Andrew Taylor Still and the Mayo brothers: convergence and collaboration in 21st-century osteopathic practice.

Orenstein • Special Communication B in Lee County, Virginia, in 1828, Andrew Taylor Still, MD, DO, witnessed the ravages of many of the infectious diseases prevalent in 19th-century America while traveling the country as a boy with his father, who was both a physician and a Methodist minister. At the time, the practice of medicine was a cottage industry with few proven treatments. Therapies often were concerned with ridding the body of disease rather than returning the body to health. There was little standardization or evidence-based practice at the time. As a young surgeon, Dr Still witnessed the inadequacy and lack of scientific basis for contemporary medical practice. Dr Still saw osteopathy as a science and philosophy. The science was the understanding of anatomical, structural, and functional relationships. The philosophy was that by maintaining normal structure, homeostasis and health could be maintained. Dr Still grew to understand that illness was more than the interaction of infectious agents with their hosts; the whole person and his or her family could be devastated by disease. Dr Still was one of several visionary physicians who emerged from rudimentary 19th-century medical practices to seek improvements in the way healthcare was delivered. In 1863, a frontier surgeon and British emigré named William Worrall Mayo, MD, arrived in Rochester, Minnesota, to examine Union soldiers prior to enlistment—around the same time that Dr Still was establishing his practice in rural Missouri. Both of these visionaries would champion improvements in the existing system of medicine by basing it on more rational and scientific models. Dr Still envisioned the patient as a complex unit, encompassing mind, body, and spirit. He believed that structure and function were integrally related and that he could use manual therapy restore health.1 Attracted by Dr Still’s successful treatment of previously “untreatable” illnesses, many physicians began to embrace his philosophies, adopt his techniques, and support the establishment of a new kind medical practice known as osteopathy. People came from throughout the United States to Kirksville, Missouri, to learn osteopathic principles and practice. Dr Still shared his methods with others freely, demonstrating the benefits of osteopathy in the maintenance of health and the treatment of disease. In 1892, he established the American School of Osteopathy with the primary mission of disseminating the principles and practice of this unique form of medicine. Meanwhile, Dr Mayo’s sons, William James Mayo, MD, and Charles Horace Mayo, MD, (“Dr Will” and “Dr Charlie”) joined the family surgical practice in Rochester with a similar vision—to place the needs of the patient first. The Mayos believed that delivering the best med-