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In 1899, the Ohio Supreme Court in State v. Liffring supported the earlier lower court decision in the Eastman case and confirmed that Osteopathy did not constitute the practice of medicine in Ohio. A grand jury indicted William Liffring for practicing with a license, but went to the circuit court and quashed the indictment. The state sought to overturn the lower court’s decision and prosecute Liffring for violating the state’s licensing law. Prosecutors argued that medicine had “a wider significance than has the word drug.” They also cited “The Ohio Osteopath,” which was published by the faculty of the Ohio Institute of Osteopathy. This publication identified fifty diseases that could be treated successfully by Osteopathy. The court disagreed and found that the practice of medicine required the use of “drug or medicine.”<ref> State v. Liffring, 61 Ohio St. 39; 55 N.E. 168 (1899), 39-51.</ref>
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In Nelson v. State Board of Health, an Osteopath named Harry Nelson filed a petition of equity to enjoin the Kentucky State Board of Health from harassing him. Nelson was concerned that the board was going to prosecute him for violating the state’s practice and he sought to short-circuit their efforts. They refused to enjoin the board from enforcing the law against Nelson. After the lower Law and Equity Division entered a judgment in favor of the board, Nelson asked the Kentucky court of appeals to reverse the decision and force the board to recognize his college, the American College of Osteopathy in Kirksville, as legitimate under the state’s medical practice act.<ref> Nelson v. State Board of Health, 108 Ky. 769, (1900), 770-774.</ref>
====Osteopaths lobby legislatures for protection from prosecution====
[[File:1200px-Illinois_House_of_Representatives.jpg|left|370px|thumbnail|Illinois House of Representatives]]Since the courts were deadlocked over the issue of Osteopathy, Osteopaths quickly realized that the only way to ensure the survival of their medical specialty was to lobby for their own licensing laws. While a majority of courts exempted Osteopaths from licensing laws, Osteopaths wanted their practice to not only be legal throughout the country but legitimate. Like Regulars and Irregulars, Osteopaths quickly organized themselves in medical societies and created research journals. Aside from giving Osteopaths a sheen of respectability, the infrastructure gave Osteopaths a way to wage a concerted campaign to secure licensing. Between 1897 and 1901, fifteen states passed separate licensing laws for Osteopaths. Unsurprisingly, most of these states were in the Midwest, but New York, California, and Connecticut also passed laws favoring Osteopaths.<ref> Gevitz, 47.</ref>
These new laws were not ideal. In order to secure medical licensing, Osteopaths lobbied in favor of laws that were not always particularly beneficial to them. They struggled to get traction in state legislatures because Osteopaths were hampered by their small numbers, the relative youth of the specialty, disorganized campaigns, and lack of agreement among themselves about the type of laws that were most appropriate. In many states, efforts to secure legislation flamed out. In the states where Osteopaths secured licensing, they often were placed at the mercy of licensing boards that they did not have any representation on.
One of these states was Illinois which passed a new licensing law in 1899 designed to license Osteopaths and other medical specialists. Under the new law, the practice of medicine was broadly defined to include physicians who practiced medicine and surgery in all their branches and anyone who wished to practice a specific system of medicine without the use of medicine or instruments. This law was designed to put the state board of health in charge of all medical practitioners including midwives, Osteopaths and potentially Christian Scientists. Physicians from the three major medical sects controlled the board and Osteopaths had little say over how the law was administered. Even under the 1887 medical practice act, practitioners who rubbed or manipulated their patients were classified as physicians. <ref>Eastman v. People, 71 Ill.App. 236 (1896).</ref> Suffice it to say, the state’s new law did not necessarily help Osteopaths. Under Illinois law, Osteopaths were required to meet the same standards as all other physicians. They were not given a lower standard to become a physician in the state. Laws like Illinois‘ would require Osteopathic schools of medicine to rethink their school’s curriculum to help their students pass licensing exams.
Still, Osteopaths did benefit from a majority of courts’ unwillingness to interfere with their practice rights. Despite the split between the courts, a clear majority ruled that Osteopathy did not constitute the practice of medicine. In some ways, these decisions suggested that the ambivalence expressed earlier by courts about medical licensing in general. They did not hesitate to hobble these laws because of sloppy drafting or overreaching provisions. By finding Osteopathy to be outside the practice of medicine, a majority of courts sent a clear message to state legislatures that they would not allow an expansion of who was a physician without explicit legislation classifying Osteopath as doctors. While these decisions typically favored Osteopaths, the outcome was still problematic. These court decisions essentially stated that Osteopaths were not equal to physicians as healers. If Osteopaths wanted to be considered by the public to be legitimate, they needed to gain state validation.
Osteopaths already had been somewhat successful in establishing licensing laws in several states between 1892 and 1904, but they wanted to create separate licensing boards controlled by Osteopaths and expand the legislative recognition of their sect. With separate boards, Osteopaths could develop their own criteria for licensure and increase the status of legitimate practicing Osteopaths. In California alone, the newly established Osteopathic board between 1901 and 1907 issued more than nine hundred certificates to practice Osteopathy. <ref> Dudley Tait, M.D., “Report of the Committee on Medical Education,” California State Journal of Medicine, Vol. VI, No. 5 (1908): 161, http://books.google.com/ebooks.</ref> Even as Regulars, Homeopaths, and Eclectics were moving toward unified boards, Osteopaths realized that separate boards could preserve their unique sect.
====Conclusion====
The American Osteopathic Association developed a model law that was similar to licensing laws used to create Regular, Eclectic, and Homeopathic boards. Osteopathic physicians throughout the country pushed for licensing based on this model. While they did not always succeed, as historian Norman Gevitz pointed out, this effort was fairly effective. Despite pushback from the three major medical sects, Osteopaths secured practice rights in thirty-nine states and created seventeen independent boards around the country by 1913. <ref>Gevitz,54-56</ref>
By 1923, Osteopaths secured licensing in forty-six states and about half of those states created separate osteopathic boards. Osteopaths established a secure foothold in America and have never relinquished it. Contrarily, after the major sects established unified boards and the AMA admitted Irregulars to its ranks, Eclecticism and Homeopathy began their slow decline. Osteopaths successfully transformed themselves from a small Midwestern medical sect into physicians in the eyes of both the public and the law.
Today, Osteopaths and MDs are virtually indistinguishable. During the 20th Century, Osteopaths have almost abandoned the teachings of slowly moved away from Andrew Still 's drugless treatments. Medical licensing allowed osteopaths to transform the sectarian medical doctrine that had defined osteopathy at the end them and still be distinct from MDs. Instead of being subsumed by the 19th century and moved away from drugless treatmentsregulars, Osteopaths were allowed to transform their medical practices. Currently, there are over 34 American Osteopathic medical schools and over 130,000 osteopaths practicing medicine across the United States.
====References====
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