1. The first years after the foundation of the ASO and the first legal recognitions

The sensational success of the Kirksville School contributed to the development of osteopathy and to the winning of regulation laws in some American states.

The establishment of the American School of Osteopathy (ASO) in the small town of Kirksville, Missouri, produced a further boost to Andrew Taylor Still‘s infirmary, where a constantly increasing number of patients were treated successfully. The newspapers amplified the notoriety of the osteopathic discipline through a wide coverage of cases resolved with the new science, whereas they had been considered hopeless by the official medicine. Sick people and students flocked to Kirksville, as well as journalists eager to expose what they believed to be a form of quackery. Residents were building hotels, opening stores and renting out rooms, and railway companies were running trains at special rates especially for the patients and their families.

According to the account of a local journalist, it was difficult to describe the overwhelming caos of the city. There were patients coming down the hills everywhere, some in carriages, some in wheelchairs pushed by their attendants, some struggling down on their crutches. Sick people flocked from almost every corner of the United States, suffering from more or less serious ailments. Throughout the day, a never-ending stream of people flowed in and out of the clinic, while a new load of patients was brought in by each train arriving at Kirksville station.1

From 1894 the ASO administrative office was entrusted to Henry Patterson, who introduced a set of rules that patients had to abide by. Thanks to these rules the clinic functioned in an orderly manner despite the large influx of patients. Payments were collected regularly, and Dr Still was shielded from the too many people who wished to talk to him or be treated only by him.2:151

In 1894 the school’s monthly bulletin – the Journal of Osteopathy – was founded, it was the first journal about osteopathy. Its first editorial director was Jeanette Hubbard Bolles. Two years later it reached a circulation of 15-18,0003 copies. It was issued until 1964.

Such a success seemed to turn A. T. Still‘s ideas into reality: according to its founder, osteopathic medicine would eventually replace orthodox medicine, since its scientific validity was proven by its countless successes and since it healed people without poisoning their body with drugs. Dr. A.T. Still was sincerely convinced that anyone could practice his method because it was based on the incontrovertible laws of nature, and he constantly emphasized this, both in his lectures and in his editorials, which opened the Journal of Osteopathy every month.

Nevertheless, most people would still consider Dr Still an eccentric, at the very least. His fascinating personality had been formed within a family of devout Methodists who had lived on the wild frontier. He was a man with a great self-taught knowledge of nature combined with a deep philosophical insight, an unconventional and inquisitive mind, a sense of candid awe and admiration of all creation, an incredible knowledge of anatomy, an astonishing ability to manipulate  bones, a deep knowledge of the language and culture of the Shawnee Indians, and a hatred of “heroic” medicine. He also had a revulsion for alcohol, and refused to treat or welcome as students people who used it. In addition to all of this, he categorically ruled out any remedies of orthodox medicine and homeopathy from his clinic. 4:25 All this made him more like a guru than a scientific researcher, consequently his students often were more like followers than students.

The graduates and faculty members of the ASO were the first protagonists who contributed to the development of osteopathy: they were responsible for founding new schools, writing manuals and study texts, and participating in the social life of the professional associations established in the single states under the AOA. Between 1895 and 1903 an estimated 30 training institutes emerged, many of which were either short-lived or not serious and therefore forced to close thanks to the rules imposed by the ACO, the association of osteopathic colleges active since 1898.

Osteopathy took its first steps under constant attacks from orthodox physicians, so it became essential to take action to obtain legal protection: the battles for recognition began. In the United States it had to be obtained separately in each individual state. In Missouri – the U.S. state in which the town of Kirksville was located – the law was passed thanks to the tenacity of Alfred Hildreth. In 1895 Hildreth was the architect of an initial attempt at recognition that fell through because, at the very last minute, when the law already looked like a done deal, the governor rejected it because he thought osteopathy to be a “secret” art that could only be practiced by its followers.

Alfred Hildreth was one of the osteopaths who graduated from the ASO‘s first course and is said to have been among those who knew Dr Still best. He had such an admiration and loyalty towards him that he was jokingly nicknamed Fido Acate, after Aeneas’ companion of Virgilian memory. Not only that, he also had an unwavering faith in osteopathy. So much so that the very Dr Still ironically stated that he would not stop treating a patient until he had been dead for three days.6:259-260 Hildreth himself recounts that when he learned the news of the veto he was overcome with anguish and disappointment. Above all, he was sorry to think how much he had disappointed Dr Still and longed to console him. He set out in search of him, but could not find him at home or in the clinic, and was told that he had gone down to the city. Knowing that he would have to pass by his house on his return, he lurked through his window and as soon as he saw Dr Still he ran to him full of sorrow. Dr Still approached him smiling, telling him not to worry because they would get a better bill two years from now at the next legislation, and he ended up being the one to console Hildreth. As the two men lingered talking about osteopathy behind the house, sheltered from the wind, Still told Hildreth that he did not have to worry about the future of osteopathy, confirming his indomitable spirit in the face of adversity.5:80-81

Even when osteopaths succeeded in gaining recognition, it sometimes happened that a new legislature amended the previously passed law, pushing the process back to square one. Legal protection was essential not only to avoid charges of abuse of the medical profession and the risk of being disqualified, but also to ward off the proliferation of imitators and charlatans who called themselves osteopaths and discredited the entire profession.

The practice of osteopathy was first approved in Vermont (1895), then in 1897 it was the turn of North Dakota, Michigan, and Missouri. In his second attempt to get the law passed, Hildreth made it a point of honor to describe osteopathy to all the congressmen who were to vote for it, often subjecting them to free treatments to demonstrate its effectiveness, and he made contact with all orthodox physicians to explain his position.5:97

on March 4, 1897, when Arthur Hildreth and Henry Patterson, secretary of the ASO, stepped off the train, returning from the capital after the governor had signed the bill into law, they were greeted by the town band and carried through the streets in triumph. The next day the entire populoation of Kirksville took part in the festivities, closing all businesses and decorating stores and houses. The uproar began in the morning with cannon and rifle shots, followed throughout the day by factories’ alarm sirens, pealing of churches, fireworks, and choruses of jubilation.2:171,5:31-32,6 By 1901 osteopathy was recognized in eleven other states (Iowa, South Dakota, Illinois, Tennessee, Montana, Kansas, California, Indiana, Nebraska, Wisconsin, and Connecticut).7

  1. Journal of Ostepathy, v.2, n.6, Sept 1895:7.
  2. Trowbridge C. Andrew Taylor Still 1828-1917. Truman State University Press, Kirksville MO, USA 1991.
  3. Journal of Osteopathy, v.3, n.1, June 1896.
  4. Gevitz N. The DOs. The Johns Hopkins University Press, Baltimora, Maryland, USA 2004:25.
  5. Hildreth The Lengthening Shadow of Dr. Andrew Taylor Still by Arthur Grant Hildreth. Arthur Grant Hildreth, Macon, Missouri, 1938.
  6. Lewis, J. A.T. Still: From the Dry Bone to the Living Man. Dry Bone Press, Blaenau Ffestiniog, Kings Lynn, UK 2012. Trad. it. 2016: A.T. Still: dalle aride ossa all’uomo vivente. Dry Bone Press, Blaenau Ffestiniog, Kings Lynn, UK.
  7. Gevitz, N. (2014). The “doctor of osteopathy”: expanding the scope of practice. Journal of Osteopathic Medicine114(3), 200-212.

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The spread of osteopathy in the United States

6. The 1920s and the historic decision of the AOA

The events causing the turning point that in 1929 determined the beginning and the evolution towards an osteopathic medicine parallel to orthodox medicine, with a similar training and scope of practice.


5. World War I and the Spanish flu pandemic.

The departure for the front lines of regular doctors and the successes achieved in treating influenza gave an encouraging boost to osteopathy.


4. The Flexner Report and its consequences

The scandal that exposed the poor quality of most U.S. medical schools' degree programs also involved osteopathic institutions and shaped their evolution.


3. Internal controversies on the development of osteopathy and on osteopaths' professional scope

The debate between osteopaths loyal to tradition and those open to collaboration with orthodox medicine shaped the progress of osteopathy in the United States.


2. The establishment of the American Osteopathic Association (AOA)

The creation of a single registry that held annual conferences and published a monthly newsletter was a key step in the growth of American osteopathy.