Chiropractic history

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Chiropractic history began in 1895 as 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.^[1] The theory of modern medicine, fuelled by Louis Pasteur's refutation 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,^[2] ventured into magnetic healing (meaning hypnotism then) and bonesetting in 1875. He opened the American School of Osteopathy (ASO) in Kirksville, Missouri in 1892.^[3] 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,^[4] DD Palmer gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard, on September 18, 1895.

Contents 1 The first chiropractic adjustment 2 Early growth 3 Changing political and healthcare environment 4 Osteopathy vs chiropractic 5 Medicine vs chiropractic 6 BJ Palmer re-develops chiropractic 7 DD Palmer's last years 8 Straight versus mixer 9 The movement toward scientific reform 10 AMA plans to eliminate chiropractic 11 References 12 External links

[edit] The first chiropractic adjustment

See also: Daniel David Palmer

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 partially 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. ^[5]

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." ^[6]

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." ^[7]

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. ^[8]

[edit] Early growth

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."^[5]

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." D.D. initially hoped to keep his discovery a family secret,^[9] but in 1896 he 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.^[10] DD Palmer, who was not interested in mixing chiropractic with other cures, turned down an offer to be a partner.

[edit] 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 1800s, 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.^[11] 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.^[12] 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.^[12] 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.^[11] By 1910, the AMA was a powerful force; this was the beginning of organized medicine.^[13]

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.^[14] 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.^[11]

[edit] 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.^[4] Osteopaths began a nationwide campaign that resulted in the passing of legislation to protect their profession.

Further information: History of osteopathic medicine in the United States

[edit] Medicine vs chiropractic

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.^[14] Osteopathic schools across the country responded immediately by developing a program of college inspection and accreditation.^[4] 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.^[14] 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".

[edit] BJ Palmer re-develops chiropractic

Main article: B.J. Palmer

D.D. Palmer's student and son, B.J. Palmer, assumed control of the Palmer School in 1906, and promoted professionalism and formal training in chiropractic, expanding enrollment to a peak of above 1,000 students in the early 1920s. Chiropractic leaders of the time often invoked religious imagery, and B.J. seriously considered declaring chiropractic a religion, deciding against this partly to avoid confusion with Christian Science. B.J. also worked to overcome chiropractic's initial resistance to the use of medical technology, by accepting diagnostic technology such as spinal X-rays (which he called spinography) in 1910.^[9]

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.^[15] 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".

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.^[16] 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."^[17]

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.^[10]

[edit] 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."^[5]

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."^[5][18]

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."^[19]

[edit] 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 MD physician control of the profession.^[20] 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.^[20] 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.

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.^[20] 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),^[21] 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.^[22]

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.

[edit] 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.^[23] 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."^[24] 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.^[25] 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.^[25]

[edit] 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."^[26]

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.^[27]

[edit] References

[edit] External links

• Association for the History of Chiropractic (AHC)

• Chiropractic History Archive @ Chiro.Org - Joseph C. Keating Jr, PhD

• Chiropractic History - AHC journal