J Martin Littlejohn (1865–1947) and James Buchan Littlejohn (1868–1947): Two distinct directions – Osteopathy and the birth of osteopathic medicine

John O’Brien,  IJOM March 2017, Vol 23 pp 4-10

Seeing as this blog is one lengthy confessional where I lay bare my professional ignorance at the altar of social media, I might as well give you the sum total of my imperfect knowledge of Littlejohn right now:

1. People who trained at the BSO seem to think he’s really important
2. He fell out with Still over the relative importance of anatomy and physiology, and one day when he was teaching physiology Still came in and wrote “ANATOMY” on the blackboard
3. He brought osteopathy to the UK
4. People who trained at the ESO have learnt some arcane system of diagnosis which involves something which is called “Littlejohn’s pivot points”(?).  See this blog by Danny Sher for some more on this.

But now that I’ve read John O’Brien’s interesting article in the International Journal of Osteopathic Medicine, I know a lot more.  The chief point of interest is that there were two Littlejohns:  elder brother JM (John Martin), the one we know and the BSO love, and younger brother JB (James Buchan), who stayed in America.  (Well, in fact there were four Littlejohn brothers,  all trained doctors, but this article is about JM and JB.  By the way, JM, the famous one who came back and brought osteopathy with him, was the elder by two or three years.  Interestingly they both died in the same year, 1947, at the grand ages of about 82 and 80).

O’Brien makes a case here that JB’s contribution to osteopathy was overshadowed, even deliberately obscured by JM, as a result of bad fraternal blood.  The story begins in Glasgow, where JB, the younger, trained in medicine straight out of school, but our JM went a more “circuitous” route.  He had interests in law, teaching, homeopathy, medicine and religion.  He became an ordained Presbyterian minister, and also suffered repeated bouts of ill-health of the glandular fever/chronic fatigue variety.  O’Brien sees this as setting the tone for JM’s more metaphysical approach to osteopathy, in contrast to his brother JB’s more medical direction.  After the whole family emigrated to the USA,  JM discovered AT Still, and found that osteopathic treatment gave him relief from his symptoms.  Before long, both brothers (plus one more, David) were teaching at Still’s osteopathy school, and quickly became the “creme de la creme” of the faculty, causing some resentment amongst other staff.  Next step was the development of their own educational institution in Chicago, which was later to become known as the Littlejohn College of Osteopathy.  They left Kirksville in 1900, so still the early days of osteopathy.

Osteopathy at its inception was in part a reaction to the poor practice and teaching of medicine at the time.  Osteopaths were radically opposed to the use of drugs (specifically opioids and alcohol) and regarded spinal lesions as the chief cause of illness and disease.  However there seems to have arisen early on a distinction between the majority who followed this belief – known as “lesion osteopaths”, and a minority known as “broad osteopaths” who did not believe manual therapy was best for all ills.  The Littlejohns agreed that the osteopathic approach was to make adjustments, but thought that these adjustments could be in “in the structural field, in the environment, in the mental field, or in the fields of diet and occupation”.  (Yes, I know what you’re thinking, biopsychosocial pioneers!) The Littlejohn College Idea was that

Adaptation, function and environment plus immunity … are the crucial values within the science of osteopathy

 They became the target of much hostility, regarded as heretics for diluting the idea that the spinal lesion was the sole cause of physical dysfunction.

They forged ahead, though.  JB, with his rather more straight-track medical training and career, ensured that major surgery was a part of the osteopathic curriculum and introduced the teaching of the materia medica, in preparation for prescribing rights.  At the point, JM and JB still seemed like brothers in arms, but an apparently stressful decade led to their eventual schism.  JM seemed to struggle under the pressure of leading the school, while JB “determined to see the LCO develop into a proper medical school and its alumni upgrade from osteopaths to osteopathic physicians and surgeons”.  It was not to be.  They were heavily criticized in a 1920 report, and the very traditional Illinois Medical Board would not accredit their school as a bona fide medical school.  At the same time, a blow came from the other side as the American Osteopathic Association threatened to expel them for teaching materia medica.  They were caught between two stools.  In the ensuing discontent, JM was told by his own faculty that he needed to reapply for his job as President of the school (never a ringing endorsement).  In an episode reminiscent of the infamous Miliband betrayal, the only other applicant was younger brother JB, who was given the job,  while JM returned  back across the Atlantic with his wife and six children, where his reputation was good.

So how did they end up?

Well,  the Chicago school initially returned to more traditional osteopathic teachings, JB gave up seeking medical licensing, and trained in law.  However, he remained deputy leader; the college became the Chicago College of Osteopathy, and a younger cohort of reformers took up his broader ambitions.   His vision eventually found its expression:

Before his death in 1947, James was able to witness his own vindication: materia medica was mandatory for all AOA accredited schools…. a cohort of osteopathic physicians sought full licences to practice; and osteopathic schools went through .. reform .. to become osteopathic medical schools (Chicago College of Osteopathy alumni granted full medical licences in 1957).

JM severed all contact with his brother and barely mentioned him or his family again.

He returned to the spinal lesion as a fundamental component of ill-health and also religious aspects too. Even in his last article to BSO students he describes osteopathy in terms of Christianity, returning to a metaphysical role.

Thus the path of osteopathy in the USA and in Europe diverged.  American osteopathy exists within conventional medicine and academia;  osteopathy elsewhere has maintained its traditional roots and alternative links.  O’Brien wonders if we can invoke the spirit of both brothers, who died unreconciled, to “attain degree and higher award parity with other health care professions.”

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