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Special Communication  |   February 2014
The “Diplomate in Osteopathy”: From “School of Bones” to “School of Medicine”
Norman Gevitz, PhD
Author Notes
  • Address correspondence to Norman Gevitz, PhD, Senior Vice President, Academic Affairs, A.T. Still University, 800 W Jefferson St, Kirksville, MO 63501-1443. E-mail: ngevitz@atsu.edu  
Article Information
Medical Education / Obstetrics and Gynecology / Being a DO / Curriculum
Special Communication   |   February 2014
The “Diplomate in Osteopathy”: From “School of Bones” to “School of Medicine”
The Journal of the American Osteopathic Association, February 2014, Vol. 114, 114-124. doi:https://doi.org/10.7556/jaoa.2014.025
The Journal of the American Osteopathic Association, February 2014, Vol. 114, 114-124. doi:https://doi.org/10.7556/jaoa.2014.025
Abstract

This article is the second installment in a series of 6 articles on the history of and controversies related to the DO degree. This article examines how Andrew Taylor Still made the transition from informally training apprentices to launching a formal chartered institution—the American School of Osteopathy. In its first decade of existence, Still expanded both the length and breadth of the curriculum and transformed his college from what he called a “school of bones” to a “school of medicine.” As this shift was occurring, J. Martin Littlejohn, then the dean of the American School of Osteopathy, questioned whether the DO degree was the appropriate degree to award its graduates.

On January 14, 1891, the Weekly Graphic, a Kirksville, Missouri, newspaper, published a speech given by Andrew Taylor Still to his sons and other apprentices. This appears to have been the first public announcement of the name of Still's “new science of health,” in which he declared, “Its name is and will be Osteopathy.”1(p2) Labeled as his first “Annual Address,” Still appended to his name the letters “DO,” which he did not then explain, but these would constitute the initials for a professional title that would be inscribed on a diploma that he later awarded his graduates and that continues to be the initials of the degree awarded today, although the title itself has since undergone substantial change. 
Still was making an important semantic distinction when he called what he had discovered and developed a “new science of health” rather than a new school of medicine. He argued that osteopathy, unlike medicine, was an exact science. “Many diseases, pronounced incurable,” he declared, “are caused by partial or complete dislocation of the bones of the neck, chest, spine, or limbs…[and] are seldom cured until the bones at fault are adjusted.”1(p2) He told his students, “You are now in the pursuit of a study that is as true as mathematics. You can answer yes to all questions as surely as the Astronomer can trace velocity and magnitude of the heavenly bodies.”1(p2) By contrast, “medicine” was not only inexact but it consisted largely of guessing and speculations about the cause and cure of diseases. Addressing students in what he then called his “school of bones,” he declared,
 

Now let me say to you in solemn truth, that no greyhaired nor youthful physician has ever answered the question. What is the cause and cure of asthma? You can, and prove what you say by your work. Can the M.D.'s do as much? No! not to the present age.1(p2)

Still went further in his disdain for the medical profession. Medicine, he claimed, was the cause of prevailing social evils, and he cast osteopathy as the cure. Still told his students,
 

When you are old and all the world can look over your life and say ‘No man, woman or child has been made a drunkard nor addicted to any of the habits of drugs by you’…[or] by your school. Can any one of the one hundred and fifty thousand M.D.s of America say as much?1(p2)

 
To celebrate Independence Day—July 4, 1891—Still printed and distributed a handbill entitled “Osteopathy: Oration and Prayer” in which he blended a religious sensibility and argumentation in framing his new form of healing. His variation of The Lord's Prayer employed language—typical for him—which caused some of his neighbors to think him daft, if not a heretic.2 “Our Father,” Still wrote, “who art in heaven and in earth and in all things but whiskey and such things as men have no business with…give us our daily bread, and no whiskey; give us reason and keep snakes out of our boots.”2 He prayed further, “Give us good knowledge of our true bodily forms and tell us how to know when a bone has strayed from its true position and how to return them to their natural places.”2 He even prayed for the medical doctors. “O, Lord,” he expostulated, “throw a few lightning bugs of reason on our M.D's. Thou knowest their eyes can't all open at once like a litter of pups, but light them out one at a time, and if thou failest, open the minds of the people, so they will not be the subjects of experiments any longer.”2 In concluding his idiosyncratic supplication, he asked God to “deliver us from all drugs, for thou seest just in front of us a world of maniacs, idiots, criminals, nakedness for the babies and hunger for the mothers. For thine is the kingdom from now on. Amen.”2 
After he had trained his small number of apprentices for a considerable time, one of them wished to practice apart from Still's direct observation and supervision. Months away from obtaining a charter for his formal school, the founder wrote a letter of recommendation dated February 15, 1892, in which Still declared, “This is to certify that W.H. Wilderson of Nevada, Mo. is a student in my School of Osteopathy or School of Bones.” Still limited his endorsement. He declared Wilderson “is now capable of doing some work in bonesetting to cure some diseases among males but not what is called female diseases. He has taken the first year's course in the study of O.P.” The founder signed the note, “A.T. Still D.O.”3 This letter is important for it signifies that prior to the creation of the American School of Osteopathy, Still was giving thought to what should be the appropriate depth and breadth of educational training that would be required to independently launch his students. 
The Beginning of the ASO
In May 1892, the Weekly Graphic announced that the State of Missouri had granted Still a certificate of incorporation for the American School of Osteopathy. “There is now abundant capital backing the institution,” the notice proclaimed, “and at an early day the organization of a company will be perfected, and suitable buildings erected to carry on the work of the school.”4(p3) Still's institution was first organized as a joint-stock corporation. The total value of the stock was capitalized at $5000, with 50 shares issued at the value of $100 a share.5 There were 7 stockholders. A.T. and his wife, Mary Elvira Still, owned 25 shares (or 50%), and his sons Charles and Harry and his brother Edward each owned 5 shares, representing another 30%. The remaining stock was held by 2 non-family members: Marcus L. Ward, one of Still's apprentices, had bought 8 shares, and Elias Falor of Rich Hill—one of the places in western Missouri that Still often visited as an itinerant practitioner—purchased the remaining 2 shares. The shareholders selected a Board of Directors, which consisted of A.T. Still and his wife, their 2 sons, and Marcus Ward, and the Board at their first meeting officially elected A.T. Still as president of the school; Marcus Ward, vice president; and Charles Still, secretary.5 
Under the first charter,
 

[T]he purpose and object of this Association shall be to improve on our systems of surgery, midwifery and treatment of general diseases in which the adjustment of bones is the leading feature of this school of pathology.5

Once again, the language was purposeful. Still adamantly refused to identify osteopathy as a “school of medicine.” Elsewhere in the charter, he refers to osteopathy as a “school of philosophy.”5 For him, the word “medicine” was inseparably tied to drugs, and he had no desire to have his science in any way associated with either the term or its contemporary application. 
The Charter stipulated that the faculty of the school “shall have the power to issue diplomas to all qualified students of Osteopathy,” but at the time of the ASO's incorporation, the only faculty member was A.T. Still himself.5 Nor was it clear when he would begin classes or what subjects would be included. However, in June 1892, Dr William Smith serendipitously arrived in Kirksville and became fascinated in what Still was accomplishing there with patients who found little or no relief from their regular physicians. Unlike Still, Smith was formally educated. Born in Jamaica and raised in Scotland, Smith entered the University of Edinburgh in 1880, spent the first 4 years there, contracted syphilis while working in the venereal wards of the Royal Infirmary, and left school to receive treatment and recover from the disease. When he was ready to complete his medical education, he enrolled instead in the Royal College of Physicians, also located in Edinburgh. He graduated in 1888, and after examination in Glasgow, became a licentiate in each of the 3 branches of the healing arts: medicine, surgery, and midwifery. Exhausting himself in a busy practice in Scotland, Smith decided to journey to the United States, where he was able to travel across the country as a salesman for a medical supply company. It was in this capacity that he eventually landed in Kirksville. As “Professor of Anatomy,” Smith agreed to teach a course in the subject and in exchange, Still would teach him his distinctive system of practice.6-9 
The story of Still hiring William Smith is an iconic part of osteopathic history and is often repeated in the literature. What is not generally known is that Still contracted with another professor who, like Smith, was willing to teach in exchange for obtaining knowledge of his new science of healing. Still named Dr Andrew P. Davis “Professor of Surgery and Midwifery.”10 Davis, a graduate of both an allopathic and a homeopathic school, was an inveterate seeker of knowledge in alternative practices. In the years before he learned of Still, Davis had investigated orificial surgery, the Junod system of hemaspasia, therapeutic sarcognomy, mental science, Christian science, and hypnotism.11(p x) With Still as “Professor of Osteopathy” and with Smith and Davis in the fold, he was prepared to open his school in the fall of 1892. 
Lectures were given in a 14 ft by 18 ft wooden structure (a mere 252 square feet of floor space) that Still had built the previous summer. Perhaps 10 or 11 students were in class on the first day of school; a similar number would be joining in the next few months. At the beginning of his course Smith had no materials other than Gray's Anatomy and a Quiz Compend with which to instruct. There was no body to dissect, and only later did he have an articulated skeleton with which to point out bony structures. Widely lauded by his students as a gifted lecturer, Smith could do no more than teach the bare rudiments of what students needed to know. Each morning, Smith drilled the class in anatomy. Still also occasionally lectured and perhaps Davis did as well, though there is no documentation or testimony that he did so or that the subjects of surgery and obstetrics were part of the first curriculum. Typically, after spending an hour with Smith, the class proceeded to the nearby infirmary to observe Still and his sons and other apprentices (most of whom were also part of the first class) treat patients in the 10 “operating rooms.”12-14 
On February 15, 1893, Still issued to Smith a hand-written certificate, which on the top read “American School of Osteopathy” and below stated:
 

Know all men by these presents, that William Smith, M.D. having attended a full course of lectures on, and Demonstrations of Osteopathy, and having, after due examination, been found fully qualified to practice the Art in all its branches, is hereby conferred by me with the title: Diplomate in Osteopathy.

It was signed “AT Still President.”12(p6) The founder issued approximately 18 such handwritten diplomas through March on the basis of his students' attendance and their passing of an anatomy examination.12(p7) 
Still never explicitly explained in writing why he wanted the title of the DO designation to read “Diplomate in Osteopathy” rather than “Doctor of Osteopathy,” though his likely reasons can be discerned. In the winter of 1892-1893, the Missouri State Medical Association became aware of Still's charter and sought to introduce a bill mandating that “no school of medicine in the state except the eclectic, allopathic and homeopathic schools, shall grant diplomas to graduates.”15(p2) The advocates of osteopathy rallied, started a petition drive, and lobbied lawmakers, and the bill was soundly defeated.12 Still and his supporters maintained that osteopathy was not the practice of medicine, which they conceived strictly as the use of drugs. The founder argued that he would not graduate “physicians” or what he considered that title's synonym, ie, “doctors.” Indeed repeatedly through the early years, Still referred to his acolytes as “engineers,” “architects,” “mechanics,” “plumbers,” “blacksmiths”— rather than “doctors.”7 In the Weekly Graphic, Smith wrote, “We do not desire to be called doctors, we are Osteopaths.” He also noted tellingly, “We have never asked [for] the precious degree of M.D. If it were offered me I would not use it…I would not exchange what I have learned since I came to Kirksville for all the degrees in this wide world.”16(p2) Still's selection of the term “diplomate” rather than “doctor” may have also been designed to convince members of the medical profession, legislature, judiciary, and most importantly juries that the practice of DOs would not infringe upon the legal prerogatives, scope of practice, or standing of the MDs, thus minimizing the potential for harassment and persecution. 
In April 1893, Still hosted a banquet to celebrate the first class of diplomates.12 However, even by this early date, he was expressing misgivings about several of his students and the adequacy of their training. William Smith, Andrew Davis, and Davis' son F.S. (also a licensed physician and surgeon) had provided Still with a notarized testimonial on the value of osteopathy. Upon receiving their diplomas, they left Kirksville and soon after the founder concluded that each of them violated his trust by combining osteopathy with the practice of medicine.17 In the first issue of the Journal of Osteopathy, Still sullenly declared,
 

Experience has proven, that those who have previously studied medicine, and afterwards tried to add Osteopathy, have been but a hindrance to the science. An allegiance to drugs once established, is almost impossible to overcome.18(p4)

He therefore announced that henceforth, “as a general rule no person shall be admitted as a student who has previously studied and practiced medicine.” Still argued that his goal was to “make successful operators of all who enter the school, and results have shown the nonmedical student far surpasses those who have studied medicine.”18(p4) 
Still kept many of his first graduates in Kirksville so that they might obtain further training at his infirmary. Despite already awarding them diplomas, he recognized that they had not gained sufficient experience in treating actual patients. In March 1894, Still provided those students from the first class who stayed on, as well the physicians in the class who had not, a printed “Diplomate in Osteopathy” certificate to replace and supersede the handwritten diploma issued the year before.19 
Disappointed in his first efforts at teaching, Still gave serious thought to quitting the school business. However, his patients, their family members, and others continued to clamor for instruction, and Still relented by admitting another class. With Smith gone, he convinced Nettie Bolles, one of the members of the first class who held a liberal arts baccalaureate, to teach anatomy in Smith's place. Still also made some curricular improvements. He lengthened the course of study to 2 terms (each 5 months in length) and required that his students would first have to learn the anatomy of the arms and legs before they were admitted into the infirmary.20,21 
In October 1894, he began a third class. Once again, anatomy was the only formal basic science course. However, in addition to Gray's Anatomy and Potter's anatomy Quiz Compend, students were now expected to obtain Yeo's Manual of Physiology textbook. He also required that they complete the entire anatomy course before they could enter the infirmary, where “the remainder of the time [will] be devoted to practical work under the direction of an experienced operator.”22 
The same month that the third class began, the American School of Osteopathy obtained a new charter. In legally creating his school 2 years earlier, Still's attorney had made the mistake of obtaining the wrong type of legal instrument—one designated for a commercial business rather than one constructed for an educational institution awarding diplomas.5,12 In writing the new charter, Still's legal counsel melded the original language regarding the mission of the school as found in the first charter with language typically employed in establishing a school of medicine. The new instrument read as follows:
 

The object of this corporation is to establish a College of Osteopathy, the design of which is to improve our present system of surgery, obstetrics, and treatment of diseases generally, and place the same on a more rational and scientific basis.12(p14)

This language is consistent with the wording of the first charter, but then new language was substituted for the old. Instead of the provision reading “the faculty of this school of philosophy shall have the power to issue diplomas to all qualified students of Osteopathy,”5 the ASO would now have the power “to grant and confer such honors and degrees as are usually granted and conferred by reputable medical colleges.”12(p14) In essence, the American School of Osteopathy had been legally transformed—at least on paper—from being a “school of philosophy” to a “school of medicine.” This new language allowed Still to reflect on and determine what kind of a school he ideally wanted to operate, what its curriculum would be, and what type of degree he would award. 
The Law and the Curriculum
Although the bill introduced to prevent the practice of osteopathy in Missouri without first possessing a medical diploma was defeated, the existing medical practice act was in force and Still's graduates were subject to its provisions.23 To avoid prosecution, they needed to either amend the law to exempt them from its enforcement or they had to devise and pass a separate osteopathic license act. So in January 1895, Still's supporters in the legislature introduced a bill in the Missouri House of Representatives “to regulate the practice of the science of healing diseases and injuries without the use of drugs, known as Osteopathy.”24 Consisting of 5 sections, the bill, if it became law, would have made it illegal to practice osteopathy without having a diploma and established a mechanism by which graduates would present their diploma to the county clerk who would officially register them. It stipulated that the act shall not “be construed to confer any rights upon any person to practice medicine or surgery in this state,” disqualified from practice any registrant who in treating patients was intoxicated or under the influence of opiates, and set fines for individuals practicing without a license.24 By February, the bill passed both houses and awaited the signature of Governor William J. Stone, who let it sit on his desk before vetoing it on the last day of the legislative calendar, thus preventing a likely override.25 
Stone rejected the argument that the practice of osteopathy could be construed as other than the practice of medicine and declared that Still's graduates were too narrowly educated. “Medicine and surgery are sciences,” he declared. “A judicious or successful practice of them requires a good general education, and a thorough knowledge of anatomy, chemistry, physiology, the obstetric art, the use of surgical instruments, and the like.”25 He observed that the most enlightened and learned practitioners “have labored assiduously for years to elevate the profession and to exclude from its ranks those who do not possess the knowledge necessary to qualify them to deal intelligently with matters directly affecting human life.”25 Stone argued that osteopathy was then a secret. “Only those initiated into its mysteries know what it is.”25 The bill did not define the practice, nor did the legislation “require any course of instruction in anatomy or physiology or knowledge of anything except osteopathy.”25 
After the initial shock and anger at the Governor's veto, Still and his advisors came to the pragmatic conclusion that in order to secure an osteopathic practice act in Missouri as well as other states, they would have to both broaden the curriculum to incorporate a range of basic and clinical science subjects and lengthen the curriculum. The need was becoming more apparent. Several of Still's graduates had been prosecuted or faced other harassment.14,26 Fake osteopaths—those with little or no formal knowledge of the system—were advertising themselves and giving the science a bad name.27 There was the palpable fear by Still's supporters that, should this state of affairs continue for much longer, enrollment in the ASO might suffer. The school's administration needed to ensure that students had a guaranteed pathway to legally practicing osteopathy upon graduation. 
Still was investing a large sum of money in his school. He had just erected an expensive brick building designed to accommodate both his clinic patients and students, and soon after he began construction on 2 large wings. He also expanded the course of study. Before Stone's veto, he had decided to extend the curriculum from 10 months to 18 months; and after Stone's veto, Still standardized the length to 4 terms of 5 months to be completed over 2 years. He introduced a separate course in physiology and decided there would now be lectures in diagnosis and symptomatology, minor surgery, diseases of women, obstetrics, and the treatment of poisons. Training would also include use of the microscope, the stethoscope, and urinalysis.12,28 To teach a greatly expanded course in anatomy incorporating cadaver dissection, Still rehired Smith, who convinced the founder that after leaving Kirksville he practiced osteopathy rather than medicine.29 
When the Missouri legislature began its next term in early 1897, Still's advisors, working with sympathetic lawmakers, introduced a revised bill which quickly passed both houses and was signed in March by Lon Stephens—the new governor.30 Missouri became the third state, following Vermont and North Dakota, to give legal status to the new system.14,31 The Missouri act declared that osteopathy…
 

…as taught and practiced by the American School of Osteopathy…is hereby declared not to be the practice of medicine and surgery within the meaning of article 1, chapter 110 of the Revised Statutes of Missouri of 1889, and not subject to the provisions of this article.32(p3)

The Act mandated personal attendance of a student in a legally chartered and regularly conducted school of osteopathy for at least 4 terms of 5 months each, after which the graduate would be able to register with the county clerk's office. The Act also set stiff financial penalties for those practicing osteopathy without the requisite educational requirements. Lastly, the legislation omitted a grandfather clause, meaning that all of Still's previous graduates and other self-proclaimed osteopaths had to enroll in the ASO or in another legally chartered osteopathic school to complete the 20-month course if they were to legally practice their system in Missouri.32 
In commenting on the language of the first section of the new Act, Henry Patterson, secretary of the ASO, explained to an osteopathic audience, “You will note that the section read does not say that Osteopathy is not Medicine and Surgery, but that it shall not be so considered within the meaning of this article requiring registration with the State Board of Health.”32(p3) Patterson then declared, “Osteopathy is both medicine and surgery,—in the broad sense of those terms. Medicine is any remedial agent, and includes surgery.”32(p3-4) Patterson's explanation provides strong evidence that the language of the second charter classifying the ASO among “reputable medical colleges” was purposeful and had real practical meaning. By the end of 1897, the Journal of Osteopathy was using the term “doctor” to refer to DOs, though the certificate at graduation continued to read “Diplomate in Osteopathy.”33 
A “School of Medicine”
Numerous newspaper and magazine articles about osteopathy drew a great many people across the country seeking treatment—the vast majority for injuries and chronic conditions.31 Still needed more instructors to deliver his expanded curriculum, and some of these new patients with academic credentials became teachers at the ASO. In October 1897, the Journal of Osteopathy published a roster of the new faculty.34 Joining Smith and S.S. Still—the founder's nephew who now taught the preliminary didactic course in anatomy—were D.M. Desmond, PhD, a physiologist who was a graduate of Harvard and the Baltimore Medical College; Chas W. Proctor, PhD, who had done postgraduate work in chemistry in Germany; Charles Hazzard, PhB, a Northwestern University graduate who lectured on histology; and A.H. Sippey, an MD as well as a graduate pharmacist who taught urinalysis. At this time, the infirmary staff included several well-known practitioners including Alice M. Patterson, DO, and Carl McConnell, DO, MD.34 As dean of the ASO, the Board of Trustees appointed C.M.T. Hulett, an osteopathic student who was a blood relative of the founders' wife.12,31,34 
In January 1898, John Martin Littlejohn, a bona fide academic and intellectual, and now also an osteopathic student, joined the ASO faculty teaching physiology and psychology.35 Littlejohn, like Smith, was a Scot. The University of Glasgow awarded him 3 degrees in succession—a master of arts, a bachelor of divinity, and a bachelor of laws. He immigrated to the United States, enrolled in Columbia University, and after completing his doctoral dissertation, obtained a PhD in political science. At the age of 29 years he was appointed president of Amity College in Iowa, where he served 4 years before resigning because of ill health. Looking for a cure, he found both it and a new calling in Kirksville.35 Soon his brothers followed him. James Buchanan Littlejohn also attended the University of Glasgow where he earned both medical and surgical degrees. He too would enroll in the ASO while simultaneously becoming professor of surgery. The youngest brother, David Littlejohn, who also attended Glasgow University, was awarded a PhD at Amity College and then an MD degree at Central Michigan where he taught sanitary science. He later enrolled as an ASO student and became a professor of public health.36 Still and his secretary, Henry Patterson—who appears to have run the school on a day to day basis—had now assembled a creditable, even distinguished group of faculty members who had the potential of making the ASO a highly reputable academic institution. 
In the latter months of 1898, C.M.T. Hulett announced he would soon be moving to Ohio to practice osteopathy and resigned as dean.37 The faculty unanimously petitioned the Board of Trustees to name J. Martin Littlejohn as his successor, which the Board did without reservation.38 Littlejohn, in the brief time he had been at the school, already had established himself not only as an able teacher, but as one who had the potential of enriching osteopathic theory and practice and the capacity to represent the profession to a skeptical learned audience. Littlejohn may have also had designs on becoming Still's successor in Kirksville. Decades ago, Mary Jane Denslow, Still's granddaughter, had informed this author that Littlejohn was an ardent but unsuccessful suitor of her mother, A.T. Still's daughter Blanche. At the time she had revealed this, the significance in regards to Littlejohn's ambitions was not immediately apparent. Whether or not this tidbit of family lore is true, Littlejohn was certainly committed to leading the school forward—but only on terms that matched his vision of what osteopathy was and what it could become. 
In addressing the graduating class in June 1898 before he became dean, Littlejohn presented a cohesive argument as to the proper definition of medicine: “It comes from medicus, medicina and medeor to heal,” he explained. “The Encyclopedic dictionary defines it as ‘a science and art directed first to the prevention of diseases, and secondly to their cure.’”39(p117) Littlejohn noted, “It has been stated that there is no science of medicine. If by medicine you mean drugs, it is correct.”39(p117) Having agreed with Still's original position, he noted “But any of you who are familiar with the great medical schools of this country and Europe know very well that drugs occupy only a small part of the educational system taught in these celebrated schools.”39(p117) Littlejohn observed that only 2 of the 17 chairs at the University of Edinburgh “deal directly with drugs, the remaining fifteen dealing with the human system in its normal and abnormal conditions.”39(p117) In short, the term medicine per se was not equivalent to the term drugging. He declared, “The science of medicine deals with the preservation and prolongation of human life and with the prevention and cure of those abnormal conditions or diseases which threaten and destroy life.”39(p117) 
Still was on the stage listening to his presentation, and in a deft move, Littlejohn turned toward him and said,
 

In the presence of the founder of Osteopathy I dare not attempt to define Osteopathy. It is sufficient to say it presumes that the body is a perfect mechanism and that when it becomes disordered, nature has within her own resourceful economy all nature's remedies. All that is needed is the magic hand of a skillful operator to bring these remedies to the aid of a diseased part.39(p117)

Having defined osteopathy in terms fully acceptable to the founder, he then stated “While true to Osteopathy, remember that you owe a debt of gratitude to ancestors who have tilled the field of anatomy and physiology…” thus, rooting osteopathy upon the history of medical science instead of characterizing it, as Still usually did, as totally distinct from and contrary to medicine.39(p117) 
In February 1899, Littlejohn, now dean, was scheduled to address the next class of graduates. The title of his presentation was “Osteopathy in Line of Apostolic Succession in Medicine.”40 Ill with a respiratory ailment, Littlejohn attended the event but was unable to talk. His speech was read by Smith, whose booming voice and theatrical flair undoubtedly enhanced Littlejohn's words. Littlejohn explicitly argued that osteopathy as was allopathy, homeopathy, and eclecticism a school of medicine, and like the other schools, graduated “physicians.” He forcefully argued, “Osteopathy claims that it is the heir of all the medical knowledge accumulated through the ages and it takes the position that the use of drugs as remedial agents is a mistake in Therapeutics.”40(p425) Using his religious training to full effect, Littlejohn (via Smith) declared,
 

For our profession then let us claim, not that we are cut off from the apostolic succession of the medical fraternity from the days of Hippocrates to this day, not that we are unchurched from the fatherhood and brotherhood of medicine, but that in lineal and legitimate descent we are the heirs of those who, as true physicians, have in every age made the claim to cure diseases, to prevent those abnormal conditions that threaten disease and death to members of our human family.40(p427)

 
Littlejohn then put his legal knowledge to good use in explaining the current position of Osteopathy with respect to the law. He noted,
 

There is a difference between a statutory privilege and a constitutional right; the former can never conflict with or override the latter. If Osteopathy is a school or system of medicine, which means that it is a method of healing, then it has a constitutional right to protection.40(p429)

But he continued, “If it is not a school of medicine then it can only claim statutory privilege where statutes exist.”40(p429) And then, Littlejohn made a prediction, which may have astonished many in the audience. He declared,
 

Medicine will ultimately be interpreted in the wider sense to include the whole art of healing and the laws upon which this practice is based, so that the Doctorate in Medicine will be the appropriate title of the Osteopath as well as the Allopath.40(p429)

 
After Smith finished reading J. Martin Littlejohn's address, the latter's brother—James—was scheduled to speak next on the program to deliver Still's prepared remarks. Still also suffered from a cold or the flu and wasn't expected to attend, but he did attend, and before James Littlejohn could deliver his talk, Still rose and unexpectedly walked to the rostrum to make some remarks. What he said extemporaneously may have startled many in the audience. Still said hoarsely,
 

After listening to Dr. Littlejohn's masterly address, I feel like saying to him and to you all what my old father said to his boys after he set us to plowing and doing other things which we came to do by degrees to his entire satisfaction. ‘Boys, you are doing mighty well—I am not sure but you are beating me at it—yes, I think you are.’41(p434)

Had Still understood Littlejohn's meaning? Had he just endorsed all that Littlejohn said? Did Still believe that “ultimately…the Doctorate in Medicine will be the appropriate title of the Osteopath as well as the Allopath”? 
Encouraged by Still's public comments at graduation, J. Martin Littlejohn presented a formal resolution at the next regular meeting of the ASO faculty in March 1899:
 

Whereas it is provided in the Charter that this College ‘shall grant and confer such honors and degrees as are usually granted and conferred by reputable medical colleges’…and whereas the title of Diplomate or Doctor in Osteopathy has never been conferred by any medical college; it is hereby resolved that the faculty recommend to the Trustees the execution of the charter power of the School by hereafter conferring the Degree of Doctor of Medicine.

Furthermore,
 

[I]n recognition of Osteopathy as an Independent School of Medicine and system of healing as it is declared in Missouri and other states that have recognized Osteopathy…that the designation and the title shall be hereafter MD (Osteopathic).42

At the next faculty meeting on April 8, the motion was considered and “it was accepted by the faculty and was ordered to be submitted to the trustees for approval with the strongest recommendation of the faculty that the Trustees authorize the proposed change in the Diploma.”43 There was no recorded vote of each faculty member, no tabulation of the total, but the phrase “strongest recommendation” of the faculty would suggest more than a simple majority. 
We have no minutes of the ASO Board of Trustees for this particular period. There is no mention of this faculty resolution or its disposition by the Board in the Journal of Osteopathy or in the local newspapers. In July 1899, Littlejohn—still serving as dean—sailed for London where he delivered a scheduled talk on osteopathy before the prestigious Royal Society of Literature.44,45 However, over the summer, a storm was brewing. In September, the Journal of Osteopathy printed an article by C.M.T. Hulett, entitled “Some Queries,” in which he launched a pointed attack on his successor as dean, although he did not identify his target.46 Hulett noted that “one undergraduate said to the writer sometime since; ‘DO does not mean anything. Our title ought to be M.D.O.’” Hulett was incredulous. “In the minds of some of us,” Hulett proclaimed, “D.O. stands for Dr. Still's work, and means just what that means.” Hulett then acidly asked—knowing full well the answer—“Where did the student get the suggestion for any other idea? Why is there such an apparently eager desire to ring the changes on ‘medicine?’”46(p141) At the end of Hulett's piece, Still wrote an endorsement. “I approve the above article…We want no M.D.O. in our school—for the American School is strictly Osteopathic—and D.O. means just what it stands for, Diplomate in Osteopathy.”47(p141) 
Littlejohn returned to Kirksville following the publication of Hulett's article and Still's endorsement of its contents. He was quickly removed as dean without any published notice appearing in the Journal of Osteopathy. Littlejohn, however, remained a faculty member and a student. In his place as dean, Still appointed Arthur Hildreth, a graduate of the first class who was then in private practice in St. Louis. Hildreth, a talented practitioner and legislative lobbyist, was an advocate for a narrow conception of the scope of osteopathy.13 Having had no collegiate education, he presented a marked contrast to the erudite Littlejohn, and his blunt, sometimes harsh language against the advocates of a broader conception of osteopathy became problematic to maintaining institutional harmony.48 Smith soon resigned from the ASO and immediately left Kirksville, and the Littlejohn brothers announced that they too would depart after they completed the requirements for their diplomas.13,49 
The 3 Littlejohn brothers would next surface in Chicago to establish their own school whose original name—the American College of Osteopathic Medicine and Surgery—reflected their conception of what should be the rightful evolution of Still's system of theory and practice.36 Indeed, by this time and certainly in the years forward, other osteopathic colleges—along with the Kirksville school—were and would continue to be central battlegrounds over the standards, scope, and identity of osteopathic practitioners and the direction of the osteopathic profession. As such, this chronicle of the history of the DO degree will turn its focus in the next article in the series to considering these institutions, as well as the national osteopathic associations that their graduates established. 
   Financial Disclosures: None reported.
 
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