Transcript 19 th Century America Age of Heroic Medicine

Introduction to
Osteopathic Medicine
for Non-DO Faculty:
What Makes an Osteopathic
Education Different?
Photo courtesy of NSU-COM
Educational Council of Osteopathic Principles
19th Century America
Age of Heroic Medicine
 Rise of Allopathy
 Phlebotomy
 Medicinals
 Surgery
 Founding of American Medical Association
1847
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Becoming a Physician in
19th Century America
 Attend medical school
 1760 William Shippen, Jr.
lectures on anatomy in
Philadelphia
 1765 Morgan funds first U.S.
medical school in Philadelphia
 1790 medical journal
published in New York
 Set up practice
 Generally richer patients
 More urban practice
 Apprentice with a registered/
licensed physician
 One – several years
 Learn medicinals, midwifery,
surgery
 Mentor would sign statement
 Sometimes involved test,
sometimes just mentor’s
statement
 Set up practice
 Common people as patients
 More rural practice
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19th Century America
Reactions to Age of Heroic Medicine
Alternatives to Contemporary Medicine:
Thompsonism
Lightning Bone Setters
Grahmism
Chiropractic
HydroTherapy
Homeopathic
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A.T. Still, MD
 Rural farmer, hunter, inventor,
local politician
 Civil War abolitionist
 Personal tragedy 1864
 Denounces medical treatment
 Becomes a medical reformer
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June 22, 1874
Flies high the banner of osteopathy.
Relocates to Kirksville, Missouri.
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May 10, 1892
 Obtains charter for the first school.
 American School of Osteopathy (ASO)
“To improve our systems of surgery, midwifery, and
the treatment of diseases in which the adjustment of
bones is the leading feature of this school of Pathology.
Also to instruct and qualify students so that they may
lawfully practice the Science of Osteopathy as taught and
practiced by A.T. Still, the discoverer of this philosophy.”
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Tenets of Osteopathy
1. The human body is a functional unit.
Mind, body, and spirit are interconnected.
2. Form and function are inter-dependant.
3. The human body has the innate ability
to heal itself.
4. Osteopathic Manipulative Treatment is based
upon individualized, rational application of the
above tenets.
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Anatomy/Development
Module
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“It is impossible for an
osteopathic physician
to perform a physical examination
without knowledge of anatomy.”
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The practicing osteopathic physician
needs to understand:
 The body’s numerous and complex
anatomic structures
 The interrelationship between anatomy
and physiology
 The critical importance of the neuromusculoskeletal system in human function
 That the knowledge of anatomy is essential
to the practice of medicine and surgery
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“All osteopathic physicians use their
knowledge of anatomy in practice”
 Surface Anatomy
 Visualization
 Palpation
 Functional Anatomy
 Anatomic elements related to the body’s
biomechanical functions
 Surgical Anatomy
 Knowledge required for surgical diagnosis and
treatment
 Cross-sectional anatomy
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Knee Pain Case
A patient presents with knee pain.
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Differential Diagnosis
Basic Categories
 Infection
 Inflammation
 Tumor
 Trauma
 Genetic
 Somatic dysfunction
 Psychological
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Differential Diagnosis of Knee Pain Includes:

Patellofemoral syndrome

Referred pain (hip = avascular necrosis)

Iliotibial band syndrome

Prepatellar bursitis

Patellar tendonitis

Baker’s cyst (popliteal)

Anserine bursitis

Septic Joint

Meniscus tear

Collateral ligament tear –
medial or lateral

Cruciate ligament tear –
anterior or posterior

Osgood Schlatter

Osteochondritis dessicans

Neuropathic arthropathy

Medial Plica syndrome

Charcot Joint

Referred pain from back

Tumor (osteosarcoma)
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 Gonococcal

Arthritis






Osteo
Rheumatoid
Gout
Septic
Pseudogout
Reactive arthritis (Reiters)
 Sciatica

Fracture
Applied Anatomy and Knee Pain
 Surface and functional anatomy are
required for examination and treatment
of the painful knee.
 Surgical anatomy may be required for
the treatment of the painful knee.
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Osteopathic Considerations
 Discussion of likely anatomic involvement
in the knee pain case.
 Probably will focus on functional vs.
surgical possibilities.
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Medicine and A.T. Still
 “Man should study and use the drugs
compounded in his own body.”
 Autobiography of A.T. Still, p. 89
 The basis of scientific medicine
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Not all of osteopathic
principles and practice is
osteopathic manipulative
medicine.
Osteopathic medical students study all
of medicine, surgery and obstetrics.
In addition, they study osteopathic
philosophy, principles and practice for
about 200 hours.
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OMM Perspective for
Analyzing Patient Problems
1. Biomechanics
Is there a biomechanical component to the patient’s condition?
2. Fluid flow
Are there issues with fluid flow that could be solved by releasing
tissue tension and enhancing movement and respiration?
3. Nervous system, including autonomics
Is the sympathetic nervous system up regulated to a level that
impedes organic or systemic function?
Are there peripheral nerve issues that can be improved by
releasing tissue tension and compression?
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Osteopathic Manipulative Treatment (OMT)
OMT is used to:
 Lengthen hypertonic muscles and
connective tissue.
 Help joint surfaces glide more normally
in physiologic motion.
 Decrease pressure on sensitive
small vessels and lymphatics.
 Decrease nociceptive input to the CNS,
which may decrease level of sympathetic
nervous system activation.
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Current Numbers
 26 osteopathic colleges
at 32 sites in 23 states.
 About 60,000 DOs
in practice.
 Projection: by 2020,
¼ of all medical students
will be osteopathic
medical students.
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Doctor of
Osteopathic
Medicine