Although osteopathy and chiropractic emerged as medical revitalization movements with a similar disease theory during the late 19th century, osteopathy has evolved into osteopathic medicine and surgery, and chiropractic has evolved into a musculoskeletal speciality. In this article I attempt to explain the divergent evolution of these two schools of manual medicine in the United States by considering their respective roles in addressing various structural problems in American health care, their contrasting relationships with biomedicine, organized biomedicine's stance toward the two alternative medical systems, and internal organizational conflicts within osteopathy and chiropractic. It will also show that both osteopathy and chiropractic were forced to some degree to converge with biomedicine both conceptually and therapeutically.
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