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

The overwhelming growth of osteopathy in the United States was directed by the guidelines of the American Osteopathic Association (AOA), the professional body that protected and guided its development.

Founded in 1897 under the name AAAO (American Association for the Advancement of Osteopathy), the AOA was initially established by a group of ASO students and undergraduates. From January 1899 to June 1900 its official newsletter was The Popular Osteopath, a periodic journal, independent of the actual schools. Established with the aim of discussing topics of interest to the profession and publishing articles explaining osteopathy to prove all falsehoods circulating about it. The number of practicing osteopaths in 1896 was sixty-six, however, by 1896-7 the new members of the ASO already amounted to 280, not counting the professionals who were being trained in the new schools. The AAAO‘s priority goals were professional consolidation and legal recognition. Representatives from six schools were present at the 1898 annual meeting.

On July 5-7, 1900, osteopaths met in Chattanooga, Tennessee,  for the fourth annual convention. In addition to the approval of motions on the management of the association itself and the appointment of new governing bodies, the floor was given to a number of osteopaths, who presented papers on various topics of interest, such as professional ethics, osteopathy’s relationship to the law, training paths, obstetrics, gynecology, the correct anatomical position of the ribs, the abdomen, and the possibility of learning osteopathy only by studying a textbook.¹

A standing committee was also set up to work on all issues related to the requirements for gaining admission to the AAAO, in cooperation with the Associated Colleges of Osteopathy (ACO), an association established in 1898 for the standardization of training courses: only osteopaths who graduated from schools recognized by the ACO could join the AAAO. During the proceedings of the fourth convention, Arthur Hildreth and Charles Still donated a commemorative gavel to the AAAO.

At the fifth annual convention of the AAAO, held in Kirksville from July 2 to July 5, 1901, a new statute² was approved, which included the change of name into American Osteopathic Association (AOA). The AOA is still active in America today, has retained the same name and currently represents more than 186,000 U.S. osteopathic physicians.³

At the same time, the launch of a bimonthly publication of about 48 pages was approved. From September 1901 it became the official organ of the AOA under the name of Journal of the American Osteopathic Association (JAOA). The journal has been issued monthly since 1902, throughout the 20th century and then until 2020. In January 2021 it took the new name of Journal of Osteopathic Medicine (JOM) without disruption in its activities but suspending its printed publication  and making its contents available online in the “open access” format, that is, accessible to anyone without the need for a subscription.⁴

As early as the last years of the nineteenth century, therefore, American osteopaths formed themselves into a single association that represented and defended them, offering the public and legislators an even and unified image of the entire profession. This was probably one of the factors that contributed to the development of American osteopathy within the legal and health care system, along with the historical circumstances that saw it emerge over the last two decades of the 19th century. At that time, in fact, the U.S. orthodox physicians had not yet come together as practitioners of the dominant medical science, and medicine had not yet introjected the transformation associated with the advances in vaccine and drug research that took place since the last quarter of the nineteenth century.

The different path taken by osteopathy in most other countries, as for example in the United Kingdom and France, indicates that the evolution and the very survival of American osteopathy were due to the tenacity and tireless efforts of the many practitioners who represented it. On its own, word of mouth from satisfied patients would not have been enough to keep alive a form of treatment that had been tremendously invisible to orthodox medicine since its inception.

The AOA‘s annual conferences were therefore the defining events in the development of American osteopathy. The works would last for several days, with administrative activities such as budget approvals and election of president and other institutional officers as well as voting on fundamental issues such as training courses’ duration and subjects.

Within the conference, seminars were offered in which the most famous osteopaths were invited to speak, and spaces for discussion were provided. There was no shortage of convivial moments, and all activities were then thoroughly reported in the JAOA, whose issues were often divided into two parts. The first part contained editorials and other articles on clinical cases, research, and professional reflections, while the second one was dedicated to a description of the association’s activities – these activities also included those of the various osteopathic associations in the single states, which were being formed as practitioners established themselves in different cities within the U.S., and which in turn organized conferences and events.

The AOA therefore took on the arduous task of regulating, defining and establishing the osteopathic profession in America. Its efforts focused primarily in the areas of legal recognition and education, working on two fronts: internally, trying to find a common ground to overcome the sometimes apparently irreconcilable conflicts among osteopaths, and externally, striving to create a consistent image for the entire profession.

Among the early initiatives that characterized the first decades of the twentieth century were the above mentioned launch of the Journal of the American Osteopathic Association (JAOA) in 1901, the establishment of numerous standing committees, including those for publication, legislation and education,⁵ the consideration on the need to adopt a written code of ethics,⁶ the close collaboration with the Associated Colleges of Osteopathy (ACO), established in 1898 to develop the educational curriculum and create a list of recognized schools. The AOA also spent efforts to promote research and to disseminate original articles or descriptions of treatments, such as the collections of clinical cases published by E.F. Ashmore, DO, in the first decade of the twentieth century.⁷

The AOA was also well aware that all osteopathic training institutions had to maintain high standards or else be excluded from the health care system. In 1903, the AOA Education Committee instructed E.R. Booth to make an inspection of all osteopathic colleges in order to point out their strengths and weaknesses.⁸ In 1906, the report of the AOA Education Committee reiterated what it had already called for the previous year, namely, the establishment of a Board of Regents in order to standardize the training courses and establish a postgraduate course to teach surgery and other subjects that could not be comprehensively developed in the curricula. The faculty members of such an additional course would have to be graduates of a recognized college, maintain the osteopathic perspective and also engage in research activities. The Post-Graduate College of Osteopathy became a reality in 1908 and later, beginning in 1913, changed its name to A.T. Still Research Institute.⁹

In spite of these efforts, a 1910 report by the Education Committee highlighted how a number of problems often persisted in osteopathic institutes, like low admission standards, poor laboratories for the study of basic science, lack of suitable clinical facilities, and inadequate teaching staff.¹⁰ In addition to this, heated discussions were tearing the professional community apart, especially concerning the equivalence of osteopathic and orthodox physicians, an issue that could not be addressed without addressing the eligibility pharmacology in the curriculum.