Marketplace of the Marvelous (39 page)

More than words, regulars tried to use the law to destroy, or at the very least restrict, osteopathy and chiropractic. The primary issue hinged on whether either actually qualified as a form of medicine. Many states narrowly defined medicine as prescribing drugs, so drugless systems like chiropractic and osteopathy were not medicine and therefore could not be regulated or subject to laws for practicing “medicine.” But that did not stop regulars from claiming otherwise. Still's own son, Charles, who had achieved success treating victims of a diphtheria outbreak in Minnesota, was the first osteopath to come
to the attention of the state health authorities. In treating the disease, Charles likely followed his father's instructions to “bring the clavicles and sternum far enough forward to take off any pressure that exists, in order to let venous blood and other fluids return to the heart” and to keep patients in a clean, well-ventilated room. As an infectious bacterial disease, diphtheria was likely little helped by Charles's manipulations. His patients may have had mild cases, and they probably recovered on their own; most fatalities from the disease occur in children under five. Working in such close proximity to his patients, Charles was fortunate to escape without contracting diphtheria himself, though he could not escape the law. Charles was arrested and charged with practicing medicine without a license. The case against him was dropped, however, as the number of people seeking his care grew so large that it became hard for the state to deny his effectiveness. Not every osteopath was so lucky, and many others faced trials in the 1890s.
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Chiropractors had to watch out not only for regulars but for osteopaths, too. Some hid their DC diplomas and practiced behind closed shades and locked doors. Many chiropractors did go to court for practicing without a license, but few were convicted. Those who were usually went to jail willingly as a demonstration of their dedication to medical freedom. One of the first to be jailed was Palmer himself, who was arrested in Davenport in 1905 for violating medical practice laws. The case hinged, in part, on claims made by Palmer in his journal, the
Chiropractor
, in which the state claimed that Palmer professed to cure all kinds of diseases with his unlicensed healing method. The jury found him guilty, but Palmer's refusal to pay the $350 fine led the
Davenport Democrat & Leader
to report, “He will stick with chiropractic to the end [and] offer himself as a martyr” by going to jail. In the end, Palmer only served twenty-three days of his 105-day sentence after his wife paid the fine.
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Following Palmer's lead, the Federated Chiropractors of California launched a “Go to Jail for Chiropractic” campaign in the 1920s that helped to infuse chiropractors with a sense of martyrdom mixed with heroism. Arrests sometimes proved good for business. Publicly sacrificing oneself in defense of medical freedom against the tyranny of regular medicine was a winning storyline for many Americans.
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Although many received pardons and acquittals, osteopaths and chiropractors knew that depending on the favor of juries, particularly
as regular medicine campaigned to have both prohibited by state legislatures, was a dangerous course. Besides legal action, regulars denied them membership in local medical societies and refused to allow them admission to university and public hospitals. Medical societies also prohibited regulars from any kind of professional cooperation, tactics they had previously employed against homeopaths, hydropaths, and other irregulars. Osteopaths and chiropractors responded with a very different course of action than their predecessors, though. Rather than fight the enactment and enforcement of licensing laws, as the Thomsonians had done in the 1830s, they fought to be licensed themselves.
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Osteopaths took a pragmatic course, fighting for full rights in some states and partial rights in others depending on their resources, support, and, of course, how much resistance they faced from regulars. In 1896, Vermont became the first state to license osteopaths, a move that led Dr. Robert T. Morris of the New York County Medical Society to label Vermont “the garbage ground of the profession.”
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Osteopaths often gave demonstrations and free manipulations to legislators to win support in key states. North Dakota and Missouri soon followed Vermont's lead, and by 1901, fifteen states had granted osteopathy legal standing. A little more than a decade later, osteopaths could lawfully practice in forty states. Not every state was so easily won, however; Mississippi, the last holdout, finally consented to license osteopaths in 1973.

Osteopathy also expanded its college curriculum in the early twentieth century to include surgery, obstetrics, and even, most controversially, drug therapy.
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Many state legislatures insisted that if osteopaths were to be licensed to provide surgery, they should be required to study all of the same subjects as regular doctors, including drugs. Osteopathy yielded to the pressure, though not without considerable pain and torment to Still, who urged his supporters to not be “trampled in the mud” by regulars but to “hold up the pure and unadulterated osteopathic flag.”
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Chiropractors suffered far more arrests and abuse than osteopaths because winning licensure was a slower process. In 1913, Kansas became the first state to license chiropractors, and the total had climbed to twenty-two by the early 1920s. Twenty-five more states had passed licensing laws by the end of the 1920s, leading journalist H. L. Mencken to complain of “a chiropractor at every cross-roads,
and in such sinks of imbecility as Los Angeles they are as thick as bootleggers.”
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It would be decades before the chiropractic battle for licensure ended, though.

After licensure, improving education was the priority for both osteopaths and chiropractors. Osteopaths concentrated on keeping pace with the requirements and standards of regular medical schools so that by the 1930s, the curriculum of regular and osteopathic schools looked nearly identical; by the 1950s, most osteopaths had become more or less the equals of regular medicine practitioners.
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At the same time, osteopaths insisted on maintaining a separate identity, something homeopathy had failed to do. They were not MDs, as homeopaths had considered themselves, even though osteopaths legally had the right to use that title; they were DOs. Osteopaths maintained their own schools, hospitals, professional journals, and associations and asserted that the quality and scope of their care was comparable if not superior to regular medicine. They resisted joining regulars as a therapeutic option within regular medicine, understanding, as other irregulars had not, that the allure of ostensible acceptance would likely lead to their demise as the actual distinctions between osteopathy and regular medicine blurred. Osteopathy became, in essence, a parallel profession to regular medicine with a similar range of institutions and periodicals.
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In fact, many doctors today wonder why osteopathy persists and question its reason for being. But many regulars are perhaps unaware of osteopathy's history and its rise to prominence at a time when no medical system, regular or irregular, dominated. While manual manipulation plays a smaller role in osteopathy than it did at first, many osteopaths still use it in their practices, particularly those in solo practice. Proficiency in manipulation does require practice and time, things that osteopaths practicing in regular institutions often do not have due to the constraints of the modern medical system.
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Most critically, osteopaths survived by locating a medical need and defining their own niche. Many served small towns and rural areas where they were often the only doctors in town. The geographic scarcity of doctors in some regions led both federal and state governments to appropriate funds for the training of osteopaths as one strategy for solving the primary care shortage in rural areas. Osteopaths also did not actively pursue new medical research and subspecialties as quickly as regulars. This was, in part, because outside of the developing
regular medical system, osteopathy lacked the resources for schools, equipment, and training. They focused, instead, on primary care and took advantage of the growing need for general practitioners in the 1940s as more regulars choose to specialize in fields like surgery and psychiatry. Barred from providing medical service and exempt from the draft in World War II, osteopaths who had not volunteered for other war duties provided much-needed medical care on the home front. With roughly forty-five thousand regular doctors in the military defense force, many Americans who might not otherwise have been exposed to osteopathy gave it a try. Many regulars returned from the war and found they had lost their patients. Osteopathy, in essence, gained legitimacy by stepping into the primary care vacuum left by regulars, even if many patients did not know the difference between the two forms of medicine (a problem that persists to this day). With these shifts, regular doctors found themselves dependent on an irregular system as a source of referrals for their own specialty practices, a seemingly unimaginable outcome of the more than century-long struggle between regular and irregular healers.
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Even so, osteopathy traded ideological purity for survival. In the 1930s, many osteopathic schools began referring to their practice as “osteopathic medicine,” with increasing emphasis on the word “medicine,” to gain more financial backing. They may also have hoped to “pass” as regular doctors without the necessary theoretical qualifiers to attract more clients. Rather than stress their differences from regular medicine as they had in Still's time, osteopaths emphasized the quality of their care. They also relied less and less on manipulation as the primary mode of treatment. Today, many osteopathic medical schools still teach manual manipulation but regard it more as an option rather than as the only treatment. In deemphasizing manipulation, osteopaths tried to counter the accusations of regulars that osteopathy was a quackish cult. It seemed to work. In 1969, no longer able to easily justify their exclusion on the basis of education or quality of care, the AMA opened its membership as well as internships and residencies to osteopaths.
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Those patients who sought manipulative relief for chronic musculoskeletal problems continued to turn to chiropractic for help. Chiropractors' devotion to low-technology adjustment as their therapeutic method kept them on the fringes of regular medicine at a time when medical care was growing increasingly complex and technological.
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Palmer's belief that he had discovered a higher form of medicine, “the antithesis of medicine,” in B. J. Palmer's words, significantly influenced the direction of the profession and its overall unwillingness to absorb the theories and therapies of regular medical science. Osteopaths, by contrast, tended to view themselves as reformers rather than crusaders of an entirely new health paradigm, so perhaps their accommodation and cooperation with regular medicine was more predictable.
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To function within regular medicine, chiropractors would have to gain patients through referrals from regular doctors rather than reaching out to patients directly. Chiropractors proved unwilling to relinquish their autonomy, a position strengthened by osteopathy's move into primary care. Treatment of musculoskeletal conditions, particularly back pain, was left almost solely in their hands. While a far more diminished role than many chiropractors aspired to and that Palmer had envisioned for his science, this focus gave chiropractors authority in an arena where regular medicine had little to offer and allowed them to remain independent.
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In recent years, manual medicine has made some inroads into regular medicine, as regular doctors have recognized the benefits of osteopathic manipulation for specific cases. Some hospitals have even integrated it into overall patient management because it scores well in client satisfaction.
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Osteopaths themselves are osteopathy's most significant and visible influence on regular medicine today. Many now practice and interact on equal terms with regular doctors. But the parallel profession path has its problems, as many patients cannot distinguish between the two types of medicine, and osteopathy has struggled to maintain and assert its identity. The time and bureaucratic constraints of the modern medical system make it challenging for osteopaths to practice manipulation and to take the detailed patient histories that Still required. Many regulars, too, continue to view osteopathy as inferior and see its schools as an easier and substandard path to becoming a doctor.

Chiropractors, on the other hand, have remained a marginal profession, not quite accepted but not as far to the fringe as holistic health movements like naturopathy and even homeopathy in its modern form. Unresolved conflicts and tensions between chiropractors and regulars continue to color relations between the two and perhaps bear the most resemblance to the strife that characterized
nineteenth-century medicine. Some regulars still feel that chiropractic adjustments pose potentially serious health risks. Several reports have linked chiropractic manipulation of the neck to stroke.
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Many regulars would prefer that chiropractic-like adjustments be provided by physical therapists under their supervision or at least within the confines of a regular medical institution, a position chiropractors reject. Chiropractors today seem to have socially and psychologically accepted their outsider status, finding unity in a role as an extremely popular but “oppressed minority” within the dominant medical system.
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Perhaps that's just the way the elder Palmer and his son wanted it. The two made much of the martyrdom of chiropractors who suffered at the hands of the law for their healing convictions. Conflict increased solidarity and gave chiropractic practitioners and their followers a sense of righteous indignation. Regular medicine “condemns every method, every procedure, every theory, idea or help to humanity that does not originate within and financially help to fill the pockets of its own ranks,” declared B. J. “It cares not what you, as a patient, think.”
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