Chiropractic - History

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Chiropractic Main Article

Historical overview[edit | edit source]

D.D. Palmer[edit | edit source]

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] Allopathy, fueled by Louis Pasteur's refuting 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.

The first chiropractic adjustment[edit | edit source]

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] Another refutation of the story came when investigator Cyrus Lerner opined in 1952 that the Lillard story disagreed with other evidence published about the same time, speculated that B.J. had concocted the date of the first adjustment in order to establish priority for chiropractic, and compared the Lillard story to the Tales of the Arabian Nights.^[8]

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. ^[9]

Early growth[edit | edit source]

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]

Origin and Etymology of Term "Chiropractic"[edit | edit source]

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.^[10] DD Palmer, who was not interested in mixing chiropractic with other cures, turned down an offer to be a partner.

Philosophical contribution[edit | edit source]

Traditional and evidence-based chiropractic belief systems vary along a philosophical spectrum ranging from vitalism to materialism. These opposing philosophies have been a source of debate since the time of Aristotle and Plato. Vitalism, the belief that living things contain an element that cannot be explained through matter, was responsible for legally and philosophically differentiating chiropractic from conventional medicine and thereby helping ensure professional autonomy.^[12] Chiropractic also retains elements of materialism, the belief that all things have explanations, which forms the basis of science. Evidence-based chiropractic balances this dualism by emphasizing both the tangible, testable principle that structure affects function, and the untestable, metaphorical recognition that life is self-sustaining.^[11]

The chiropractor's purpose is to foster the establishment and maintenance of an organism-environment dynamic that is the most conducive to functional well-being of the person as a whole.^[11] Principles such as holism, naturalism, therapeutic conservatism, critical rationalism, and thoughts from the phenomenological and humanistic paradigms form an important part of the philosophy of chiropractic."^[13]

Chiropractors can adopt or share vitalist, naturalist, or materialist viewpoints and emphasize a holistic, patient-centered approach that appreciates the multifactorial nature of influences (i.e. structural, chemical, and psychological) on the functioning of the body in health and disease and recognizes the dynamics and interplay between lifestyle, environment, and health. This holistic paradigm is also blended with a biopsychosocial approach, which is also emphasized in chiropractic care. In addition, chiropractors also retain naturopathic and naturalist principles that suggest decreased "host resistance" of the body facilitates the disease process and that natural interventions are preferable towards strengthening the host in its effort to optimize function and return to homeostasis.^[11] Chiropractic care primarily emphasizes manipulation and other manual therapies as an alternative than medications and surgery.^[14]

Chiropractors also commonly use nutrition, exercise, patient education, health promotion and lifestyle counseling as part of their holistic outlook towards preventive health care.^[15] Chiropractic's claim to improve health by improving biomechanical and neural function by the manual correction of joint and soft tissue dysfunctions of the neuromusculoskeletal system differentiates it from mainstream medicine and other complementary and alternative medicine (CAM) disciplines, but is also rooted, in part, in osteopathy and eastern medicine interventions.^[13] All chiropractic paradigms emphasize the spine as their focus, but their rationales for treatment vary depending on their particular belief system.

The philosophy of chiropractic also stresses the importance of prevention and primarily utilizes a pro-active approach and a wellness model to achieve this goal.^[16] For some, prevention includes a concept of "maintenance care" that attempts to "detect and correct" structural imbalances of the neuromusculoskeletal system while in its primary, or functional state.^[17] The objective is early identification of mechanical dysfunctions to prevent or delay permanent pathological changes.^[18]

In summary, the major premises regarding the philosophy of chiropractic include:^[11]

• Holism

• non-invasive, emphasizes patient's inherent recuperative abilities
• recognizes dynamics between lifestyle, environment, and health
• spine and health are related in an important and fundamental way, and this relationship is mediated through the nervous system.^[12]
• 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

• Conservatism

• balances the benefits against the risks of clinical interventions
• emphasizes non-invasive treatments to minimize risk with a preference to avoid surgery and medication
• recognizes as imperative the need to monitor progress and effectiveness through appropriate diagnostic procedures
• prevents unnecessary barriers in the doctor-patient encounter

• Manual and biopsychosocial approaches

• strives toward early intervention, emphasizing timely diagnosis and treatment of reversible conditions before loss of functionality
• emphasizes a patient-centered model in which the patient is considered to be indispensable in, and ultimately responsible for, the maintenance of health^[12]
• approach of improving health through influencing function through structure primarily via manual therapies

Schools of thought and practice styles[edit | edit source]

Common themes to chiropractic care include holistic, conservative and non-medication approaches via manual therapy.^[19] Still, significant differences exist amongst the practice styles, claims and beliefs between various chiropractors.^[20]

Straight chiropractors are the oldest, and today the smallest faction; representing perhaps less than 10% of the profession in the US.^[21] They adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities. Straight chiropractors believe that vertebral subluxation leads to interference with an Innate intelligence within the human nervous system and is a primary underlying risk factor for almost any disease. Straights view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary for treatment. Thus, straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not "mix" other types of therapies.^[22] Their philosophy and explanations are metaphysical in nature and prefer to use traditional chiropractic lexicon (i.e. perform spinal analysis, detect subluxation, correct with adjustment, etc.). They prefer to remain separate and distinct from mainstream health care.

The Mainstream of Chiropractic, which was pejoratively called "Mixer's" by the so-called "Straight" chiropractors are an early offshoot of the straight movement. This branch "mixes" diagnostic and treatment approaches from naturopathic, osteopathic, medical, and chiropractic viewpoints. Unlike straight chiropractors, mixers believe subluxation is one of the many causes of disease, and they incorporate mainstream medical diagnostics and employ myriad treatments including joint and soft tissue manipulation, electromodalities, physical therapy, exercise-rehabilitation and other complementary and alternative approaches such as acupuncture. Mixers tend to be open to mainstream medicine.^[23] Mixers are the majority group.^[24]

Internal conflicts[edit | edit source]

So-called "straights" and the mainstream have had conflicts that continue to this day.^[25] Objective Straight chiropractors, who were an off-shoot of straights, only focused on the correction of chiropractic vertebral subluxations while traditional straights claimed that chiropractic adjustments are a plausible treatment for a wide range of diseases.^[26] Reform chiropractors were an evidence-based off-shoot of mixers who rejected traditional Palmer philosophy and tended not to use alternative medicine methods.^[27] There is disagreement over what does innate and subluxation mean to chiropractic.^[23] Some chiropractors believe in Innate intelligence, an untestable faith-based belief, not of science, which has been a source of derision for chiropractors.^[28] In Wisconsin, US, there was local chiropractic support to offset a chiropractic anti-fluoridation campaign.^[29]

Historical term, "Vertebral subluxation"[edit | edit source]

Palmer hypothesized that vertebral joint misalignments, which he termed vertebral subluxations, interfered with the body's function and its inborn (innate) ability to heal itself.^[30] D.D. Palmer 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. D.D. Palmer, using a vitalistic approach, imbued the term subluxation with a metaphysical and philosophical meaning. He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic.^[31] This concept was later expanded upon by his son, B.J. Palmer and was instrumental in providing the legal basis of differentiating chiropractic medicine from conventional medicine. In 1910, D.D. Palmer theorized that the nervous system controlled 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 that 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 functionality—too much or not enough action—which is disease."^[32]

The concept of subluxation remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades.^[33] In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, dogmatic beliefs and metaphysical approach. While straight chiropractic still retains the traditional vitalistic construct espoused by the founders, evidence-based chiropractic suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community.^[33] This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic (for example, Palmer College of Chiropractic^[34]) still teaching the traditional/straight subluxation-based chiropractic, while others (for example, Canadian Memorial Chiropractic College^[35]) have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions but retains a holistic approach and an emphasis on manual therapy.^[36][37] A 2003 survey of North American chiropractors found that 88% wanted to retain the term vertebral subluxation complex, and that when asked to estimate the percent of visceral ailments that subluxation significantly contributes to, the mean response was 62%.^[38] In 2005, subluxation was defined by the World Health Organization as "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.… This definition is different from the current medical definition, in which subluxation is a significant structural displacement, and therefore visible on static imaging studies."^[39]

Changing political and healthcare environment[edit | edit source]

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.^[40] 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.^[41] 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.^[41] 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.^[40] By 1910, the AMA was a powerful force; this was the beginning of organized medicine.^[42]

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.^[8] 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.^[40]

Osteopathy vs chiropractic[edit | edit source]

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.

Medicine vs chiropractic[edit | edit source]

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.^[8] 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.^[8] 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[edit | edit source]

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.^[43] 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.^[44] 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."^[45]

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]

DD Palmer's last years[edit | edit source]

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][46]

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."^[47]

Straight versus mixer[edit | edit source]

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.^[48] 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.^[48] 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.^[48] 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),^[49] 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.^[50]

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[edit | edit source]

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.^[51] 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."^[52] 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.^[53] 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.^[53]

Medical opposition[edit | edit source]

In 1899, a medical doctor in Davenport, USA, named Heinrich Matthey started a campaign against drugless practitioners.^[8][54] D.D. Palmer insisted that his techniques did not need the same courses or license as medical doctors, as his graduates did not prescribe drugs, perform surgery or evaluate laboratory diagnostics. However, in 1906, D.D. Palmer was convicted for practicing medicine without a license. In response, B.J. created the Universal Chiropractic Association (UCA) for the purpose of protecting its members by covering their legal expenses should they get arrested for practicing medicine.^[55]

Its first case came in 1907, when Shegataro Morikubo, DC was charged with unlicensed practice of osteopathic medicine in Wisconsin. Morikubo was freed using the defense that chiropractic philosophy was different from osteopathic philosophy. The victory reshaped the development of the chiropractic profession, which then marketed itself as a science, an art and a philosophy.^[8] This began a longstanding feud between chiropractors and medical doctors that would culminate in the mid 1980's in a landmark case, Wilk et al. vs American Medical Association (AMA). Until 1983, the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner," and labeled chiropractic "an unscientific cult."^[56] In 1984, Joseph Janse, DC, ND, attempted to describe the divide in chiropractic and medical philosophy regarding prevention and patient care:

"Unless pathology is demonstrable under the microscope, as in the laboratory or by roentgenograms, to them [medical doctors] it does not exist. For years the progressive minds in chiropractic have pointed out this deficiency. With emphasis they [chiropractors] have maintained the fact that prevention is so much more effective than attempts at a cure. They pioneered the all-important principle that effective eradication of disease is accomplished only when it is in its functional (beginning) phase rather than its organic (terminal) stage. It has been their contention that in general the doctor, the therapist and the clinician have failed to realize exactly what is meant by disease processes, and have been satisfied to consider damaged organs as disease, and to think in terms of sick organs and not in terms of sick people. In other words, we have failed to contrast disease with health, and to trace the gradual deteriorization along the downward path, believing almost that mild departures from the physiological normal were of little consequence, until they were replaced by pathological changes…"^[57]

Legal battles[edit | edit source]

AMA conspires to eliminate chiropractic[edit | edit source]

On November 2, 1963, the AMA Board of Reagents created the "Committee on Quackery" with the goals of first containing, and then eliminating chiropractic. Doyle 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."^[58]

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.^[59]

Wilk et al. vs. American Medical Association[edit | edit source]

Chester A. Wilk, DC from Chicago initiated an antitrust suit against the AMA and other medical associations in 1976 - Wilk et al. vs AMA et al.^[59] The landmark lawsuit ended in 1987 when the US District 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.^[60] A summary of the court's opinion concluded:

"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."^[60]

On February 7, 1990, the AMA lost its appeal,^[61] and could no longer prevent medical physicians from collaborating with chiropractors.^[60]

Relations improve[edit | edit source]

In 1992, the AMA stated "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."^[62] In 1997, the following literature was adopted as policy of the AMA after a report on a number of alternative therapies. The report said (about chiropractic care): "Manipulation has been shown to have a reasonably good degree of efficacy in ameliorating back pain, headache, and similar musculoskeletal complaints."^[63]

The British Medical Association (BMA) notes that "There is also no problem with GPs 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."^[64] In 1997, the BMA identified chiropractic health care as having "the potential for greatest use alongside orthodox medical care."^[65]

The Present Day[edit | edit source]

Today, the chiropractic profession generally divides itself into "mainstream" and, "traditional" a/k/a, "straight" Chiropractic. Historically the terms "straights" and "mixers," were applied by Palmer to distinguish those who rigorously followed his teachings from those who incorporated Physiotherapy, nutrition and or other methods to treat patients. Although both groups have had off-shoots. ^[23][30] Significant differences regarding scope of practice, claims made about spinal manipulation, and beliefs regarding professional integration, differentiated the various schools of thought and practice styles held within the profession.^[20] Naturally, the various State's scope of practice legislation and CCE (Council on Chiropractic Education) accreditation rules have been a unifying force, between traditional and evidence-based chiropractic beliefs which ranged range from vitalism to materialism.^[12]

References[edit | edit source]