Leslie Ching, DO
OSU-CHS
Faculty Development Series

 To understand the historical context of the development of osteopathic medicine
 To review osteopathic philosophy and principles
 To discuss the relevance to clinical practice today

(1828-1917)

 1864—Pasteur established germ theory
 1865—Lister tries to spread concept of antiseptic surgery
(largely unsuccessful)
 Standards of treatment were “heroic medicine”: enemas, bleeding, purgatives, calomel (mercury-based)

 Born in rural Virginia; father was an itinerant Methodist minister, farmer, and physician
 Moved to Kansas in 1844 when father was assigned to be missionary to Shawnee Indians
 Apprenticed as physician with father, may have attended medical school in Kansas City
 Left Kansas to serve in Union Army during Civil War, was discharged as a Major
 Established osteopathy as the name of his medical approach in 1874
 Started first osteopathic medical school in Kirksville, MO in 1892
 Died in 1917, multiple osteopathic medical schools opened by this time

 Several of his children died from meningitis, caused him to challenge his understanding of disease and medicine
 What causes disease?
 Given a theoretical etiology, how do we go about assessing and treating disease?

 Started with supposition that bodies have self-healing mechanisms for the following reasons
 His spiritual beliefs
 Observation that even if exposed to same disease, not all people exposed got sick
 Observation that patients generally recovered from illnesses
 Observation that few diseases were ALWAYS fatal

 Observations of nature
 Contemporary anatomy and physiology
 Spiritual beliefs
 Bone setting
 Spiritualism
 Magnetic healing

 Original name for Still’s system of medicine
 Osteo=bone, pathy=to suffer
 His intention was that knowledge of the skeletal system was the beginning of understanding disease
 “Bones can be used as levers to relieve pressure on nerves, veins and arteries” 1
 Became osteopathic medicine in 1991 to better reflect the practice of DOs

 Anatomical hindrances within muscles, soft tissues, or joints that may decrease the local circulation of blood, lymphatic fluid, and/or endocrine secretions and may impinge on nerves
 This decrease leads to decreased adaptability of the musculoskeletal system and patient’s overall physiology
 For example, an elevated first rib

 Various manual techniques—goal is to restore normal function to joints and surrounding soft tissues to help to normalize physiology (e.g., blood flow, lymphatics, nerve function) as much as possible
 Joint-specific: articulation, HVLA— “popping” a joint;
“auditory reward” is not necessary to gap joint and improve function
 Muscle specific: muscle energy, counterstrain
 Soft tissue techniques: myofascial

 HOST+disease=ILLNESS
 Host+DISEASE=ILLNESS
 HOST+DISEASE=ILLNESS
 What factors are playing into this patient’s illness and how do we treat the patient?

 “Allopathic” medicine is standard medical care
 Its paradigm is based on the understanding of pathology and disease processes
 I.e., host +DISEASE=ILLNESS
 How do you treat the disease?

 Common modifiable ones include: nutrition, exercise, exposure to pollutants, stress level, hours of sleep, mood, etc
 Specific to osteopathic medicine: musculoskeletal dysfunction and how it can affect the physiology of the patient
 Treating musculoskeletal dysfunction becomes a way to restore the host to musculoskeletal and physiological balance
 For example, treating the thoracic spine, rib cage, and diaphragm to decrease work of breathing in patients with pneumonia

1. The body is a unit; the person is a unity of body, mind, and spirit
2. The body is capable of self-regulation, self-healing, and health maintenance
3. Structure and function are reciprocally interrelated
4. Rational therapy is based upon an understanding of the basic principles of body unity, self-regulatory mechanisms, and the interrelationship of structure and function

 Allostasis—maintaining stability through change through physiologic mediators
 Allostatic load—cumulative effect of cycles of allostasis or when allostasis isn’t sufficiently maintained (e.g., sustained psychological stress)

 Salutogenesis=origin of health
 Not a binary system (healthy or diseased) but a continuum of health and disease
 Why are some people more resistant to challenging circumstances?
 Validated measurements include sense of coherence
(general approach to life that views it as structured, manageable, and meaningful/coherent) and generalized resistance resources (resources that help patient cope— may be material or nonmaterial)

(After Still’s death in 1917)

 1923-AMA declared it was unethical for MDs to associate with DOs
 Through the 1930s-1950s, AMA’s opinion was that osteopathy was a “medical cult”
 Osteopathic hospitals established because DOs could not be attendings in allopathic hospitals
 Early 1960s—AMA decided, after visiting 5 COMs, that individual state societies could decide on whether to associate professionally with DOs
 1963—US Civil Service Commission declared MD and DO degrees equivalent
 1966—DOs allowed to practice medicine in US military
 Unlimited practice rights in all 50 states only by 1989 (Nebraska was last state)
 DOs are in all specialties of medicine

 Osteopathic medicine is a philosophically distinct system of medicine that is usually practiced in conjunction with allopathic medicine (caveat)
 Osteopathic philosophy is consistent with other models of health and disease, such as allostasis (more physiologic) and salutogenesis
(more sociological)
 OPP philosophically starts with a whole view of the patient (top down) when looking at the etiology of a disease state in an individual patient
 Allopathic approach is generally broken down by systems (bottom up)
 Criticisms of this approach because you tend to lose the concept of the whole patient

 How do you keep the whole patient in mind when you learn medical school curriculum in systems format?
 We have an opportunity to continue to foster this whole patient approach, using modern medicine as well as osteopathic philosophy
 Empathy study

 Chila AG (ed). Foundations of Osteopathic Medicine, 3 rd Ed. Baltimore, MD: Lippincott Williams &
Wilkins; 2011.
 Dyer R. History of Osteopathic Medicine. First Year OMM lecture. Tulsa, OK.
 Gevitz N. A Degree of Difference: The Origins of Osteopathy and First Use of the “DO” Designation. J
Am Osteopath Assoc. January 2014;114(1):30-40.
 Gevitz N. The ‘little m.d.’ or the ‘Big D.O.’: The Path to the California Merger. J Am Osteopath Assoc.
May 2014;114(5):390-402.
 Gevitz N. From “Doctor of Osteopathy” to “Doctor of Osteopathic Medicine”: A Title Change in the
Push for Equality. J Am Osteopath Assoc. June 2014;114(6):486-497.
 Lewis J. AT Still: From the Dry Bone to the Living Man. Gwnedd, Wales: Dry Bone Press; 2013.
 McEwen B, Seeman T. Allostatic Load and Allostasis. Available at: http://www.macses.ucsf.edu/research/allostatic/allostatic.php
. Accessed on September 23, 2015.
 http://www.salutogenesis.hv.se/eng/Salutogenesis.5.html