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During the 1870s and 1880s, Still traveled around Missouri and demonstrated his healing techniques. He avoided prosecution for his work because he was licensed as a Regular physician. Still’s demonstrations intrigued numerous people, and he convinced a number of people that his techniques had merit. By 1889, he was successful enough to establish a hospital in Kirksville, Missouri. At this time, he proclaimed to the public that he had discovered a new branch of medicine. Next, Still opened an Osteopathic school in Kirksville. After establishing the American School of Osteopathy, he began to draw the attention of the Missouri State Board of Health and the medical societies of three major sects in Missouri.<ref>Gevitz, 20-28</ref>
====Medical Boards begin to prosecute Confusion over Osteopathsstatus====
The medical societies of the three sects were concerned about Osteopathy’s growing popularity and successfully lobbied the Missouri legislature in 1889 for a law requiring anyone who manipulated bodies to treat disease to pay a licensing fee of one hundred dollars per month. Even though the law was approved, state authorities neglected to enforce it. In 1893, the three sects then lobbied for another law that required Osteopaths to be graduates of medical schools in good standing. The only school of Osteopathy in the United States was Still’s and it would not have satisfied the Missouri board’s requirements for this rating. The Missouri legislature rejected this bill and instead passed a bill legalizing Osteopathy. While this first law was vetoed by the governor, another law in 1897 that legalized Osteopathy was passed and went into effect across Missouri after the governor, an Osteopathic patient, refused to veto it. Osteopathy spread rapidly from Missouri into neighboring Midwestern states over the next decade.<ref>Gevitz, 28-31</ref>
Just as Regulars had demonized Homeopaths and Eclectics in the past, licensed physicians from the three medical sects worked together and relentlessly attacked these new medical specialists. Licensing united the three sects against these new interlopers. While the sects still viewed medicine somewhat differently, their differences were not nearly as great as those between them and these new medical apostates. Additionally, Regulars, Eclectics, and Homeopaths dominated medical licensing, and they did not want these specialties to flourish unchallenged. Licensed physicians directed their state organizations to prosecute Osteopaths and Christian Scientists.<ref> Martin Kaufman, Homeopathy in America: The Rise and Fall of Medical Heresy (The Johns Hopkins University Press, Baltimore, 1971), 141-142.</ref> ====Courts determine whether Osteopathy is medicine====There were several early decisions that addressed whether Osteopaths needed to be licensed as physicians under existing licensing laws. Typically, Osteopaths defended themselves by claiming that they were not physicians and did not fit within the existing licensing laws. In Missouri, the state legislature passed an exemption in 1892, but Osteopathy presented a conundrum for most state courts. Courts struggled to develop a consensus on whether Osteopathy was a practice of medicine. Interestingly, courts ended up analogizing Osteopathy to Christian Science. Typically, if courts believed that Christian Science was a medical practice, then they would come to the same conclusion about Osteopathy. Not only were the court decisions at odds<ref> In Nebraska, but Osteopaths also were forced to make contradictory arguments about their medical specialty. They advertised that their medical system could cure numerous ailments. They also were competing with physicians from the three major medical sects for patients. While Osteopaths primarily treated patients for chronic conditions, they argued that both Osteopathy could treat other types of diseases and deserved Christian Science were found to be viewed as more than simply a system of body manipulationmedical practices. From their patients’ perspectives, Osteopaths performed the same services as licensed physiciansSee Little v. Osteopaths achieved their results by different methodsNebraska, but their clients would have viewed Osteopaths as doctors60 Neb. When licensing 749 (1900) and state boards of health prosecuted Osteopaths for practicing medicine, Osteopaths argued that they were not physicians despite their public pronouncements to the contraryNebraska v. From a legal perspective, Osteopaths made a credible argument. They contended that they did not practice medicine because they did not prescribe drugsBuswell 58 N. It may have been a solid argument in court to compare to Osteopaths to nurses or massage therapists, but it also would also have undermined their credibility as legitimate healersW. Osteopaths wanted to be seen as more than just nurses728 (1894).</ref>
Not only were the court decisions at odds, but Osteopaths also were forced to make contradictory arguments about their medical specialty. They advertised that their medical system could cure numerous ailments. They also were competing with physicians from the three major medical sects for patients. While Osteopaths primarily treated patients for chronic conditions, they argued that Osteopathy could treat other types of diseases and deserved to be viewed as more than simply a system of body manipulation.<ref> Gevitz, 42.</ref> From their patients’ perspectives, Osteopaths performed the same services as licensed physicians. Osteopaths achieved their results by different methods, but their clients would have viewed Osteopaths as doctors. When licensing and state boards of health prosecuted Osteopaths for practicing medicine, Osteopaths argued that they were not physicians despite their public pronouncements to the contrary. From a legal perspective, Osteopaths made a credible argument. They contended that they did not practice medicine because they did not prescribe drugs. It may have been a solid argument in court to compare to Osteopaths to nurses or massage therapists, but it also would also have undermined their credibility as legitimate healers. Osteopaths wanted to be seen as more than just nurses.<ref> State v. Gordon, 194 Ill. 560, 62 N.E. 858 (1902)</ref> ====Illinois prosecutes Eugene Holt Eastman for the illegal practice of medicine====Eugene Holt Eastman was one of the first Osteopaths prosecuted for practicing Osteopathy. Eastman was unique because he was tried in two separate states, Illinois and Ohio, for practicing Osteopathy in two consecutive years. He was a graduate of the newly formed American School of Osteopathy in Kirksville, Missouri. <ref> Eastman v. Ohio, 6 Ohio Dec. 296, 297 (1897).</ref>As a practicing Osteopath, Eastman’s treatment “consisted wholly of rubbing and manipulating the affected parts with his hands and fingers, and flexing and moving the limbs of the patient in various ways.” <ref> Eastman v. People, 71 Ill. App. 236, 238 (1896).</ref> Eastman argued to the Illinois Board of Health that he was not a practicing physician because he did not prescribe medicine or use instruments to treat his patients. <ref> Eastman, 238.</ref> The Illinois board ignored his arguments and determined that he was a physician. The Illinois board ruled that Eastman was a physician because he stated that his treatments could cure a “long list of diseases” relying only on the “manipulation, flexing, rubbing, extension” of his client’s limbs. Both the Illinois board and the court of appeal simply defined medicine as “the art of understanding diseases and curing or relieving them when possible.” <ref>Eastman, 239.</ref> Under this definition, Eastman was found to be practicing medicine and his conviction was upheld. After the Illinois board’s decision, Eastman left Illinois and moved to Akron, Ohio, late in 1896. In Akron, he continued his Osteopathic practice, but within one month he was charged with practicing medicine without a license. Contrary to the Illinois Court of Appeals, the Court of Common Pleas in Ohio did not believe that Eastman was a practicing physician. The court refused to find that Osteopaths, clairvoyants, mind healers, faith curers, massage therapists, and Christian Scientists were physicians under the Ohio licensing statute. If the legislature sought to ban or regulate these practices, the court argued it would need to do so explicitly, as Iowa had done.<ref> Eastman v. Ohio, 299-301.</ref>
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.
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. Even as Regulars, Homeopaths, and Eclectics were moving toward unified boards, Osteopaths realized that separate boards could preserve their unique sect.
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. 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.
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