OSTEOPATHY

[To the Editor of the SPECTATOR.]

Sia,—" A layman " from the shelter of his anonymity accuses me of an " unfair," statement concerning osteopaths, because I said that they claim admission to the Medical Register. I shall deal with this point first. The General Medical Council at the present time keeps two registers, the Register of Medical Practitioners and the Register of Dental Practitioners. Osteo. paths, as I understand their desires, seek registration by the General Medical Council. As their claim is to have founded a new " system of drugless medicine and bloodless surgery " which they propose to practise under the aegis of the General Medical Council, and so become to all intents and purposes practitioners of medicine and surgery, their obvious place is the Medical Register. • If osteo- pathy were as easily definable and as limited in its scope as dentistry, there might be a case for placing osteopathy in a separate register, on the same lines as dentistry. But osteopaths claim all medicine and surgery as their province, and consider themselves competent to diagnose and treat any kind of illness whatsoever. A dentist who undertook a ease of influenza would be speedily pulled up by the General Medical Council, but it is actually a cause of complaint by E. R. Booth (" doctor of osteopathy ") in a recent book that "Osteopathic _Physicians," as he calls them, were not allowed to treat cases of influenza in the American Army and Navy during the epidemic of 1918.

May I illustrate the danger of allowing untrained and ignor- ant persons the free run -of medical and surgical practice by the following concrete instances, of which I have first-hand information ?

1. A gentleman suffering from severe headache for several days was treated by an osteopath by massage of the scalp. Not getting better, the patient sought the advice of a registered practitioner, who diagnosed " typhoid," and his diagnosis was -confirmed by the usual serological test.

2. A famous " bone-setter 7 (who is so-called in the Com- stnercial Telephone Directory) treated a lady of fifty, whose knee joint had been fixed from the age of twenty from tuberculous disease. Being told by him that she would recover full movement of her knee, she allowed him to move it forcibly, under an anaesthetic. Acute suppuration was thus set up, which spread to the tissues around the joint, and to save her life the leg had to be amputated at the thigh by a surgeon whose notes have been submitted to me.

3. The same " bone-setter " had manipulated the knee of a lady under the mistaken impression that the joint was affected. The lady came immediately afterwards under the care of a surgeon, who caused an X-ray photograph to be prepared: a precaution omitted by the " bone-setter "--and malignant disease of the bone (subsequently confirmed by microscopical examination) was disclosed, the joint being entirely normal: If the General Medical 'Council were to adniit to registration osteopaths with such wide claims to it would "be Sane=

tioning two classes of Persons' PUrsuifig the sante activities in medicine and surgery; but with very different qualifications' for doing so. The One class *mild consist of regular practi- tioners trained in medical schOcils; and having. PaSsed exaMina-. ',ions Strictly* Controlled by- the Connell, and imbued with the traditions and following the stringent ethical rides Of an tioneurable and learried :profession ; the other elasS would consist of osteopaths, of whoin all that need be said is that,' in their case, none of these ccinditioni-wottld obtain. .

The PreSident of the''General Medical Cduncil has recently - publiihed, ex cathedr4 the statement that the principal Vunetion of the General Medical Council is to " enable the public

to distinguish qualified from unqualified practitioners of medicine." I submit that if the General Medical Council conceded the claim to registration of osteopaths it would fail in .its principal function. .

Layman " is mistaken in stating that " it takes -four years of .highly-skilled training and study to acquire the technique

of osteopathy." The longest period of study exacted by any of the osteopathic colleges is four years, but three-fourths of. this time is spent in securing a smattering of the medical sciences. I say " smattering " advisedly, because the attempt is made to crowd, into three years, courses of study which it takes at least six years for the ordinary medical student to assimilate. _ That one year may be regarded as ample for the acquisition of any special technique which may be found in osteopathy is evident from the fact that " the British Osteo- pathic Association " declare themselves prepared " to grant their diploma to registered British medical practitioners who have completed one year's tuition in the principles and practice of osteopathy at the British School of Osteopathy." I quote this statement from the manifesto recently published by the British Osteopathic Association.

I have expressed in the medical Press my personal opinion that while the theory upon which osteopaths base their practice is demonstrably absurd, that practice may, notwith-• standing, chance to be beneficial, as it may also chance to be fatally mischievous. One is reminded of the advice given by a distinguished Judge to a newly appointed and very nervous Justice of the _Peace, wholly ignorant of law " Give your judgments," it ran " without giving your reasons for them ; your judgments will probably often be right (for you arc a fair-minded man), but your reasons will almost certainly be wrong."

The theory of osteopathy promulgated by its founder, Andrew Still, in 1874, remains to-day its basis of practice. That theory postulates that the primary cause of every disease is some interference with the blood supply or perve function, always caused by a dislocation of one of the small bones which make up the spinal column. There is nothing to indicate that Andrew Still was divinely inspired, but osteopaths remain as pathetically faithful to this fatuous dogma as if they believed it was indeed a revelation from God.

Medicine has made immense advances in the fifty years which have elapsed since Andrew Still wrote. Osteopaths prefer to ignore all these advances ; Dr. Heiman MacDonald, a chosen prophet of the creed, in his address at the meeting held in the House•of Commons said " it did not matter what the discoveries of the future might be . . . the great principle of structural integrity remained, and on it osteopathy was founded." Bacteriology is to osteopaths a sealed book ; radiology is too often a hostile witness making hay of their pre- tensions, and is consequently usually taboo. The revolution. which has taken place in surgical methods has passed them by. The innumerable chemical, physiological, microscopical and biological tests of disease, which are every day making medicine. more and more of an exact science, meet only with their ignorant scorn.

I have never expressed contempt for the manipulative exercises which form part of osteopathic practice, but there is nothing occult about these exercises ; and I have urged mem-. bers of my profession to undertake the study of the influence of such exercises—a study which they are more competent to carry out than persons who seem to remain permanently obsessed by the outworn doctrines of Andrew Still, and arc deaf to any other inspiration.

For reasons which I have giVen, I think that this technique should be acquired after graduation. I have even suggested the possibility that proper scientific study might result in the elevation of a purified art of " Osteopathy " into a specialism fit to rank with other medical speeialisms. In–this connexion I am glad to note that there seems to be a movement within the RoYal Colleges at the present time to secure the establishment of a diploma, obtain- able after graduation, to comprise the study of manipulative movements and cognate procedures. • This developthent Would probably-satisfy "a layman" whoSe bona fides is-unques- tionable, and whose desire that the public should obtain the benefit which he looks for from osteopathic treatment is entirely legitimate "and -praisewortliy.--I am, Sir, &c.,