The History of Osteopathy in the UK

Several other American-trained osteopaths worked in the UK since the first decade of the 20th century. For example, in 1902 Francis (Franz) J. Horn, a friend of J.M. Littlejohn, opened a practice in London while L. Willard Walker practiced in Glasgow. Jay Dunham, at the request of one of his patients who wanted to cure his sister, left Kansas and settled in Ireland in 1903, where Harvey Foote also moved the following year. In 1907 two new practices were opened by Wilfrid Streeter and Elmer Pheils, one in Glasgow and one in Birmingham, respectively. The restless William Smith, the first Anatomy lecturer at the ASO, also moved to Scotland after 1910, where he sadly died prematurely of pneumonia in 1912 (Colllins 2005; Grigg 1967). The JAOA (October 1907:67) had words of commendation for the aforementioned osteopaths and some others who, although did not hold the title of doctor, were successful in treating their patients.

In un articolo del 1909 (The Osteopathic Physician, 1909:2-3) Stanley H. Hunter, neurologo ed oculista osteopatico, vice presidente e professore di oftalmologia presso il Pacific College of Osteopathy, descrisse le possibilità di sviluppo dell’osteopatia nel Regno Unito. A suo avviso, pur se fino ad allora non sembravano essere emersi problemi con la legge, gli osteopati avrebbero dovuto astenersi dall’uso del titolo di dottore ed evitare di prescrivere di farmaci. Ottenere il riconoscimento legale sarebbe stato molto difficile finché non fosse stato fondato un istituto di formazione britannico. 

In a 1909 article (The Osteopathic Physician, 1909:2-3) Stanley H. Hunter, an osteopathic neurologist and ophthalmologist, vice president and professor of Ophthalmology at the Pacific College of Osteopathy, described the possibilities for the development of osteopathy in the United Kingdom. In his opinion, even though no problems with the law seemed to have emerged until that time, osteopaths should still refrain from using the title of doctor and avoid prescribing any drug. Obtaining legal recognition would have been very difficult before the establishment of a British training institution.

In the meantime, a repetition of the events already experienced by American osteopaths could be witnessed in the UK: in the absence of a regulatory law, there was a proliferation of operators who would call themselves osteopaths despite having no qualifications. However, several American osteopaths who had moved to London and Manchester established themselves as successful osteopaths, perhaps thanks to the deep-rooted bone-setting tradition in parts of the British Isles. We could easily say then that Initially osteopathy was not frowned upon, but, on the contrary, it obtained the support of some members of the upper-class and even sparked some interest within the medical profession. In 1910 Dr. Alexander Bryce wrote an article in which, while warning that manipulation could aggravate acute cases, he encouraged to find the good in that method and integrate it into the official medicine (Bryce 1910; Collins 2005:13).

However, the British General Medical Council (GMC) was strongly against the practice of health care exercised by unqualified operators, and in the first decade of the new century the council worked to eradicate the popular tendency to resort to practitioners with no medical degree. For example, in 1908 it launched a campaign against Herbert Barker, a famous bonesetter who was also in great demand among the upper classes and the aristocracy. Backed by the GMC, a client took Barker to court and managed to get him convicted.

When a 1910 report highlighted that, despite the policies of the medical class, the bone-setting category was more prosperous than ever, the GMC’s reaction came fast: in addition to forbidding its members to collaborate with unqualified people, it disbarred Dr. Axam, the anesthesiologist who worked with Barker, for defamatory conduct. However, this move proved to be counterproductive, in fact a large part of public opinion and even The Times newspaper, usually a supporter of orthodox medicine, considered it an extreme measure (O’Brien 2016:59). For his part, Herbert Barker  boasted of having helped thousands of patients, many of whom had turned to him after the doctors had failed to cure them. Since he wished to teach at some medical colleges and pass on his methods, Barker needed to qualify, but the controversy surrounding his case prevented him from being awarded an honorary doctorate. Eventually the matter was settled by conferring a baronetcy on him in May 1922 (Bishop 2002). In 1936 he demonstrated his methods to a hundred members of the British Orthopedic Association, of which there is a video recording (Youtube a, Youtube b).

The battle of the medical establishment to ensure that all health care services would be provided exclusively by professionals exploded in the USA at this same time. In 1910 the Flexner Report was published which photographed the conditions of American medical universities, giving an overall very negative judgment (Flexner 1910). The news had wide resonance also in the United Kingdom.  Abraham Flexner, author of the report, had excluded chiropractic and mechano-therapeutic schools from the survey, and had divided the remaining schools into scientific and sectarian. In this second category he had included the eight American osteopathic schools, as well as the eclectic, homeopathic and physiotherapy schools, all judged very negatively. According to Flexner, a total of 1,300 osteopathic students generated revenues of more than $200,000 a year, which the school owners used to expand buildings or enrich themselves rather than hiring full-time teachers and purchasing materials.

Unlike what happened in the USA, where the AOA was able to defend the category of osteopaths by joining together despite their differences, in the United Kingdom there was a proliferation of different training institutions and various associations, which sometimes represented osteopaths together to naturopaths and chiropractors. These institutions failed to find a shared strategy to defend the profession, indeed in some cases they donated the scarce resources to long controversies regarding who could claim the title of osteopath, in an atmosphere of hostility on the part of the medical world.

Molto schematicamente, fra le associazioni e le scuole che furono protagoniste nello sviluppo dell’osteopatia in Gran Bretagna nel primo trentennio del Novecento si possono ricordare le seguenti:

Very schematically, among the associations and schools that were acting in the development of osteopathy in Great Britain in the first thirty years of the twentieth century, the following deserve to be mentioned:

• 1910 – the British Osteopathic Society, the association founded by the first American osteopaths on English soil, which then took the name of BOA, British Osteopathic Association (affiliated to the American AOA), currently the Institute of Osteopathy.

• 1917 – la British School of Osteopathy o BSO, la prima scuola sul territorio del Regno Unito, fondata nel 1917 da J.M. Littlejohn, che dal 2017 ha preso il nome di University College of Osteopathy, UCO;  1917 – the British School of Osteopathy or BSO, the first school to be established in the United Kingdom, founded in 1917 by J.M. Littlejohn, which, in 2017, changed its name into University College of Osteopathy, UCO;

• 1921-1926 – the Manchester School of Bloodless Surgery (known as Looker College of Osteopathy and Chiropractic since 1923) founded by William Looker, who died prematurely of pneumonia in July 1926.

• 1924 – the Osteopathic Defense League, founded by Wilfrid Streeter, gathered sympathizers of osteopathy.

• 1925 – the IAO, Incorporated Association of Osteopaths, founded by some graduates of the Looker School, who were not admitted to the BOA. The IOA members could bear the title of “osteopathic physician” or “osteopathic surgeon”

• 1925 – the Nature Cure Association of Great Britain and Ireland, which brought together operators who practiced different natural therapies.

• 1925 – British College of Chiropractic – founded by A. Warde Allen.

• 1928 – the Western Osteopathic School – founded by Tom Mitchell Fox.

Let us now see them in detail:

• BOA, or British Osteopathic Association (1910)

In 1910, 12 American osteopaths founded the association of British osteopaths, initially called British Osteopathic Society and then British Osteopathic Association, BOA, which operated in line with the standards set by the AOA, the American Osteopathic Association. In fact, as it had already been the case in the USA, many osteopaths worked in the United Kingdom without adequate training, or defined themselves as osteopaths after attending short courses or after reading do-it-yourself guides. The publisher Psychic Research C, for example, had published in London the “Home Study Course in Osteopathy, massage and manual therapeutics“, very similar to the American version published by the Columbia College of Osteopathy  (Collins 2005; O’Brien 2013).

The BOA – which in 1923-24 had 36 members including 11 women (O’Brien 2013:17) and in 1925 had 50 members including 6 physicians (Collins 2005) – never managed to gain control of the profession unlike its counterpart overseas, however through its connections with the upper classes it had a considerable influence on British osteopathy. It counted among its honorary members the famous bonesetter Herbert Barker, to whom the Kirksville College of Osteopathic Medicine and Surgery  (into which the ASO had merged) conferred an honorary doctorate in osteopathy in 1925.

• British School of Osteopathy (1917)

J.M. Littlejohn left the United States for good and moved to England in 1913, and already in 1914 he discussed the idea of opening a school with Francis Horn and L. Willard Walker. In March 1915 they made a first attempt in this direction but, due to the war, it was not possible to set up the school, which, instead, worked as a clinic, attended by 30-50 patients a week. Amongst the other, several successful treatments administered to officers of the armed troops have been mentioned.

In 1921 Littlejohn developed a four-year program that did not cover pharmacology or surgery: the initial two years were devoted to the basic sciences and the last two years to the study of osteopathy – students with a medical degree were admitted in the third year. The courses did not start until 1922, when some members of the BOA offered their collaboration as part-time teachers.

The first two degrees were awarded in 1925, respectively to Elsie Wynter Waring and to Captain Gerald Lowry, who had lost his eyesight during the war (Collins 2005; O’Brien 2013). Both were admitted to the BOA, of which Littlejohn was president, in 1925-26.

Until roughly 1925 the BOA worked in unity of purpose with the BSO (the school founded by Littlejohn) welcoming BSO graduates into its membership. They were later torn by irreconcilable differences over the management of the institution, which the BOA wanted to be aligned with the American AOA  guidelines, regulated by a law for osteopathic practice and managed by an independent body (Collins 2005; GCRO ca. 1962). At the end of 1926 Littlejohn resigned from the BOA, which no longer accredited the BSO, whose graduates were then welcomed into the Association of British Osteopaths, especially founded for this purpose in 1926. This association had a short life and in 1929 merged with the IAO.

• (1921-1926),  Manchester School of Bloodless Surgery (since 1923 Looker College of Osteopathy and Chiropractic) (1921-1926)

Founded in 1921 by William Looker, British by birth who had moved to study and practice in the United States. In 1909 Looker enrolled in the American College of Mechano-therapy in Philadelphia, then attended other institutes of naturopathy, chiropractic, medicine and osteopathy (at the International College of Osteopathy in Elgin, organized by Charles Murray but not recognized by the AOA). He finally returned to England in 1919.

Looker claimed to follow the teachings of A.T.Still and D.D. Palmer, and was against the administration of drugs. According to some, six months of study was enough to obtain the chiropractic diploma, while officially the courses lasted three years. The school was initially based in Manchester but in 1925 was moved to London. The untimely death of William Looker marked the closure of the institute.

After Looker’s death, a dozen students of his school applied to graduate from the BSO and were accepted by Littlejohn, who dubbed them “apostles”. They were credited the three years of study already completed to which an additional year of graduate school was mandated together with the final exam.

• Osteopathic Defense League (1924)

The Osteopathic Defense League was founded in 1924, with Wilfrid Streeter as honorary secretary, with the aim of gathering osteopathic sympathizers from among influential people who could pave the way for regulation of the profession (O’Brien 2013:7). In addition to working for a law that would place osteopathy on a level of legal equity with medicine, the league set out to spread the knowledge of osteopathy to the general public as a system of bloodless surgery and drug-free therapy.

• Incorporated Association of Osteopaths (IAO) (1925)

The Incorporated Association of Osteopaths was founded in 1925 as a trade association by some graduates of the Looker College who were not admitted to the BOA. This association organized regular meetings, study groups and conferences. Its members could bear the title of “osteopathic doctor” or “osteopathic surgeon”.

From 1929, the IAO officially became the trade association for BSO graduates, supplanting the Association of British Osteopaths.

• Nature Cure Association of Great Britain and Ireland

Established around 1920 and officially incorporated in 1925, the Nature Cure Association brought together operators of natural therapies, which had been spreading in the United Kingdom since the beginning of the twentieth century. One of the initiators was the American Bernarr Macfadden, famous bodybuilder and advocate of fasting and physical exercise in order to achieve a healthy life. Macfadden opened an office in London to publish his journal Physical Culture (printed in the USA since 1899). Around 1909 he traveled personally to Great Britain, where he established a clinic in Brighton and a residential institution in Chesham, later taken over by Stanley Lief, founder of the British Naturopathic College, later renamed the British College of Osteopathic Medicine. The Nature Cure Association fought against the legal regulation of osteopathy, fearing that its members would be barred from using manipulative therapies once the law would b approved.

• British College of Chiropractic (1925) and Western Osteopathic School (1928) 

In 1925 A. Warde Allen founded the British College of Chiropractic in London. The institute moved to Plymouth two years later under the presidency of Tom Mitchell-Fox, who had studied at Looker’s school. This school offered a combination of osteopathy, chiropractic and naturopathy. This institution remained very small and in the first graduation ceremony, held in 1928, only two candidates succeeded, William Minifie and Lannan Floyd McKeon (Wilson 2012). In 1928 Mitchell-Fox decided to establish a different school in the same building, which he called the Western Osteopathic School. Both institutions closed in 1929, and some students were admitted to Littlejohn’s BSO, and subsequently to the IAO after graduation.

The various institutions described above were all committed in the spreading of osteopathy but without following a common path. In the 1920s several books were also issued, for example in 1927 L.C. Floyd McKeon, who had studied at the British College of Chiropractic, published “Osteopathy and Chiropractic explained“, and Harvey Foote published “The Science of Osteopathy“. The following year Captain Gerald Lowry, the second BSO graduate, wrote “A Place Among Men” and in 1929 “The New Healing” by Wildrid A. Streeter was released. From 1929 Littlejohn published the Journal of Osteopathy (with the same title as that of the ASO of Kirksville) which continued to appear until the war years (Collins 2005).

Graduates who had taken the relatively regular courses offered by the aforementioned schools and who had subsequently joined one of the trade associations were a minority compared to the many self-proclaimed unqualified osteopaths who responded to public demand by administering questionable therapies.

The paths of the BOA and the BSO were now separated. The former remained in line with the American guidelines and never had more than 80 members, who practiced mainly in London and had important connections with the upper classes. Conversely, the IAO, which also welcomed BSO graduates, hosted osteopaths, naturopaths and chiropractors working in the northern and western regions.

In 1927 the BOA opened a clinic in London, inaugurated by George Bernard Shaw, to make osteopathy available to the community. Patients paid what they could according to their economic situation, and it was possible to make donations.

The BOA made constant efforts to obtain legal recognition for osteopathy. In 1926 the British Minister for Health had specified the impossibility of regulating a profession for which there were no training institutes on national soil. Further attempts made in 1931 and 1933 were unsuccessful. In 1934 he managed to get the House of Lords to appoint a special committee to look into the matter.

One of the most active advocates for the recognition of osteopathy in the UK was Wilfrid Streeter, who belonged to the BOA  (the association of osteopathic doctors linked to the US AOA) and had founded an association of osteopathic sympathizers, the Osteopathic Defense League (ODL). The repeated presentation of a bill to define the osteopathic profession had resulted in the appointment of a special committee (Select Committee) which met in March 1935. The main objective of the bill was to protect the public, which had no tools to distinguish qualified operators from those without training.

Two factions participated in the discussion, whose representative lined up for or against the bill. Opponents included the British Medical Association, the Royal College of Physicians, the Royal Colleges of Surgeons of London, Edinburgh and Glasgow and various universities. The medical representatives arrived at the appointment compact, organized and well prepared, having made contact with the American Medical Association (AMA) which had decades of similar battles behind itself in the USA.

The supporters of the bill were the ODL, represented by Wilfred Streeter, the BOA represented by Kelman MacDonald, the IAO (the association of non-medical osteopathic graduates) represented by Harvey Foote, and the British School of Osteopathy (BSO) represented by J.M. Littlejohn. These four groups constituted a fragmented group, which the BSO had joined at the last minute.

During the debate the osteopaths had to answer the questions of the lawyers hired by the doctors: first to answer was Wilfrid Streeter, who pointed out that in the USA there were already more than eight thousand osteopaths, while in the United Kingdom there were one hundred and seventy-nine qualified professionals but also about two thousand self-styled osteopaths. He also described the four-year course offered by the BSO, which had already awarded ninety-eight diplomas and, at that time, counted forty-five students. He also specified how eighteen hundred patients had been treated at the school’s clinic in 1934 (GCRO: 13-14; O’Brien 2013: 35-39; Osteopaths Bill, March 1935: 488-491).

Kelman MacDonald was next. He had studied in Kirksville and explained how osteopathy had evolved into a medical discipline in the USA. MacDonald represented the BOA, the association which had split from the BSO in 1926 after falling out with Littlejohn. The doctors’ attorney used his knowledge of this dispute to obtain unfavorable statements from MacDonald on the BSO, which he himself considered inferior to the American schools by far.

Overall, the statements made by Streeter and MacDonald, men of the world with an extroverted temperament, seemed to have made a good impression on the members of the special committee, and to have convinced them of the reliability of the osteopathic theory and its usefulness in the therapy of various pathologies.

On March 22, J.M. Littlejohn, a typical shy, introverted professor with no oratory skills, was summoned. He probably expected to have to defend or explain the scientific aspects of osteopathy and instead suffered a personal attack that questioned his academic qualifications and heavily criticized his management of the school, even implying that he had sold some diplomas to get rich. Nothing was further from the truth: Littlejohn had dedicated his life to the development of osteopathy, however he had a complex personality, authoritarian but also kind and reserved, and was indifferent to what others thought of him. For these reasons he made such an unfortunate impression that Harvey Foote, representative of the IAO, decided not to appear in defense of osteopathy and therefore was not questioned before the committee.

 Alcuni mesi dopo venne rilasciato il rapporto del comitato speciale, secondo cui l’unico istituto preposto alla formazione degli osteopati presente sul suolo britannico aveva un’importanza trascurabile, era del tutto inadatto allo scopo e soprattutto si trovava in mani assolutamente disoneste (GCRO: 15-21; O’Brien 2013: 39-40).

A few months later the report of the special committee was released, which stated that “the only existing establishment in this country for the education and examination of osteopaths was exposed in the course of evidence before us, as being of negligible importance, inefficient for its purpose, and above all, in thoroughly dishonest hands.” (GCRO: 15 -21; O’Brien 2013: 39-40).

This was not the truth, since the judgment on the British School of Osteopathy (BSO), unselfishly run by one man and with only seventeen years of activity behind, had been formulated by comparison with orthodox medical schools, which came from a very long tradition and were also subsidized by the state. For his part, Littlejohn saw no need to take official defensive action: convinced that he was on the right track, he continued with his mission. He never accepted the accusation of having “dirty hands” and expressed his reasons in some articles published in the British Journal of Osteopathy, the journal of the BSO.

The Ministry of Health of the United Kingdom, having examined the report of the special committee, decreed that the conditions did not exist at that moment for the adoption of the bill on osteopathy, suggesting to those who practiced osteopathy to register with the medical order or to create a voluntary register, as well as setting up institutes on British soil as soon as possible for the adequate training of those wishing to be admitted to this register in the future (GCRO: 21-24).

At that time there were three professional bodies which osteopaths would join: the BOA, which welcomed osteopathic graduates from the six American colleges then recognized in the USA, the IAO, which would later take the name of Osteopathic Association of Great Britain, which would bring together the graduates of the BSO, and the National Society of Osteopaths Ltd, whose members held diplomas from other institutions, some of which have disappeared, or were trained through apprenticeships. After some lengthy discussions, on July 22, 1936 these associations created the General Council and Register of Osteopaths, of which Viscount Elibank was president until 1944, the person having introduced the bill in favor of osteopathy in the House of Lords.

One of the General Council ‘s first actions was to force changes to the BSO to improve its educational standards and to amend its statute in order for the school’s stock to be held by three trustees. After fulfilling the required formalities, the school was recognized and the BSO graduates were able to join the Register.

The establishment of several specialized schools and associations led the progress of osteopathy in Great Britain, although such institutions could often express divergent and conflicting ideas. The intricate events that ensued did not only involve British osteopaths but also some American and French practitioners.

Very schematically, the main currents of thought were divided into various strands, headed by the bodies listed below:

•   the BOA, linked to its American counterpart (AOA), together with the London College of Osteopathy (the training institution founded in 1946), wished for osteopathy to develop in accordance with the American guidelines;
•   the General Council and Register of Osteopaths (GCRO), established as a voluntary register which qualified osteopaths could join after the unsuccessful attempt to gain recognition by the accountable government authorities, was trying  to impose its own criteria as standards.
•   the BSO, Littlejohn‘s school, would engage in the training of osteopaths outside the medical world. The criteria of this institution did not meet those of the BOA, therefore its graduates joined  the IAO, which in 1936 changed its name to OAGB (Osteopathic Association of Great Britain);·

the National Society of Osteopaths, an association founded in 1930, had the aim of gathering and protecting osteopaths who did not have a recognized American training or even a BSO diploma;

•   the British College of Naturopathy (BCN) trained naturopaths who would also have some knowledge of osteopathy. The school had been founded by Stanley Lief, who had studied natural therapies and bodybuilding with Bernarr Macfadden and chiropractic medicine at a Chicago institution. There were conflicts with the General Council and Register of Osteopaths over who had the right to bear the title of Registered Osteopath. In 1961 the institute changed its name to the British College of Naturopathy and Osteopathy (BCNO), creating its membership association: the British Naturopathic and Osteopathic Association (BNOA);
•   the Maidstone Osteopathic Clinic founded in 1949 by John Wernham, a pupil of Littlejohn, who advocated a treatment procedure called the General Osteopathic Technique, or GOT.
•   the European School of Osteopath – formerly École Française d’Ostéopathie or EFO, the institution founded in Paris by Paul Gény in 1951 – moved to London at the BCNO in 1965 and then to Maidstone in 1971. The school offered courses in osteopathy under the guidance of Thomas (Tom) G. Dummer and several other British osteopaths. The Society of Osteopaths was founded in 1971 to gather graduates of the ESO and BCNO.
•   the Edimburgh College of Naturopathy, Osteoathy and Chiropractic, with the relative association, the United Association of Osteopaths, Chiropractors and Naturopaths: the two bodies mantained that the manipulative method could not be considered a complete healing system, but that osteopathy and chiropractic should be considered complementary to naturopathy.

After the negative opinion expressed in 1935 by the special committee appointed by the House of Lords to examine the bill on osteopathy in the United Kingdom, some members of the BOA (the association of British osteopathic doctors, counterpart of the American AOA) established in 1936 a professional register – the General Council and Register of Osteopaths, driven above all by the need to distinguish themselves from mere charlatans.

All BOA members were officially accepted into the GCRO, although many did not join because the new register seemed to them a less prestigious duplicate of their membership. Non-BOA osteopaths – such as BSO graduates, OAGB and National Society of Osteopaths members and also other osteopaths – could apply individually. In 1939 the GCRO had one hundred and thirty-nine members (forty-five of whom held US degrees, while the overwhelming majority of British graduates were from the OAGB), and seventeen associates.

With regard to Littlejohn’s school (BSO), the institution survived the difficult years following the negative report drawn up by the Special Committee of the House of Lords and those of the second world war thanks to the volcanic figure of T. Edward Hall, who was then considered the best osteopathic technician in the world by contemporaries, and to Shilton Webster-Jones, known as Webber, more thoughtful. Upon Littlejohn’s death in 1947, Webster-Jones took over the management of the school and reorganized the courses with a more biophysical focus. The personalities of Hall and that of Webster-Jones were profoundly different, and the conflict between them culminated in 1964 with the umpteenth and definitive resignation of Hall from his teaching posts.

One of the most famous students of the BSO, John Wernham made a great contribution to osteopathy, dedicating his whole life to deepening and spreading the discipline. At the BSO he befriended T. Edward Hall and, after Littlejohn‘s death, moved to Kent where in 1949 he founded the Maidstone Osteopathic Clinic. In 1954, at Hall‘s suggestion, John Wernham became a founding member of the Institute of Applied Technique, now the Institute of Classical Osteopathy. One of the reasons for the birth of this institute was to preserve the philosophical and practical roots of osteopathy. In addition, John Wernham helped teach Paul Gény‘s French School (EFO), which was later forced to move to England due to legal problems, and contributed to Tom Dummer‘s European School of Osteopathy, which was later transformed into a full-time institution thanks to the high influx of students.

Meanwhile the General Council and Register of Osteopaths (GRCO), whose headquarters were for some time located in the basements of the BSO building, came to consist mainly of BSO graduates and OAGB members. To achieve its goal of protecting the public, GRCO sought to prevent members of other associations from using the title of Registered Osteopath. To this purpose, in the early 1950s the GRCO filed a lawsuit against a naturopath, W.H. Dodd, who persisted in using the title of Registered Naturopath and Osteopath despite being denied admission to the GRCO. The lawsuit dragged on for about a decade and finally earned the GRCO an unnecessary victory: the opposing party withdrew from appearing because the accused osteopath had meanwhile passed away. Besides, in 1961 the BNC changed its name to British College of Naturopathy and Osteopathy (BCNO), simultaneously changing the name of its related association, which became the British Naturopathic and Osteopathic Association (BNOA), Consequently it was now able to guarantee its graduates the title of Registered Naturopath and Osteopath. Although some of them also openly used the title of Registered Osteopath that had been the subject of this long and costly legal confrontation, neither of the two contenders could afford any further action.

In the 1960s the BSO faced some difficulties related to the low number of students (the total number of students enrolled was 40 in 1965, 29 in 1966, 34 in 1967-68). It changed the curriculum from three to four years in 1970, renewed its management by electing Colin Dove as its president in 1968 and worked to expand and reorganize its work spaces, which had become insufficient. The clinic continued to operate, treating about 500 patients a week in 1961 and about 550 in 1968.

The full-time courses of the BCNO began in 1964, with a timetable stretching from Monday to Thursday. When Paul Gény’s École Française d’Ostéopathie (EFO) was unable to continue its courses in France, its seminars were scheduled from Friday to Sunday at the BCNO headquarters, under the guidance of Tom Dummer, who had graduated as a naturopath at the BNC in 1953. The coexistence of the two schools continued from 1965 to 1971, but the two institutes maintained separate curricula. EFO courses became in great demand, so much so that in 1968 to enter the school you had to join a two-year waiting list; due to the need for space some seminars were organized at John Wernham‘s institute in Maidstone.

As a consequence of the great success of the ‘French’ course and because of some difficulties of coexistence with the BCNO, in 1971 the EFO moved to Maidstone, in a building owned by John Wernham, assuming the name of École Européenne d’Ostéopathie or EEO . The Society of Osteopaths (SO) was also founded in order to gather BCNO and EEO graduates. A non-political body committed to disseminating osteopathic principles and practice, encouraging non-competitive relationships and respect towards rival institutions.

The detachment of the EFO (now EEO) from the BCNO, the structure that had hosted it in London, was not without consequences. By a series of circumstances a quarter of the teaching staff and a third of the students of the BCNO converged in 1974 in Maidstone, where Dummer started a new school, the European School of Osteopathy or ESO, which offered a four-year full-time course. Dummer was the proponent of the specific adjustment technique, or Specific Adjustment Technique (SAT) which was opposed to the general treatment, or General Osteopathic Treatment (GOT), developed by John Wernham and which gave rise to lively discussions between the two authoritative osteopaths.

In the 1970s English osteopathy remained very fragmented. Initially the GRCO, despite having the merit of improving the professionalism of osteopaths, did not operate as a united association, but kept some distinctions alive within its members. Nevertheless, the number of members grew from 279 in 1971 to 354 in 1979.

In these same years, cranial osteopathy arrived in the United Kingdom through two different routs. BSO President Colin Dove traveled to the USA to visit the Sutherland Cranial Teaching Foundation (SCTF) and found the way for UK GRCO members to be admitted to its courses. What is more, the members of the Society of Osteopaths (SO) were also admitted to the courses, thanks to the SCTF President, Rollin Becker. For its part, the BCNO made arrangements with John Upledger, also a member of the SCTF, to teach cranial therapy courses at the school.

Over time, the diffusion of alternative and complementary therapies in the United Kingdom continued to grow, particularly during the seventies and eighties, while there was also a proliferation of voluntary associations that brought together professionals. In the field of osteopathy, for example, the Osteopathic and Naturopathic Guild was founded in 1967, the Guild of Osteopaths London in 1971, the British and European Osteopathic Association in 1976, the Faculty of Osteopathy in 1978, and the Association of Osteopathic Practitioners in 1984. However, the GCRO continued to represent the largest number of osteopaths, reaching 1,140 active practitioners in 1988 against a total of 864 practitioners in the other associations (Stojan 2006).

The governmental authorities had no intention of limiting the right of each individual and left them free to decide how to take care of themselves. Nevertheless, they wanted to introduce some form of protection for the citizens, such as, for example, a register and a code of ethics. The fist possible solution they thought of was the constitution of an “umbrella” organization that would bring together all the unconventional therapies, but such idea proved to be impracticable and in the end each group acted individually.

Osteopaths had already tried several times to obtain a proper regulation for their profession, and in 1985 the Minister of Health had set out the five criteria necessary for a profession to be recognised: it had to be “mature”; have a single organization for its regulation; have a systematic body of knowledge; have recognized training courses and be able to demonstrate its effectiveness. A sixth was added to these criteria in 1987, namely that any regulatory initiative undertaken from then on had to have the primary objective of guaranteeing public safety.

In 1992, a bill was introduced to establish the General Osteopathic Council (GOsC), the body that would be responsible for the regulation of osteopathy and for the creation of its professional register. Approval came on July 1, 1993, and was followed by a transitional period during which the different associations settled their differences down. The regulation had significant costs for individual osteopaths, who had to pay £1350 each to enter the register. Since the Osteopaths Act came into force in 2000, anyone claiming the title of osteopath without being on the register is liable to penalties for committing a criminal offense (Walker and Budd 2002).

Osteopathy is therefore a formally recognized branch of alternative medicine in the UK, which makes it possible for healthcare professionals to refer their patients to an osteopath. Initially, British schools used to award their graduates with  a Diploma of Osteopathy (DO), nevertheless this turned out to be quite confusing. This acronym, in fact, was the same used to distinguish American osteopathic physicians, belonging to the category of regular doctors and qualified for the unlimited practice of the medical profession. After 2005, American osteopathic doctors gained recognition in the UK, gaining the right to practice as regular doctors provided that they passed a language exam and did a year’s supervised practice in the NHS. As a consequence, British osteopathic schools started  awarding titles different from DO, conferred upon completion of a four-year course in osteopathic training at university level (BSc [Hons] Osteopathy, BOst [Hons]) and master’s degrees in osteopathy (MOst), other than those in medical training.

In general, in the UK, osteopathic training institutions focus on the study of the philosophical and practical principles of osteopathy and on the foundations of basic sciences (anatomy, physiology, pathology, nutrition and spinal mechanics and in some cases pharmacology) during the first two years of their courses, while the last two years of study are devoted to clinical practice. Typically, they also offer basic courses in psychology, midwifery, paediatrics, and rheumatology, and require the submission of a research project to obtain the diploma.

As a rule, osteopaths in the UK focus primarily on corrective musculoskeletal procedures, as they are excluded from the practice of official medicine. The London College of Osteopathic Medicine, founded in 1946 and recognized by the GOsC, is an exception; in fact, only graduates in traditional medicine can access this institution, where they follow a 13-month postgraduate training in osteopathy and are then accepted into the Association of Medical Osteopaths.

Therefore, in the UK, osteopathy is an “alternative” path to orthodox medicine, confirmed for example by the fact that the curriculum of the European School of Osteopathy and the University College of Osteopathy (formerly the British School of Osteopathy) also includes courses in naturopathy, phytotherapy and yoga.

Most of the time British osteopaths work in private practices, alone or in association with other practitioners. Very often they practice in centers that offer interdisciplinary therapies, while only occasionally they work in medical surgeries where they provide alternative therapies such as osteopathy and acupuncture.

In the UK osteopathy has been steadily expanding: in 1983 there were between 1,000 and 1,200 osteopaths, this number rose to 3,823 in 2007. This figure included both registered osteopaths and osteopathic physicians, broken down by gender at 2,039 men and 1,784 women

According to GOsC data, as of January 1, 2020, there were 5,456 active osteopaths in the UK, the vast majority distributed in England. The registry also establishes and maintains standards for professional ethics and practice, quality of education, and patient complaints management. Recognized training institutions are listed on the GOsC website, which publishes an annually searchable online report on its activities (Bloomfield 2009; Collins 2005; GCRO; O’Brien 2013).

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