5. World War I and the Spanish flu pandemic.

By 1917 osteopathy was well established in different parts of the United States. There were seven osteopathic training schools and more than six thousand professionally active osteopaths. The regulation of the profession, however, was not even, as each of the federated states dictated its own laws on the subject. Therefore, although the new medicine was recognized in more than forty states, only in thirteen of them did DOs and MDs have equivalent rights to practice. The state licensing commissions responsible for examining medical graduates were sometimes independent. Therefore, some times they were composed only of osteopaths, while some other times they were mixed, or even formed only of MDs. The scope of practice also varied across geographic borders: in some states, legislation granted DOs only the application of manipulative treatments and the use of so-called nonpharmacological adjuncts, while some other states authorized the practice of obstetrics, minor surgery and the prescription of certain drugs.¹

Despite the AOA‘s protests, DOs were not enlisted as doctors during World War I; moreover, at the beginning, the osteopathy students could not even benefit from the law that granted their allopathic medicine counterparts exemption from the draft in order to pursue their studies.²

However, this situation had unpredictable positive repercussions for the DOs who remained at home; in fact, having to fill the void left by the MDs committed to the front, they experienced an increase in the number of their clients accompanied by an increased notoriety of osteopathic medicine.

In addition to this, most colleges continued their efforts to improve the quality of their training. For example, in a document of 1917, five osteopathic colleges – the College of Osteopathic Physicians and Surgeons, the Chicago College of Osteopathy, the Des Moines Still College of Osteopathy, the Massachusetts College of Osteopathy, and the Philadelphia College and Infirmary of Osteopathy – stated that they would not admit new freshmen unless they possessed a high school diploma, and pledged to have an external official approved by the AOA Education Committee evaluate this requirement.³

An additional important factor, particularly for “pure” osteopaths, was the successes achieved in curing a particularly virulent strain of influenza, the so-called Spanish flu, which raged in 1918 and 1919. Some five hundred and fifty thousand people died of it in the United States (28 percent of the population) and an estimated forty million people worldwide, a number greater than the sum of all the casualties of World War I. ^4,5

According to the osteopaths’ claims, the percentage of recovery they achieved with osteopathic treatments compared to traditional treatments were impressive: for the flu the mortality rate was 0.25% for osteopathic medicine versus 5-6% for orthodox medicine, while for pneumonia the deaths were 10% versus 33%, respectively. The AOA urged osteopaths to send as much data as possible so that a report could be prepared, which was then read at the annual convention held in New York in 1919 and finally published in the JAOA in 1920. Although its non-conformity to the standards of current scientific research makes it scarcely credible, it is likely that manipulative maneuvers did actually make a difference, especially in the absence of effective drugs.^{4,6,7,8,9,10,11,12}

The maneuvers used at the time have been studied and are still considered important today, especially with respect to dystopian pandemic scenarios in which vaccines and/or drugs would not be available for the entire population.^11,13,14,15

The data released by the schools as of September 29, 1919, reported an encouraging partial figure that saw more than five hundred enrollments already registered before the enrollment closing dates – 162 in Chicago, 45 in Los Angeles, 16 in Kansas City, 64 in Des Moines, 34 in Boston, 54 in Philadelphia, and 150 in Kirksville.¹⁶

At the end of World War I, “pure” osteopaths enjoyed an ephemeral upper hand over the faction of “broad” osteopaths, partly thanks to the support of the AOA and especially thanks to the growth of osteopathic medicine and the excellent results obtained in the treatment of the flu.⁴