Chiropractic history

Chiropractic history began in Davenport, Iowa with a teacher and grocer turned magnetic healer, Daniel David Palmer(DD).

By 1885, the era of the drastic measures of heroic medicine was gone, and purveyers of scientific medicine, herbalism, magnetism and leeches, lances, tinctures and patent medicines were all in competition. Neither patients nor many practitioners had much knowledge of either the causes of, or cures for, illnesses, and drugs, medicines and quack cures were becoming more common and were mostly unregulated. Concerned about what he saw as the abusive nature of drugging, Andrew Taylor Still ventured into 'magnetic healing' and bonesetting in 1875, and opened the American School of Osteopathy in Missouri in 1892.

Daniel David Palmer (DD Palmer), a teacher and grocer turned magnetic healer, opened his office of magnetic healing in Davenport, Iowa in 1886. Nine years later, on September 18, 1895, he gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard. Palmer and Lillard subsequently gave different accounts of this first experiment with spinal manipulation. According to Palmer, Lillard had told him that, while working in a cramped area seventeen years earlier, he had felt a 'pop' in his back and had since been virtually deaf. Palmer found a sore lump that indicated spinal misalignment, he corrected the misalignment, after which Lillard could then "hear the wheels of the horse-drawn carts" in the street below. However, Lillard's daughter, Valdeenia Lillard Simons, said that her father told her that he was joking with a friend in the hall outside Palmer's office when Palmer joined them. As Lillard reached the punchline, Palmer, laughing heartily, slapped Lillard on the back with the heavy book he had been reading. A few days later, Lillard's hearing seemed better, and Palmer 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."

After the event, Palmer said: "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 friend, the Reverend Samuel Weed, to help him name his discovery; he suggested combining the words cheiros and praktikos (meaning 'done by hand'). In 1896, DD Palmer added a school to his magnetic healing infirmary and began to teach others the new "chiropractic"; it would become the Palmer School (now College) of Chiropractic. Among the first graduates were his son, BJ Palmer, Solon Langworthy, John Howard, and Shegataro Morikubo. Langworthy moved to Cedar Rapids, Iowa and opened in 1903, the 'American School of Chiropractic & Nature Cure', combining chiropractic with osteopathy and other natural cures from the newly developing field of naturapathy. DD Palmer, who was not interested in mixing chiropractic with other cures, refused the offer of a partnership. ^[1]

Changing political and healthcare environment

The country needs fewer and better doctors; ...the way to get them better is to produce fewer. Abraham Flexner[1]

The early 19th century saw the rise of patent medicine and the nostrum trade. Some remedies were sold by doctors of medicine, but most were sold by lay people, often using very dubious advertising claims. The addictive or toxic effects of some remedies, especially morphine and mercury-based cures prompted the rise of the alternative remedies of homeopathy and eclectic medicine, that were less dangerous and probably no more ineffective in most cases. In the USA, licensing for healthcare professionals had all but vanished around the Civil War, leaving the profession open to anyone who declared themselves to be a physician; the market alone determined who would succeed and who would fail. Medical schools were plentiful, inexpensive and mostly privately owned, leading to an overabundance of practitioners. In 1847, the American Medical Association (AMA) was formed and established higher standards for medical education, restricting the number of new practitioners. ^[2]

In 1849, the AMA formed a board to analyze quack remedies and to educate the public about their dangers. By the turn of the century, the AMA were represented in Washington by a Committee on National Legislation, and after intense political pressure, medical boards were formed in almost every state, requiring licentiates to have a diploma from an AMA-approved college. By 1906, the AMA’s Council on Medical Education had drawn up a list of unacceptable schools, and in 1910, as a result of the Flexner Report, hundreds of private medical and homeopathic schools were closed. The AMA had created the nonprofit, federally subsidized university hospital setting as the new teaching facility of the medical profession, with Johns Hopkins as the model school, effectively gaining control of federal healthcare research and student aid.^[3]

Medicine, osteopathy, and chiropractic; the three rivals

With no patent protection for new discoveries, claims for the drugless healing professions proliferated. In 1896, DD Palmer's first descriptions for chiropractic were very similar to Andrew Still's earlier principles of osteopathy: both described the body as a 'machine' whose parts could be manipulated to effect a drugless cure, and both claimed to affect the blood and nerves and promote health. However, Palmer stated that he concentrated on reducing 'heat' from friction of the misaligned parts, while Still claimed to enhance the flow of blood. As news spread about the new doctor of drugless healing in Iowa, osteopaths began to campaign to protect osteopathy.

In September 1899, a Davenport MD, Heinrich Matthey, began a campaign against drugless healers in Iowa. He sought to change the state law (which referred to 'the healing arts') to prevent drugless healers from practicing in the state, arguing that health education could not be entrusted to anyone but doctors of medicine. Osteopathic schools responded by developing a program of college inspection and accreditation, but DD Palmer, whose school had just graduated its 7th student, insisted that his techniques did not need the same training or licensing as medicine, as his graduates did not prescribe drugs or evaluate blood or urine. Nevertheless, in 1901, he was charged with misrepresenting to a student a course in chiropractic which was not a real science. He persisted in his opposition to licensing, arguing for freedom of choice, and was arrested twice more by 1906. Although he denied that what he practiced was medicine, he was convicted for claiming that he could cure disease when he had no license to practise either medicine or osteopathy.

At the 'American School of Chiropractic & Nature Cure', Solon Langworthy narrowed the scope of chiropractic to the treatment of the spine and nerve, 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' (intervertebral foramina). In 1906, he published the first book on chiropractic, Modernized Chiropractic - Special Philosophy; A Distinct System. DD Palmer objected vigorously to the mixing of chiropractic, and persuaded the Governor of Minnesota to veto legislation that would have allowed Langworthy's students to practice there. However, he did accept some of Langworthy's concepts, introducing the concept of Innate Intelligencein about 1904.

BJ Palmer re-develops chiropractic

After DD Palmer's conviction, he turned his interests in the 'Palmer School of Chiropractic' over to his son, BJ Palmer. The conviction of DD Palmer prompted the creation of the 'Universal Chiropractic Association'; its initial purpose was to provide for legal defense of members should they get arrested, and its first case was in 1907, when Shegataro Morikubo DC of Wisconsin was charged with unlicensed practice of osteopathy. In an ironic twist, using mixer Langworthy's book Modernized Chiropractic, attorney Tom Morris 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 chiropractic, which then marketed itself as a science, an art and a philosophy. ^[4] In the next 15 years, 30 more chiropractic schools opened, including John Howard's National School of Chiropractic (now the National University of Health Sciences).

Of the more than 15000 prosecutions of DCs that were fought in the first 30 years, BJ Palmer the 'Philosopher of Chiropractic', later said,

"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." ^[5]

BJ Palmer's influence over the next few years further divided mixers (who mixed chiropractic with other cures) from straights (who practiced chiropractic alone). While he continued at the Palmer school, his father developed his ideas in Oregon, challenging his son's methods and philosophy, and trying to regain control of chiropractic. In 1910, DD Palmer proposed that: "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 death in 1913 (allegedly run over by an automobile driven by his son) he repudiated his earlier theory that vertebral subluxations caused pinched nerves in favor of subluxations causing altered 'nerve vibration', and declared that "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." ^[6]

Straight vs Mixer

Laws to regulate and protect chiropractic were eventually introduced in all states in the USA, but it was a hard-fought struggle. Medical Examining Boards tried to keep all healthcare under their control, and disagreement between DCs complicated the process. Initially, the UCA opposed state regulation, fearing that it would lead to allopathic control of the profession. The UCA eventually conceded, but BJ Palmer continued to argue that examining boards should be composed exclusively of chiropractors (not mixers), and that the educational standards to be adhered should be the same as those of the Palmer School. In 1922, a 'model bill' was presented to states that did not yet have a law. They began a process of 'cleaning house' of mixers, warning state associations to purge their mixing members or face competition from a new 'straight' association.^[7]

In response, mixers founded the American Chiropractic Association. Its growth was initially stunted by its decision to recognize physiotherapy and other modalities as related to chiropractic, but in 1924, a disagreement within the UCA turned the tide. BJ Palmer was still trying to purge mixers from chiropractic, and he saw a new invention by Dossa D. Evans, the Neurocalometer, as the answer to straight chiropractic's legal and financial problems. As the owner of the patent on the Neurocalometer, he planned to limit it to 5000, and lease them only to members of the UCA. He then claimed that the Neurocalometer was the only way to accurately locate subluxations, preventing over 20,000 mixers from being able to defend their method of practice. ^[8]

There was uproar among DC's, and even Tom Morris, BJ Palmer's old ally and president of the UCA, displayed his dismay by resigning. BJ Palmer resigned as treasurer, ending his relationship with the UCA, and moved on to form the 'Chiropractic Health Bureau' (today's ICA) along with his staunchest supporters. In 1930, the ACA and UCA combined to form the 'National Chiropractic Association' and made John J Nugent responsible for raising educational standards; his zeal earned him the nickname 'Chiropractic's Abraham Flexnor' from admirers and 'Chiropractic's Anti-christ' from adversaries. The CES became today's Council on Chiropractic Education, chiropractic's accrediting body. [2]

The movement toward scientific reform

By the late 1950s, healthcare in the USA 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 the antiquackery efforts of the AMA. Osteopathy developed in parallel to medicine and stopped relying on spinal manipulation to treat illness, and a similar reform movement began within chiropractic: shortly after the death of BJ Palmer in 1961, a second generation chiropractor, Samuel Homola, proposed that chiropractic should focus on conservative care of musculoskeletal conditions. "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 of the ACA was not renewed, and his views were rejected by both straight and mixer associations. ^[9]

In 1978, the Journal of Manipulative & Physiological Therapeutics (JMPT) was launched. Keating dates the birth of chiropractic as a science to a 1983 commentary in the Journal in which Kenneth DeBoer, an instructor at Palmer College, revealed the power of this journal to empower faculty at chiropractic schools, enabling them to challenge the status quo, to publicly address issues related to research, training and skepticism, and to raise professional standards. [3]

The American Medical Association plans to eliminate chiropractic

Medicine, Monopolies, and Malice (Chester Wilk, book title[4])

In November 1963, the American Medical Association (AMA) formed a 'Committee on Quackery' to first contain, and then eliminate chiropractic. Doyl Taylor, Secretary of the Committee, outlined steps needed to ensure that Medicare should not cover chiropractic; to ensure that the U.S. Office of Education should not recognize a chiropractic accrediting agency; to encourage continued separation of the two national associations; and to get state medical societies to initiate legislation to control 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 guidelines for medical schools about the 'hazards' of chiropractic. ^[10] In 1966 the AMA declared that "chiropractic is an unscientific cult whose practitioners... constitute a hazard to healthcare in the United States." and set out to forbid its members fromworking with chiropractors; until 1980, Principle 3 of the AMA 'Principles of Medical Ethics' stated that "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." However, the AMA crusade against chiropractic raised suspicions that it was motivated at least in part by narrow professional self-interest, and in 1975, an anonymous informant leaked internal documents about the crusade. To challenge the AMA, in 1976, a Chicago DC, Chester Wilk, and three other DCs brought an antitrust suit against the AMA and two other medical associations - Wilk et al vs AMA et al.

The judge in the ensuing landmark trial said that, according to the evidence given:

"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 said that DCs clearly wanted "a judicial pronouncement that chiropractic is a valid, efficacious, even scientific health care service". However, she said that no well-designed, controlled, scientific studies 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".

In 1987, the Federal Appeals Court found the AMA guilty of conspiracy and restraint of trade (two co-defendants, the Joint Council on Accreditation of Hospitals and the American College of Physicians were exonerated). The court recognized that the AMA had a duty to show its concern for patients, but was not persuaded that this could not have been achieved in a way that was 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 chiropractors. ^[11]

After the court victory, Wilk said (of the AMA)

"They don't have to love us, but they'll have to respect us and respect the law." [5]

In 1992, the AMA declared "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." [6]

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