Osteopathy and Influenza.

“Andrew Taylor Still was not simply curing headaches and stiff necks at this time (19th century, my addition). Epidemics of serious infectious diseases regularly swept through frontier settlements of the period, and Still took on these problems without hesitation. He used manipulation to treat cases of pneumonia, erysipelas, typhoid fever, and the often-fatal, infectious diarrhoea’s of children, then called the flux.”

Andrew Weil, M.D., Harvard Medical School. Health and Healing, 1995.


It seems with increasing embarrassment that the osteopathic profession, in US and UK, have to endure a legacy of their past.  With regular occurrence the osteopathic successes of the past slowly begin to surface.  Unfortunately it is due to a lack of ‘modern scientific’ explanation that the osteopathic profession denies any knowledge of these successes simply dismissing achievements by the very physicians upon whose shoulders modern osteopaths stand.  One such embarrassment is the treatment of influenza.


While researching for other publications over the past 15 years I came across papers and articles on the treatment of influenza.  Not just one or two papers and articles but running into treble figures all in osteopathic journals.  If there were so many papers why had nobody mentioned this in osteopathic training and during continuing professional development?  What I have discovered is fascinating. It was not that the osteopaths didn’t know the treatment of influenza but they actively denied any knowledge of influenza treatment, until recently.

In this short essay/compilation I will try to explain how the osteopaths managed, treated and saved the lives of thousands especially during the 1918-19 pandemic in which an estimated 70 million died world wide. I will refer to old and new documents giving references of source material that will allow you to follow up any further investigations.

The first recoded cases were French soldiers in the trenches during WW1. There is no evidence that even though it was called Spanish flu that it originated from Spain, in Spain they call it French flu. In Britain the earliest cases were in Glasgow and in the following months over 200,000 people died throughout Britain.


What the Journals Say.

Ward (1937) gave an interesting introduction to influenza when he wrote:

“Influenza is regarded as the last and greatest uncontrolled pestilence and continues to challenge the best efforts of the osteopathic school of practice to marshal its scientific resources to combat it.

“It is interesting to note that the word influenza was first used by the Italians in 1743 to denote some influence, as it was thought then that this disease, heretofore known as “epidemic catarrh”, was caused by an influence of unknown origin, probably the stars, while to the French influenza was known as la grippe from the word agipper to attack.”

It may have grabbed your attention that the first paragraph talks of influenza and osteopathic practice. It definitely grabbed my attention about ten years ago while researching for other publications. I have now turned towards the issue of osteopathy and influenza to try and clear once and for all the major role of osteopaths in the 1918-19 pandemic of influenza for the public and for the modern osteopath.

In an editorial of The Journal of the American Osteopathic Association (JAOA), January 1919, R. Kendrick Smith, D.O., Boston wrote:

“Osteopathy’s opportunity is today at its zenith. The necessity for osteopathy was never so apparent. And yet the danger to osteopathy looms more menacing than ever before. One of the greatest dangers is in the possibility that the osteopathic profession will not rise quickly enough to meet this great opportunity. Delay spells ruin for osteopathy.”

Ward continued…

“The influenza pandemic gives us two strings to our bow. Never in the history of the civilised world has there been such evidence of incompetence in the medical profession as in its abject failure to meet the present situation. Not only is the medical profession aware of this, but the lay public has received a jolt in its confidence in medicine which will last many years. Six million deaths in three months is the price paid by the world for the incompetence of loudly lauded modern medicine. Half a million American lives is the price paid by this country, more than our total causalities in the war.”

The above reflects the feeling among osteopathic physicians during and after the epidemic towards the medical profession due to the arrogance of its approach and the reluctance to join forces with the osteopathic profession. Modern medicine has been trying to claw its way back to respectability ever since. Why is it that the only epidemic they scare us with is the one they have little power over, the deadly bird flu? Television programmes, newspaper and magazine articles are flooded with the fear of a bird influenza epidemic. Yes, it may be on the way but I have a feeling that the medical profession is trying to set a stage of disaster so that the real disaster won’t seem as bad as their predictions. Anyway this essay and compilation is about the potential of osteopathy not the failure of medicine.

Papers published in the JAOA after the epidemic were under the title “Experience with the Epidemic.” It is around these personal experiences that the greatest contribution to the reality of clinical practice comes to light. You may be unaware that osteopaths in the United States have complete rights to prescribe drugs and perform surgery as doctors do in the United Kingdom. Osteopaths in the US are physicians and surgeons who as part of their initial training were taught to use their hands. Here are a few extracts sent to The Journal by physicians.

“Regarding the “flu” I wish to give my experience with it during the past epidemic…Handled thirty-seven cases of well defined “flu” having omitted all cases not well defined.

“Their ages ran from 3 years to 60 years. The highest fever in any case that I attended from beginning was 103 degrees; the average duration of fever two and two-third days; average duration of treatment four and one-half days. Had no cases of pneumonia. One case threatened with it, but did not develop, and was free from symptoms in twenty-four hours.

“The results that I have got have left a very strong impression with the people that osteopathy is the treatment for the “flu.” One person told me that the M.D. (medical doctor) told them if they get the “flu” to call the osteopath. No doubt many have had more cases than I and if they gave good or better results, osteopathy has gained many friends.”

Geo. Moffett, D.O., Elizabeth, Ill. (JAOA, Feb. 1919).

“Had four cases of advanced influenzal pneumonia that had been under the care of medical doctors before I took them on; two of these died.

“I feel that the recent epidemic has been the means of bringing osteopathy into prominence, in my community, much more than anything else that has ever happened, as I have been called into many homes to treat “flu” patients where I had never been called before.

“In closing let me say that I am the only osteopath in the largest county in Iowa.”

L. V. Andrews, D.O., Algona, Iowa. (JAOA, Feb. 1919)

“During the past six months we have treated 140 cases of “flu.” Nothing ever happened in our sixteen years practice that has given us so much confidence in osteopathy in acute cases. It has given us an experience in well defined infections. We have always thought that the whole body had wonderful recuperative powers if properly influenced by osteopathic manipulation.”

E. H. Cosner, D.O., Dayton, O. (JAOA, Feb. 1919)

“I had 186 well-defined “flu” cases. Only one death (apoplexy). In my community only three deaths from “flu” and all treated by M. D.s and the community is continually crying for more osteopathic treatment. It has made an impression on the community that will never be forgotten.

“We need more than anything a public lecture on osteopathy two times per year at the county seat. The people are hungry to know the best way to keep well and if I was able to do this osteopathy would forever bloom in this community. Osteopathy is the principle topic in the gatherings for the last two months.”

J. L. Fetzer, D. O., Dalton, Mo. (JAOA, March, 1919)

“In my practice we have treated over 150 cases which showed definite symptoms of influenza, and our death rate so far is zero.”

L. M. Bush, D. O., Jersey City, N. J. (JAOA, March, 1919)

“One hundred per cent efficiency is the only term that correctly describes osteopathy as the rational and reliable therapy for universal use in cases of Spanish or any other type of influenza.

“To date I have had eighty-seven cases of this particular disease without a single death; no pneumonia or other complication of any kind whatsoever. There is not an M. D. in this vicinity with such a record and the “dear public” is finding out something of the value of osteopathy as compared with ancient medical methods in the care of really acute and dangerous diseases.”

James A. Cozart, D. O., Canonsburg, PA. (JAOA, March 1919)

“in summing up will say that osteopathy has made a wonderful impression on the community. Three of us here, Dr. Yoder and Dr. Olmstead, also reported great success. We note that the patients that have died have been those who were drugged, allowed to eat at will (that’s poison) or disobeyed instructions. Have had five cases of “flu” during pregnancy and all got well.”

W. L. Burnard, D. O., York, Neb. (JAOA, April, 1919)

“I had 150 well defined cases of “flu.” Gave two treatments per day for three days…. It made a great impression upon the public and has brought me more patients than I have been able to handle.”

W. B. Linville, D. O. Middletown, O. (JAOA, April, 1919)   

The Journal from 1919 continues to publish the experiences of osteopathic physicians in the United States up to the present day.

“The 2-year influenza outbreak that occurred between 1918 and 1919 was a worldwide epidemic. Original estimates placed related fatalities at 21 million, 1% of the world’s population at that time. Several recent estimates place the number of fatalities at 30 million.

In the United States, more than 28% of the population succumbed to the disease overall. In US military hospitals, the mortality rate averaged 36%, while the mortality rate in US medical hospitals fell between 30% and 40%, with the exception of a rate of 68% in medical hospitals in New York City.

The osteopathic medical profession had few hospitals then, but the American School of Osteopathy, now the Kirksville College of Osteopathic Medicine of A. T. Still University of Health Sciences, in Kirksville, Mo, contacted all their alumni. This effort culminated in 2445 osteopaths responding in treating 110,122 patients with influenza, with a resulting mortality of 0.25%. One of the few osteopathic medical hospitals, 400-bed Massachusetts Osteopathic Hospital, in Boston, also reported a mortality of 0.25% for that period.

Why the difference in outcome? Allopathic medical treatment for patients with influenza consisted of cough syrup and aspirin, treating the fever as a symptom, rather than recognizing fever as the body’s response to an infection. And as Andrew Taylor Still, MD, DO, stated in his autobiography, “Fever is a natural and powerful remedy.”

In contrast, osteopathic medical treatment for patients with influenza consisted of cough syrup, yes, but also gentle OMT (osteopathic manipulative treatment), resulting in a dramatic difference in mortality. Thomas L. Northup, DO, has reported that the same mode of therapy is effective in patients with pneumonia.”

Harold I. Magoun, Jr, D.O., More About the Use of OMT (Osteopathic Manipulative Treatment) During Influenza Epidemics, JAOA, Oct. 2004.

“A pandemic virus will likely be unaffected by currently available flu vaccines that are modified each year to match the strains of the virus that are known to be in circulation among humans around the world,” according to Tommy G. Thompson, secretary of Health and Human Services. Each year, currently available flu vaccines are modified to match virus strains that are known to be in circulation among humans globally. Of concern is that such strains will likely be ineffective against a pandemic virus. Of primary concern, however, is the time required to produce a vaccine against a new virus strain, possibly one that is created by genes of the A(H5NI) strain of avian influenza combining with the genes of a human influenza strain.

“We have a precedent in our own history—the success of osteopathic care of patients with influenza during the pandemic of 1918. In a paper, the first admitted and read before an “old school” medical convention, R. Kendrick Smith, MD, DO, presented statistics showing the “osteopathic conquest of disease in which medicine has failed.

“Dr Smith reported that mortality among a total of 110,120 patients with influenza  treated by the 2445 members who reported “authenticated detailed case reports” to the American Osteopathic Association was 0.25%. Mortality due to influenza in patients receiving traditional medical care, however, was ultraconservatively estimated at 5% to 6%. Among patients with pneumonia treated medicinally, mortality was estimated at 33%, and even as high as between 68% and 78% in some large centers. The death rate due to pneumonia among 6258 patients cared for by osteopathic physicians was 10%.”

Gilbert E. D’Alonzo, Jr, DO, AOA Editor in Chief, Influenza Epidemic or Pandemic? Time to Roll Up Sleeves, Vaccinate Patients, and Hone Osteopathic Manipulative Skills. JAOA, Sept. 2004.

“However, the lessons learned within the osteopathic medical profession as a result of the 1917-1918 pandemic could prove useful once again if (or when) a new influenza pandemic occurs. As AOA editor in chief, Gilbert E. D’Alonzo, Jr, DO,  noted in his 2004 editorial, “Influenza epidemic or pandemic? Time to roll up sleeves, vaccinate patients, and hone osteopathic manipulative skills,” influenza patients treated osteopathically during 1917-1918 had a 0.25% mortality rate, as compared to the national average of 6% (and 10% for pneumonia patients, compared with 33% to 75% for the national average).

“In 1918, C.P. McConnell, DO, reported that the most effective treatment during the influenza pandemic was begun early in the onset of symptoms (within the first 24 hours) and consisted of carefully applied muscular relaxation and, most importantly, relaxation of the deep and extensive contractions of the deep spinal musculature and mobilization of the spine. These treatments would be repeated two or three times early in the course of the infection, along with traditional supportive measures such as hydration. During later influenza epidemics, such as the 1928-1929 and the 1936-1937 outbreaks, various lymphatic pump treatments and more attention to the cervical and upper thoracic regions were added to this recommended treatment protocol. These treatments, individualized to each patient’s needs, were apparently the most commonly applied osteopathic medical procedures during the epidemics.”

Michael M. Patterson, PhD, The Coming Influenza Pandemic: Lessons From the Past for the Future. JAOA, Nov. 2005

“The victims of the deadliest flu pandemic in history were killed when their bodies unleashed an uncontrolled immune reaction as a protective mechanism, say scientists. Patient’s lungs rapidly became inflamed and filled with blood and other fluids which eventually drowned them.

“In the latest experiment scientists used re-constructed virus to infect macaque monkeys. They found that the over-reaction of the immune system destroyed the monkey’s lungs within weeks.

“Scientists believe the 1918 virus had the same effect on humans. “There was some surprise that it was that nasty. It was the robustness of the immune system that helped victimise them, said Michael Katze, a microbiologist at the University of Washington in Seattle, who took part in the research. “That breaks the paradigm as always thinking of the host response as protective.”

It might explain why the 1918 flu virus killed so many healthy adults in their 20s and 30s; conventional influenza prays mostly on babies, the elderly or sick.”

Alok Jha, Scientists reveal how world’s worst flu killed 50m. The Guardian, Thursday January 18 1007, p.9.

It seems that the osteopathic profession is denying its past, present and potential future. How can this be and why is it being ignored?

The original discoverer of a “system of natural immunity” was Dr. Andrew Taylor Still, M. D., an American Civil War surgeon in the second half of the 19th century in North America. Notice how his discovery was a “system of natural immunity” not a treatment for back pain, tennis elbow or any other muscle and joint problems. This system of natural immunity was before Louis Pasture and other medical scientists that have gone on to fame.


How Osteopaths Treated Influenza

Before we can understand how osteopaths treated influenza a few facts and misconceptions have to be cleared up.

During the late 19th and early 20th century in the US osteopaths did not manipulate the same way they do today. They were true physicians, the word meaning to return to normal. As I have mentioned, medication and surgery were part of the osteopaths fight against disease in addition to nutrition and exercise. Over the years manipulation has changed from a surgical approach, where you treated what you found based on the anatomy in front of you, to the learning of procedures before you saw the patient and then applying the technique to the patient. What’s the difference? In the first case the osteopath would reason with the situation at hand never repeating the same approach twice. In the second case a technique is taught by mimicking the actions of another osteopath. You then apply the technique to the patient. This is not tailor-made for the patient and is ineffective for the patient’s personal problem.

Modern manipulation is similar to going to football (soccer) training learning the drills and then trying to repeat the drills exactly as you learnt them during a game. The end result is no game and very dull.

The object of manipulation is to improve circulation (blood and lymph) to and from organs, the movement of joints and muscle and in fact all tissue.

A major misconception about influenza (or any infection) is that the virus causes the symptoms of sweating, headache, sore throat and an overwhelming desire to lie down. It doesn’t. People can be carriers of the virus without ill effects.

Briefly this is what seems to happen:

  • For various reasons the mucus membrane of the upper respiratory tract becomes weakened and a relative acidosis begins. Usually, a structural disturbance (joint, muscle, circulation, nerve supply etc) from stress, poor nutrition, cognitive dissonance, to name but a few.
  • Virus “enters” person.
  • Virus settles mainly in nose and throat region.
  • Virus enters epithelial cells (ECs): the cells lining the nose and throat.
  • Virus kills ECs by RNA disturbance.
  • ECs die.
  • An accumulation of dead ECs leads to a response from your immune system to clear these dead and dying cells.
  • White blood cells are generated from the lymph glands in the body. This is why your glands swell, to produce more white blood cells.
  • This is what is known as an inflammatory response.
  • Your natural response to everyday dead cells is low so the glands do not swell.
  • You enter into a shock and stress situation of sweating, shivering, stiffness, and headache. This is because the whole body is becoming toxic due the accumulation and circulation of dead cells and the subsequent response by your body to destroy them.
  • This is known as a Cytokine Storm
  • So influenza is the response of the body to the accumulation of dead cells caused by the virus; not the virus itself.

The osteopath helps to keep the circulation and white cells moving at their best to deal with the rapid accumulation of dead ECs. As long as the ECs are cleared at a rate that your body is comfortable with you will not exhibit the signs and symptoms of influenza.

How is this achieved?

The most important aspect is knowledge of anatomy. If a practitioner does not know their anatomy they cannot even begin to understand what to do. The main organiser of your circulation function is a division of the nervous system known as the autonomic nervous system. A subdivision of this is the sympathetic nervous system. It was called sympathetic because it is in sympathy with you in your environment. This part of the nervous system is what makes you blush and causes you to swell in summer and contract in winter.

The osteopath knows how to feel the movement and obstructions to the function of the sympathetic nervous system. This is of paramount importance in the treatment of influenza.

Additionally, because the body is going into a style of shock and stress there is an adrenaline overproduction. It is this overproduction of adrenaline that makes your muscles stiff and quickly results in fatigue and exhaustion. Adrenaline moves the circulation into the muscles and away from the vital organs, liver, kidneys etc. In extreme cases the organs collapse due to poor circulation and an excess of toxins from dead cells and the person dies. Young adults produce more immune cells and adrenaline than infants and the elderly; this was a characteristic of the 1918-19 pandemic.

“…this epidemic was largely a young adult’s disease. The life insurance companies report their death claims from this cause average at thirty-three years of age as against fifty-five to sixty years of age of deaths from general causes.” H. L. Chiles, D.O., A New Survey of Public Health, (JAOA, Jan. 1919.)

“The physiological picture of influenza centres around one of the smallest but most important and interesting organs of the body – the adrenal gland. …Its nerves come chiefly from the eleventh dorsal segment of the spine, just above the waist line. That is why the first symptom of this disease is usually backache in this region….In the female, it is the partner gland, the pituitary body, that is correspondingly more important. And you will notice there is a marked difference in the “flu” in males compared to females.” E. E. Tucker, D. O., New York, N. Y. Spanish Influenza – What and Why? (JAOA, Feb. 1919.)

The osteopath has to literally “decompress the system.” Treatment is aimed at reducing obstructions to circulation caused by tight muscles, ribs that are not moving,  organs (spleen) that are not pumping, nerve bundles (sympathetic nervous system) that need stretching, and immune (lymphatic) channels that need unblocking. All this happens at once during the treatment and treatment should be two to three times in two to three days.

Is the virus removed? No. But the cause of the signs and symptoms is reduced and the reason for the virus to continue multiplying, resulting in immune suppression, is also drastically reduced. Osteopathic manipulation will get you back on your feet and there is no sign of that two week fatigue that most of us go through after the crisis is over. Think of the implications for the work place and the business world.

As Ward (1937) wrote, “By retarding the virulence of the invading organisms, appropriate osteopathic treatment reduces the incidence of complications and forces down the mortality rate in these cases.”

They used to call osteopaths “bloodless surgeons” and “fever fighters” in the nineteenth century and especially during the 1918-19 pandemic. Osteopaths have the history and the skill to make a major contribution to the reduction of deaths during an epidemic, pandemic or isolated cases of influenza.


Chiles, H. L. (1919) A New Survey of Public Health. Editorial in The Journal of the American Osteopathic Association, January. p.227-230.

D’Alonzo, G. E. (2004) Influenza Epidemic or Pandemic? Time to Roll Up Sleeves, Vaccinate Patients, and Hone Osteopathic Manipulative Skills. The Journal of the American Osteopathic Association, September, Vol. 104, no.9, p. 370-371.

Magoun, H. I. (2004) More About the Use of OMT During Influenza Epidemics. The Journal of the American Osteopathic Association, October, Vol. 104, no. 10, p.406-407.

Patterson, M. M. (2005) The Coming Influenza Pandemic: Lessons From the Past for the Future. The Journal of the American Osteopathic Association, November, Vol. 105, no. 11. p.498-500

Tucker, E. E. (1919) Spanish Influenza – What and Why? The Journal of the American Osteopathic Association, February, p.270-273.

Ward, Edward A. (1937) Influenza and Its Osteopathic Management. The Journal of the American Osteopathic Association, Vol. 37, no. 1, p.3-6.

© Walter Llewellyn McKone, DO, 2007. Updated 30 September 2017.