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.

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


  1. Gevitz, N. (1998). The sword and the scalpel – the osteopathic ‘war’ to enter the Military Medical Corps: 1916-1966. The Journal of the American Osteopathic Association98(5):279-286
  2. Silver, S. A. (2012). Thanks, but no thanks: how denial of osteopathic service in World War I and World War II shaped the profession. Journal of Osteopathic Medicine112(2):93-97.
  3. “Standards of Associated Colleges of Osteopathy – Admission of Students”. JAOA September 1917, in JAOA v. 17 1917-18:46.
  4. Gevitz N. The DOs. The Johns Hopkins University Press, Baltimora, Maryland, USA 2004:81-82.
  5. Tsoucalas, G., Kousoulis, A., & Sgantzos, M. (2016). The 1918 Spanish Flu Pandemic, the origins of the H1N1-virus strain, a glance in history. European Journal of Clinical and Biomedical Sciences2(4), 23-28.
  6. Smith, R. K. (2000). One hundred thousand cases of influenza with a death rate of one-fortieth of that officially reported under conventional medical treatment. 1919. Journal of Osteopathic Medicine100(5), 320-323; 
  7. Baroni, F., Mancini, D., Tuscano, S. C., Scarlata, S., Lunghi, C., Cerritelli, F., & Haxton, J. (2021). Osteopathic manipulative treatment and the Spanish flu: a historical literature review. Journal of Osteopathic Medicine121(2), 181-190. 
  8. Mueller D. M. (2013). The 2012-2013 influenza epidemic and the role of osteopathic manipulative medicine. Journal of Osteopathic Medicine113(9), 703-707. 
  9. Déry, MarkAlain. “One Hundred Thousand Cases of Influenza With a Death Rate of One-Fortieth of That Officially Reported Under Conventional Medical Treatment” Journal of Osteopathic Medicine, vol. 108, no. 9, 2008:484-530. 
  10. Chila A.G. (a cura di). Foundations of Osteopathic Medicine. 3rd ed. Lippincott Williams & Wilkins, Baltimora Philadelphia, USA 2011:1054. 
  11. Hruby R.J., Hoffman K.N.. Avian influenza: an osteopathic component to treatment. Osteopathic Medicine and Primary Care, 1:10, 2007. 
  12. Magoun H.I. jr. More About the Use of OMT During Influenza Epidemics. JAOA, vol.104, n.10, October 2004: 406-407
  13. Hodge LM. Osteopathic lymphatic pump techniques to enhance immunity and treat pneumonia. Int J Osteopath Med. 2012 Mar;15(1):13-21. 
  14. Yao, S., Hassani, J., Gagne, M., George, G., & Gilliar, W. (2014). Osteopathic manipulative treatment as a useful adjunctive tool for pneumonia. JoVE (Journal of Visualized Experiments), (87), e50687. 
  15. Patterson MM. The Coming Influenza Pandemic: Lessons From the Past for the Future. JAOA, v.105, n.11, November 2005:498-500. 
  16. “Attendance at Our Colleges”. JAOA October 1919, in JAOA v. 19 (1919-1920):63-64.

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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.


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.


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.


Francesca Galiano


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