User:Dematt/ChiroHistory

This is Dematt's chirohistory sandbox.

Other Dematt Pages

• Chirohistory2
• Chirohistory2 work page
• Chiropractic Defintions

Great resources (add to the list)

Though the school ended up voting against opening a chiropractic school, the efforts did produce this report which is filled with facts and figure all of which may be useful for our article. It's over 200 pages! But it does include a detailed outline of the Chiropractic history, verifiable statistics and so much more. I've read the first 50 pages so far. Thought I'd share it with you all. -- Levine2112 20:02, 27 April 2006 (UTC)

Excellent choice! This might be a good place to list more good resources, starting with Levine2112's contribution. (I've experimented with a workable format.) -- Fyslee 21:07, 27 April 2006 (UTC)

• The Chiropractic Profession and Its Research and Education Programs. FSU, Dec. 15, 2000

-- Levine2112 20:02, 27 April 2006 (UTC)

• The Future of Chiropractic Revisited: 2005 to 2015

-- Fyslee 21:07, 27 April 2006 (UTC)

• CCP Guidelines - 2003: Vertebral Subluxation in Chiropractic Practice

-- Fyslee 21:07, 27 April 2006 (UTC)

• Chiropractic History Archive - Joseph C. Keating, Jr., Ph.D

-- Fyslee 21:07, 27 April 2006 (UTC)

• G. Douglas Andersen, DC - Articles

-- Fyslee 21:07, 27 April 2006 (UTC)

• Stephen M. Perle, D.C., M.S., lots of good stuff

-- Fyslee 21:07, 27 April 2006 (UTC)

• Dr. Perle's ethics articles

-- Fyslee 21:07, 27 April 2006 (UTC)

• Chiropractic Medicine Internet Resources

-- Fyslee 21:07, 27 April 2006 (UTC)

• Chiropractic History: a Primer (2004)

-- Fyslee 06:37, 7 May 2006 (UTC)

• History of Chiropractic: The Irish Perspective

-- Levine2112 07:52, 9 May 2006 (UTC)

• Some good chiropractic pre-history here

-- Levine2112 08:03, 9 May 2006 (UTC)

• Chiropractic Care for America's Veterans

-- Levine2112 08:12, 9 May 2006 (UTC)

• Treatment of tension headache

DD History

5/2/06

Daniel David Palmer (DD Palmer) was born near Toronto, Canada in the spring of 1845. His paternal ancestors came to this continent from England, and settled in New York State. His grandfather, Stephen Palmer, emigrated to what was then known as Canada West, now the Province of Ontario, where Daniel’s father, Thomas Palmer, was born in 1824. From all accounts, DD's father eaked out a meager existence as a shoemaker, then grocer and carried out functions as postmaster and school director for his community. When his business failed in 1856, he moved his family to Iowa, leaving 11 year old DD and his brother TJ in Canada.

In 1865 the War between the States had resulted in Canada's low wages and overrun labor markets. DD, now 20, packed his carpet bag and with his brother TJ made his way south to the states to rejoin his family. He spent the next 20 years in various occupations in teaching, raising fruit and honey, and the grocery business. All the while, the country was well into the second industrial revolution, marked by innovation, invention and creativity. Man was conquering his environment with his ever advancing machinery. At this point, Medical science was in its infancy. Allopathy, fueled by Louis Pasteur's recent refutal of the centuries old spontaneous generation theory in 1859, was growing rapidly. Drugs and medicines were making their way across the countryside claiming cures for all sorts of ailments while Vitalists mostly in the form of magnetic healers continued with their claims of quick and drugless cures. Records indicate that it was during this time that Andrew Taylor Still, MD originally expressed his principles of osteopathy in 1874. A medical doctor, Still believed that diseases were caused by mechanical interference with nerve and blood supply and were curable by manipulation of "deranged, displaced bones, nerves, muscles -- removing all obstructions -- thereby setting the machinery of life moving." His autobiography states that he could "shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck." [1]

In 1885 DD began a career as magnetic healer in Burlington, then Davenport IA on 4th floor of Ryan building at corner of Second and Brady Streets and was quite successful. His records indicate, "During this period much of that which was necessary to complete the science(chiropractic) was worked out. I had discovered that many diseases were associated with derangements of the stomach, kidneys and other organs... One question was always uppermost in my mind in my search for the cause of disease. I desired to know why one person was ailing and his associate, eating at the same table, working in the same shop, at the same bench, was not Why? What difference was there in the two persons that caused one to have pneumonia, catarrh, typhoid or rheumatism, while his partner, similarly situated, escaped? Why? This question had worried thousands for centuries and was answered in September, 1895. Harvey Lillard..."

5/4/06 Try this one;

In 1885, the country was well into the second industrial revolution, marked by innovation, invention and creativity. Health care was no exception consisting primarily of competing treatments of vitalism, herbalism, magnetism and leeches, lances and tinctures. Scientific research played only a limited role, and often no role, in the choice of treatments. Neither consumers nor practitioners had much knowledge of either the causes of, or cures for, illnesses.. Allopathy, fueled by Louis Pasteur's recent refutal of the centuries old spontaneous generation theory in 1859, was growing rapidly. Drugs and medicines were making their way across the countryside, mostly unregulated and claiming cures for all sorts of ailments. Andrew Taylor Still, an MD dismayed by the shortcomings of drugs and surgery[[20]], ventured into magnetic healing and bonesetting, opening the American School of Osteopathy(ASO) in Kirksville, Missouri in 1875.[21]] Daniel David Palmer, a teacher, grocer turned magnetc healer opened his office of magnetic healing in Davenport, IA. In 1892. On September 18, 1895, DD Palmer gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard.

Of course there is more, but what do you think so far?--Dematt 15:53, 4 May 2006 (UTC)

Osteopathy history

Andrew Still, DO

• Then with my father I doctored the Indians all fall. The erysipelas, fever, flux, pneumonia, and cholera prevailed among the Indians. The Indian's treatment for cholera was not much more ridiculous than are some of the treatments of some of the so-called scientific doctors of medicine. They dug two holes in the ground, about twenty inches apart. The patient lay stretched over the two, -- vomit in one hole and purge in the other, and die stretched over the two, thus prepared, with a blanket thrown over him. Here I witnessed cramps which go with cholera dislocate hips and turn legs out from the body. I sometimes had to force the hips back to get the corpse in the coffin. As curatives they gave teas made of black-root, ladies' thumb, sagatee, muck-quaw, chenee olachee. Thus they doctored and died, and went to Illinoywa Tapamalaqua, "the house of God."[[22]]

• I have worked from the days of a child, for more than fifty years, to obtain a more thorough knowledge of the workings of the machinery of life, to produce ease and health. And today I am, as I have been for fifty years, fully established in the belief that the artery is the father of the rivers of life, health, and ease, and its muddy or impure water is first in all disease.[[23]]

Indeed, Dr. Still is a crank, according to the most approved definition of that term, Dr. Oliver Wendell Holmes aptly describes Dr. Still in his description of a crank and the estimate often put upon him. It runs thus:

"A crank is a man who does his own thinking. I had a relation who was called a crank. 1 believe I have been spoken of as one, myself. That is what you have to expect if you invent anything that puts an old machine out of fashion, or solve a problem that has puzzled all the world up to your time. There never was a religion founded but its messiah was called a crank. There never was an idea started that woke men out of their stupid indifference but its originator was spoken of as a crank." - Over the Teacups, page 151.[24]

Osteopathy and the medical laws.

To one not familiar with the influences brought to bear upon members of a legislature, both individually and collectively, it would seem as if almost everything asked for by the osteopaths would have been willingly granted; but, on the contrary, certain conditions existed which rendered the desired legislation either difficult or impossible of attainment. Foremost among the forces very naturally arrayed against Osteopathy were the members of the medical profession, generally acting collectively and under the guise of enforcers of the law and protectors of the people against impostors. They sometimes tried to wield their influence by such flagrant misrepresentations that the result was more favorable than injurious to the cause of Osteopathy; but generally they have used more discreet measures, such as are employed by those who are adepts at securing the support of the people, by appealing to their pride or prejudice, or by pleading policy or personal interest.

For years, the medical fraternity has had almost complete control of all matters pertaining to the practice of the healing art. Had their concern always been for the public weal, the people should not object to this condition of affairs. Had they not undertaken to block advance in their art, they might have remained masters of the situation. Had they followed any fixed principle based upon eternal truth and undisputed facts, they would have enforced the respect of the scientific world, and maintained their influence with the people. As it is, all is chaos. Dr. Alexander Wilder said in the Arena for December, 1901:

"Medical legislation as a general fact is but meddling and muddling whenever it interferes. It cannot be intelligent, and there fore cannot be just. For medical men seldom agree, and none of them are experts in matters of legislation: hence, it is not possible to obtain the requisite knowledge to legislate to any right purpose. The legislators who vote for such enactments are little else than dupes of those who seek them; and unfortunately medical, men have a great pecuniary interest in disseminating exaggerated notions about infection and other matters. If there was no pecuniary interest involved, I do not believe that such legislation would be sought; and, indeed, medical men in the first class in their profession are seldom found seeking to obtain it."

Many proofs of the statements just made and the extreme measures to which they often resort, are at hand. The following resolution, unanimously passed by the Miami County Medical Society at Piqua, Ohio, March 6, 1902, will serve for illustration:

"WHEREAS, There is now pending in the Ohio Legislature a bill known as the 'Brown Bill,' to establish a board of examiners to legalize a pretended system of curing disease by rib adjustment, spine setting, bone pulling, nerve pressing, and pipe adjusting, claimed to have been discovered by H. E. Still, of Baldwin, Kansas, in 1894, known as Osteopathy,

"WHEREAS, This class of men and women are manifestly ignorant of the first principles of a medical education and totally ignorant of the nature, of disease, especially the class known as contagious diseases, which require early recognition to prevent epidemics. Be it therefore

"Resolved, That it is the sense of this Society that to legalize this class of pretenders, thereby opening the doors of the sick room to them, would be a serious menace to the health of the community by scattering diseases of this class broadcast and imposing upon the credulity of the sick. Be it further

"Resolved, That it is the consensus of opinion of this Society that the system has no foundation based on experience or good Sense, and therefore to be classed with the Indian Hoo-doo or Doweyite, or Christian Science pretenders, wholly unscientific and therefore dangerous to the commonwealth.

"Resolved, That a copy of these resolutions be forwarded to our Representative and Senator with a request that they use their influence to defeat the bill."

Comment is hardly necessary. It may justly be said that the medical profession of Miami County, Ohio, probably had as good a chance to know something about Osteopathy as any other in the United States. It was in the adjoining county that Dr. Gravett was arrested in 1900. (See Chapter V.) There a relentless war was waged against Osteopathy till the passage of the osteopathic amendment to the medical law in April, 1942. It is, therefore, unreasonable to suppose that they were wholly ignorant of what was being done by osteopaths right in their midst, or of the methods or procedures by which cures were effected. Such statements as those quoted above would excite mirth if they did not arouse the higher feeling of pity that a noble profession should be so willing to prostitute the truth. The last resolution was carried out and doubtless did Osteopathy good rather than harm by its reactionary effect.[25]]

Pictures

5/5/06

Requested to use pictures from webmaster at auccoweb@yahoo.com

Yes you may use the photos, thanks for asking and not just using. And the the reference to our site would be appreciated.

Jeannie West, webmaster

DAVID INNIS <dmi@prodigy.net> wrote: Dear webmaster, I am working on a wikipedia article on chiropractic. I am looking for pictures of DD Palmer and BJ and any others that might spruce up the article. Can I use the pictures on your site? Wiki has strict copyright rules and will be glad to reference your site. Or do you know where I might be able to get access to some?

Thanks for your quick reply! Dematt

5/6/06

DD Palmer

5/7/06

email sent to chirowebs.net

Dear Webmaster,

We are in the process of building the chiropractic page on wikipedia and are looking for pictures that depict chiropractic, especially historical and anything that helps explain the subluxation, etc. Can we get permission from you to use some pictures from your site? wikipedia has very strong copyright rules that photos are free to be used anywhere in their site. If you have some that we could use that would be great. Thanks for your consideration. Dematt

5/9/06

Hi Dematt,

Are you referring to this page: :http://en.wikipedia.org/wiki/Chiropractor

if so, then yes. I'm glad to see that the information is more more factual than previously. Yes, as long as the material continues to be presented in a fair, non-bias manner you may use and and all information from www.chiro.cc

You may also wish to see www.chiro.org for additional resources.

Thanks,

Michael

DD Discussions

5/7/06

1905 (July): The Chiropractor [1(8)] notes: -DD refers to Langworthy, Smith & Paxson’s book (p. 2): “Modernized Chiropractic” is a mixture of stretching machines, vibrators, baths, Osteopathy, Chiropractic and Napravit. -M.R. McBurney, D.O. of Allegheny PA writes (p. 9): A STUDENT’S OPINION A Practicing Osteopath Takes a Short Course - Is Well Pleased Three years ago I became interested in Chiropractic by taking a week’s adjustment of Dr. D.D. Palmer, after which I wanted to know more of the science. Therefore I have taken a short course at The Palmer School, during which I have learned much and consider myself well repaid for my time and expense. “I Find Original Investigation” I find in it the evidence of deep research and original investigation. The methods are brief, direct and decisive. The teachers of The Palmer School evidently understand the principles of Chiropractic, for they are able to demonstrate clearly to their students. A knowledge of this science enables us to see the limitation of other systems, yet each have helped to prepare the way for Chiropractic. Osteopathy, First Glimmer Osteopathy gave us the first glimmer of light, and started a revolution in the healing art. But its methods are cumbersome and more or less uncertain. The change from fetichism to a scientific study of the human body and its needs was welcomed by thousands. Chiropractic Direct and Effective If we but wished to amuse and impress our patients, then the more movements and apparatus the better. But if we desire to relieve them of sickness and disease, we will use that method which is most direct and effective; this we find in Chiropractic. A friend once said to me, “I would rather have your opinion than your argument.” The foregoing is my opinion; the demonstration of Chiropractic principles can be better applied in the clinic and adjusting room. M.R. M’Burney D.O. 1201 Boyle St., Allegheny, Pa.[26]pg23

BJ suggests uniting under chiropractic by state laws -BJ notes that A.P. Davis is in Los Angeles (p. 13) -"Our Alma Mater: Her Mission, Accomplishments, Our Duties Towards Her" by JFA Howard, notes formation of the UCA, notes graduation date of August 17, 1906 (pp. 18-20): ...it will be necessary to organize and band ourselves together in order that we shall become strong as a body of practitioners. It is in this way only that we can raise the dignity of our profession. In this manner alone will we be able to protect ourselves against the great opposition that we shall be forced to meet and overcome. The great medical trust will see to it that we do not have smooth sailing. We will have to watch closely the laws that they have been able to clothe themselves with, and learn the lesson that they have learned and do likewise. We have greater truths than they. We must see that they do not stifle our growth and progress. In unity only can we do it. The association now organized should be nourished by each and every one of the students of The P.S.C. Its motives are correct; its by-laws and scope so lenient and broad that we cannot afford to be non-members as long as we have the science of Chiropractic at heart. It assures justice and equity to all. It rests with each member to know just how far he can go in using any adjunct or aids should he think or desire to do so, which will depend entirely on the laws governing the practice of healing in his or her state. In conclusion, I will add, as “self-preservation is the first law of nature” we are complying with this law when we help to support our Alma Mater in upholding and maintaining the pure principles of our profession. We need and must have the strength of union...We must to a man be united. Disorganized we shall fail... “Brothers all.” “United we stand, divided we fall.”[27]pg32

DD discusses health habits 1908?: DD asks for job at Carver/Denny, but soon returns to Portland OR where he teaches at the Gorby-Hinkley School [mentioned in Adjustor] (Gielow, 1981, p. 119); see also Jackson, 1998 -DD mentions the “‘The Palmer-Gregory School’ and ‘The Gorby & Hinkley School’ over all of which I once presided...” (Palmer, 1910, p. 420) -DD says: ...As a rule, those who give the closest attention to the laws of right living have the poorest health. For example, look to the Chiropractors of Oklahoma City; Gorby, Gregory and Palmer eat all they want, and whenever they have a desire, of anything that will tickle their palates. The Carver-Denny School have specimens of those who are abstemious in their diet, observe and teach certain fixed rules for the promotion of health...[28]pg30 something

-DD emphasizes the impingement (rather than pinching) notion (p. 29): ...We adjust the toes for corns and bunions; there are no nerves between the articulations; therefore nerves cannot be pinched by the displacement of these joints...[29]p40

-DD says (p. 40): Ninety-five percent of all displacements which disarrange the transmission of motion and sensation will be found to exist contiguous to the exit of nerves from the spinal canal. Herein is the lock which Chiropractic has at last furnished the key. This science has found the cause of disease and by hand adjusting is able to replace articulations to their normal position, thereby freeing any tension on nerves caused by bone pressure.[30]p40

-(p. 49): ...I doubt very much that nerves are ever pinched, squeezed or compressed anywhere. Nerves cannot be impinged between any two bones, vertebrae or other joints...[31]p40

- DD Palmer mentions the "Portland College of Chiropractic" (Palmer, 1909b, p. 40) -D.D. Palmer authors “The Minnesota Naturopathic Association” (pp. 52-3): We received a mimeograph letter from the chairman of the above association, Charles E. Merritt, D.C. This letter states, “The Chiropractors of this state have a bill before the present legislature which has for its purposes not only the regulation of Chiropractic, but also of every other drugless system of healing not already regulated by law.” In Oklahoma the Chiropractors objected to the medical fraternity passing any laws which would regulate any other practice except their own, and we won out. The medical society have a right to regulate their own affairs, by law or otherwise; but they have no moral right and we prevented them having a legal right to regulate any other practice except their own. We had no objection to their regulating themselves, but they had no right to regulate the other fellow. The Oklahoma Medical Bill now consists of two sections, one of medicine, the other of surgery. That allows all other methods the right to practice and the “dear people” the right to choose the practitioner of their choice. The right we claimed in Oklahoma and now in Oregon, is the right to regulate our own practice and none other. Our objection to the above paragraph of the bill is that “The Chiropractors of Minnesota desire to “regulate every other drugless system of healing not already regulated by law.” How much of that which is protected by law, would also, if loose, be enclosed in their bill can be conjectured. This Chiropractic Bill is for the purpose of regulating “Hydropathy, the Kneipp system, Medical Electricity,Scientific Massage, Swedish Movements, Chiropractice, Chromopathy, Suggestive or Psycho-Therapy, Magneto-Therapy and Mental Science” and every drugless system not nailed fast by the medical men. I observe that there are three drugless systems not enumerated in the above, viz.: Massage that is not scientific, Christian Science and Chiropractic. Chiropractors should not try to regulate other systems, they have enough to do to tend their own affairs. “It was, therefore, considered policy to make common cause with the other natural healers.” Chiropractic should not be classed as one of the healing systems; for it has nothing in common with any other system; it is not therapeutical, they do not use remedies, they neither treat nor cure. It may have been considered a skillful movement, cunning management, policy to take everything in sight, that was not locked up by the medical men. “Our success is practically assured, and the success of our bill means the future success of similar bills in other states.” This is the third bill that was an assured success. The other two were killed by the Palmers and were I (D.D.) near enough, I would look after the present one. The Chiropractors of Oregon do not want such a bill. A Chiropractic bill in Oklahoma, that was full of graft, was killed through the influence of D.D. Palmer. “The bill provides in substance that all those who have practiced at least one year previous to its passage, should be licensed without passing an examination before the Board of Naturopathic Examiners.” This is contemptible, mean. For those who are now, and have been in practice one year, regardless of their qualifications, to be exempt from the requirements they lay down for others. Such unjust measures make me long to be again in St. Paul to talk to the legislators and the Governor. “Now, Doctor, remember, we are fighting your battle as well as ours.” Mixing Chiropractic with every conceivable method and remedy, merging it into the depths of superstition, is the very thing I have been fighting against. [32]p43

1911 (May 4): letter to P.W. Johnson, D.C. from DD Palmer, deals with religion, notes he’s not been teaching or practicing since leaving Portland (Palmer College Archives): D. D. PALMER SCHOOL OF CHIROPRACTIC PERSONALLY CONDUCTED BY THE ONE WHO DISCOVERED THE BASIC PRINCIPLE OF CHIROPRACTIC, DEVELOPED ITS PHILOSOPHY, ORIGINATED AND FOUNDED THE SCIENCE AND ART OF CORRECTING ABNORMAL FUNCTIONS BY HAND-ADJUSTING, USING THE VERTEBRAL PROCESSES AS LEVERS. D.D. PALMER gave CHIROPRACTIC to the WORLD. ___________________ Santa Barbara, Cal., May 4, 1911. P.W. Johnson, D.C.; Yours of April 26th at hand. It contains an interesting and financial question, one which I think Old Dad hold the key of. Stop right now and read two sections in this enclosed circular, on pages 2 and 8 marked, and see if you cannot grasp the way out, that which I see that we are coming to. I want you to study those two items marked. The same ideas are in my book, altho not put out quite so plain as found in these two sections. I occupy in chiropractic a similar position as did Mrs. Eddy in Christian Science. Mrs. Eddy claimed to receive her ideas from the other world and so do I. She founded theron a religion, so may I. I am THE ONLY ONE IN CHIROPRACTIC WHO CAN DO SO. Ye, Old Dad always has something new to give to his followers. I have much new written for another edition, when this one is sold. It is STRANGE TO ME WHY EVERY CHIROPRACTOR DOES NOT WANT A COPY OF MY BOOK. You write as tho you did not know of my change of location. I lived in this city nine years ago and have always had a hankering for its climate, fruits and flowers. I can edit, publish and place my book on the market as well here as elsewhere. I have not been teaching or practicing since leaving Portland, but have today placed an add in the city paper, of which I am sending you a copy, and will instruct by book or in person as the way opens. I have been and continue to watch your rights with "The American Octopus". I want you to STUDY the religious move. California has an organization with Miss Michelson as our attorney. Please drop me a few lines as soon as your trial is over, so that I may know how matters proceed. You ask, what I think will be the final outcome of our law getting. It will be that we will have to build a boat similar to Christian Science and hoist a religious flag. I have received chiropractic from the other world, similar as did Mrs. Eddy. No other one has lad claim to that, NOT EVEN B.J. Exemption clauses instead of chiro laws by all means, and LET THAT EXEMPTION BE THE RIGHT TO PRACTICE OUR RELIGION. But we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and other who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase. Now, if chiropractors desire to claim me as their head, their leader, the way is clear. My writings have been gradually steering in that direction until now it is time to assume that we have the same right to as has Christian Scientists. Oregon is free to Chiropractors. California gives Chiropractors only one chance, that of practicing our religion. The protective policy of the U.C.A. is O.K., but that of religion is far better. The latter can only be assumed by having a leader, a head, a person who has received chiropractic as a science, as an art, as a philosophy and as a religion. Do you catch on? The policy of the U.C.A. is the best that B.J. can be at the head of, BUT THE RELIGIOUS MOVE IS FAR BETTER, but we must incorporate under the man who received the principles of chiropractic from the other world, who wrote the book of all chiropractic books, who today has much new matter, valuable, which is not contained in that book. If you will watch my book closely as you read, you will find it has a religion contained in it, altho I do not so name it. If either of the Davenport schools would take advantage of practicing our religion founded by D.D. Palmer, it will make the way of chiropractic as easy as it was for the S.C.'s. I have given you some special hints on the question which is uppermost in your mind, will you please give it consideration -- never mind if it is new. Truly, (Signed) D.D. Palmer.[33]pg46

Definition of Koch's postulates

Koch's postulates: In 1890 the German physician and bacteriologist Robert Koch set out his celebrated criteria for judging whether a given bacteria is the cause of a given disease. Koch's criteria brought some much-needed scientific clarity to what was then a very confused field.

Koch's postulates are as follows:[34]

The bacteria must be present in every case of the disease. The bacteria must be isolated from the host with the disease and grown in pure culture. The specific disease must be reproduced when a pure culture of the bacteria is inoculated into a healthy susceptible host. The bacteria must be recoverable from the experimentally infected host. However, Koch's postulates have their limitations and so may not always be the last word. They may not hold if:

The particular bacteria (such as the one that causes leprosy) cannot be "grown in pure culture" in the laboratory. There is no animal model of infection with that particular bacteria. A harmless bacteria may cause disease if:

It has acquired extra virulence factors making it pathogenic. It gains access to deep tissues via trauma, surgery, an IV line, etc. It infects an immunocompromised patient. Not all people infected by a bacteria may develop disease-subclinical infection is usually more common than clinically obvious infection. Despite such limitations, Koch's postulates are still a useful benchmark in judging whether there is a cause-and-effect relationship between a bacteria (or any other type of microorganism) and a clinical disease. [35]

Chiro history primer

Excerpts from:

Chiropractic History: a Primer

Below is found this key phrase:

"...most chiropractors have carried forward these etiological ideas." :

The Palmers are both considered "segmentalists," in that they held to a view which suggested that individual joints of the spine subluxate independently of one another. Indeed, D.D. insisted that he only adjusted a single joint in a patient at any given treatment session. This segmental orientation is epitomized by the "Meric" charts that relate individual spinal segments to specific organs of the body. Old Dad Chiro posited that there were three causes of subluxations: toxins, physical trauma and auto-suggestion; most chiropractors have carried forward these etiological ideas. B.J. Palmer later claimed that the NCM he marketed to the profession was the only valid means of identifying these subluxated spinal joints. In the mid-1930s he further proposed that the only adjustment-worthy subluxations occurred in the upper cervical spine, and heavily promoted his "Hole-In-One" (HIO) method of upper cervical adjusting. At this point, although B.J. was still fundamentally a segmentalist, the NCM and its derivative, the neurocalograph (an NCM with a kymographic strip chart) were used to monitor patterns of subluxations before and after HIO interventions.

Regarding research and subluxation:

Chiropractic research to date has helped to establish the benefit of SMT for a limited number of musculoskeletal ("Type M") problems, most especially low back pain (Bronfort 1999) and, to a lesser extent, headaches and neck disorders (Coulter et al. 1996). However, the mechanism(s) of this benefit remain uncertain (Haldeman 2000), as do the etiologies of these conditions. The scientific literature bearing on the possible benefit of manipulation for a broader range of health problems (termed "Type O" for organic or visceral diseases) remains very limited, although not completely unexplored (Budgell 1999; Masarsky and Todres-Masarsky 2001). The scientific data base has also facilitated efforts to establish guidelines for clinical practice and for encouraging greater quality in the clinical services rendered by chiropractors (Haldeman et al. 1993; Henderson et al. 1994; Vear 1992).

A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. Chiropractors' tendency to assert the meaningfulness of various theories and methods as a counterpoint to allopathic charges of quackery has created a defensiveness which can make critical examination of chiropractic concepts difficult (Keating and Mootz 1989). One example of this conundrum is the continuing controversy about the presumptive target of DCs' adjustive interventions: subluxation (Gatterman 1995; Leach 1994). While some in the profession question the meaningfulness of the traditional chiropractic lesion (e.g., Nelson 1997), others proclaim its significance routinely in marketing materials distributed to the public (Grod et al. 2001).

The following four points could be used in the beginning of the article:

Contemporary Expressions of the Chiropractic Paradigm

Various authors have summarized a core chiropractic paradigm that includes the following:

1. The body is a self-regulating and self-healing organism.

2. The nervous system is the master system that regulates and controls all other organs and tissues and relates the individual to his/her environment.

3. Spinal biomechanical dysfunction in the form of vertebral subluxation complex may adversely affect the nervous system's ability to regulate function.

4. The central focus of the doctor of chiropractic is to correct, manage or minimize vertebral subluxation through the chiropractic spinal adjustment.

For many chiropractors, these four points constitute the foundation of traditional chiropractic, but also reflect elements compatible with broad-scope perspective that expands beyond these concepts in terms of scope of practice and patient assessment. Moreover, these elements convey this essence without metaphysical terminology. Chiropractors comfortable with the term innate intelligence will recognize this in the first component. Likewise, those chiropractors who prefer to think of self-regulation and healing in terms of homeostasis and normal physiological function are accommodated. Notably, the relationship between structure and function as mediated by the nervous system is given prominence here. This is the essence, the distinctive feature, of chiropractic thought and practice.

Chiropractic History: a Primer

-- Fyslee 07:17, 7 May 2006 (UTC)

Thank you. Coming from a mixer POV that did not graduate from a Palmer affiliated school, the four points above are the crux of my mindset. That was what I was eluding to with stats about subluxation vs VSC. Everyone should be able to agree on these, however, that does not mean they will.

When I describe subluxation to a patient(and I may or may not use the word) or a survey comes out and asks me if I believe the subluxation plays a role in all diseases, that is what I am thinking. It doesn't mean (to me), that a pinched nerve is the cause of all disease(as it might to others), but when the body has lost the ability to heal itself, improving nervous system function certainly can't hurt and just might help. That means it is playing a role. I assume that is why the stats look so strange to you. You're thinking subluxation is one thing, while chiros are answering to another. The wording makes it impossible to tell. It would be interesting to conduct a survey with 20 different defintions of subluxation and then see who believes what.

Also, note that you used the phrase vertebral subluxation complex. To chiros that signals more that just the classic Palmer subluxation. That was the response to the realization that the classic subluxation was elusive and, guess what, not every deaf person's hearing came back. It was time to define subluxation in more rational terms. That was not easy. Could you imagine trying to tell DD.. Sorry, you got me rambling again.--Dematt 12:42, 7 May 2006 (UTC)

chiro lead

Chiropractic, or chiropractic care, is a complementary and alternative medicine health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal manipulations termed adjustments. There is little scientific evidence as to the effectiveness of the treatments for anything other than back pain and impaired spinal motion.

Chiropractors’ ingenuity in devising assessment and adjusting strategies has been phenomenal, and today dozens of brand-name and “generic” techniques (see Table 7) are taught at chiropractic schools (e.g., Gleberzon 2002) and practiced within the profession (Bergman et al. 1993). Clear favorites are apparent (National 2000), but none has yet received the scientific investigation that can justify claims for effectiveness or superiority. However, a specific procedure, side-posture lumbar manipulation, has enjoyed considerable success in clinical trials for patients with low back pain and is highly regarded by expert reviewers (Cooperstein et al., 2001;Gatterman et al., 2001).[36]see page 29.--Dematt 14:07, 11 May 2006 (UTC)

Not bad. I think we'd need to paraphrase it (copyright considerations; we'd have to include their references as ours, and "yet" is a violation of Wikipedia is not a crystal ball (and slightly misleading — some modalities have been shown ineffective)), but an excellent choice of a starting point. — Arthur Rubin | (talk) 14:24, 11 May 2006 (UTC)

Excellent reference! It could be summed up in this way:

While there is no satisfactory evidence for claims for effectiveness made for many chiropractic procedures, there is evidence that one of the most used procedures -- side-posture lumbar manipulation -- is effective for lower back pain.

That may be a bit clumsy, but I have to run now. -- Fyslee 15:00, 11 May 2006 (UTC)

What about this;

Chiropractic, or chiropractic care, is a complementary and alternative medicine health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. It emphasizes the bodies own natural ability to heal itself and works to remove obstructions to this process, principally the chiropractic subluxation. There is an emphasis on manual treatments including spinal manipulations termed adjustments. While there is no satisfactory evidence for claims for effectiveness made for many chiropractic procedures, there is evidence that one of the most used procedures -- side-posture lumbar manipulation -- is effective for lower back pain.

It does seem to flow better. We still need to add info related to what ends up being in the article, but first we need to finish the article.--Dematt 19:12, 11 May 2006 (UTC)

where we are on 6/5/06

Chiropractic is a complementary and alternative health care profession which aims to diagnose, treat, and prevent mechanical disorders of the musculoskeletal system and their effects on the nervous system and general health. Chiropractic practice is based around the theory that subluxations of the spine interfere with the body's self-regulating mechanisms. Despite inconclusive evidence, 75% to 90% of practicing chiropractors believe that adjusting subluxations will eliminate an obstruction to healing and help many disorders including low back pain, asthma, carpal tunnel syndrome, painful menstrual periods, migraine and menopausal symptoms. Chiropractic care emphasizes passive manual treatments such as spinal adjustments and manipulation of the extremities.

History

In 1885 the world was well into the second industrial revolution, marked by innovation and creativity. Health care was no exception consisting of competing treatments including scientific medicine, vitalism, herbalism, magnetism and leeches, lances, tinctures and patent medicines. Neither consumers nor many practitioners had much knowledge of either the causes of, or cures for, illnesses. Allopathy, fueled by Louis Pasteur's refutal of the centuries old spontaneous generation theory in 1859, was growing rapidly. German bacteriologist, Robert Koch formulated his postulates bringing some much-needed scientific clarity to what was then a very confused field.[37] Drugs, medicines and quack cures were becoming more prevalent and were mostly unregulated. MD Andrew Taylor Still [38], ventured into magnetic healing (meaning hypnotism then) and bonesetting in 1875. He opened the American School of Osteopathy (ASO) in Kirksville, Missouri in 1892.[39] Daniel David Palmer (DD Palmer), a teacher, grocer turned magnetic healer opened his office of magnetic healing in Davenport, Iowa in 1886. After nine successful years, DD Palmer gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard, on September 18,1895.

Conflicting accounts of the first Chiropractic adjustment

Palmer and his patient Harvey Lillard gave differing accounts of when and how Palmer began to experiment with spinal manipulation. Palmer recalled an incident in 1895 when he was investigating the medical history of a deaf janitor, Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years earlier, he felt a 'pop' in his back, and had been nearly deaf ever since. Palmer’s examination found a sore lump which indicated spinal misalignment and a possible cause of Lillard's deafness. Palmer corrected the misalignment, and Lillard could then hear the wheels of the horse-drawn carts in the street below. Palmer said there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude" about this adjustment; it was specific so much so that no chiropractor has equalled it.[40]

Palmer's version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and, Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make [something of] it, then they both would share. But, it didn't happen."

Early Developement

DD Palmer asked a patient and friend, Rev. Samuel Weed, to help him name his discovery. He suggested combining the words cheiros and praktikos (meaning "done by hand") to describe Palmer's treatment method, creating the term chiropractic. In 1896, DD added a school to his magnetic healing infirmary and began to teach others his method. It would be become known as Palmer School of Chiropractic (now Palmer College of Chiropractic). Among the first graduates were Andrew P. Davis MD,DO, William A. Seally,MD, BJ Palmer (DD's son), Solon M. Langworthy, John Howard, and Shegataro Morikubo.

Langworthy would move to Cedar Rapids, Iowa and open the second chiropractic school in 1903, the American School of Chiropractic & Nature Cure combining it with naturapathy cures and Osteopathy. DD Palmer, who disliked the mixing of chiropractic with other cures, turned down an offer to be a partner. The two schools of thought mark the beginning the feud between those who mixed chiropractic with other methods and those who practiced straight chiropractic in its pure form.

Changing Political Environment

The early 19th century had seen the rise of patent medicine and the nostrum trade. Though some remedies were marketed through doctors of medicine, most were sold directly to consumers by lay people with the use of questionable advertising claims. The addictive and sometimes toxic effects of some remedies, especially morphine and mercury based folk cures, prompted the early laws that defined the practice of medicine. In the mid 1800's, as the germ theory began to take hold, medicine began to embrace the scientific method as a way to battle disease. In 1847, the American Medical Association formed to establish standards for the preliminary medical education and for the degree of MD. In 1849 a board was established to analyze quack remedies and nostrums and to enlighten the public in regard to the nature and danger of such remedies. Relationships were developed with pharmaceutical companies in an effort to curb the patent medicine crisis and consolidate the patient base around the medical doctor. In 1901, the AMA had re-organized as the national organization of state and local associations and by 1910, the AMA was a powerful national force. This was the beginning of organized medicine.[41].

In 1913 the AMA established a "Propaganda Department" to gather and disseminate information concerning health fraud and quackery In 1905, AMA establishes Council on Pharmacy and Chemistry to set standards for drug manufacturing and advertising and fight the war on quack patent medicines and nostrum trade,1925,AMA Propaganda Department becomes Bureau of Investigationalong the AMA and organized medicine were creating laws.

DD would get in trouble with the law! He was a bad boy:) Then he gave up the school to BJ. He was probably out of money, but we can't prove that! Anyway, that would start the battle.. BJ Palmer would take over Palmer College of Chiropractic and Howard would open National School of Chiropractic in 1906 (now National University of Health Sciences in Chicago)with DD's blessings. [42].[43](pg15) The next 15 years would see the opening of 30 more chiropractic schools, including Chiropractic would face several obstacles to its growth in the coming years that would both divide and unify its members.

Out of fear of prosecution, BJ and friends started the UCA.

BJ in an effort to keep control of the profession, created the NCM and leased it to chiros.

He tried to keep chiro pure and cleaned house of mixers.

Organized medicine adds pressure to educate and pass laws.

DD wants to go the religious route.

Mixers create the ACA.

ACA worked to improve education and practice laws.

BJ gets kicked out of UCA and starts CHB.

ACA and UCA join to form ACA-UCA and then NCA.

Shegato Morikubo is successfully defended by NCA for practicing medicine without a license.

Education standards are improved. State laws are passed.

Soon after, DD turned over his rights to Palmer School of Chiropractic to BJ Palmer and his wife.

In an effort to promote his discovery and advertise for patients and students, DD Palmer began producing a periodical, "The Chiropractor". It was often filled with claims of cures and testimonials of patients. He touted his method of cure without the use of medicine. In 1906 DD was arrested for practicing medicine without a license.

Palmer said he "received chiropractic from the other world" during a seance, from a deceased physician named Dr. Jim Atkinson.

He regarded chiropractic as partly religious in nature, and in a letter of May 4, 1911 he said: "we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and other who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase."

After being repealed early in the 19th century, medical statutes were reintroduced in Iowa in 1886. Keating et al writing for the Association for the History of Chiropractic said D.D. Palmer

"introduced the concept of Innate Intelligence circa 1904. Innate, he believed, was an intelligent entity which directed all the functions of the body, and used the nervous system to exert its influence. (Donahue 1986, 1987)."

Palmer’s son B. J. Palmer initiated research, development and promotion of chiropractic.

DD Palmer's effort to find a single cause for all disease led him to say:

A subluxated vertebra . . . is the cause of 95 percent of all diseases. . . . The other five percent is caused by displaced joints other than those of the vertebral column. (From: Palmer D.D. The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.)

Wilk et al. vs The American Medical Association

Before 1980, Principle 3 of the American Medical Association Principles of Medical Ethics stated: "A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally associate with anyone who violates this principle." Until 1983, the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner," and labeled chiropractic "an unscientific cult."

As a result of this policy, an antitrust suit was brought against the AMA and other medical associations in 1976 - Wilk et al v. American Medical Association et al - by Wilk and other chiropractors. The landmark lawsuit ended in 1987 when the Federal Appeals Court found the AMA guilty of conspiracy and restraint of trade; the Joint Council on Accreditation of Hospitals and the American College of Physicians were exonerated. The court recognized that the AMA had to show its concern for patients, but was not persuaded that this objective could not have been satisfied in a manner less restrictive of competition, for instance by public education campaigns. The AMA then lost its appeal to the Supreme Court and had to allow its members to collaborate with chiropractors. ^{PDF of key transcripts}

The judge in the Wilk case said that the AMA had covered up research on the effectiveness of chiropractic for back pain. She then said that chiropractors clearly wanted "a judicial pronouncement that chiropractic is a valid. efficacious, even scientific health care service." She said no "well designed, controlled, scientific study" had been done, and concluded "I decline to pronounce chiropractic valid or invalid on anecdotal evidence." ^{PDF of key transcripts}

DD BJ Controversy

Among the students at the Palmer School in Davenport, Iowa as 1906 dawned were several who would leave a profound mark upon the profession, including John F.A. Howard and Shegataro Morikubo. Later in the year, Dr. Howard, the ink barely dry on his PSC diploma (dated 17 August 1906), consented to a request from several Palmer students who, dissatisfied with the new president of the school, B.J. Palmer, DC, asked Howard to establish another chiropractic college in the profession's home city. Late in the year, with the explicit approval of "Old Dad Chiro,"1 Howard founded the National School of Chiropractic.3 The new institution's first home was the same building in which D.D. Palmer had adjusted Harvey Lillard a decade earlier.[44]

The relationship between Old Dad Chiro and his son, B.J., had never been good, and the stress of the legal ordeal soured it further. On the basis of binding arbitration mediated by Joseph Schillig, DC, and R.H. St. Onge,7 the founder relinquished all interest in the PSC, except for several books and part of the school's osteological collection, for the sum of $2,196.79. He and his new bride promptly boarded a train for Medford, Okla., where his brother, Thomas J. Palmer, a newspaper publisher, would assist him in establishing a grocery store. It was indeed a bitter outcome for the father of chiropractic, and his resentment against his son would smolder for years.

Although he had not been the first to be jailed for practicing chiropractic,15 the founder's legal ordeal must have left a profound impression on the son, alumni and students of the PSC. In August 1906, during the annual homecoming of the PSC, a protective legal society was established, the Universal Chiropractors' Association (UCA). Founded by Drs. B.J. Palmer, Ernest Erz, Shegataro Morikubo, Hod Norton, T.J. Owens and a dozen others,17,20 the new organization involved membership dues paid to a central treasury, from which the costs of legal services would be paid when a chiropractor faced charges for unlicensed practice.15 The UCA (forerunner of today's American Chiropractic Association) subsequently expanded its services to include legal defense in civil/malpractice suits, sponsorship of a professional journal,8 educational seminars and annual conventions held in conjunction with the PSC's homecomings.

The UCA was not the first attempt to establish a national membership society,8 credit for which apparently belongs to the chiropractors of Minnesota and Solon M. Langworthy, DC, president of the ASC&NC. However, the UCA was the more enduring alliance and in 1930 would spawn the National Chiropractic Association (immediate predecessor of today's ACA). The new association's first major legal victory came in 1907, when Shegataro Morikubo, DC, was successfully defended against charges of unlicensed practice in LaCrosse, Wisc.12

A singular year in the history of chiropractic, 1906, saw the courtroom defeat of the founder, the spread of his healing art and of chiropractic education, and the creation of a lasting component of the profession's infrastructure. It is a time to remember and merits further scrutiny. .[45]

Subluxation

from ICA web site

SPINAL ADJUSTMENT AND SPINAL MANIPULATION

The ICA holds that the chiropractic spinal adjustment is unique and singular to the chiropractic profession. The chiropractic adjustment shall be defined as a specific directional thrust that sets a vertebra into motion with the intent to improve or correct vertebral malposition or to improve it juxtaposition segmentally in relationship to its articular mates thus reducing or correcting the neuroforaminal/neural canal encroachment factors inherent in the chiropractic vertebral subluxation complex.

The adjustment is characterized by a specific thrust applied to the vertebra utilizing parts of the vertebra and contiguous structures as levers to directionally correct articular malposition. Adjustment shall be differentiated from spinal manipulation in that the adjustment can only be applied to a vertebral malposition with the express intent to improve or correct the subluxation, whereas any joint, subluxated or not, may be manipulated to mobilize the joint or to put the joint through its range of motion.

Chiropractic is a specialized field in the healing arts, and by prior rights, the spinal adjustment is distinct and singular to the chiropractic profession.

Straight v Mixer

1906 UCA created after DD convicted to protect chiros.[46]pg1-2

1922 ACA created in response to harsh treatment by UCA and BJ.[47]pg4

History

In 1885 the world was well into the second industrial revolution, marked by innovation and creativity. Health care was no exception consisting of competing treatments including scientific medicine, vitalism, herbalism, magnetism and leeches, lances, tinctures and patent medicines. Neither consumers nor many practitioners had much knowledge of either the causes of, or cures for, illnesses. Allopathy, fueled by Louis Pasteur's refutal of the centuries old spontaneous generation theory in 1859, was growing rapidly. German bacteriologist, Robert Koch formulated his postulates bringing some much-needed scientific clarity to what was then a very confused field.[48] Drugs, medicines and quack cures were becoming more prevalent and were mostly unregulated. MD Andrew Taylor Still [49], ventured into magnetic healing (meaning hypnotism then) and bonesetting in 1875. He opened the American School of Osteopathy (ASO) in Kirksville, Missouri in 1892.[50] Daniel David Palmer (DD Palmer), a teacher, grocer turned magnetic healer opened his office of magnetic healing in Davenport, Iowa in 1886. After nine successful years, DD Palmer gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard, on September 18,1895.

Conflicting accounts of the first Chiropractic adjustment

Harvey Lillard 1906

Palmer and his patient Harvey Lillard gave differing accounts of when and how Palmer began to experiment with spinal manipulation. Palmer recalled an incident in 1895 when he was investigating the medical history of a deaf janitor, Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years earlier, he felt a 'pop' in his back, and had been nearly deaf ever since. Palmer’s examination found a sore lump which indicated spinal misalignment and a possible cause of Lillard's deafness. Palmer corrected the misalignment, and Lillard could then hear the wheels of the horse-drawn carts in the street below. Palmer said there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude" about this adjustment; it was specific so much so that no chiropractor has equalled it.[51]

Palmer's version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and, Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make [something of] it, then they both would share. But, it didn't happen."

Early Growth of Schools

Following the case of Harvey Lillard, Palmer encountered a case of heart trouble. He examined the spine and found a misalignment in the area where the nerves supply the heart. After improvement in that case as well, he states, "Then I began to reason if two diseases, so dissimilar as deafness and heart trouble, came from impingement, a pressure on nerves, were not other disease due to a similar cause. Thus the science (knowledge) and art (adjusting) of Chiropractic were formed at that time".

DD Palmer asked a patient and friend, Rev. Samuel Weed, to help him name his discovery. He suggested combining the words cheiros and praktikos (meaning "done by hand") to describe Palmer's treatment method, creating the term chiropractic. In 1896, DD added a school to his magnetic healing infirmary and began to teach others his method. It would be become known as Palmer School of Chiropractic (now Palmer College of Chiropractic). Among the first graduates were Andrew P. Davis MD,DO, William A. Seally,MD, BJ Palmer (DD's son), Solon M. Langworthy, John Howard, and Shegataro Morikubo.

Langworthy would move to Cedar Rapids, Iowa and open the second chiropractic school in 1903, the American School of Chiropractic & Nature Cure combining it with naturapathy cures and Osteopathy. DD Palmer, who disliked the mixing of chiropractic with other cures, turned down an offer to be a partner. The two schools would mark the beginning of a feud between those who mixed chiropractic with other methods and those who practiced straight chiropractic in its pure form.

In a controversial move, DD Palmer would abruptly turn the the Palmer School over to BJ Palmer. DD would move on to open several schools in several states, but would never again return to PSC. At the request of some of Palmer's students and with DD's blessing, John Howard would open National School of Chiropractic in 1906 (now National University of Health Sciences in Chicago) across the street from the Palmer School of Chiropractic.[52].[53] The next 15 years would see the opening of no less than 30 additional chiropractic schools, each attempting to develop its own identity while BJ Palmer continued to develop his father's discovery. Chiropractic was to face several obstacles in the coming years that would both divide and unify its members.

Changing Political Environment

The early 19th century had seen the rise of patent medicine and the nostrum trade. Though some remedies were marketed through doctors of medicine, most were sold directly to consumers by lay people with the use of questionable advertising claims. The addictive and sometimes toxic effects of some remedies, especially morphine and mercury based folk cures, prompted the early laws that defined the practice of medicine. In the mid 1800's, as the germ theory began to take hold, medicine began to embrace the scientific method as a way to battle disease. In 1847, the American Medical Association formed to establish standards for the preliminary medical education and for the degree of MD. In 1849 a board was established to analyze quack remedies and nostrums and to enlighten the public in regard to the nature and danger of such remedies. Relationships were developed with pharmaceutical companies in an effort to curb the patent medicine crisis and consolidate the patient base around the medical doctor. In 1901, the AMA had re-organized as the national organization of state and local associations and by 1910, the AMA was a powerful national force. This was the beginning of organized medicine.[54].

Palmer said he "received chiropractic from the other world" during a seance, from a deceased physician named Dr. Jim Atkinson.

He regarded chiropractic as partly religious in nature, and in a letter of May 4, 1911 he said: "we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and other who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase."

Keating et al writing for the Association for the History of Chiropractic said D.D. Palmer

"introduced the concept of Innate Intelligence circa 1904. Innate, he believed, was an intelligent entity which directed all the functions of the body, and used the nervous system to exert its influence. (Donahue 1986, 1987)."

Palmer’s son B. J. Palmer initiated research, development and promotion of chiropractic.

DD Palmer's effort to find a single cause for all disease led him to say:

A subluxated vertebra . . . is the cause of 95 percent of all diseases. . . . The other five percent is caused by displaced joints other than those of the vertebral column. (From: Palmer D.D. The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.)

The term chiropractic originated when Palmer asked a patient - Rev. Samuel Weed - to come up with a name from the Greek language to describe his practice. Weed suggested combining the words chiros and praktikos (meaning "done by hand") to describe the adjustment of a vertebra in the spinal column.

Wilk et al. vs The American Medical Association

Before 1980, Principle 3 of the American Medical Association Principles of Medical Ethics stated: "A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally associate with anyone who violates this principle." Until 1983, the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner," and labeled chiropractic "an unscientific cult."

As a result of this policy, an antitrust suit was brought against the AMA and other medical associations in 1976 - Wilk et al v. American Medical Association et al - by Wilk and other chiropractors. The landmark lawsuit ended in 1987 when the Federal Appeals Court found the AMA guilty of conspiracy and restraint of trade; the Joint Council on Accreditation of Hospitals and the American College of Physicians were exonerated. The court recognized that the AMA had to show its concern for patients, but was not persuaded that this objective could not have been satisfied in a manner less restrictive of competition, for instance by public education campaigns. The AMA then lost its appeal to the Supreme Court and had to allow its members to collaborate with chiropractors. ^{PDF of key transcripts}

The judge in the Wilk case said that the AMA had covered up research on the effectiveness of chiropractic for back pain. She then said that chiropractors clearly wanted "a judicial pronouncement that chiropractic is a valid. efficacious, even scientific health care service." She said no "well designed, controlled, scientific study" had been done, and concluded "I decline to pronounce chiropractic valid or invalid on anecdotal evidence." ^{PDF of key transcripts}

History

In 1885 the world was well into the second industrial revolution, marked by innovation and creativity. Health care was no exception consisting of competing treatments including scientific medicine, vitalism, herbalism, magnetism and leeches, lances, tinctures and patent medicines. Neither consumers nor many practitioners had much knowledge of either the causes of, or cures for, illnesses. Allopathy, fueled by Louis Pasteur's refutal of the centuries old spontaneous generation theory in 1859, was growing rapidly. German bacteriologist, Robert Koch formulated his postulates bringing some much-needed scientific clarity to what was then a very confused field.[55] Drugs, medicines and quack cures were becoming more prevalent and were mostly unregulated. MD Andrew Taylor Still [56], ventured into magnetic healing (meaning hypnotism then) and bonesetting in 1875. He opened the American School of Osteopathy (ASO) in Kirksville, Missouri in 1892.[57] Daniel David Palmer (DD Palmer), a teacher, grocer turned magnetic healer opened his office of magnetic healing in Davenport, Iowa in 1886. After nine successful years, DD Palmer gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard, on September 18,1895.

Conflicting accounts of the first Chiropractic adjustment

Harvey Lillard 1906

Palmer and his patient Harvey Lillard gave differing accounts of when and how Palmer began to experiment with spinal manipulation. Palmer recalled an incident in 1895 when he was investigating the medical history of a deaf janitor, Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years earlier, he felt a 'pop' in his back, and had been nearly deaf ever since. Palmer’s examination found a sore lump which indicated spinal misalignment and a possible cause of Lillard's deafness. Palmer corrected the misalignment, and Lillard could then hear the wheels of the horse-drawn carts in the street below. Palmer said there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude" about this adjustment; it was specific so much so that no chiropractor has equalled it.[58]

Palmer's version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and, Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make [something of] it, then they both would share. But, it didn't happen."

Early growth

Following the case of Harvey Lillard, Palmer stated: "I had a case of heart trouble which was not improving. I examined the spine and found a displaced vertebra pressing against the nerves which innervate the heart. I adjusted the vertebra and gave immediate relief -- nothing "accidental" or "crude" about this. Then I began to reason if two diseases, so dissimilar as deafness and heart trouble, came from impingement, a pressure on nerves, were not other disease due to a similar cause? Thus the science (knowledge) and art (adjusting) of Chiropractic were formed at that time."

Rev. Samual Weed

DD Palmer asked a patient and friend, Rev. Samuel Weed, to help him name his discovery. He suggested combining the words cheiros and praktikos (meaning "done by hand") to describe Palmer's treatment method, creating the term chiropractic. In 1896, DD added a school to his magnetic healing infirmary and began to teach others his method. It would be become known as Palmer School of Chiropractic (now Palmer College of Chiropractic). Among the first graduates were Andrew P. Davis MD,DO, William A. Seally,MD, BJ Palmer (DD's son), Solon M. Langworthy, John Howard, and Shegataro Morikubo.

Langworthy would move to Cedar Rapids, Iowa and open the second chiropractic school in 1903, the American School of Chiropractic & Nature Cure (ASC & NC) combining it with naturapathy cures and Osteopathy. DD Palmer, who disliked the mixing of chiropractic with other cures, turned down an offer to be a partner.

In a controversial move, DD Palmer would abruptly turn the Palmer School over to BJ Palmer. DD would move on to help open several schools in several states. At the request of some of Palmer's students and with DD's blessing, John Howard would open the National School of Chiropractic in 1906 in the same building Harvey Lillard had received the first adjustment, several blocks from PSC.[59].[60]

Changing political and healthcare environment

The early 19th century had seen the rise of patent medicine and the nostrum trade. Though some remedies were marketed through doctors of medicine, most were sold directly to consumers by lay people with the use of questionable advertising claims. The addictive and sometimes toxic effects of some remedies, especially morphine and mercury based folk cures, prompted the early laws that defined the practice of medicine. In the mid 1800's, as the germ theory began to take hold, medicine began to embrace the scientific method as a way to battle disease. In 1847, the American Medical Association formed to establish standards for the preliminary medical education and for the degree of MD. In 1849 a board was established to analyze quack remedies and nostrums and to enlighten the public in regard to the nature and danger of such remedies. Relationships were developed with pharmaceutical companies in an effort to curb the patent medicine crisis and consolidate the patient base around the medical doctor. By the turn of the century, the AMA had created a Committee on National Legislation to represent the Association's interest in Washington and re-organized as the national organization of state and local associations. By 1910, the AMA was a powerful national force. This was the beginning of organized medicine.[61].

Straights and Mixers

File:BJPalmer2.jpg

BJ Palmer Developer of Chiropractic 1882-1961

Many of the initial students at PSC and ASC & NC had previous experience in healthcare as naturopaths, osteopaths, and medical physicians. As the profession grew, it inevitably became more common to mix chiropractic with those and other techniques. While some techniques were not unusual, others were questionable in their design and application. With the new AMA definitions for the practice of medicine becoming the new law of the land, DD continued to refine chiropractic as a unique form of practice seperate from that of medicine. He frequently denounced the mixing of his drugless discovery with any other form of cure and refused to defend those who did.pg4 However, as a result of his own extravagant claims of cure being touted in his new periodical, The Chiropractor, DD, too, was convicted of practicing medicine without a license. Refusing to pay the fine, he would spend 105 days in jail before eventually paying the $389.50. Thereafter, DD would relinquish all rights to PSC to BJ and see his influence significantly diminish. BJ Palmer was now in charge of the Fountainhead of Chiropractic (PSC).

The next 15 years would see the opening of no less than 30 additional chiropractic schools, including John Howard's National School of Chiropractic (now the National University of Health Sciences) that would move to Chicago, Illinois . Each school would attempt to develop its own identity while BJ Palmer continued to develop his father's discovery. Chiropractic was to face several obstacles in the coming years that would both divide and unify its members. BJ would lead the subsequent struggle to legally practice chiropractic as a seperate and unique health care profession. His influence over the next several years would further define the Mixers of chiropractic and those who practiced it Straight..

Association battles

Imediately following the conviction of his father, BJ along with many of his colleagues would create the Universal Chiropractic Association (UCA). It's original purpose was to provide a safety net for those who would later be arrested by the AMA medical trust. It's first success was in the aquittal of Shegetaro Morikubo, DC in 1907 where BJ would later note;

"We are always mindful of those early days when UCA...used various expedients to defeat medical court prosecutions. We legally squirmed this way and that, here and there. We did not diagnose, treat, or cure disease. We analyzed, adjusted cause, and Innate in patient cured. All were professional matters of fact in science, therefore justifiable in legal use to defeat medical trials and convictions."pg5

With each susequent case, BJ's direction for chiropractic was more evident.

After 1910

Okay, if we think about the healthcare environment in the early 1900's, there was no penicillin, no insulin, no chemotherapy. All sorts of doctors were treating all conditions. Chiropractors were treating all conditions as well. Hughgr pointed out that DC's got popular when their patients did better with the flu epidemic in the 1910's. By 1918, most states had laws to protect the practices of drugless healing. Of course, by now they were feeling pretty good about themselves and were looking at trying to determine what specific adjustments to give for specific conditions, typhoid, etc., just as homeopaths, medical doctors and a host of other practitioners were working their sciences to determine the best treatments while some were continuing to push blatant quack cures. Nobody had all the answers. Homeopaths were very popular until AMA begins to "scientifically" evaluate their cures. There was a gluten of MD's who are practicing anything that will let them make a few dollars. MD schools were teaching anything that could be thought of as a cure, even chiropractic. But MD's had the AMA and Rockefellar and the Flexnor report that closed these schools and improved lab capabilites and their schools were being publically subsidized, making scientific research affordable and an MD degree cheaper. The AMA develops its political aspirations to make sure federal dollars do not end up in non-scientific practitioners hands in an effort to choke off funding and eliminate any competition. Palmer wants his school to remain private because that is the only way he makes money. Practitioners of all types take the short chiropractic course and now call themselves chiropractors but practice all kinds of treatment methods including quacks using radionics, etc. Palmer, perhaps foreseeing a conflict with MD's, tries to eliminate these mixing chiropractors. Some mixing chiropractors lean toward scientific medicine and make changes to fall in line with mixing scienceIn the early 1920's comes the railroad company doctor, who actually gets paid salary and has an office and doesn't have to do housecalls or make his patients pay. Shortly after comes insurance re-imbursement. So everybody starts filing insurance. 1922 insulin was discovered and in 1928 penicillin is discovered. The battles now are over who gets to treat and get paid by insurance companies. Palmer, whose profession is far from being able to prove itself in a lab, is directing his followers to adjust cause(subluxations) and innate heals, probably to legally be able to continue to see patients for things other than back pain. MD's start to overtake the infectious disease field, but that still left cancer.

Vertebral Subluxation page

History

The neologistic "subluxation" concept was introduced by Andrew Still, MD, the founder of osteopathy in 1885. He described his theoretical phenomena as obstruction of bodily fluids from what he called "osteopathic lesions". Vertebral subluxation is a concept that evolved over decades of research conducted in the chiropractic profession. The concept may have been borrowed from osteopathy, and applied to vertebrae, to designate a disruption of normal nerve activity, theorized to be at the source of noticeable changes in the body. There are historical references going back to Hippocrates to support the long held belief and clinical impression that the function of the spine was a key element in the proper maintenance of health.

Chiropractic page before Oct 19, 2006

{{Alternative medical systems}}

Chiropractic is a complementary and alternative health care profession which focuses on diagnosing, treating, and preventing mechanical disorders of the musculoskeletal system, their effects on the nervous system, and on general health. Chiropractic's premise is that spinal joint misalignments, which chiropractors call vertebral subluxations, can interfere with the nervous system and result in many different conditions of diminished health. In contrast, the term subluxation, as used in conventional medicine, is usually associated with specific conditions which are a direct consequence of injury to joints or associated nerves.

Manipulation of the spine is the main technique in today's chiropractic adjustment, or treatment. Though its use has been documented from the time of the ancient Egyptians, spinal manipulation in an attempt to correct the theoretical vertebral subluxation is solely a chiropractic endeavor. Chiropractic's contribution to the field of manipulative therapies is the concept of applying a precise adjustment to a specific affected vertebra, as opposed to the generalized maneuvers of the early osteopaths. While some chiropractors adhere strictly to the use of only spinal manipulation in their adjustment, others include a broad range of methods directed at correcting the subluxation and/or just relieving musculoskeletal pain.

Some chiropractors specialize in treating specific musculoskeletal problems or sports injuries, or they may combine chiropractic with manipulation of the extremities, physiotherapy, nutrition, or exercises to increase spinal strength or improve overall health. Some also use other complementary and alternative methods as a part of a holistic treatment approach. However, chiropractors do not prescribe drugs; they believe this to be the province of conventional medicine, and that their role is to pursue drug-free alternative treatments. Depending on the country or state in which the Chiropractic school is located, some train in minor surgery. When indicated, the doctor of chiropractic consults with, co-manages, or refers to other health care providers.

Chiropractic was founded in 1895 by Daniel David Palmer, based on his assertion that all health problems could be prevented or treated using "adjustments" of the spine, and sometimes other joints, to correct what he termed "subluxations." He, and later his son, B.J. Palmer, proposed that subluxations were misaligned vertebrae which caused nerve compression that interfered with the transmission of what he named Innate Intelligence. This interference interrupted the proper flow of Innate Intelligence from "above, down, inside, and out" to the organ to which it traveled. As a result, the human body would experience "dis-ease" or disharmony which would result in loss of health. He compared this process to stepping on a hose that slowed the flow of water to a garden: if you take your foot off the hose, the flow returns to normal and the garden will flourish.

While the "pinched garden hose theory" has mostly been abandoned, it is still used in a modified form by some chiropractors to explain vertebral subluxation. However, the concept of the subluxation, which has marginal evidence, remains integral to typical chiropractic practice, and in 2003 90% of chiropractors believed the vertebral subluxation complex played a significant role in all or most diseases.

There is evidence that spinal manipulation is effective for the treatment of acute low back pain, tension headaches and some musculoskeletal issues, but not all studies support this conclusion. There are no objective controlled trials with definitive conclusions for or against chiropractic claims concerning other health benefits.

Today, there are 17 accredited chiropractic colleges in the USA and two in Canada, and an estimated 70,000 chiropractors in the USA, 5000 in Canada, 2500 in Australia, 1300 in the UK, and smaller numbers in about 50 other countries. In the USA and Canada, licensed individuals who practice chiropractic are commonly referred to as chiropractors, doctors of chiropractic, (DC) or chiropractic physicians.

There are four main groups of chiropractors: "traditional straights", "objective straights", "mixers", and "reform". All groups, except reform, treat patients using a subluxation-based system. Differences are based on the philosophy for adjusting, claims made about the effects of those adjustments, and various additional treatments provided along with the adjustment.

Chiropractic’s approach to healthcare

According to Robert Mootz D.C. and Reed Phillips DC, Ph.D., although chiropractic has much in common with other health professions, its philosophical approach distinguishes it from modern medicine. Chiropractic philosophy involves what has been described as a "contextual, naturopathic approach" to health care. The traditional, "allopathic" or "medical" model considers disease as generally the result of some external influence, such as a toxin, a parasite, an allergen, or an infectious agent: the solution is to counter the perceived environmental factor (e.g., using an antibiotic for a bacterial infection). By contrast, the naturopathic approach considers that lowered "host resistance" is necessary for disease to occur, so the appropriate solution is to direct treatment to strengthen the host, regardless of the environment. In contemporary clinical practice, one can find elements of both naturopathic and allopathic philosophy among all types of providers. The degree to which a practitioner emphasizes different tenets of these philosophies is one factor that determines the manner in which they practice.

Chiropractic Perspectives That Reflect a Holistic Approach to Patient Care

• noninvasive, emphasizes patient's inherent recuperative abilities
• recognizes dynamics between lifestyle, environment, and health
• emphasizes understanding the cause of illness in an effort to eradicate, rather than palliate, associated symptoms
• recognizes the centrality of the nervous system and its intimate relationship with both the structural and regulatory capacities of the body
• appreciates the multifactorial nature of influences (structural, chemical, and psychological) on the nervous system
• balances the benefits against the risks of clinical interventions
• recognizes as imperative the need to monitor progress and effectiveness through appropriate diagnostic procedures
• prevents unnecessary barriers in the doctor-patient encounter
• emphasizes a patient-centered, hands-on approach intent on influencing function through structure
• strives toward early intervention, emphasizing timely diagnosis and treatment of functional, reversible conditions

Source:AHCPR Chapter 2 Chiropractic Belief Systems, Robert D. Mootz DC; Reed B. Phillips DC, PhD

Most patients who visit a chiropractor do so initially because of symptoms arising from musculoskeletal problems (especially low back and neck pain), although most chiropractors say they concern themselves with the overall health of the patient. According to a survey by the National Center for Complementary and Alternative Medicine, in 2002, chiropractic was the fourth (7.5%) most commonly used CAM therapy among adults in the USA. The profession has evolved so that treatment consists of hundreds of different techniques. The U.S. Department of Labor's Occupational Outlook Handbook said:

Because chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform surgery, chiropractic care is appealing to many health-conscious Americans. Chiropractic treatment of the back, neck, extremities, and joints has become more accepted as a result of research and changing attitudes about alternative, noninvasive health care practices.

Most DCs are self employed or work in small groups, employing chiropractic assistants as office staff and to perform therapeutic activities. They may also employ massage and physiotherapists as adjuncts to chiropractic care.

History

(see also article on Daniel David Palmer)

DD Palmer

In 1885, the world was well into the second industrial revolution, marked by innovation and creativity. Health care had recently emerged from the drastic practice of heroic medicine and was well into an age of alternatives. All varieties of treatments and cures including scientific medicine, vitalism, herbalism, magnetism and leeches, lances, tinctures and patent medicines were developing and competing to be the new method for the century. Neither consumers nor many practitioners had much knowledge of either the causes of, or cures for, illnesses. Allopathy, fueled by Louis Pasteur's refutal of the centuries old spontaneous generation theory in 1859, was growing rapidly just as Charles Darwin published his book on natural selection. German bacteriologist, Robert Koch formulated his postulates bringing scientific clarity to what was a very confused field. Drugs, medicines and quack cures were becoming more prevalent and were mostly unregulated. Concerned about what he saw as the abusive nature of drugging, MD Andrew Taylor Still, ventured into magnetic healing (meaning hypnotism then) and bonesetting in 1875. He opened the American School of Osteopathy (ASO) in Kirksville, Missouri in 1892. Daniel David Palmer (DD Palmer), a teacher, grocer turned magnetic healer opened his office of magnetic healing in Davenport, Iowa in 1886. After nine successful years, DD Palmer gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard, on September 18, 1895.

The first chiropractic adjustment

Harvey Lillard 1906

Palmer and his patient Harvey Lillard gave differing accounts of when and how Palmer began to experiment with spinal manipulation. Palmer recalled an incident in 1895 when he was investigating the medical history of a deaf man, Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years earlier, he felt a 'pop' in his back, and had been nearly deaf ever since. Palmer’s examination found a sore lump which indicated spinal misalignment and a possible cause of Lillard's deafness. Palmer corrected the misalignment, and Lillard could then hear the wheels of the horse-drawn carts in the street below. Palmer said there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude" about this adjustment; it was specific so much so that no chiropractor has equaled it. However, this version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and, Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make [something of] it, then they both would share. But, it didn't happen." Since DD Palmer's first claim of restoring hearing to Harvey Lillard, there has been controversy about whether a link actually could exist between the spinal adjustment and return of hearing. Critics asserted that a spinal adjustment cannot affect certain areas -like the brain- because the spinal nerves do not extend into the encephalon. Years later, V. Strang, D.C. illustrated several neurological explanations including the recognition that sympathetic nerves arising in the lateral horns of the upper thoracic levels of the spine form the upper cervical ganglion with postganglionic fibers ascending to supply, among other things, blood vessels of the brain.

Early growth

Rev. Samuel Weed

After the case of Harvey Lillard, Palmer stated: "I had a case of heart trouble which was not improving. I examined the spine and found a displaced vertebra pressing against the nerves which innervate the heart. I adjusted the vertebra and gave immediate relief — nothing "accidental" or "crude" about this. Then I began to reason if two diseases, so dissimilar as deafness and heart trouble, came from impingement, a pressure on nerves, were not other disease due to a similar cause? Thus the science (knowledge) and art (adjusting) of Chiropractic were formed at that time."

DD Palmer asked a patient and friend, Rev. Samuel Weed, to help him name his discovery. He suggested combining the words cheiros and praktikos (meaning "done by hand") to describe Palmer's treatment method, creating the term "chiropractic." In 1896, DD added a school to his magnetic healing infirmary, and began to teach others his method. It would be become known as Palmer School of Chiropractic (PSC, now Palmer College of Chiropractic). Among the first graduates were Andrew P. Davis MD, DO, William A. Seally, MD, BJ Palmer (DD's son), Solon M. Langworthy, John Howard, and Shegataro Morikubo. Langworthy moved to Cedar Rapids, Iowa and opened the second chiropractic school in 1903, the American School of Chiropractic & Nature Cure (ASC & NC) combining it with what would become naturopathic cures and osteopathy. DD Palmer, who was not interested in mixing chiropractic with other cures, turned down an offer to be a partner.

Changing political and healthcare environment

The early 19th century had seen the rise of patent medicine and the nostrum trade. Although some remedies were sold through doctors of medicine, most were sold directly to consumers by lay people, some of whom used very questionable advertising claims. The addictive, and sometimes toxic, effects of some remedies, especially morphine and mercury-based cures (known as quicksilver or quacksilber in German), prompted the popular rise of alternative and less dangerous methods of homeopathy and eclectic medicine. In the mid 1800's, as the germ theory struggled to replace the metaphysical causes of disease, the search for invisible microbes required the world to embrace the scientific method as a way to discover the cause of disease.

In the USA, licensing for healthcare professionals had all but vanished around the Civil War, leaving the profession open to anyone who felt inclined to become a physician; the market alone determined who would prove successful and who would not. Medical schools were plentiful, inexpensive and mostly privately owned. With free entry into the profession, and education in medicine cheap and readily available, many men entered practice, leading to an overabundance of practitioners which ultimately drove down the individual physician's income. In 1847, the American Medical Association (AMA) was formed and established higher standards for preliminary medical education and for the degree of MD. At the time, most medical practitioners were unable to meet the stringent standards, so a "grandfather clause" was included. The effect was to limit the number of new practitioners.

In 1849, the AMA established a board to analyze quack remedies and nostrums and to enlighten the public about their nature and their dangers. Relationships were developed with pharmaceutical companies in an effort to curb the patent medicine crisis and consolidate the patient base around the medical doctor. By the turn of the century, the AMA had created a Committee on National Legislation to represent the AMA in Washington and re-organized as the national organization of state and local associations. Intense political pressure by the AMA resulted in unlimited and unrestricted licensing only for medical physicians that were trained in AMA-endorsed colleges. By 1901, state medical boards were created in almost every state requiring licentiates to provide a diploma from an AMA approved medical college. By 1910, the AMA was a powerful force; this was the beginning of organized medicine.

Just before 1881, the teaching profession had begun significant changes as well. Advances in chemistry and science in Germany created strong incentives to create markets for their new products. By 1895, the new "Kulturopolitik" ideology of "First teach them; then sell them" had begun creating the political pressure necessary to improve teaching in science and math in schools and colleges in the US. The medical schools were the first to suffer the attack; they were ridiculed as obsolete — inadequate — and inefficient. The crisis attracted the attention of some of the world's richest men. In 1901 the "Rockefeller Institute for Medical Research" was started by John D. Rockefeller. By 1906, the AMA’s Council on Medical Education had created a list of unacceptable schools that in 1910, as a result of the Flexner Report financed by the Carnegie Foundation, closed hundreds of private medical and homeopathic schools and named Johns Hopkins as the model school. The AMA had created the nonprofit, federally subsidized university hospital setting as the new teaching facility of the medical profession, effectively gaining control of all federal healthcare research and student aid.

Osteopathy vs chiropractic

As there was no constitutional or patent protection for new discoveries, the claims for the drugless healing professions took on a life of their own. In 1896, DD Palmer's first descriptions for chiropractic were strikingly similar to Andrew Still's principles of osteopathy established a decade earlier. Both described the body as a "machine" whose parts could be manipulated to produce a drugless cure. Both professed to affect the blood and nerves and promote health, though Palmer stated he concentrated on reducing "heat" from friction of the misaligned parts and Still claimed to enhance the flow of blood. Though Palmer publicly denied it, osteopaths claimed that he had even studied at Dr. Still's American School of Osteopathy. Palmer drew further distinctions by noting that he was the first to use the vertebral processes as levers. Osteopaths began a nationwide campaign that resulted in the passing of legislation to protect their profession.

Medicine vs chiropractic

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Chiropractic Caduceus

In September 1899, a medical doctor in Davenport IA named Heinrich Matthey started a campaign against drugless healers in Iowa. Suddenly, the existing state law, which referred to "the healing arts", was severely denounced. The demand was made for a change in the statute to prevent any drugless healer practicing in the state. Matthey warned that health education could no longer be entrusted to anyone but doctors of medicine. Osteopathic schools across the country responded immediately by developing a program of college inspection and accreditation. DD Palmer, whose school had just graduated its 7th student, insisted that his techniques did not need the same courses or license as medicine, as his graduates did not prescribe drugs or evaluate blood or urine. However, in 1901, DD was charged with misrepresenting to a student a course in chiropractic which was not a real science. He persisted in his strong stance against licensure citing freedom of choice as his cause. He was arrested twice more by 1906, and although he contended that he was not practicing medicine, he was convicted for professing he could cure disease without a license in medicine or osteopathy.

Dr Solon Langworthy, who continued to mix chiropractic at the ASC&NC, took a different route for chiropractic. He improved classrooms and provided a curriculum of study instead of the single course. He narrowed the scope of chiropractic to the treatment of the spine and nerve, leaving blood to the osteopath, and began to refer to the brain as the "life force". He was the first to use the word subluxation to describe the misalignment that narrowed the "spinal windows" (or intervertebral foramina) and interrupted the nerve energy. In 1906, Langworthy published the first book on chiropractic, called "Modernized Chiropractic" — "Special Philosophy — A Distinct System". He brought chiropractic into the scientific arena.

DD responded to Langworthy with malice concerning the mixing of chiropractic, and persuaded the Governor of Minnesota to veto legislation that would have allowed ASC&NC students to practice in his state. But he did accept some of the concepts laid out by Langworthy. He introduced the concept of Innate Intelligence in about 1904. Innate, he believed, was an intelligent entity which directed all the functions of the body, and used the nervous system to exert its influence.

After DD's conviction in 1906 and time in jail, he was forced to turn over his interests in the PSC to his son, BJ and wife Mabel. DD relocated first to Oklahoma and then to California, leaving BJ Palmer in charge of the PSC, the "Fountainhead of Chiropractic".

BJ Palmer re-develops chiropractic

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BJ Palmer Developer of Chiropractic 1882-1961

Prosecution of DCs for unlicensed practice after the conviction of DD Palmer and a previous charge against BJ Palmer resulted in BJ and several Palmer graduates creating the Universal Chiropractic Association (UCA). Its initial purpose was to protect its members by covering their legal expenses should they get arrested. Its first case came in 1907, when Shegataro Morikubo DC of Wisconsin was charged with unlicensed practice of osteopathy. It was a test of the new osteopathic law. In an ironic twist, using mixer Langworthy's book Modernized Chiropractic, attorney Tom Moore legally differentiated chiropractic from osteopathy by the differences in the philosophy of chiropractic's "supremacy of the nerve" and osteopathy's "supremacy of the artery". Morikubo was freed, and the victory reshaped the development of the chiropractic profession, which then marketed itself as a science, an art and a philosophy, and BJ Palmer became the "Philosopher of Chiropractic".

John F.A. Howard DC, Founder National College of Chiropractic 1906

The next 15 years saw the opening of 30 more chiropractic schools, including John Howard's National School of Chiropractic (now the National University of Health Sciences) that moved to Chicago, Illinois. Each school attempted to develop its own identity, while BJ Palmer continued to develop the philosophy behind his father's discovery. Fueled by the persistent and provocative advertising of recent chiropractic graduates, local medical communities, who had the power of the state at their disposal, immediately had them arrested. There were only 12,000 practicing chiropractors with more than 15,000 prosecutions for practicing medicine without a license in the first 30 years. Tom Moore and his partner, Fred Hartwell, were able to successfully defend 80% through the UCA. BJ would later note about those battles:

"We are always mindful of those early days when UCA...used various expedients to defeat medical court prosecutions. We legally squirmed this way and that, here and there. We did not diagnose, treat, or cure disease. We analyzed, adjusted cause, and Innate in patient cured. All were professional matters of fact in science, therefore justifiable in legal use to defeat medical trials and convictions."

His influence over the next several years further divided the mixers, or those who mixed chiropractic with other cures, from the straights who practiced chiropractic by itself.

DD Palmer's last years

While BJ worked to protect and develop chiropractic around the Palmer school, DD Palmer continued to develop his techniques from Oregon. In 1910, he theorized that nerves control health:

"Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent. Impressions are made on the peripheral afferent fiber-endings; these create sensations which are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionating—too much or not enough action—which is disease."

Before his sudden and controversial death in 1913, DD Palmer often voiced concern for BJ Palmer's management of chiropractic. He challenged BJ's methods and philosophy and made every effort to regain control of chiropractic. He repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or too slack, affecting the tone(health) of the end organ and noted,

"A subluxated vertebra . . . is the cause of 95 percent of all diseases. . . . The other five percent is caused by displaced joints other than those of the vertebral column."

During the long fought battle for licensure in California, in 1911 he wrote of his philosophy for chiropractic, and hinted at his plan for the legal defense of chiropractic:

"You ask, what I think will be the final outcome of our law getting. It will be that we will have to build a boat similar to Christian Science and hoist a religious flag. I have received chiropractic from the other world, similar as did Mrs. Eddy. No other one has laid claim to that, NOT EVEN B.J. Exemption clauses instead of chiro laws by all means, and LET THAT EXEMPTION BE THE RIGHT TO PRACTICE OUR RELIGION. But we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and other who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase. Now, if chiropractors desire to claim me as their head, their leader, the way is clear. My writings have been gradually steering in that direction until now it is time to assume that we have the same right to as has Christian scientists."

Straight versus mixer

State laws to regulate and protect chiropractic practice were eventually introduced in all fifty states in the US, but it was a hard-fought struggle. Medical Examining Boards worked to keep all healthcare practices under their legal control, but an internal struggle among DC's on how to structure the laws significantly complicated the process. Initially, the UCA, led by BJ Palmer, opposed state licensure altogether. Palmer feared that such regulation would lead to allopathic control of the profession. The UCA eventually caved in, but BJ remained strong in the opinion that examining boards should be composed exclusively of chiropractors (not mixers), and the educational standards to be adhered to were the same as the Palmer School. A "Model Bill" was drafted in 1922 to present to all states that did not yet have a law. They embarked on a method of "cleaning house" of mixers by warning state associations to purge their mixing members or face competition by the formation of a new "straight" association in their state.

Frank Margetts circa 1922

Mixers, disturbed by the edicts of the PSC having so much influence in their daily practice, came together to create the American Chiropractic Association (one of the early precursors to today's ACA). Though born out of necessity to defend against the UCA attacks, the ACA's stated purposes were to advance education and research for chiropractic. Its growth was initially stunted by its resolution to recognize physio-therapy and other modalities as pertaining to chiropractic. What growth did occur was credited to its second president, Frank R. Margetts, DC with support from his alma mater, National Chiropractic College. He insisted that no college administrator could hold an official position in the association, essentially giving doctors in the field a collective voice. But a disagreement within the UCA in 1924 turned the tide for the ACA. BJ was still working to purge mixers from practicing chiropractic, and he saw a new invention by Dossa D. Evans, the "Neurocalometer" (NCM), as the answer to all of straight chiropractic's (and particularly PSC's) legal and financial problems. As the owner of the patent on the NCM, he planned to limit the number of NCMs to 5000 and lease them only to graduates of the Palmer related schools who were members of the UCA. He then claimed that the NCM was the only way to accurately locate subluxations, preventing over 20,000 mixers from being able to defend their method of practice.

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John J. Nugent

There was an immediate uproar among practicing DC's. Even Tom Moore, BJ's long-time ally and president of the UCA, displayed his dismay by resigning (though he was later reinstated). BJ reluctantly resigned as treasurer, ending his relationship with the UCA. BJ moved on to form the Chiropractic Health Bureau (today's ICA), along with his staunchest supporters and Fred Hartwell (Tom Moore's partner) acting as council. Membership in the UCA dropped while the ACA membership rose. In 1930, the ACA and UCA joined to form the National Chiropractic Association (NCA). The NCA developed a Committee on Educational Standards (CES), making John J. Nugent DC responsible for raising educational standards for the profession. The years of consolidation or closing of unacceptable schools while developing the new standards earned Nugent the nickname "Chiropractic's Abraham Flexnor" from his admirers and "Chiropractic's Anti-christ" from his adversaries. The CES evolved into today's Council on Chiropractic Education (CCE), and was granted the status of chiropractic's accrediting body by the US Department of Education. Nugent was also later instrumental in the Chiropractic Research Foundation (CRF), today's Foundation for Chiropractic Education and Research (FCER). The differences in state laws that exist today can be traced back to these early legal struggles.

The movement toward scientific reform

By the late 1950s, healthcare in the US had been transformed: the discovery of penicillin and development of the polio vaccine was restoring hope to millions, and the homeopathic physician had all but vanished as a result of antiquackery efforts of the medical trust and leadership efforts of the AMA. BJ reduced the adjustment to HIO (Hole In One - the adjustment of only the atlas), while mixers continued to add and refine new proprietary techniques to find and reduce subluxations and improve health. Osteopathy in the USA developed in parallel to medicine and dropped its reliance on spinal manipulation to treat illness. A similar reform movement began within chiropractic: shortly after the death of BJ in 1961, a second generation chiropractor, Samuel Homola, wrote extensively on the subject of limiting the use of spinal manipulation, proposing that chiropractic as a medical specialty should focus on conservative care of musculoskeletal conditions. His sentiments echoed those of the NCA Chairman of the Board (C.O. Watkins DC) twenty years earlier: "If we will not develop a scientific organization to test our own methods, organized medicine will usurp our privilege. When it discovers a method of value, medical science will adopt it and incorporate it into scientific medical practice." Homola's membership in the newly formed ACA was not renewed, and his position was rejected by both straight and mixer associations.

In 1975, the National Institutes of Health brought chiropractors, osteopaths, medical doctors and PhD scientists together in a conference on spinal manipulation to develop strategies to study the effects of spinal manipulation. In 1978, the Journal of Manipulative & Physiological Therapeutics (JMPT) was launched, and in 1981 it was included in the National Library of Medicine's Index Medicus. Joseph Keating dates the birth of chiropractic as a science to a 1983 commentary in the JMPT entitled "Notes from the (chiropractic college) underground" in which Kenneth F. DeBoer, then an instructor in basic science at Palmer College in Iowa, revealed the power of a scholarly journal (JMPT) to empower faculty at the chiropractic schools. DeBoer's opinion piece demonstrated the faculty's authority to challenge the status quo, to publicly address relevant, albeit sensitive, issues related to research, training and skepticism at chiropractic colleges, and to produce "cultural change" within the chiropractic schools so as to increase research and professional standards. It was a rallying call for chiropractic scientists and scholars.

AMA plans to eliminate chiropractic

On November 2, 1963, the AMA Board of Reagents created the "Committee on Quackery" with the goals of first containing, and then eliminating chiropractic. Doyl Taylor, the Director of the AMA Department of Investigation and Secretary of the Committee on Quackery, outlined the steps needed:

1. to ensure that Medicare should not cover chiropractic
2. to ensure that the U.S. Office of Education should not recognize or list a chiropractic accrediting agency
3. to encourage continued separation of the two national associations
4. to encourage state medical societies to take the initiative in their state legislatures in regard to legislation that might affect the practice of chiropractic.

The AMA distributed propaganda to teachers and guidance counselors, eliminated "Chiropractic" from the U.S Department of Labor's Health Careers Guidebook, and established specific educational guidelines for medical schools regarding the "hazards to individuals from the unscientific cult of chiropractic."

In 1975, an anonymous AMA insider describing himself as a disgruntled AMA staffer and identifying himself as "Sore Throat" released information concerning the Committee on Quackery and its proposed methods to eliminate chiropractic to the press.

Wilk et al. vs the American Medical Association (AMA)

Main article: Wilk v. American Medical Association

Until 1983, the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner", and labeled chiropractic "an unscientific cult". Principle 3 of the AMA Principles of Medical Ethics stated:

"A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally associate with anyone who violates this principle."

Armed with Sore Throat's information about the methods of the Committee on Quackery, Chicago chiropractor, Chester A. Wilk initiated an antitrust suit against the AMA and other medical associations in 1976 - Wilk et al. vs AMA et al.. The landmark lawsuit ended in 1987 when the Federal Appeals Court found the AMA guilty of conspiracy and restraint of trade; the Joint Council on Accreditation of Hospitals and the American College of Physicians were exonerated. The court recognized that the AMA had to show its concern for patients, but was not persuaded that this could not have been achieved in a manner less restrictive of competition, for instance by public education campaigns. The AMA lost its appeal to the Supreme Court, and had to allow its members to collaborate with DCs.

The judge in the Wilk case said:

"Evidence at the trial showed that the defendants took active steps, often covert, to undermine chiropractic educational institutions, conceal evidence of the usefulness of chiropractic care, undercut insurance programs for patients of chiropractors, subvert government inquiries into the efficacy of chiropractic, engage in a massive disinformation campaign to discredit and destabilize the chiropractic profession and engage in numerous other activities to maintain a medical physician monopoly over health care in this country."

She then said that chiropractors clearly wanted "a judicial pronouncement that chiropractic is a valid, efficacious, even scientific health care service". She said no "well designed, controlled, scientific study" had been done, and concluded "I decline to pronounce chiropractic valid or invalid on anecdotal evidence, even though "the anecdotal evidence in the record favors chiropractors".

Chiropractic vertebral subluxation

DD Palmer's early reduction of his chiropractic theories. Note that the 1914 remarks came from his book, The Chiropractic Adjuster, released after his death in 1913. Chart reprinted from Keating J (1995), D.D. Palmer's Forgotten Theories of Chiropractic"

Main article: Vertebral subluxation

DD Palmer, using a vitalistic approach, imbued the term subluxation with a metaphysical and philosophical meaning. He held that a malposition of spinal bones, which protect the spinal cord and nerve roots, interfered with the transmission of nerve impulses. Because half of the nervous system is sensory and the other half motor (control), he postulated that living things had an Innate intelligence, a kind of "spiritual energy" or life force that received the sensory information from the various parts of the body and made a decision as to what the motor nerves should convey. DD Palmer claimed that subluxations interfered with this innate intelligence, and that by fixing them, all diseases could be treated. He qualified this by noting that knowledge of Innate Intelligence was not essential to the competent practice of chiropractic. The idea that all diseases were the result of a subluxation was in line with the common thinking of the day; that there was one cause for disease. The vitalistic concepts implied an intelligent governing entity that was readily perceived as spiritual constructs by many both inside and outside the profession. Chiropractors used these metaphorical concepts to rationalize their thinking about the body’s self-healing capacity. In 1998, Lon Morgan DC, a reform chiropractor, wrote that: "Innate Intelligence clearly has its origins in borrowed mystical and occult practices of a bygone era. It remains untestable and unverifiable and has an unacceptably high penalty/benefit ratio for the chiropractic profession. The chiropractic concept of Innate Intelligence is an anachronistic holdover from a time when insufficient scientific understanding existed to explain human physiological processes. It is clearly religious in nature and must be considered harmful to normal scientific activity."

Meridel I. Gatterman DC, educator and writer observed:

"The word subluxation has been ... embodied with a multitude of meaning by chiropractors during the past one hundred years. To some it has become the holy word; to others, an albatross to be discarded ... to add to the confusion, more than 100 synonyms for subluxation have been used. Why then do we persist in using the term when it has become so overburdened with clinical, political, and philosophical ... significance ... that the concept that once helped to hold a young profession together now divides it and keeps it quarrelling over basic semantics? The obvious answer is: The concept of subluxation is central to chiropractic."

Debate about the need to remove the concept of subluxation from the chiropractic paradigm has been ongoing since the mid 1960's. While straights hold firmly to the term and its vitalistic construct, reformers suggest that the mechanistic model will allow chiropractic to better integrate into mainstream medicine without making claims inherent in the term. Anthony Rosner PhD, director of education and research at the Foundation for Chiropractic Education and Research (FCER) considered subluxation and the concept of Occam's razor. He suggests "there is no obvious reason to discard the concept of subluxation, while at the same time maintaining that it is not a rigid entity, but rather an important model and concept; a work in progress that undoubtedly will undergo extensive modification as our concepts of light or psychoanalysis have evolved over half a century."

Scientific investigation of chiropractic

The Testable Principle	The Untestable Metaphor
Chiropractic Adjustment	Universal Intelligence
Restoration of structural integrity	Innate Intelligence
Improvement of Health Status	Body Physiology
Materialistic	Vitalistic
Operational definitions possible	Origin of Holism in chiropractic
lends itself to scientific inquiry	cannot be proved or disproved
Table 1. Two chiropractic system constructs. Source: Phillips RB, Mootz RD. Contemporary chiropractic philosophy. In Haldeman S (ed). Principles and Practice of Chiropractic, 2nd Ed. Norwalk, CT: Appleton & Lange, 1992. Chart reprinted from Keating J (1995), D.D. Palmer's Forgotten Theories of Chiropractic[62]

Chiropractic researchers Robert Mootz and Reed Phillips suggest that, in chiropractic's early years, influences from both straight and mixer concepts were incorporated into its construct. They conclude that chiropractic has both materialistic qualities that lend themselves to scientific investigation and vitalistic qualities that do not (Table 1).

With relatively little federal funding, academic research in chiropractic has only recently become established in the USA. In 1994 and 1995, half of all grant funding to chiropractic researchers was from the US Health Resources and Services Administration (7 grants totaling $2.3 million). The Foundation for Chiropractic Education and Research (11 grants, $881,000) and the Consortium for Chiropractic Research (4 grants, $519,000) accounted for most of the rest. By 1997, there were 14 peer-reviewed chiropractic journals in English that encouraged the publication of chiropractic research, including The Journal of Manipulative and Physiological Therapeutics (JMPT), Topics in Clinical Chiropractic, and the Journal of Chiropractic Humanities. However, of these, only JMPT is included in Index Medicus. Research into chiropractic, whether from Universities or chiropractic colleges, is however often published in many other scientific journals.

While there is still debate about the effectiveness of chiropractic for the many conditions in which it is applied, chiropractic seems to be most effective for acute low back pain and tension headaches. When testing the efficacy of health treatments, double blind studies are generally considered the highest standards of scientific rigor. These are designed so that neither the patient nor the doctor knows whether they are using the actual treatment or a placebo (or "sham") treatment. However, chiropractic treatment involves a manipulation; no "sham" procedure can be devised easily for this, and even if the patient is unaware whether the treatment is a real or sham procedure, the doctor cannot be unaware. Thus there may be "observer bias" - the tendency to see what you expect to see, and the potential for the patient to wish to report benefits to "please" the doctor. This problem is not confined to chiropractic - many medical treatments are not amenable to double-blind placebo-controlled trials, indeed this is true for all surgical procedures. It is also a problem in evaluating treatments; even when there are objective outcome measures, the placebo effect can be very substantial. Thus, DCs have historically relied mostly on their own clinical experience and the shared experience of their colleagues, as reported in case studies, to direct their treatment methods. In this, they are not different to the practice in much of conventional medicine.

Sociologist Leslie Biggs interviewed 600 Canadian DCs in 1997: while 86% felt that chiropractic methods needed to be validated, 74% did not believe that controlled clinical trials were the best way to evaluate chiropractic. Moreover, 68% believed that "most diseases are caused by spinal malalignment", although only 30% agreed that "subluxation was the cause of many diseases".

Even when a valid mechanism of action is not determined, it is generally thought sufficient to present evidence showing benefit for the claims made. There is wide agreement that, where applicable, an evidence based medicine framework should be used to assess health outcomes, and that systematic reviews with strict protocols are important for objectively evaluating treatments. Where evidence from such reviews is lacking, this does not necessarily mean that the treatment is ineffective, only that the case for a benefit of treatment may not have been rigorously established.

A 2005 editorial in JMPT, "The Cochrane Collaboration: is it relevant for doctors of chiropractic?" proposed that involvement in Cochrane collaboration would be a way for chiropractic to gain greater acceptance within medicine. The collaboration has 11,500 contributors from more than 90 countries organized in 50 review groups. For chiropractic, relevant review groups include the Back Group; the Bone, Joint, and Muscle Trauma Group; the Musculoskeletal Group; and the Neuromuscular Disease Group. The editorial states that, for example, "a chiropractor may provide conservative care supported by a Cochrane review to a patient with carpal tunnel syndrome. If the patient's symptoms become progressive, the doctor may consider referring the patient for surgery using a recent Cochrane review that examined new surgical techniques compared with traditional open surgery..."

The Cochrane Collaboration did not find enough evidence to support or refute the claim that manual therapy (including, but not limited to, chiropractic) is beneficial for asthma. Carpal tunnel syndrome trials have not shown benefit from diuretics, non-steroidal anti-inflammatory drugs, magnets, laser acupuncture, exercise or chiropractic and there is not enough evidence to show the effects of spinal manipulation (including, but not limited to, chiropractic) for painful menstrual periods. Bandolier found limited evidence that spinal manipulative therapy (including, but not limited to, chiropractic) might reduce the frequency and intensity of migraine attacks, but the evidence that spinal manipulation is better than amitriptyline, or adds to the effects of amitriptyline, is insubstantial for the treatment of migraine, although "spinal manipulative therapy might be worth trying for some patients with migraine or tension headaches." According to Bandolier, a systematic review of a small, poor quality set of trials, provided no convincing evidence for long-term benefits of chiropractic interventions for acute or chronic low back pain, despite some positive overall findings [63] but there might be some short-term pain relief, especially in patients with acute pain. However, the BMJ noted in a study on long-term low-back problems "...improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear." A 1994 study by the U.S. Agency for Health Care Policy and Research (AHCPR) and the U.S. Department of Health and Human Services endorses spinal manipulation for acute low back pain in adults in its Clinical Practice Guideline.

The first significant recognition of the appropriateness of spinal manipulation for low back pain was performed by the RAND Corporation. This meta-analysis concluded that some forms of spinal manipulation were successful in treating certain types of lower back pain. Some chiropractors claimed these results as proof of chiropractic hypotheses, but RAND's studies were about spinal manipulation, not chiropractic specifically, and dealt with appropriateness, which is a measure of net benefit and harms; the efficacy of chiropractic and other treatments were not explicitly compared. In 1993, Dr Shekelle rebuked some DCs for their exaggerated claims: ...we have become aware of numerous instances where our results have been seriously misrepresented by chiropractors writing for their local paper or writing letters to the editor....

There is conflict in the results of chiropractic research. For instance, many DCs claim to treat infantile colic. According to a 1999 survey, 46% of chiropractors in Ontario treated children for colic. In 1999 a Danish randomized controlled clinical trial with a blinded observer suggested that there is evidence that spinal manipulation might help infantile colic. However, in 2001, a Norwegian blinded study concluded that chiropractic spinal manipulation was no more effective than placebo for treating infantile colic.

In 1997, historian Joseph Keating Jr described chiropractic as a "science, antiscience and pseudoscience", and said "Although available scientific data support chiropractic's principle intervention method (the manipulation of patients with lower back pain), the doubting, skeptical attitudes of science do not predominate in chiropractic education or among practitioners". He argued that chiropractic's culture has nurtured antiscientific attitudes and activities, and that "a combination of uncritical rationalism and uncritical empiricism has been bolstered by the proliferation of pseudoscience journals of chiropractic wherein poor quality research and exuberant over-interpretation of results masquerade as science and provide false confidence about the value of various chiropractic techniques". However, in 1998, after reviewing the articles published in the JMPT from 1989-1996, he concluded,

"substantial increases in scholarly activities within the chiropractic profession are suggested by the growth in scholarly products published in the discipline's most distinguished periodical (JMPT). Increases in controlled outcome studies, collaboration among chiropractic institutions, contributions from nonchiropractors, contributions from nonchiropractic institutions and funding for research suggest a degree of professional maturation and growing interest in the content of the discipline."

The Manga Report

The Manga Report was an outcomes-study funded by the Ontario Ministry of Health and conducted by three health economists led by Professor Pran Manga. The Report supported the scientific validity, safety, efficacy, and cost-effectiveness of chiropractic for low-back pain, and found that chiropractic care had higher patient satisfaction levels than conventional alternatives. The report states that "The literature clearly and consistently shows that the major savings from chiropractic management come from fewer and lower costs of auxiliary services, fewer hospitalizations, and a highly significant reduction in chronic problems, as well as in levels and duration of disability."

Workers' Compensation studies

In 1998, a study of 10,652 Florida workers' compensation cases was conducted by Steve Wolk. He concluded that "a claimant with a back-related injury, when initially treated by a chiropractor versus a medical doctor, is less likely to become temporarily disabled, or if disabled, remains disabled for a shorter period of time; and claimants treated by medical doctors were hospitalized at a much higher rate than claimants treated by chiropractors." Similarly, a 1991 study of Oregon Workers' Compensation Claims examined 201 randomly selected workers' compensation cases that involved disabling low-back injuries: when individuals with similar injuries were compared, those who visited DCs generally missed fewer days of work than those who visited MDs.

A 1989 study analyzed data on Iowa state records from individuals who filed claims for back or neck injuries. The study compared benefits and the cost of care from MDs, DCs and DOs, focusing on individuals who had missed days of work and who had received compensation for their injuries. Individuals who visited DCs missed on average 2.3 fewer days than those who visited MDs, and 3.8 fewer days than those who saw DOs, and accordingly, less money was dispersed as employment compensation on average for individuals who visited DCs.

In 1989, a survey by Cherkin et al. concluded that patients receiving care from health maintenance organizations in the state of Washington were three times as likely to report satisfaction with care from DCs as they were with care from other physicians. The patients were also more likely to believe that their chiropractor was concerned about them.

American Medical Association (AMA)

In 1997, the following statement was adopted as policy of the AMA after a report on a number of alternative therapies:[64]

Specifically about chiropractic it said,

"Manipulation has been shown to have a reasonably good degree of efficacy in ameliorating back pain, headache, and similar musculoskeletal complaints."

In 1992, the AMA issued this statement:

"It is ethical for a physician to associate professionally with chiropractors provided that the physician believes that such association is in the best interests of his or her patient. A physician may refer a patient for diagnostic or therapeutic services to a chiropractor permitted by law to furnish such services whenever the physician believes that this may benefit his or her patient. Physicians may also ethically teach in recognized schools of chiropractic. (V, VI)"[65]

British Medical Association

The British Medical Association notes that "There is also no problem with GPs [doctors] referring patients to practitioners in osteopathy and chiropractic who are registered with the relevant statutory regulatory bodies, as a similar means of redress is available to the patient."

Safety

The International Chiropractic Association (ICA) suggests that chiropractic is one of the safest health professions and chiropractors have some of the lowest malpractice insurance premiums in the health care industry. As with all interventions, there are risks associated with spinal manipulation. According to Harrison's, these include vertebrobasilar accidents (VBA), strokes, spinal disc herniation, vertebral fracture, and cauda equina syndrome. A 1996 Danish study determined that the greatest risk is with manipulation of the first two vertebra of the cervical spine, particularly passive rotation of the neck, known as the "master cervical" or "rotary break." However, serious complications after manipulation of the cervical spine are estimated to be just 1 in 3-4 million manipulations or fewer, based on international studies of millions of chiropractic cervical adjustments from 1965 to the present. The RAND Corporation's extensive review estimated "one in a million." Dvorak cites figures of 1 in 400,000, while Jaskoviak reported no vertebral artery strokes or serious injury in approximately 5 million cervical manipulations from 1965 to 1980 at The National College of Chiropractic Clinic in Chicago. By contrast, cervical spine surgery, an alternative to spinal manipulation for neck pain and radiating arm pain, has a 3-4% complication rate and 4,000-10,000 deaths per million neck surgeries.

Statistics on the reliability of incident reporting for spinal manipulation vary; the RAND study assumed that only 1 in 10 cases would have been reported. However, Dr Ernst surveyed neurologists in Britain for cases of serious neurological complication occurring within 24 hours of cervical spinal manipulation (not specifically by a chiropractor); 35 cases had been seen by the 24 who responded, but none had been reported. He concluded that underreporting was close to 100%, rendering estimates "nonsensical." The NHS Centre for Reviews and Dissemination agreed that the survey had methodological problems with data collection. Both NHS and Ernst noted that bias is a problem with the survey method of data collection.

A 2001 study in the journal Stroke found that vertebrobasilar accidents (VBAs) were five times more likely in those aged <45 years who had visited a chiropractor in the preceding week, compared to controls who had not visited a chiropractor. No significant associations were found for those aged >45 years. The authors concluded; "While our analysis is consistent with a positive association in young adults... The rarity of VBAs makes this association difficult to study despite high volumes of chiropractic treatment." The NHS notes that this study collected data objectively by using administrative data, involving less recall bias than survey studies, but the data were collected retrospectively and probably contained inaccuracies.

There are also concerns about using cervical manipulation for conditions for which it is not indicated. In 1996, Coulter et al. surveyed 4 MDs, 4DCs and 1 MD/DC to evaluate the risks and benefits of manipulation or mobilization of the cervical spine (not necessarily performed by a chiropractor). After looking at more than 700 conditions, there was consensus in only 11% of those conditions that cervical manipulation or mobilization was appropriate.

Few studies of stroke and cervical manipulation take account of the differences between "manipulation" and the "chiropractic adjustment". According to a report in the JMPT, manipulations administered by a Kung Fu practitioner, GPs, osteopaths, physiotherapists, a wife, a blind masseur, and an Indian barber had all been incorrectly attributed to chiropractors. The report goes on to say:

"The words chiropractic and chiropractor have been incorrectly used in numerous publications dealing with SMT injury by medical authors, respected medical journals and medical organizations. .... Such reporting adversely affects the reader's opinion of chiropractic and chiropractors."

Chiropractic adjustments are set apart from manipulation due to their precision and specificity. While there are nearly 200 different chiropractic techniques, which vary considerably, such differences have never been taken into account in relation to safety.

A New Zealand Commission report in 1979 said "We are satisfied that chiropractic treatment in New Zealand is remarkably safe... By the end of the inquiry we found ourselves irresistibly and with complete unanimity drawn to the conclusion that modern chiropractic is a soundly based and valuable branch of the health care in a specialized area." (Report of the Commission of Inquiry Into Chiropractic 1979:p 77). However, the judge in the Wilk vs AMA case described this report as "unsatisfactory", and a review by the US Congress' Office of Technology Assessment found 'serious problems' in its treatment of safety and efficacy issues.

In a 1993 study, J.D. Cassidy DC and co-workers concluded that the treatment of lumbar intervertebral disk herniation by side posture manipulation is "both safe and effective."

Chiropractic education, licensing, and regulation

United States

Graduates of chiropractic schools receive the degree Doctor of Chiropractic (DC), are referred to as "doctor", and are eligible to seek licensure in all jurisdictions. The Council on Chiropractic Education [66] (CCE) sets minimum guidelines for chiropractic colleges, but additional requirements may be needed for a license depending on the jurisdiction where a chiropractor chooses to practice. All 19 chiropractic institutions are accredited by the CCE. In 1991, the University of Bridgeport established its College of Chiropractic, becoming the first chiropractic school in the USA to be affiliated with a university.[67]

Students often enter chiropractic school with a Bachelor's degree, but, in 2005, only one chiropractic college required this as an admission requirement. [68] The minimum prerequisite for enrollment in a chiropractic college set forth by the CCE is 90 semester hours, and the minimum cumulative GPA for a student entering is 2.50. Commonly required classes include: psychology, biology, organic and inorganic chemistry, and physics. Other common medical classes are: anatomy or embryology, physiology, microbiology, diagnosis, neurology, x-ray, orthopedics, obstetrics/gynecology, histology, and pathology. Chiropractic programs require at least 4,200 hours of combined classroom, laboratory, and clinical experience. The last 2 years stress courses in manipulation and spinal adjustment and provide clinical experience in physical and laboratory diagnosis, orthopedics, neurology, geriatrics, physiotherapy, and nutrition.

To qualify for licensure, graduates must pass 4 examinations from the National Board of Chiropractic Examiners [69] and complete State specific requirements; most State boards require at least 2 years of undergraduate education, and an increasing number require a 4-year bachelor’s degree. All licensing boards in the US require the completion of a 4-year program at an accredited college leading to the DC degree. Once licensed, most States require chiropractors to attend 12-48 hours of continuing education annually. Chiropractic colleges also offer postdoctoral training in neurology, orthopedics, sports injuries, nutrition, rehabilitation, industrial consulting, radiology, family practice, pediatrics, and applied chiropractic sciences. After such training, chiropractors may take exams leading to "diplomate" status in a given specialty including orthopedics, neurology and radiology.

Australia

In Australia, chiropractic is taught at three universities: RMIT in Melbourne, Murdoch University in Perth and Macquarie University in Sydney. To be registered by various state Chiropractic Registration Boards, a Bachelor of Chiropractic Science, a Bachelor of Science or health-related degree, plus the successful completion of a full-fee paying postgraduate qualifying program for the Master of Chiropractic is required.

United Kingdom

There are three UK chiropractic colleges with chiropractic courses recognised by the General Chiropractic Council (GCC), the statutory governmental body responsible for the regulation of chiropractic in the UK. These are the Anglo European College of Chiropractic (AECC), a faculty of Bournemouth University, the McTimoney College of Chiropractic (MCC), validated by the University of Wales and the Welsh Institute of Chiropractic (WIOC) a faculty of Glamorgan University. The AECC graduates chiropractors with both a Bachelor of Science and an undergraduate Masters degree. The WIOC graduate chiropractors with a Bachelor of Science (Hon) and the MCC graduates chiropractors with a BSc (Hons) Chiropractic.

It is a legal requirement that all chiropractors in the UK register with the GCC to practice.

South Africa

In SA there are two schools of chiropractic: Durban Institute of Technology and University of Johannesburg Doornfontein campus. They are both 6 year full-time courses leading to a MTECH or Masters of technology in Chiropractic. It's a legal requirement that to practice Chiropractic in SA chiropractors must be registered with the Allied Health Professions Council of SA. Being a member of the Chiropractic Association of SA (CASA) is voluntary. CASA is the only association in the country and aims to promote the profession through publications in newspaper, interviews, internet and public enquires over the phone.

Federation of Chiropractic Licensing Boards

Main article: Federation of Chiropractic Licensing Boards

The FCLB is a conglomeration of all 50 US state licensing boards and the District of Columbia. It also includes several Canadian provinces and US territories. Its stated purpose is to protect the public and to serve the member boards by promoting excellence in chiropractic regulation.

Each state has a regulatory board that is appointed by its Governor. The board's responsibilities include:

• to investigate consumer complaints;
• to oversee the general application of health care laws;
• to help update and develop regulations which better define appropriate conduct by professionals and clarify what the consumer may expect;
• to continually review required credentials for doctors to practice safely, effectively, and ethically;
• to apply appropriate disciplinary action or retraining to doctors who may have broken the public trust through violation of statute or regulation;
• to function in the global regulatory community to assist other professions or jurisdictions affected by chiropractic.

The requirements to enter licensed chiropractic practice are defined by laws and regulations designed to protect the public's health, safety and welfare.

An essential part of the regulatory board's responsibility is to discipline and/or retrain doctors who step outside law and regulation. After sufficient inquiry determines a doctor has committed an offense, the severity of the offense will determine what sanctions are appropriate:

• Formal letter of reprimand
• Fine
• Probation
• Suspension
• Revocation of License
• Retraining / re-examination
• Other appropriate sanctions

The public may contact the licensing board in each jurisdiction to determine the status of the doctor's license. The Federation also maintains an on-line, international databank, known as CIN-BAD. This databank carries information on public actions by chiropractic regulatory agencies related to licenses of individual practitioners. It also lists doctors prohibited from receiving Medicare reimbursement due to federal sanctions imposed by U.S. Department of Health & Human Services. Members of the public may use a query form to request a search of the database.

Practice styles and schools of thought

Contemporary chiropractic can be divided into several approaches to patient care: all are based on non-invasive, non-medication approaches, with many based on the use of manipulation as a treatment for mechanical musculoskeletal dysfunction of the spine and extremities. Most chiropractors advertise themselves as primary care doctors, and consider themselves part of "alternative health care", but there can be large differences between practitioners. The differences between straights and mixers are reflected in multiple national practice associations, but most chiropractors are not members of any national organization.

1. Traditional Straight chiropractors are the oldest movement; they adhere to the tenets, set forth by DD and BJ Palmer, that vertebral subluxation leads to interference of the human nervous system and is a primary underlying risk factor for almost any disease. Straights view the diagnosis of patient complaints, which they consider to be "secondary effects", to be unnecessary for treatment. Instead, patients are typically screened for "red flags" of serious disease, and treated based on a practitioner's preferred chiropractic technique. This stance against diagnosing has been a source of contention between mixers and straights, because accreditation standards mandate that differential diagnosis be taught in all chiropractic programs so that patient care is safe and relevant to their complaints. Additionally, several state chiropractic licensing boards mandate that patient complaints be diagnosed before receiving care. The most popular national association for traditional straights is the International Chiropractors Association (ICA).
2. Mixing chiropractors are an early offshoot of the straight movement. This branch originated from naturopathic, osteopathic, medical, and even chiropractic doctors who attended the Palmer College of Chiropractic and then re-organized the treatment system to include more diagnostic and treatment approaches. They eventually split from the traditional straight group and formed various other chiropractic schools including the National College of Chiropractic. Their treatments may include naturopathic remedies, physical therapy devices, or other CAM methods. While still subluxation based, mixers also treat problems associated with both the spine and extremities, including musculoskeletal issues such as pain and decreased range of motion. Mixers describe vertebral subluxations as a form of joint dysfunction or osteoarthritis. Diagnosis is made after ruling out other known disorders and noting general signs of mechanical dysfunction in the spine. They tend to be members of the American Chiropractic Association, and all the major groups in Europe are also in membership of the European Chiropractors Union.
3. Objective Straight chiropractors [70] are a recent off-shoot of the traditional straights and are a minority. This group is differentiated from traditional straights mainly by the claims made. While traditional straights claimed that chiropractic adjustments are a plausible treatment for a wide range of diseases, objective straights only focus on the correction of chiropractic vertebral subluxations. Like traditional straights, objective straights typically do not diagnose patient complaints. They also don't refer to other professionals, but do encourage their patients "to see a medical physician if they indicate that they want to be treated for the symptoms they are experiencing or if they would like a medical diagnosis to determine the cause of their symptoms". [71] Most objective straights limit treatment to spinal adjustments; they tend to be members of the Federation of Straight Chiropractic Organization (FSCO) and the World Chiropractic Alliance (WCA).
4. Reform chiropractors, also a minority group, are primarily mixers who advocate the use of manipulation as a treatment for osteoarthritis and other musculoskeletal conditions. They do not subscribe to Palmer philosophy or the vertebral subluxation theory. Instead they recommend the use of palpation and manipulation to identify and treat painful joints which may contain adhesions. This group is very similar in practice to mixer chiropractors, though they tend not to use CAMs.

See also

• Applied kinesiology
• Manipulative therapy
• Naprapathy
• Osteopathy
• Physical therapy
• Reflexology

External links

Professional organizations

• American Chiropractic Association (ACA)
• Association of Chiropractic Colleges (ACC)
• British Chiropractic Association (BCA)
• Canadian Chiropractic Association (CCA)
• Chiropractic Association of South Africa (CASA)
• Chiropractic Doctors' Association of Hong Kong (CDAHK)
• Christian Chiropractors Association (CCA)
• Council on Chiropractic Education - USA (CCE-USA)
• European Chiropractors' Union (ECU)
• Federation of Chiropractic Licensing Boards (FCLB)
• Federation of Straight Chiropractors and Organizations (FSCO)
• Foundation for the Advancement of Chiropractic Education (F.A.C.E.)
• Foundation for Chiropractic Education and Research (FCER)
• Hong Kong Chiropractors' Association (HKCA)
• International Chiropractic Pediatric Association (ICPA)
• International Chiropractors Association (ICA)
• Japanese Association of Chiropractors (JAC)
• McTimoney Chiropractic Association (MCA)
• National Association for Chiropractic Medicine (NACM)
• National Board of Chiropractic Examiners (NBCE)
• United Chiropractic Association (UCA)
• World Chiropractic Alliance (WCA)
• World Federation of Chiropractic (WFC)

Chiropractic schools

• See article: Chiropractic schools

Other resources

• The Chiropractic Resource Organization
• Chiropractic History Archive - Joseph C. Keating Jr, PhD
• The Chiropractic Profession and Its Research and Education Programs
• Chiropractic in the United States: Training, Practice, and Research (1997) - Cherkin, Daniel C.; Mootz, Robert D.
• Chiropractic treatments for back pain - Steven G. Yeomans, DC. A Spine-health.com feature (use menu points on left side)
• Dynamic Chiropractic Online - ChiroWeb, Chiropractic news source
• National Directory of Chiropractic - Listing of Chiropractors and information on education and the profession.
• National Center for Complementary and Alternative Medicine - National Institute of Health - Manipulative and Body-Based Practices
• The Future of Chiropractic Revisited: 2005 to 2015
• Olympic Games Inspire Optimal Athletic Care

Internal criticism

• Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion From a Veteran Chiropractor

Samuel Homola DC, a notable and outspoken dissident within the profession, expresses his opinion that evidence-based chiropractic is the only way forward.

• Chiropractic, Bonesetting, and Cultism - Samuel Homola (entire book on-line).

This book, published in 1964, contains trenchant criticism of the profession, and the following year Homola's application to renew his membership of the ACA was rejected. In 1991, David J. Redding, chairman of the ACA board of governors, welcomed Homola back to membership of the ACA, and in 1994, 30 years after its publication, the book was reviewed for the first time by a chiropractic journal. [72]

• Chiropractic Ethics: An Oxymoron?

JC Smith, a chiropractor in private practice, writes in 1999 that ethical issues are "in dire need of debate" because of "years of intense medical misinformation/slander" and because of well publicised examples of tacky advertising, outlandish claims, sensationalism and insurance fraud.

• Chiropractic: Science and Antiscience and Pseudoscience Side by Side

Joseph C. Keating, Jr, PhD, professor at the Los Angeles College of Chiropractic and notable historian of chiropractic, warns of pseudoscientific notions that still persist in the mindsets of some chiropractors

• Faulty Logic and Non-skeptical Arguments in Chiropractic

Dr Keating critically distinguishes between sound and unsound arguments in support of chiropractic

• Critical thinking

Christopher Kent, DC president of the Council on Chiropractic Practice, advises his colleagues of the importance of high standards of evidence, noting that in the past chiropractors were too ready to accept anecdotal evidence

• Open Letter to the Profession (See Chiroweb for commentary.)

A 1992 letter from ACA attorney, George P. McAndrews, warns the chiropractic profession that advertising of scare tactic subluxation philosophy damages the newly won respect within the AMA.

• Quackery in Chiropractic -

A 1991 editorial from chiropractic trade magazine, Dynamic Chiropractic, where Joseph C. Keating Jr discusses his concerns for advertising products before they are scientifically evaluated.

• Subluxation - The Silent Killer

A 2000 commentary by Ronald Carter, DC, MA, Past President, Canadian Chiropractic Association in the Journal of the Canadian Chiropractic Association discussing his opinion that the subluxation story regardless of how it is packaged is not the answer. He suggests it is now time for the silent majority to make their voices heard and come together to present a rational and defensible model of chiropractic so that is not just included in the health care system, but an essential member of the health care team.

External criticism

• A Different Way To Heal? - PBS, Scientific American Frontiers, Web Feature
• Chirobase: Skeptical guide to chiropractic history, theories, and current practices - Stephen Barrett, MD, and Samuel Homola, DC (combines internal and external criticism)
• Chiropractic: Flagship of the Alternative Medicine Fleet, Part One and Part Two - Steven Novella, MD 1997

Abbreviations

• AMA, The American Medical Association
• BMJ, The British Medical Journal
• DC, Doctor of Chiropractic
• FDA, Food and Drug Administration
• JMPT, The Journal of Manipulative and Physiological Therapeutics