Two persistent questions vexed the leading academic lights at the ASO and other osteopathic colleges: What subjects should be included in the school curriculum, and what should be their graduates' scope of practice? When he established the ASO, Still began by offering a narrow curriculum embracing only palpatory diagnosis and manipulative treatment. Nevertheless, there is compelling evidence in his 1892 charter and first professorial appointments that he wanted to incorporate coursework in minor surgery and obstetrics at some point. In 1897, he at last announced that he would do so, and as part of the training in these subjects, ASO students would hence-forth receive instruction in the properties and uses of anesthetics, antiseptics, and antidotes.
1 He later used the term
osteopathic materia medica to refer to these approved pharmaceuticals.
22 With his new curriculum in place, Still declared that osteopaths would now be trained to become general practitioners who could handle both acute and chronic diseases, set broken bones, stitch and dress wounds, and deliver babies.
This curricular evolution did not sit well with many earlier ASO and other osteopathic college graduates who had not been given this training. Those individuals who believed the old way was the right way soon identified themselves and other like-minded practitioners as “lesion osteopaths.” They were content restricting themselves to finding the lesion, fixing it, and leaving it alone. They argued that in the rare instances that surgery was necessary, they would refer their patients to experienced MDs in that field, preferably those who had abandoned “drugging,” entered osteopathic schools, and had now become “MD, DOs.”
1
Dozens of MDs enrolled in the ASO and other schools, convinced that osteopathy offered them something new and better in treating their patients. Some of these MD, DOs had a complete conversion experience and practiced what they considered to be a “pure” osteopathy.
23-25 Others became general practitioners incorporating osteopathy, surgery, and obstetrics and using the range of drugs Still sanctioned. But several MD, DOs thought Still's osteopathic materia medica was far too limiting. They noted that the polypharmacy that was so rampant in the day when Still practiced medicine was disappearing. Many of these MD, DOs saw no reason why they should not incorporate any diagnostic, preventive, or therapeutic modality that appeared to them to be of value. They and other DOs who thought similarly identified themselves as “broad osteopaths.”
1,26,27
The other and eventually more numerous dual-degreed osteopathic contingent was the “DO, MDs.” Some of Still's early graduates complained that the length and breadth of the curriculum was inadequate compared with what was offered by either 3- or 4-year medical schools. They bemoaned the fact that in osteopathic school there were few opportunities for dissection, little microscopic work, and inadequate opportunities to learn surgery, learn how to deliver babies, and gain meaningful hospital-based experiences either in wards or in outpatient departments. Most DOs who entered medical schools sought not only additional knowledge and skills but also the professional status that came with being an MD—especially the ability to secure full licensure privileges, which only possessors of that degree could then universally obtain. Many believed that by virtue of being dual-degreed, they would be able to raise the status of the osteopathic profession and better convince the public that they had the breadth and depth of education, experience, and access to the means necessary to successfully handle any health condition or emergency.
28,29
Among the first of the DO, MDs was Marcus L. Ward, who in the 1880s had initially come to see Still as a patient. After he successfully treated Ward, Still took him on as an apprentice. Later, Ward became a share-holder and the vice president of the ASO under the first charter. After receiving his diploma, he relocated to Ohio, enrolled in the Medical Department of the University of Cincinnati, and in 1897, upon obtaining his MD degree, moved back to Kirksville and opened the Columbian School of Osteopathy on the other side of town.
1
Ward called himself the re-discoverer of “true osteopathy”—a system of surgery, medicine, and manipulation, which he said was developed by the ancient Greeks. His college offered students the opportunity to study all the healing arts. After the first 2 years, students would be awarded a DO degree, but if they stayed for an additional year, they would obtain further medical and surgical training and on completion of the course would be graduated with an MD diploma.
1 In writing of Kirksville as well as Ward and his associates, Still acidly noted, “Every man and woman sick and tired of drugs, opiates, stimulants, laxatives and purgatives has turned with longing eyes to this Rainbow of hope…and yet these medical osteopaths are trying to paint this rainbow with calomel and perfume it with whiskey.”
30(p167) He ranted that Ward's college was a “mongrel institution” and that any student who enrolls “gets neither medicine nor osteopathy, but a smattering, enough to make a first class quack.”
30(p166) Although Ward's Columbian School attracted many matriculants during its first 2 years of operation, he and his backers had a falling out and the institution, much to Still's great relief, closed in 1901 after having awarded as many as 70 diplomas.
1