Did A.T. Still, DO, have an MD degree?

A.T. Still, DO (1828–1917), founder of osteopathic medicine, was a licensed physician practicing in late 19th- and early 20th-century America. Although many assume he held an MD degree, the reality is more complex. Examining whether Dr. Still earned an MD degree provides important insight into the origins of osteopathic medicine and the profession that followed.

Today, physician licensure requires graduation from an accredited medical school with a DO or MD (or an equivalent degree internationally), passing the national licensing board exams, completing residency training and obtaining state medical board licensure, according to the Federation of State Medical Boards.

These standards differ markedly from those of the 19th century.

Dr. Still was unquestionably a licensed physician with a long and successful career. At the time he entered medicine, the MD was the only medical degree available. Whether Dr. Still himself held an MD is the central question, one best understood by examining 19th-century American medical education, medical licensing and Dr. Still’s life.

Early 19th century medicine

Early American medicine relied on symptomatic, “heroic” treatments such as bloodletting, purging, vomiting and blistering, which were believed to remove harmful humors or stimulate the body. By the 1820s, physicians widely used powerful drugs including opium, calomel (containing mercury) and antimony.

Calomel, a mercury-based purgative, became a standard treatment despite serious side effects and remained widely used even during the Civil War, with efforts to ban it being strongly opposed by physicians as well as the American Medical Association. Practitioners of heroic medicine were known as “regulars,” while dissenters were labeled “irregulars” and severely marginalized.

Medical education in the 19th century

Early American medical education developed amid a severe physician shortage; in 1800, only four medical schools existed in the United States. Most physicians in the early 19th century trained through apprenticeships, working for two to three years under a physician preceptor. This pathway did not confer a degree, rather a certificate of apprenticeship completion.

During the 1800s, proprietary medical schools rapidly expanded. These schools, often founded by a small group of physicians (usually four or more) taught conventional heroic medicine. Training typically consisted of two lecture terms of three to four months, an informal oral examination and required fees. This was used to supplement apprenticeship training. MD degrees were awarded upon completion of the school training.

By 1875, the number of U.S. medical schools had grown to 73. Late in the century, medical schools and societies increasingly promoted the medical degree (MD) as a licensure requirement, though many physicians continued to enter practice through apprenticeship alone.

Abram Still, father and preceptor of A.T. Still, DO

Abram Still (1796–1867), Dr. A.T. Still’s father, practiced as a physician while serving as a Methodist circuit rider minister. Although there is no record of a medical degree, he likely trained through apprenticeship, learning heroic medicine of the day.

Methodist ministers occasionally practiced medicine, influenced in part by John Wesley’s “Primitive Physick,” which endorsed symptomatic treatments including herbal remedies as well as bloodletting, purging, vomiting, opium and mercury. Nineteenth-century American publications of Wesley’s “Physick” were combined with Wilkins’ “Family Advisor/Physick,” which prescribed heroic medicine of the day.

Abram Still practiced heroic medicine and trained his sons, including Dr. A.T. Still, using texts such as “Gunn’s New Family Physician,” which promoted calomel and other aggressive treatments. Although Dr. A.T. Still later rejected these methods, he acknowledged that his father practiced according to the best knowledge of his time and held him in high regard.

A.T. Still, DO

Dr. Still started medical training under his physician father in 1849, while living in Macon, Missouri. He became a physician through the apprenticeship method common at the time. By 1853, after moving to Kansas, he was practicing with his father and brothers. Dr. Still practiced as a licensed “regular” physician in Kansas until relocating to Missouri in 1874, where he was also licensed as a physician, though he soon rejected heroic medicine as he developed a new approach that he named osteopathy. He practiced as a licensed physician in Missouri, briefly in Macon and then for many decades in Kirksville until his death in 1917.

Dr. Still began questioning “regular” heroic medicine in 1855, early in his Kansas years. His criticism deepened after his Civil War medical experience and the loss of three children to meningitis in 1864. By 1874, he was ready to leave “regular” heroic medicine behind, moving from Kansas to Missouri to establish a new approach centered on the body’s inherent ability to heal rather than the toxic “remedies” of the era.

Records show that Dr. Still held medical licenses in both Macon and Adair Counties, Missouri.

A document in the Missouri Digital Heritage Collection confirms Dr. Still’s registration in the Macon County Roll of Physicians and Surgeons on Aug. 29, 1874, under an act passed by the Legislature of Missouri several months earlier, on March 27, 1874.

Containing more information is the historical record of Dr. Still’s medical license as a physician and surgeon in Adair County, Missouri, in 1883. The Certificate of Registration of Physicians and Surgeons, number 71, for the County of Adair, states that Dr. Still’s name was entered into the “Roll of Physicians and Surgeons” for the county. This certificate includes a date for the 1874 Missouri legislative act, consistent with the act mentioned in the Macon County certification.

In the Adair County Roll of Physicians and Surgeons there is a record of Dr. Still’s name and certificate, listed with the date July 28, 1883. There are blanks for “Date of Diploma” and “Name of College or University” in his registration information. The same is true for five of the 12 physicians listed on that page (including four of the 10 licensed in 1883).

This suggests that Dr. Still was not alone at that time as a physician who earned licensure through the apprenticeship method and did not have a medical degree. This is consistent with many states at that time. Dr. Still practiced as a licensed physician and was widely known as Dr. A.T. Still.

After physician licensure began in the 1870s, Missouri established the State Board of Health in 1889. Even at this later time, physicians could be licensed either by earning an MD degree or by completing an apprenticeship and passing an examination by the Board.

Dr. Still never mentioned earning an MD degree in any of his written works, which included an autobiography and three other books, as well as many published articles. Neither is this mentioned in the single authorized biography of Dr. Still that was written while he was still alive, “Booth’s History of Osteopathy and Twentieth-Century Medical Practice.”

A letter from Dr. Still’s son-in-law, George M. Laughlin, suggests Dr. Still may have briefly attended a term of medical school but was so disgusted with the program that he never returned to get a diploma.  Dr. Still also alluded to medical school study in his autobiography. He mentioned that he studied anatomy with more “zeal and satisfactory results” than he had at college as he continued to study over what he had “learned at medical schools.” The context of these statements suggest that it might have been before the Civil War.

While it is possible that Dr. Still might have attended a few weeks at a medical school in his search to learn more about medicine, it is clear that he did not embrace “regular” medicine for long during his time in Kansas, and that he deliberately broke away from conventional medicine during his following years in Missouri.

Dr. Still would go on to declare that osteopathy was independent from all other systems of healing, including allopathy, homeopathy and eclecticism. He felt that these old systems, especially “regular,” conventional medicine, which he referred to as allopathy, with its purging, vomiting, use of opium, morphine, calomel and whiskey, were obsolete and had nothing to do with the practice of osteopathic medicine.

Dr. A.T. Still remained bitterly opposed to the heroic medical therapies of his day. One powerful example was when he stated that as an adult, he used part of a set of false teeth because he had been dosed with calomel at the age of 14 years old. As Dr. Still commented in his own pithy fashion, “A few doses of calomel, and out go the teeth.” By the time he moved to Missouri, it was clear that Dr. Still had no desire to participate in the heroic therapies of conventional medicine. Yet he continued to practice as a licensed physician.

When Dr. Still started the first osteopathic medical school, the American School of Osteopathy (ASO), in Kirksville, Missouri, in 1892, he chose to grant a new degree, DO, rather than the MD degree. Still could have had the ASO grant MD degrees, but instead, he deliberately chose the DO degree. Years later, in 1899, the ASO dean and faculty petitioned the school’s Board of Trustees to change the degree granted by the school from DO to MD. Dr. Still dismissed this proposal because of his belief that osteopathic medicine was distinct from all other “schools of medicine” at that time, and so the proposal failed.

Dr. Still was a licensed physician who did not pursue an MD degree, nor did he grant that degree to his osteopathic medical students, and he refused efforts to change the first osteopathic medical school to an MD-granting institution. He preferred, instead, to blaze the trail of osteopathic medicine, including the use of the DO degree. Dr. Still himself received the DO degree from the ASO in 1897. Dr. Still did have a degree, but it was a DO degree, not an MD degree. In 1900, Dr. Still was the first to receive a state medical license from Missouri practicing as a DO.

‘A long and fruitful career’

Dr. Still was a fully licensed physician who trained in the apprenticeship method during mid-19th-century America, which was standard practice during that time. While Dr. Still was recognized, and practiced, as a medical doctor, he did not have an MD degree. Dr. Still did have a long and fruitful career, in both Kansas and Missouri, practicing as a licensed physician, going on to start the first osteopathic medical school, in Missouri, where he taught and continued to practice for the rest of his long life.

Dr. Still was a licensed physician who practiced medicine as a doctor for over 60 years; he did not have an MD degree and he was happy with that fact.

Related reading:

A.T. Still Memorial Lecture: ‘Our mission endures’

The 4th wave of osteopathic medicine: Re-establishing osteopathic distinctiveness