his life's history that the osteopathic profession deems necessary to know today. The evidence regarding Still's attendance at a medical school or college is both corroborative and contradictive4(pp138-142)—suggesting that he attended a medical educational institution but revealing doubt as to where and when he attended the institution. According to an undated and unpublished account written by Still that was copied and typed in 1931 by his daughter Blanche Laughlin, Still attended the “Kansas City School of Physicians and Surgeons” (KCSPS) in the early 1860s.6(p1) Historical method would dictate that the transcription by Still's daughter of her father's medical education is evidence representing a moderate to strong possibility. 
The evidence from Still's daughter seems to outweigh 2 tertiary accounts described in Dr Gevitz's article.1 In an account published in The Osteopathic Physician in 1909—at least 40 years after Still attended medical school—the journal's editor, Henry Stanhope Bunting, DO, MD, contacted Still's son-in-law, George M. Laughlin, DO, to have Laughlin interview Still about Still's medical education.1(p32) This written account cited by Dr Gevitz represents Bunting reporting Laughlin reporting that Still attended the Kansas City College of Physicians and Surgeons (KCCPS).7 In the second tertiary account, Grant Hildreth's book, published in 1938, relays an undated letter written by George Mahan, a prosecuting attorney in a case against Still. The trial, which Mahan recounts probably occurred between 1880 and 1886 when Still worked in Hannibal, Missouri,5(pp115,117,129) also represents a time span of about 40 years from the time of the event to the recording of the event. In Mahan's personal recollection of Still's defense, he fails to mention Still's medical school by name, stating only that it was a “southern school.”8(pp11-12) 
If Mahan could not recall the name of the school, are we to believe that he accurately remembered when and how Still “lost his diploma”?8(p12) Furthermore, can Dr Gevitz correctly conclude that it was Still who “changed the story”1(p32) rather than concede that Laughlin, Bunting, Hildreth, or Mahan might have made an error in quoting Still or in recording the school's name or the years that Still attended? 
Perhaps because of similarities in the medical school names, even Dr Gevitz seems to err when he rules out (or incorrectly names) “the Kansas City Medical College and the College of Physicians and Surgeons of Kansas City”1(p32) as opening in the late 1860s. He does not report on either the KCSPS (the school named in Blanche's transcript) or KCCPS (the school named by Bunting), though one can surmise from the date of the KCCPS catalog that it likely opened its doors in 1868.9 
All this banter does not negate the fact that the dates and location of Still's medical school attendance are uncertain. But does the blame for this uncertainty rest solely with Still? Nowadays, the memory of a graduation date is commonly aided by photos and a framed diploma. Perhaps Still did not have such records of his graduation. 
Dr Gevitz is attempting to lay down the historical record, and he is to be congratulated for that. Recording the history of the osteopathic profession is an important task, but it could lead to potential problems that were identified by Bunting more than 100 years ago when he cautioned that “some quibbling M.D. historian is very certain to try to pervert the truth in the years to come when records cannot perhaps be dug up.”7 The record might be better served by presenting it with a more neutral voice, by making allowances for alternative explanations, and by giving additional consideration to distinguishing a fact from varying degrees of probability. 
References
Gevitz N. A degree of difference: the origins of osteopathy and the first use of the “DO” designation. J Am Osteopath Assoc. 2014;114(1):30-40. doi:10.7556/jaoa.2014.005. [CrossRef] [PubMed]
Hodysh HW. Theory and practice in historical research. Educat Prac Theory. 1996;18(1):87-94. [CrossRef]
Christy TE. The methodology of historical research: a brief introduction. Nurs Res. 1975;24(3):189-192. [CrossRef] [PubMed]
Shafer RJ, Bennett DH. A Guide to Historical Method. Homewood, IL: Dorsey Press Homewood; 1969.
Still AT. Autobiography of Andrew Taylor Still With a History of the Discovery and Development of the Science of Osteopathy. Kirksville, MO: published by the author; 1897.
Still AT. Some of the circumstances and personal experiments which led to treating the bodily ills without drugs—August 26th 1907. Andrew Taylor Still Papers. No. 2009.10.136. Located at: Museum of Osteopathic Medicine, Kirksville, MO.
Bunting H. Asks if A.T. Still ever was a real doctor. Osteopathic Physician. 1909;15(1):8.
Hildreth AG. The Lengthening Shadow of Andrew Taylor Still. Kirksville, MO: The Journal Printing Co; 1938.
Todd SS. 12th Annual Announcement: Kansas City College of Physicians and Surgeons, Kansas City, MO. May 15 , 1880. https://www.aamc.org/download/172388/data/12th_annual_announcement_kansas_city_college_of_physicians.pdf. Accessed July 1, 2014.