An historical perspective on principles of

osteopathy
Jane Eliza Stark
4328 11th Concession, R.R. # 1, Moffat, ON. L0P 1J0, Canada
Received 13 March 2012; revised 15 July 2012; accepted 2 October 2012
KEYWORDS
Osteopathy;
Osteopathic medicine;
Principles of osteop-
athy;
Andrew Taylor Still;
History of osteopathy
Abstract Inconsistencies and other differences between existing sets of osteo-
pathic principlesdand the resulting difculties in comparing and contrasting these
principles and in developing new principlesdnecessitate the creation and preserva-
tion of an historical record of their development. Using a timeline framework, as
outlined by Philip Latey, DO, the author discusses three subdivisions of osteopathic
principle development: original, traditional, and modern. The original period,
which ended in about 1910, represents a time in which no single denitive principle
or set of principles was agreed upon by the profession. The traditional period, en-
compassing 1910 to about 1950, consisted of mostly individual and isolated efforts
at formulating and justifying principles, with various sets of principles differing in
number and nature.
The modern period begins in 1953 with the publishing of The Osteopathic Concept
and continues for 50 more years. This period is characterized by group efforts at
principle development and reections upon former principles, as well as consensus
on the development and adaptation of principles for use within the eld of osteo-
pathic medicine in the United States. The set of osteopathic principles that has
endured the longest was reworked and reworded by a committee of individuals,
primarily osteopathic physicians. This committee worked from a previous document
that was also formed by a consensus of mostly osteopathic physicians.
2012 Elsevier Ltd. All rights reserved.
E-mail address: janestark@on.aibn.com.
1746-0689/$ - see front matter 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ijosm.2012.10.001
International Journal of Osteopathic Medicine (2013) 16, 3e10
www.elsevier.com/ijos
Introduction
Evidence of renewed interest in principles of
osteopathy and osteopathic medicine has peri-
odically appeared in print
1e4
since the early 20th
century. In keeping with this tendency, this
special edition of the International Journal of
Osteopathic Medicine (IJOM ) offers its contribu-
tors and readership the rst opportunity in about
10 years to revisit this subject.
5
Equally important
as dening, revising, summarizing, analyzing,
and proposing updated principles is ensuring
that an historical record of the formation of
those principles be permanently available to
individuals both inside and outside of the
profession. Such a document functions as a refer-
ence for instructors, students, and future
researchers.
Comparing and contrasting the differing pub-
lished principles of osteopathy is difcult because
the word principle and the term principle of
osteopathy are used throughout the osteopathic
literature in varying and inconsistent ways.
Furthermore, other terms used in the literature,
such as fundamentals,
6(p. 999),7
command-
ments,
8
truths,
9(p. 98),10
postulates,
11(p. 354)
precepts,
10(p. 550)
and tenets,
4,12
all serve
a similar purpose to principle. In different cases,
principle may be used as a stand-alone term, it
may be prefaced by the denite article the or
the indenite article a, or it may be used in
combination with of osteopathy. It may also be
discussed as a single entitydprincipledor as
a plural conceptdprinciples. These differences
occur across authors, time, and nationalities, and
between the two streams of the profession (oste-
opathy and osteopathic medicine).
In many cases, the unstated understanding of
principle(s) is that it is (they are) related to oste-
opathy in general. In other cases, principle
specically refers to health or nature; to the
decision-making process of the practitioner; or to
a therapeutic intervention. The phrase principles
of osteopathy has been frequently used to
distinguish the theory of osteopathy from the
practice, or hands-on application, of osteopathy.
In the present article, the majority of the
principles of osteopathy that have appeared in the
literature since osteopathys inception are pre-
sented, along with the circumstances surrounding
their publication. No attempt is made in the
present article to explain, justify, or judge any
particular principle or set of principles. The
principles are organized according to the histor-
ical periods of osteopathy that were proposed
by Philip Latey, DO: the original, traditional
(or classical ), and modern periods.
13
The original
period includes osteopathy as derived from the
contributions of Andrew Taylor Still, DO; John
Martin Littlejohn, DO; and their contemporaries,
ending in about 1910. The traditional period
follows, ending in about 1950. The modern period
began in the early 1950s and continued to at least
the time of Lateys publication, in 1993. For
purposes of this article, the modern period is
considered to continue until 2003 when the last
reworking of the principles, which are used by the
osteopathic physicians in the United States, was
readjusted.
The language limitations of this author have
largely conned this account to examination of
English-language publications. Furthermore, not
every published reference to principles could be
included, nor could all the examples of included
principles be listed fully. Some were paraphrased;
others had to be omitted because of length
constraints.
Principles from the original period
Most of the contributors to the original period of
osteopathy (1874e1910) graduated from the
American School of Osteopathy (ASO) between 1897
and 1900.
14
Writing at that time, Still declared that
he had .given more attention to the study of the
Implications for clinical practice
The development of osteopathic principles from the original, traditional and modern periods have
been reviewed.
An understanding of the process of historical development of these principles may help osteo-
paths to critically appraise the value and meaning behind the principles. A deeper understanding
of osteopathic principles may better dene the uniqueness of osteopathy.
4 J.E. Stark
principles of this science [osteopathy] than all
persons now living combined.
15(p. 227)
His
contemplation of these principles may have led Still
to think of himself as a philosopher, as dened by
his erada view of Still that was shared by oth-
ers.
16e19
However, the majority of Stills writings
mention various types of principles without dening
any of them in detail.
Throughout his writings, Still refers to philos-
ophy of principles,
20(p. 297)
as well as to principles
of philosophy,
15(p. 315,336)
but expands upon
neither. He uses principle in the singular sense,
referring to the principle of animal life,
15(p. 263)
of mind,
15(p. 251)
of truth,
21(p. 164)
and of
nature.
20(p. 194)
In the plural sense, he refers to
the principles of the human body,
20(p. 98)
of life
of dead matter,
20(p. 135)
of motion,
22(p. 256)
of
life,
15(p. 263)
and of many more entities.
Still did not record any specic list of principles
of osteopathy.
7,23
In three of his books, he discusses
the term principles. In 1899, he states that [p]
rinciples to an Osteopath means a perfect plan and
specication to build in form a house, an engine,
a man, a world....
20(p. 1920)
Writing in 1902 on
principles of osteopathy, he repeats himself: [p]
rinciples of Osteopathy, gives us an understanding
of the perfect plans and specications followed in
mans construction.
22(p. 3233)
These statements
hint at the functioning of principles, but they
remain vague. In his nal book, published in 1910,
Still provides what he refers to as Our platform.
24
Although Our Platform has been equated with
Stills principles,
25
this concept seems to be mainly
concerned with declaring osteopathys position
vis-a`-vis other medical modalities. Its nine
elements
24
can be summarized as follows: the
body provides its own remedies; support for
hygiene; opposition to vaccinations; use of serums
and drugs as remedial agents; rejection of adjunct
methods, such as radiographs and hydrotherapy;
use of surgery as a last resort; and osteopathy as
a modality distinct from other systems.
Despite Stills warning about books titled
Principles of Osteopathyd.they may sell
but will fail to give the knowledge the student
desires
20(p. 12)
dASO graduates, including Charles
Hazzard, Guy Dudley Hulett, Arthur D. Campbell,
and Henry S. Bunting,
26e36
authored books on
principles of osteopathy. Dain Loren Tasker, DO, an
1898 graduate of the Pacic School of Osteopathy
(PSO), taught principles of osteopathy at PSO and
wrote a book titled Principles of Osteopathy.
37
His
book was published in several editions
33,38e40
and
was soon recognized as an essential textbook in
the training of the profession.
41(p. 269)
In its
preface, Tasker credits Stills contributions as well
as those of Hazzard. However, Tasker does not
provide a denitive list of principles.
Littlejohn was the nal signicant contributor
to principle development during the original
period. In 1899, he wrote, [t]he basic principle of
Osteopathy is that if the human organism is in
perfect health, every body tissue and structure
performs its part without interruption, .
42
In 1900, he recorded ve essential principles of
Osteopathy,
43
in which he elaborately detailed
the role of mechanical obstruction in the disrup-
tion of the vital uids and, in turn, of the vital
forces.
43(p. 17)
In a 1908 article titled The Principle of Oste-
opathy, Littlejohn wrote, Our concept of Oste-
opathy is that of a system with one central general
principles, viz: The diagnosis of disease from the
standpoint of interferences with vital activity in
the structure and environment of the body of an
organism.
44(p. 239)
In a student-transcribed manuscript of lectures
delivered by Littlejohn, he is quoted as proposing
the existence of an underlying principle.ex-
pressed in the word ADJUSTMENT.
45(p. 1)
Lit-
tlejohn found this principle so encompassing that
he wrote, osteopathy represents a principle, not
a set of principles. This principle is so extensive
that it is capable of application in the entire eld
of practice.
45(p. 31)
The original period of osteopathy began and
ended without any specic consensus regarding
denitions of a principle of osteopathy or princi-
ples of osteopathy.
Principles from the traditional period
The traditional, or classical, period of osteopathy
(w1910e1950) fostered a series of efforts by indi-
vidual osteopaths to delineate their personal
perspectives on principles. About a dozen books,
including some updated editions from the original
period, were published bearing the words osteop-
athy or osteopathic and principle or princi-
ples in their titles.
46e59
An equivalent number of
journal articles were also published on the same
topic, mostly in the US literature.
1,6,8,9,11,60e67
Two osteopathic physicians (osteopaths) during
this period generalized the idea of a principle. Guy
Dudley Hulett claimed that .a statement of the
principles which underlie the science of osteopathy
must, in the nature of things, be a very incomplete
one,
47(p.11)
and Henry J Everly, DO, stated that
a single basic principle of osteopathy runs through
all nature.
62(p. 414)
Other osteopaths during this
period listed as fewas two principles (eg, Mary Alice
Historical perspective on principles of osteopathy 5
Hoover, DO,
60
and Earl Laughlin, DO,
68(p. 61)
) but
typically, although Harrison Fryette, DO, addeda bit
of insightful humor by stating, the principle of
osteopathy is simple, as all great truths are simple,
its application is not.
69(p. 15)
A representative selection of principles from the
traditional period covers a wide range of themes.
Among these themes are the following: individuality
of each patient;
70(p. 285)
natural immunity
68
or
power to resist disease;
67(p. 601)
structural integ-
rity;
60(p. 58)
integrity of the blood
11(p. 354)
and nerve
supply;
71(p. 42)
normal owof body uids;
9(p. 98)
self-
sufciency of each cell under normal environmental
conditions;
70(p. 283)
the cells role in normal physi-
ology;
10
the spinal lesion;
53(p. 11)
the role of
manipulative therapy in management of dis-
ease;
56(p.162)
and the totality of the human being,
including physical, chemical, and psychic factors.
65
In 2002, osteopathic physician GD Huletts, 1922
book, A Text Book of the Principles of Osteop-
athy,
47
was credited as representing .the rst
professionewide attempt at codifying the osteo-
pathic philosophy into simple phrases or pre-
cepts.
4(p. 63)
This statement, however, is not
strongly supported by a careful review of GD
Huletts text. The only osteopath listed as doing
some work on the book was Charles McLeod
Turner Hulett, DO, who did so seven years prior to
its publication.
47(p. 6)
Representatives from most of
the US colleges of osteopathic medicine were
identied by their colleges instead of their names.
The sections of the book to which these repre-
sentatives contributed were not identied.
The principles listed in GD Huletts book
47
are
found on a single page, in a chapter called The
Cells Response to Stimulation. The rst three (of
seven) precepts refer specically to the microcosm
of osteopathys view of the cell,
47(p. 176)
including ideas on the cells normal structure and
function. The other four of Huletts precepts refer
to the human body, with the last one fore-
shadowing the rational treatment terminology
commonly used in the modern period.
In 1923, George W. Goodie, DO, published The
Commandments of Osteopathy. The rst seven
commandments concerned requirements for oste-
opathic practice, such as enthusiasm for the
profession, a commanding personality, and
a blackboard in the ofce.
8
In 1927, CB Atzen, DO, listed several fundamen-
tals of osteopathy. These fundamentals included
function-structure interdependency, the role of the
skin and mucous membranes, and the bodyecell
reaction to stimuli for recovery from inictions.
6
In
1929, Paul Van B. Allen spoke of a symposiumto re-
emphasize the basic principles of osteopathy.
1
Unfortunately, the proceedings from that sympo-
sium have not been located to date.
One of the few known works published in Great
Britain during this period was written by Jocelyn
C. P. Proby, DO, a graduate of the Kirksville College
of Osteopathy and Surgery. In an essay published in
1937, Proby listed only two principles: . natural
self-sufciency of the human body [and] .normal
structure and normal function go hand in
hand.
54(p. 7)
In 1938
53
and 1939,
65
Frederick A. Long, DO, lis-
ted ve principles of osteopathy. He argued that the
17th-century schism between iatrochemists and
iatrophysicists (ie, those who favored explaining
lifes phenomena on the basis of chemistry vs
physics, respectively) beneted osteopathy, with
the iatrophysicists inuenc[ing] the development
of osteopathic principles.
65(p. 465)
In 1941, Perrin T. Wilson, DO, argued that the
.principles of osteopathy are fundamentally
correct
64(p. 383)
in describing the mechanical
integrity of the body as interwoven with the
processes of natural immunity.
In 1947, John Steadman Denslow, DO, conduct-
ed a survey of highly qualied faculty and other
leaders of the osteopathic medical profession in
the United States to discover if the concept of
osteopathy was the same at that time as it was
during the time of Still. Denslow concluded that
.there has been little basic change in the
fundamental concept of osteopathy.
67(p. 601)
He
then stated three principles, which included the
ideas that the normal body can resist disease and
injury, that health requires order in structure, and
that the physician is responsible for maintaining
the bodys structural integrity.
In 1950, Allan A. Eggleston, DO, offered the
following three precepts:
10(p. 550)

1. the body possesses the inherent ability to

maintain itself in health and recover from
disease, providing all its component parts and
systems are functioning normally
2. mechanical or structural disturbances occur in
the body which interfere with, or impede, the
normal functioning of certain of its parts or
systems
3. such mechanical or structural disturbances can
be recognized and understood and that it is
possible to apply treatment which will over-
come such disturbances or enable the body to
compensate for them.
In contrast to these precepts, notes taken in
the same year by a student at the British School
of Osteopathy listed a very different set of
principles, which were credited as being Dr.
6 J.E. Stark
Andrew Taylor Stills 3 Principles.
72
These
principles were as follows:
1. structure and function are interdependent
2. body is self-sufcient e tends to cure itself and
always tends to the normal
3. rule of the artery e supreme
During the traditional period, it was accept-
able for individual osteopaths to publish their
personal lists of principles in journal articles. Few
of these articles formally acknowledged or
referenced previous authors or their principles.
Instead, each osteopath offered differing
versions of, and perspectives on, principles. No
single osteopath or list of principles was accepted
as authoritative.
Principles from the modern period
The modern period (w1953e2003) supports
reection and consensus regarding the subject of
osteopathic principles. During this time, there has
been two group efforts by osteopathic college-
based committees to reach consensus. These
efforts have involved several noted individuals
attempting to unify certain ideas, and a nal
agreement on principles by the editors of a US
osteopathic medical textbook. The year 2003
represents the last year for which principles were
examined before the present issue of IJOM.
In1953, aneight-member committeecreatedThe
Osteopathic Concept. The purpose of this text was
to serve as a teaching guide at the Kirksville College
of Osteopathy and Surgery;
73
it was never intended
for nationwide use. Within a year, the committee
published several overlapping documents on the
topic.
73e82
One of its authors noted, what has been
preparedis not complete, it is not dogma or creed, it
is interpretive, it is tentative..
75(p. 15)
The topic
headings of the four principles of The Osteopathic
Concept are as follows:
1. the body is a unit
2. the body possesses self-regulatory mechanisms
3. structure and function are reciprocally inter-
related
4. rational therapy is based on an understanding
of body unity, self-regulatory mechanisms and
the inter-relationship of structure and function
The next consensus attempt came in 1981. The
Project on Osteopathic Principles Education, based
out of Michigan State University, sought to .gain
some understanding of what osteopathic prin-
ciple meant
83(p. 29)
and to answer the question,
what characterizes an osteopathic principle?
83(p. 29)
After a lengthy process of data collection, coding,
and analysis, the conclusion of project participants
was as follows:
An osteopathic principle is a biologic, behavioral,
or clinical rule or law that is given special diag-
nostic and management emphasis by osteopathic
physicians because it exemplies the osteopathic
philosophy of health and illnesses.
83(p. 29)
The projects outcome provided ve principles
of osteopathy, three of which were taken from the
1953 Concept paper.
In 1987, Irvin M. Korr, PhD, ScD, who was a
co-author of the Concept paper, put forward
the principle of the importance of the muscu-
loskeletal system.
84
This idea surfaced again in a
2002
4
examination of osteopathic principles,
which was co-authored by Korr as part of
an nine-member multidisciplinary ad hoc
committee broadly representative
4(p. 63)
of the
osteopathic community (including professors and
osteopathic physicians representing eight
colleges of osteopathic medicine). This
committee proposed tenets of osteopathic
medicine, along with principles for patient care.
The tenets of osteopathic medicine were given
as the following
4
:
1. A person is the product of dynamic interaction
between body, mind, and spirit.
2. An inherent property of this dynamic interac-
tion is the capacity of the individual for the
maintenance of health and recovery from
disease.
3. Many forces, both intrinsic and extrinsic to the
person, can challenge this inherent capacity
and contribute to the onset of illness.
4. The musculoskeletal system signicantly inu-
ences the individuals ability to restore this
inherent capacity and therefore to resist
disease processes.
In 1993, Oliver W. Hayes, DO, and Philip E.
Greenman, DO, teamed up to redene what they
referred as Stills ve concepts.
85
Their intent was
for these concepts to continue to be relevant for
the US healthcare system into the 21st century.
They offered 10 new osteopathic principlesdeach
beginning with the wording, Osteopathic medi-
cine, followed by is limited to, treats,
recognizes, acknowledges, endorses,
emphasizes, or relies on.
85(p. 27e28)
Some 50 years after the 1953 Concept text was
published, its principles were modied by the
associate editors of the US textbook, Foundations
Historical perspective on principles of osteopathy 7
for Osteopathic Medicine.
3(p. 10),86
It is not certain
whether this group of editors took into account the
denition of osteopathic principle provided in 1981
by the Project on Osteopathic Principles.
83
However, the chapter on osteopathic philosophy
and history in the second edition of the Foundations
textbook also lists the principles for patient care
provided in the 2002 article by the ad hoc
committee headed by Korr.
86(p. 11)
Although Foun-
dations is a standard textbook used in all osteo-
pathic medical colleges in the United States, many
of the worlds non-physician education institutions
have yet to implement a consistent set of osteo-
pathic principles.
Conclusions
Classifying osteopathy and osteopathic medicine
into three time periodsdoriginal, traditional, and
moderndprovides a useful framework for chroni-
cling the numerous attempts to dene osteopathic
principles. This article is intended as an historical
summary that may serve as a resource for the
professionda resource that may help prevent the
unintentional repetition of past efforts to develop
osteopathic principles.
A decade has passed since the last set of revised
osteopathic principles was published. It is possible
that the collection of articles in this special issue of
the IJOM represents renewed interest in principles
as devised by individual authors, similar to the
principle development that occurred during the
traditional period. Perhaps a renaissance period is
upon usda renaissance in which international
cooperation will be used to consolidate past prin-
ciples with those newly proposed, incorporating
more current language and relevant biological,
medical, and scientic realities representative of
21st-century thought.
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10 J.E. Stark