In May 1892, the
Weekly Graphic announced that the State of Missouri had granted Still a certificate of incorporation for the American School of Osteopathy. “There is now abundant capital backing the institution,” the notice proclaimed, “and at an early day the organization of a company will be perfected, and suitable buildings erected to carry on the work of the school.”
4(p3) Still's institution was first organized as a joint-stock corporation. The total value of the stock was capitalized at $5000, with 50 shares issued at the value of $100 a share.
5 There were 7 stockholders. A.T. and his wife, Mary Elvira Still, owned 25 shares (or 50%), and his sons Charles and Harry and his brother Edward each owned 5 shares, representing another 30%. The remaining stock was held by 2 non-family members: Marcus L. Ward, one of Still's apprentices, had bought 8 shares, and Elias Falor of Rich Hill—one of the places in western Missouri that Still often visited as an itinerant practitioner—purchased the remaining 2 shares. The shareholders selected a Board of Directors, which consisted of A.T. Still and his wife, their 2 sons, and Marcus Ward, and the Board at their first meeting officially elected A.T. Still as president of the school; Marcus Ward, vice president; and Charles Still, secretary.
5
Under the first charter,
[T]he purpose and object of this Association shall be to improve on our systems of surgery, midwifery and treatment of general diseases in which the adjustment of bones is the leading feature of this school of pathology.5
Once again, the language was purposeful. Still adamantly refused to identify osteopathy as a “school of medicine.” Elsewhere in the charter, he refers to osteopathy as a “school of philosophy.”
5 For him, the word “medicine” was inseparably tied to drugs, and he had no desire to have his science in any way associated with either the term or its contemporary application.
The Charter stipulated that the faculty of the school “shall have the power to issue diplomas to all qualified students of Osteopathy,” but at the time of the ASO's incorporation, the only faculty member was A.T. Still himself.
5 Nor was it clear when he would begin classes or what subjects would be included. However, in June 1892, Dr William Smith serendipitously arrived in Kirksville and became fascinated in what Still was accomplishing there with patients who found little or no relief from their regular physicians. Unlike Still, Smith was formally educated. Born in Jamaica and raised in Scotland, Smith entered the University of Edinburgh in 1880, spent the first 4 years there, contracted syphilis while working in the venereal wards of the Royal Infirmary, and left school to receive treatment and recover from the disease. When he was ready to complete his medical education, he enrolled instead in the Royal College of Physicians, also located in Edinburgh. He graduated in 1888, and after examination in Glasgow, became a licentiate in each of the 3 branches of the healing arts: medicine, surgery, and midwifery. Exhausting himself in a busy practice in Scotland, Smith decided to journey to the United States, where he was able to travel across the country as a salesman for a medical supply company. It was in this capacity that he eventually landed in Kirksville. As “Professor of Anatomy,” Smith agreed to teach a course in the subject and in exchange, Still would teach him his distinctive system of practice.
6-9
The story of Still hiring William Smith is an iconic part of osteopathic history and is often repeated in the literature. What is not generally known is that Still contracted with another professor who, like Smith, was willing to teach in exchange for obtaining knowledge of his new science of healing. Still named Dr Andrew P. Davis “Professor of Surgery and Midwifery.”
10 Davis, a graduate of both an allopathic and a homeopathic school, was an inveterate seeker of knowledge in alternative practices. In the years before he learned of Still, Davis had investigated orificial surgery, the Junod system of hemaspasia, therapeutic sarcognomy, mental science, Christian science, and hypnotism.
11(p x) With Still as “Professor of Osteopathy” and with Smith and Davis in the fold, he was prepared to open his school in the fall of 1892.
Lectures were given in a 14 ft by 18 ft wooden structure (a mere 252 square feet of floor space) that Still had built the previous summer. Perhaps 10 or 11 students were in class on the first day of school; a similar number would be joining in the next few months. At the beginning of his course Smith had no materials other than
Gray's Anatomy and a
Quiz Compend with which to instruct. There was no body to dissect, and only later did he have an articulated skeleton with which to point out bony structures. Widely lauded by his students as a gifted lecturer, Smith could do no more than teach the bare rudiments of what students needed to know. Each morning, Smith drilled the class in anatomy. Still also occasionally lectured and perhaps Davis did as well, though there is no documentation or testimony that he did so or that the subjects of surgery and obstetrics were part of the first curriculum. Typically, after spending an hour with Smith, the class proceeded to the nearby infirmary to observe Still and his sons and other apprentices (most of whom were also part of the first class) treat patients in the 10 “operating rooms.”
12-14
On February 15, 1893, Still issued to Smith a hand-written certificate, which on the top read “American School of Osteopathy” and below stated:
Know all men by these presents, that William Smith, M.D. having attended a full course of lectures on, and Demonstrations of Osteopathy, and having, after due examination, been found fully qualified to practice the Art in all its branches, is hereby conferred by me with the title: Diplomate in Osteopathy.
It was signed “AT Still President.”
12(p6) The founder issued approximately 18 such handwritten diplomas through March on the basis of his students' attendance and their passing of an anatomy examination.
12(p7)
Still never explicitly explained in writing why he wanted the title of the DO designation to read “Diplomate in Osteopathy” rather than “Doctor of Osteopathy,” though his likely reasons can be discerned. In the winter of 1892-1893, the Missouri State Medical Association became aware of Still's charter and sought to introduce a bill mandating that “no school of medicine in the state except the eclectic, allopathic and homeopathic schools, shall grant diplomas to graduates.”
15(p2) The advocates of osteopathy rallied, started a petition drive, and lobbied lawmakers, and the bill was soundly defeated.
12 Still and his supporters maintained that osteopathy was not the practice of medicine, which they conceived strictly as the use of drugs. The founder argued that he would not graduate “physicians” or what he considered that title's synonym, ie, “doctors.” Indeed repeatedly through the early years, Still referred to his acolytes as “engineers,” “architects,” “mechanics,” “plumbers,” “blacksmiths”— rather than “doctors.”
7 In the
Weekly Graphic, Smith wrote, “We do not desire to be called doctors, we are Osteopaths.” He also noted tellingly, “We have never asked [for] the precious degree of M.D. If it were offered me I would not use it…I would not exchange what I have learned since I came to Kirksville for all the degrees in this wide world.”
16(p2) Still's selection of the term “diplomate” rather than “doctor” may have also been designed to convince members of the medical profession, legislature, judiciary, and most importantly juries that the practice of DOs would not infringe upon the legal prerogatives, scope of practice, or standing of the MDs, thus minimizing the potential for harassment and persecution.
In April 1893, Still hosted a banquet to celebrate the first class of diplomates.
12 However, even by this early date, he was expressing misgivings about several of his students and the adequacy of their training. William Smith, Andrew Davis, and Davis' son F.S. (also a licensed physician and surgeon) had provided Still with a notarized testimonial on the value of osteopathy. Upon receiving their diplomas, they left Kirksville and soon after the founder concluded that each of them violated his trust by combining osteopathy with the practice of medicine.
17 In the first issue of the
Journal of Osteopathy, Still sullenly declared,
Experience has proven, that those who have previously studied medicine, and afterwards tried to add Osteopathy, have been but a hindrance to the science. An allegiance to drugs once established, is almost impossible to overcome.18(p4)
He therefore announced that henceforth, “as a general rule no person shall be admitted as a student who has previously studied and practiced medicine.” Still argued that his goal was to “make successful operators of all who enter the school, and results have shown the nonmedical student far surpasses those who have studied medicine.”
18(p4)
Still kept many of his first graduates in Kirksville so that they might obtain further training at his infirmary. Despite already awarding them diplomas, he recognized that they had not gained sufficient experience in treating actual patients. In March 1894, Still provided those students from the first class who stayed on, as well the physicians in the class who had not, a printed “Diplomate in Osteopathy” certificate to replace and supersede the handwritten diploma issued the year before.
19
Disappointed in his first efforts at teaching, Still gave serious thought to quitting the school business. However, his patients, their family members, and others continued to clamor for instruction, and Still relented by admitting another class. With Smith gone, he convinced Nettie Bolles, one of the members of the first class who held a liberal arts baccalaureate, to teach anatomy in Smith's place. Still also made some curricular improvements. He lengthened the course of study to 2 terms (each 5 months in length) and required that his students would first have to learn the anatomy of the arms and legs before they were admitted into the infirmary.
20,21
In October 1894, he began a third class. Once again, anatomy was the only formal basic science course. However, in addition to
Gray's Anatomy and Potter's anatomy
Quiz Compend, students were now expected to obtain Yeo's
Manual of Physiology textbook. He also required that they complete the entire anatomy course before they could enter the infirmary, where “the remainder of the time [will] be devoted to practical work under the direction of an experienced operator.”
22
The same month that the third class began, the American School of Osteopathy obtained a new charter. In legally creating his school 2 years earlier, Still's attorney had made the mistake of obtaining the wrong type of legal instrument—one designated for a commercial business rather than one constructed for an educational institution awarding diplomas.
5,12 In writing the new charter, Still's legal counsel melded the original language regarding the mission of the school as found in the first charter with language typically employed in establishing a school of medicine. The new instrument read as follows:
The object of this corporation is to establish a College of Osteopathy, the design of which is to improve our present system of surgery, obstetrics, and treatment of diseases generally, and place the same on a more rational and scientific basis.12(p14)
This language is consistent with the wording of the first charter, but then new language was substituted for the old. Instead of the provision reading “the faculty of this school of philosophy shall have the power to issue diplomas to all qualified students of Osteopathy,”
5 the ASO would now have the power “to grant and confer such honors and degrees as are usually granted and conferred by reputable medical colleges.”
12(p14) In essence, the American School of Osteopathy had been legally transformed—at least on paper—from being a “school of philosophy” to a “school of medicine.” This new language allowed Still to reflect on and determine what kind of a school he ideally wanted to operate, what its curriculum would be, and what type of degree he would award.