Medical historian Anders Ottosson, a senior fellow at the Department of Historical Studies, University of Gothenburg, in The Lost Origin of Osteopathy and Chiropractic in European Mechanical Medicine and Physical Education presents a detailed and nuanced account of the worlds of osteopaths, chiropractors, physical therapists and conventional physicians, particularly on two sides of the Atlantic, namely North America and Europe. Osteopathy and chiropractic as manual medical systems emerged in the US Midwest, northeastern Missouri in the case of the former and southeastern Iowa in the case of the latter, in the late nineteenth century. Within the domain of orthodox medicine or biomedicine today, manipulations of the spine and the joints have become the purview of orthopaedic medicine (OM) and its younger sibling, orthopaedic manual physical therapy (OMPT). OM emerged in England around the 1930, with OMPT being its spin-off. Much of Ottosson’s book centres around Jonas Henrik Kellgren (1835–1917), a Swedish physical therapist and army lieutenant, who, he maintains, served as a precursor of North American osteopathy and chiropractic and English OM(PT). Samuel Clemens, better known as Mark Twain, as one of Kellgren’s many famous patients in London, made note of the similarities between Kellgren’s mechanical medicine system and osteopathy, of which he became an enthusiastic supporter.

In Part I (‘The use of history and professional conflicts: some theoretical guidelines’), Ottosson observes that ‘words, concepts, and professional titles can tell us something about power relations and social differentiations, not least in the labor market and in the educational system’ (p. 23). He maintains that Andrew Taylor Still, the inventor of osteopathy, and D.D. Palmer, the inventor of chiropractic, in essence distanced themselves from Kellgren and his alma matter, the Royal Central Institute of Gymnastics (RCIG), although to what degree they may have done so remains unclear. In time US osteopaths adopted many of the practices of biomedical physicians and transformed themselves legally into osteopathic physicians and surgeons. In contrast, both osteopathy and chiropractic constitute practitioners of manual medicine in the many countries where they now operate, including Britain and Australia. Conversely, physical therapists function under an assortment of bylines, such as physiotherapists, medical gymnasts and remedial gymnasts. Furthermore, while physical therapy emerged initially as a male preserve, it evolved into a largely female preserve, particularly in hospital settings mostly under the supervision of physicians.

In Part II (‘Mapping the professional historical dots’), Ottosson reports that both Still and Palmer were profoundly religious and drew from vitalism in formulating their respective systems. While he maintains that Still lacked formal education as a physician, the inventor of osteopathy studied briefly at the Kansas City College of Physicians and Surgeons in 1860 before obtaining his medical training as his father’s apprentice. After Baker University in Baldwin, Kansas (an institution that Still’s father and his brothers helped establish) rejected Still’s overture to present his osteopathic principles, he opened a practice in 1874 in Kirksville, where he established the American School of Osteopathy in 1892. While Still referred to spinal dislocations which he treated with osteopathic manipulation therapy as osteopathic lesions, Ottosson maintains that it ‘is uncertain whether Still was familiar with the term ‘spinal irritation’’ (p. 44) that was prevalent in orthodox medicine in the late nineteenth century, but it is not clear whether this was a significant issue. Along with osteopaths and chiropractors, physical therapists practised orthopaedic manipulation physical therapy, an offspring of orthopaedic medicine practised at St Thomas’ Hospital in London, particularly by James Cyriax Jr (1904–85), who expressed pronounced antipathy towards osteopaths. Ironically, Dr James Cyriax Sr was Kellgren’s son-in-law and a passionate advocate of Kellgren’s system. Cyriax Jr, who was keenly interested in manipulations of the spine and joints, mentioned Kellgren in his academic texts.

In Part III (‘A manipulated story: Kellgren, osteopathy, and mechanical medicine’), Ottosson examines the treatment of Samuel Clemens and his family, and reports that from ‘July 1899 to the beginning of the following year the Clemens family spent a lot of time in the care of “Director Kellgren” at his physical therapy in London, UK, and in Sana’ (p. 83) in Sweden. Clemens concluded that osteopathy and Kellgren’s system were identical in that they both viewed manipulations of joints and spine as means to cure illness, claimed to cure both chronic and infectious diseases, and did not recognize the germ theory. Whereas Kellgren did not publish much about his most remarkable cures, Still wrote three books, an autobiography published in 1897, The Philosophy of Osteopathy (1899), and The Philosophy and Mechanical Principles of Osteopathy (1902).

In Part IV (‘A new scenario that brings Kellgren, P.H. Ling, and osteopathy together in late 19th-century North America’), Ottosson reports that Kellgren and osteopaths drew upon the methods of Peter Henry Ling, reportedly the inventor of Swedish massage and the founder of the RCIG in 1813. Indeed, Swedish massage had diffused to the United States well before Still’s unfurling of the banner of osteopathy in 1874, where it was adopted by many orthodox physicians practising in locales such as Boston, Philadelphia and New York. While it is unclear to what extent, if any, Still incorporated aspects of Kellgren’s system, Ottosson suggests that osteopathy and Kellgren’s system ‘may be two geographically independent products of a greater common interest in mechanical medicine that, like homeopathy and hydropathy, first developed in Europe’ (p. 157). Indeed, independent invention is not uncommon in scientific research as evidenced by the development of natural selection by Charles Darwin and Alfred Russel Wallace.

In developing osteopathy, both Still and Palmer synthesized therapeutic concepts and practices in common techniques in both Europe and North America in the late nineteenth century. Ottosson observes that Kellgren’s system was more holistic than osteopathy in that it was ‘more concerned with improving healthy the body with active movements’ (p. 189). Ultimately, Kellgren’s system, osteopathy, chiropractic and still later orthopaedic medicine and orthopaedic manual physical therapy appear to constitute manifestations of medical syncretism, a process in which relatively distinct medical systems merge to form a new one. From a perspective of health anthropology, manual medicine, and bonesetting as its precursor, have been invented and reinvented numerous times, not only in Europe and North America but around the world. In the Australian context, my sense that chiropractors, osteopaths and physiotherapists freely borrow techniques from each other, is yet another example of medical syncretism or hybridization.