Historia de La Quiropraxia (Ingles)

8/3/2019 Historia de La Quiropraxia (Ingles)

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Chiropractic History: a Primer

Joseph C. Keating, Jr., Ph.D.Secretary & Historian,National Institute of Chiropractic Research

Director, Association for the History of Chiropractic

Carl S. Cleveland III, D.C.President, Cleveland Chiropractic Colleges

Director, Association for the History of Chiropractic

Michael Menke, M.A., D.C.Faculty Member, National University of Health Sciences

Faculty Member, University of Arizona

PracticeMakers_504474 3/21/05 3:35 AM Page 1


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The NCMIC Insurance Company is proud to make this primer of chiropractic history possible through a grant to the Association for the History of Chiropractic. NCMICrecognizes the importance of preserving the rich history of our profession. This primer willhopefully stimulate your interest in this saga, help you to understand the trials and tribula-tions our pioneers endured, and give you a sense of pride and identity.

Lee Iacocca, in his book about LIBERTY said:

I know that liberty brings with it some obligations. I know we have it today because others

fought for it, nourished it, protected it, and then passed it on to us. That is a debt we owe. We

owe it to our parents, if they are alive, and to their memory if they are not. But mostly we have anobligation to our own kids. An obligation to pass on this incredible gift to them. This is howcivilization works... whatever debt you owe to those who came before you, you pay to those who

follow.

That is essentially the same responsibility each of us has to preserve and protect theextraordinary history of this great profession. We share this primer with you, and hope thatyou in turn will do your part for the good of the order. Enjoy.

Louis Sportelli, D.C.

President NCMIC Group, Inc.

(c) 2004, Association for the History of Chiropractic, Davenport, Iowa

Layout by Alana Callender, M.S.Cover design by Amelia TrollingerPrinted by Sutherland Companies, Montezuma, Iowa



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Contents

Why Chiropractic History?............................................................................................5Pre-chiropractic: Nineteenth Century Medicine and Alternative Healing....................6The Palmers and the Birth of Chiropractic...................................................................8Early Chiropractic Schools..........................................................................................14Prosecution and Legislation.........................................................................................18Evolution of Theory, Technique and Instrumentation.........................................................23Legitimizing Chiropractic Education...........................................................................30In Moral Defiance........................................................................................................32

The Research Enterprise (1975 to present)..................................................................35The Straight/Mixer Controversy...................................................................................38Integration and the Future of the Profession................................................................44References....................................................................................................................47



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The authors gratefully acknowledge thesupport of the Cleveland ChiropracticColleges and the National Institute ofChiropractic Research.

The mission of the Association for the History ofChiropractic is to gather, preserve, and disseminatethe creditable history of the chiropractic profession.



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WHY CHIROPRACTIC HISTORY?

With all the study demands to learn the basic sciences which weigh upon the newchiropractic student, you may well wonder where you will find the time to learn the historyof your chosen profession. After all, its all behind us now! And yet, if we wish to under-stand philosophy in chiropractic, it will help to know how the cherished concepts of doctorsof chiropractic (DCs) emerged and blossomed overtime. If we wish to appreciate chiropractic theoryand technique in all its rich diversity and myriadforms, knowing how techniques developed, the onefrom the other and sometimes in oppositional reac-tion to each other, history can make all the differ-ence. If you expect to earn a diploma, obtain alicense and succeed in the business of clinical prac-tice, understanding how these possibilities cameabout may make the difference between a rockyroad vs. smooth sailing. Chiropractic did not springinto existence fully grown, but has been evolvingand unfolding for more than a century. And thoughhistory can offer no blueprint for the future, it canaid us to see options and strategies that might oth-erwise remain obscure.

Perhaps more importantly, history shapesidentity. Like the adolescent who seeks to defineher/himself in comparison with the peer group (other teenagers), professions also tend todefine themselves in part by comparison with each other. Now, after more than 100 years ofservice to the public, we in chiropractic have reached a more mature stage, and we mustappreciate and define ourselves from a more adult and longitudinal perspective. Our placein society, both as individuals and as a profession, is significantly shaped by the paths weve

taken. We are not merely the un-medicine, but also the sum of all the experiences we havecome through.

Lyndon McCash, DC, in jail in Oakland, Calif.,in 1920, one of hundreds of California chiroprac-tors incarcerated for unlicensed practice prior to

passage of the Chiropractic Act in 1922.


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Patients protest outside the Ohio jail where their doctor, Herbert R. Reaver, D.C., was imprisoned.



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And so the Association for the History of Chiropractic (AHC) offers this brief intro-duction to chiropractic history. We hope this primer will tickle your history bone as we

briefly explore the triumphs and tragedies, wonders and warts, passion and determination,

the funny, the sad and the bizarre in the saga of chiropractic. Its been a heck of a ride, andnow its part of your heritage, too. Welcome aboard!

PRE-CHIROPRACTIC: NINETEENTH CENTURY MEDICINE AND ALTERNATIVE HEALING

Chiropractic emerged in the final years of the 19th century, a time of great changeand growing public awareness of the incredible possibilities inherent in science, technologyand social organization. The 1800s saw the dawn of the machine age, and ushered in suchmarvels as the steamboat, the railroad, telegraphy, and mass production via the assemblyline. The century was also a time of great upheaval in America, and the Civil War tore thenation and families apart. Wounds were left, both physical and psychic, that no doctor couldheal. Spiritualism and sances grew in popularity as people yearned to make contact withtheir departed loved ones.

Health care in the 19th century was a smorgasbord of competing theories, practi-

tioners, potions and schemes (see Table 1). Except in urban centers, doctors were scarce, andmost health care was provided in the home by family members. Hospitals were even scarcerthan doctors, and were seen as places of doom where the terminally ill went to die. In anation dominated by self-reliant farmers who had liberated themselves from the Britishcrown, populist sentiments ran strong, and physicians were often seen as elitist pretendersto authority. By mid-century, most of the early statutes regulating the practice of medicinehad been repealed at the insistence of the electorate (Starr 1982). Alarmed at the loss of itsquasi-monopoly, the dominant medical sect organized the American Medical Association inan effort to re-establish its authority.

Heroic medicine was the most prevalent form oforthodox practice in the first half of the 19th century.Championed by Benjamin Rush, M.D., a signer of theDeclaration of Independence (Starr 1982, p. 83), heroic

practice involved the notion that the harshness of the doc-tors remedies should be in proportion to the severity of the

patients disease. This meant that the sickest patients were atrisk of iatrogenesis (illness caused by treatment), since hero-ic doctors black bags were filled with strong emetics andcathartics comprised of alcohol, mercury and other toxins,

as well as the physicians notorious lancet. GeorgeWashington, it might be noted, died from blood-letting atthe hands of his doctors who sought to remove impurities


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bonesettingChristian Science

eclectic medicineelectro-medicine

herbalism|heroic medicine

homeopathymagnetic healing

Native American remediesnaturopathy

osteopathypatent medicines

Physical Culturephrenomagnetism

Thomsonianism

Table 1: Several health care options available to Americans in the 19th century

Benjamin Rush, MD



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from his circulation. Although heroic medicine was in decline by 1850 (Starr 1982, p. 56),its use continued through the rest of the century (Joachims 1982).

Against this backdrop of heroic medicine, the Native American and Thompsonian

traditions of herbal and other botanical remedies grew popular, and were joined in the earlypart of the 19th century by the infin-itesimal doses of homeopathic med-icine (promoted by SamuelHahnemann, M.D., of Germany)and the magnetic healing methodsof Franz Anton Mesmer, M.D.Mesmers doctoral dissertation atthe University of Vienna in 1776had introduced animal magnetismas a vital and transferable force inliving things. Although the FrenchAcademy of Sciences, including

prominent member BenjaminFranklin, repudiated Mesmersideas as little more than suggestion(Armstrong and Armstrong 1991,

pp. 186-8), magnetic methods were imported to the New World in the 1830s where theygrew to be as popular as in Europe. As well, magnetic healing concepts and practices wouldinfluence the founders of several other alternative health care schools, including Mary BakerEddy, founder of Christian Science; Andrew Taylor Still, founder of osteopathy (Gevitz1982); and D.D. Palmer, father of chiropractic (Gielow 1981; Keating 1997a).

Political medicine had much to be humble about, but instead behaved in ratheraggressive and arrogant fashion towards its competitors. Organized medicine wrapped itselfin a cloak of science, and worked to convince governments and a sizable portion of the pop-ulace that it alone had the knowledge to justify licensure. Although medical statutes wererarely enforced in the 19th century, they laid the groundwork for allopathic dominance inyears to come. Medical doctors became the nearly exclusive source of advice to lawmakers,and the sole arbiters of health care within the embryonic government hospitals and health


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Dr. Franz Anton Mesmer, 1734-1815 19th c. caricature of themagnetic practitioner

1873: Arizona Territorial Act1874: Missouri1875: Nevada1875-6: California1876: Vermont1878: Cherokee and Choctow

Nations in Indian Territory1879: Kansas, Texas

1881: Colorado1886: Iowa1889: Idaho, North Carolina,

Tennessee1890: Florida, Washington1891: Alabama, Nebraska, North

Dakota1892: Maryland, Mississippi1893: Connecticut, Kentucky,

New York, Pennsylvania,South Dakota

1894: Georgia, Louisiana,Massachusetts, Marylandamended, New Jersey,

South Carolina, Utah,Virginia

1895: Arkansas, Delaware,Indiana, Maine, Minnesota,Montana, Oregon, RhodeIsland, New York amended

1896: District of Columbia, Ohio1897: New Hampshire,

Wisconsin1899: Illinois, Michigann.d. Wyoming

Table 2: Reintroduction of medical statutes in America, 1873-1899(Wilder 1901, pp. 775-835)(courtesy of Robert B. Jackson, D.C., N.D.)



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services (e.g., Mullan 1989). These early political advances shaped health care in Americanever after (e.g., Wilk 1996; Wolinsky & Brune 1994).

THE

PALMERS AND THE

BIRTH OF

CHIROPRACTIC

In 1886, when Daniel David (D.D.) Palmer first hung his shingle as a magneticpractitioner in Burlington, Iowa (Gielow 1981, pp. 43, 105), the licensing of doctors wasstill a novelty in the Hawkeye State. Encouraged by the belief that he had a personal excessof vital magnetic energy, he offered his services to the many patients who were wary oforthodox medicine. As was the custom of the day, Palmer adopted the title Doctor, andconducted his clinic with little concern about interference from his allopathic competitors.Had he practiced quietly in Burlington and later in Davenport, Iowa (where he relocated in1887), his destiny might have been much different. But Dr. Palmer was a man of strong con-victions and irrepressibly sharp tongue, and he broadcast his views on the horrors and abom-inations of mainstream medicine by means of a newspaper-sized advertiser (successivelyknown as The Educator, The Magnetic Cure, andThe Chiropractic) which reached thou-sands in Davenport and surrounding communities. D.D. Palmer was a lightning rod for con-

troversy.D.D. was born on 7 March 1845 in rural

Ontario, just west of Toronto (Palmer 1910, pp. 17-8). His parents and siblings relocated to theMississippi River valley in the waning days of theCivil War. Here the young man occupied himself asa farmer, grocer, bee keeper, and school teacher

before taking up the healing art (Gielow 1981;Palmer 1908, p. 14). His formal education did notextend past the sixth grade, but he was an avidreader in a variety of subjects, including spiritual-ism, vitalism and the mechanical and biologicalsciences of his day. Surviving records from his

businesses and career as schoolmaster reveal a verywell organized mind; Palmer attended to detail andsought to understand the complexities of his world.These qualities extended into his work as a mag-netic, and his curiosity led him to search for expla-nations for the beneficial effects his patients report-ed.

After nine years of clinical experience andtheorizing, D.D. had decided that inflammation was the essential characteristic of all dis-ease. With his sensitive fingers, Palmer sought to locate inflammation in his patients. Hismagnetic treatment involved pouring his personal, excess vital magnetic energy into the siteof inflammation so as to cool it off. By not later than 1895, D.D. had decided that the causeof inflammations, and hence of all or most dis-ease, were displacements of anatomic

structures. In the 1896 issue of his advertiser, The Magnetic, a homeopathic physicianoffered a testimonial concerning Palmers work which spoke to the anatomical specificity ofD.D.s orientation:


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This photo from the 1880s or early1890s shows, seated (l-r): D.D. Palmerand his father Thomas. Standing areyounger brothers Thomas J. and Bart.



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He heals the sick, the halt, the lame, and those paralyzed, through the medi-um of his potent magnetic fingers placed upon the organ or organs diseased

and not by rubbing or stroking, as other magnetic curers do Dr. Palmerseeks out the cause, the diseased organ upon which the disease depends, andtreats that organ. Magnetics generally treat all cases alike, by general stroking,

passes or rubbing. I think Dr. Palmers plan is much more rational, and shouldbe the most successful (Livezey, cited in Palmer 1896).

The same issue ofThe Magnetic included Palmers thoughts about treatment of the internalorgans:

I strengthen the weakened parts by magnetic treatment. It is a specific fortheir relaxed and debilitated condition. It imparts to the female a life givingforce, a healthy tone, a healthy stimulus, which is much better than using theknife or supporters. This treatment quickly relieves any inflammation of theovaries (Palmer 1896).

By late 1895 or early 1896, Palmers theorizing had progressed even further. Basedon the premise that inflammation occurred when displaced anatomic structures rubbedagainst one another, causing friction and heat, he sought to manually reposition the parts ofthe body so as to prevent friction and the development of inflamed tissue. The first recipi-ent of this new strategy was a janitor in the building where Palmer operated his 40-roomfacility. Patient Harvey Lillard reported in the January 1897 issue ofThe Chiropractic that:

I was deaf 17 years and I expected toalways remain so, for I had doctored a

great deal without any benefit. I hadlong ago made up my mind to not

take any more ear treatments,for it did me no good.

Last January Dr.Palmer told me that my deaf-ness came from an injury inmy spine. This was new tome; but it is a fact that my

back was injured at the time Iwent deaf. Dr. Palmer treated me

on the spine; in two treatments Icould hear quite well. That was eight

months ago. My hearing remains good.Harvey Lillard, 320 W.

Eleventh St., Davenport, Iowa

(Palmer 1897)


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Mr. HarveyLillard, c. 1906

Reverend Samuel Weed



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Delighted with this first informal experiment,Palmer extended his new work as a magnetic manipulator

(Palmer 1897) to patients with a variety of other health problems, with reportedly good results. In the summer of1896 he sought and obtained a charter for the Palmer Schoolof Magnetic Cure, wherein he would teach his new method(Wiese 1896). With the assistance of his friend and patient,Reverend Samuel Weed, D.D. adopted Greek terms to formthe word chiropractic, meaning done by hand. His school

became known informally as Palmers School ofChiropractic (PSC), and he trained a few students, severalof whom were allopathic and osteopathic doctors.

In the spring of 1902, perhaps in response to threatof prosecution, Old Dad Chiro departed Davenport and set-tled in Pasadena, California. Left to manage the Palmer

School and to cope with a sizable debt (approximately$8,000) was young Dr. B.J. Palmer, newly graduated fromhis fathers institution. Only 20 years of age, the young man

proved remarkably resourceful in assuming his fathers role.He secured financing from the local banks, grew a beard toappear older, and established his own clientele of patientsand students. While his father taught and practiced as anitinerant healer along the California coastline, B.J. restoredthe Palmer School and infirmary to financial health.

D.D. returned to Davenport late in 1904, and the twoPalmers operated the school together. However, theirs hadalways been a stormy relationship, and circumstanceswould strain their patience to its limits. Among the chal-lenges they confronted was competition from former gradu-ates, most notably the American School of Chiropractic and

Nature Cure in Cedar Rapids, Iowa, which was owned by1901 Palmer graduate Solon M. Langworthy. In addition tothe competition for students, the father of chiropractic wasincensed by Dr. Langworthys introduction of naturopathicremedies (e.g., stretching machines, herbal remedies) in thecurriculum; it was the beginning of the feud within the pro-fession between straights and mixers. WhenLangworthy and associates succeeded in having a chiro-

practic licensing bill passed by both houses of theMinnesota legislature in 1905, the Palmers (with a bit of

help from the medical community) persuaded the governorto veto the legislation (Gibbons 1993).The pages of the Palmers house organ, The


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Advertisement for the PalmerSchool, c. 1904

Drs. Alva Gregory and D.D.Palmer in Oklahoma City, c. 1907

B.J. Palmer, Christmas 1900



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Chiropractor, filled with anti-mixing rhetoric. And D.D.s continuing diatribe againstallopathy and his use of testimonial advertising prompted his arrest for practicing medicinewithout a license late in 1905. Tried, convicted and sentenced in 1906 to 105 days in Scott

County jail or a fine of $350, Old Chiro went to jail for principle, insisting that he was notpracticing medicine when he practiced chiropractic. B.J. featured his father as a Martyr toHis Science in the pages ofThe Chiropractor, but when the elder Palmer finally paid thefine and was released after several weeks behind bars, the friction between father and sonreached a pinnacle. They negotiated a settlement of their shared property, and the elder head-ed for Medford, Oklahoma, where his brother Thomas was in business. For a while, thefather of chiropractic once again operated a grocery store, but by 1907 had established yetanother school, this time in partnership with Alva Gregory, M.D., D.C. The school survivedfor several years, but D.D. Palmer again found it difficult to share leadership, and left thePalmer-Gregory College of Chiropractic for greener pastures. In November 1908, he estab-lished the D.D. Palmer College of Chiropractic in Portland, Oregon. It was here that heauthored his classic, thousand-page volume, The Chiropractors Adjuster: the Science, Artand Philosophy of Chiropractic (Palmer 1910). It was apparently in Portland as well that his

third and final theory of chiropractic (Palmer 1914) emerged.B.J. Palmer, meanwhile, continued the growth of the PSC, expanding enrollments

and developing extensive marketing programs for the school and its graduates. He was acurious soul; B.J. engaged insome of the earliest research in the

profession and greatly expandedthe osteological collection hisfather had established. He hired asuccession of MDs for his faculty,who provided a degree of legal

protection from prosecution (Iowadid not pass a chiropractic lawuntil 1921). In 1908 the PSC com-menced publication of a series ofvolumes on the chiropractic artthat would be known as the green

books, and in 1910 B.J. intro-duced x-ray technology to the pro-fession.

Old Dad Chiro died of typhoid fever in Los Angeles in 1913. Father and son had viedwith one another for recognition as the developer of chiropractic for several years, andthere was unresolved bitterness. Several of the elders followers campaigned to have B.J.

prosecuted for injuring his father during a chiropractic parade down Davenports BradyStreet hill (home of the PSC) earlier that year, but three grand juries refused to indict him(Gibbons 1994; Keating 1997a). Nevertheless, B.J. would be haunted by unjustified claims

of patricide for the rest of his life. It was a bitter pill, and perhaps one that explains some ofhis ferocity in challenging his political opponents within the profession in later years.From 1913, when his father passed away, until his 1924 introduction of the neu-


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B.J. (center) and the Palmer osteological collection, c. 1915



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rocalometer (NCM), B.J. Palmer wasthe clear majority leader of the chiro-

practic profession (Keating 1997a).

Much of this time was spent in build-ing the legal apparatus to defend themany thousands of chiropractors whowere arrested for practicing medicinewithout a license. The PSC expanded

phenomenally, its student body sup-ported by veterans benefits followingWorld War I (Keating1994), andreached a record 3,000 students in theearly 1920s. B.J. Palmer became awealthy man, his fortune eventually

expanded by his investment in the burgeoning field of radio (Keating 1995a). Radio stationWOC in Davenport, and later sister station WHO in Des Moines, became the western relay

for the National Broadcasting Company (NBC), and brought Palmer and his message of chi-ropractic healing to millions in the unseen audience. B.J., the former vaudeville show-man, became a genuine national celebrity as the broadcast media grew in popularitythroughout the 1920s and 1930s.

A significant turning point in B.J.s career and in the course of the profession camein 1924 with the official inauguration of Palmers BACK-TO-CHIROPRACTIC programat the PSCs lyceum (homecoming) (Palmer 1924b). The NCM, a two-pronged spinal-heat

sensing instrument, was heralded as the only scientifically valid method of detecting spinalsubluxations, and henceforth, the Developer announced, practice without the devicewould be considered unethical (Keating 1991 1997). Invented by engineer-chiropractor


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Broadcasting towers above the PSC campus in the 1920s

Dr. Dossa D. Evins

Early model of the neurocalometer

Dr. B.J. Palmer, c. 1920



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Dossa Evins, the instru-ment was presumablyreliable as a thermometer,

but B.J.s claims for itsvalidity as a subluxation-detection methods weredifficult for many in the

profession to accept. [Itwas] the most valuableinvention of the age

because it picks, provesand locates the cause ofall dis-eases of the humanrace, he insisted (Palmer1924a). What was more,the NCM was not avail-

able for purchase, butcould only be acquiredthrough a ten-year leasecosting more than $2,000,an exorbitant sum. Aswell, B.J. filled the pagesof his Fountain HeadNews (weekly newspaper)with threats to prosecuteanyone who infringedupon his patents on thedevice.

Palmers authority inthe profession had already begun to wane, owing to his campaigns to purge mixers fromstate chiropractic societies (Keating 1996a), but now many of his previously loyal, straightchiropractic followers also fell away (Quigley 1995). The American ChiropracticAssociation (ACA), organized in 1922 in opposition to Palmers Universal ChiropractorsAssociation (UCA), swelled in membership as Palmer loyalists joined its ranks. Undaunted,Palmer persuaded the UCA to require an NCM lease as a condition of membership in thesociety (Quigley 1995). However, in 1925, B.J. resigned as secretary of the UCA, and failedin his re-election bid. Shortly thereafter, the Chiropractic Health Bureau (forerunner oftodays International Chiropractors Association/ICA) was established by Palmer and thosewho remained faithful to his brand of chiropractic. B.J. served as president of the ICA untilhis death in 1961, but never again would he enjoy the support of a majority of the profes-sion.

In the final three decades of his career, B.J. Palmer continued the theoretical andtechnique innovations that had marked his earlier career. In the mid-1930s he committed hisschool to strict adherence to a restricted form of intervention limited to the upper cervical


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Poster prepared by the International Chiropractors Association in 1947.



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(atlas and axis) spinal adjusting only. This Hole-in-One (HIO) technique became firmlyrooted within the Palmer camp; generations of PSC students would have to seek additional,off-campus training in adjusting in order to pass the practical examinations offered by some

of the state boards of chiropractic examiners. And well into the 1950s, the PSC would per-sist in limiting its curriculum to the 18-month course established in the 1920s; the PSC resis-ted many of the expansions and improvements in chiropractic education offered at other chi-ropractic colleges.

EARLY CHIROPRACTIC SCHOOLS

Early chiropractic education resemblethe training offered to allopathic students in thenineteenth century: a few months of classroominstruction in the basic sciences, and a little bit ofsupervised clinical practicum. Also like most of

their allopathic forerunners, early chiropracticschools were almost all proprietary, that is, operat-ed for profit by their owners. There was strongincentive to emphasize quantity (of students) overquality (of instruction). High school graduationwas not usually required, and laboratory facilitieswere few and far between. Some justification forthis meager preparation can be found in the needto turn out a volume of doctors in order to estab-lish the profession. However, the largest of chiro-

practic institutions, the PSC, set an example byinsisting for decades that no more than 18 monthswere needed to train a competent chiropractor. B.J.

Palmer, president of the PSC, paradoxicallyclaimed that education constipates the mind. Hewould rather train plumbers in chiropractic rather


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Dr. John F.A. Howardfounded the NationalSchool of Chiropractic in1906.

Dr. T.F. Ratledgefounded the RatledgeSystem of Chiroprac-tic Schools, LosAngeles, in 1911.

Dr. Charles Cale foundedthe Los Angeles College ofChiropractic in 1911.

Attorney-chiropractorWillard Carver foundedhis first school inOklahoma City in 1906.

Advertisement for American University (Rehm1992)

Early chiropractic education resemble thetraining offered to allopathic students in the nine-teenth century: a few months of classroom instruc-tion in the basic sciences, and a little bit of super-vised clinical practicum. Also like most of their

allopathic forerunners, early chiropractic schoolswere almost all proprietary, that is, operated for

profit by their owners. There was strong incentiveto emphasize quantity (of students) over quality(of instruction). High school graduation was notusually required, and laboratory facilities were fewand far between. Some justification for this mea-ger preparation can be found in the need to turnout a volume of doctors in order to establish the

profession. However, the largest of chiropracticinstitutions, the PSC, set an example by insistingfor decades that no more than 18 months wereneeded to train a competent chiropractor. B.J.

Palmer, president of the PSC, paradoxicallyclaimed that education constipates the mind. Hewould rather train plumbers in chiropractic rather



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FoundingDate

18961903

19041904190519051906

19061907

1908190819081908

190819091909190919101910

1910191119111911

1911

191319141918

19191920

1922

Table 3: Several early schools of chiropractic, 1896-1922

Institutional Name

Palmer School of Magnetic CureAmerican School of Chiropractic & Nature

CureMarsh School of ChiropracticPacific School of Chiro-PracticAmerican School of ChiropracticParker School of ChiropracticCarver-Denny School of Chiropractic

National School of ChiropracticPalmer-Gregory College of Chiropractic

D.D. Palmer College of ChiropracticTexas Chiropractic CollegeMichigan College of ChiropracticRatledge System of Chiropractic Schools

Minnesota Chiropractic CollegeWichita College of KiropracticRobbins Chiropractic InstitutePacific College of ChiropracticUniversal Chiropractic College

New Jersey College of Chiropractic andNaturopathy

San Diego School of ChiropracticRatledge System of Chiropractic SchoolsLos Angeles College of ChiropracticOregon Peerless College of Chiropractic and

NeuropathyBullis and Davis School of Neuropathy,

Ophthalmology and ChiropracticCalifornia Chiropractic CollegeCanadian Chiropractic CollegeEastern College of Chiropractic

Columbia Institute of ChiropracticMissouri Chiropractic College

Cleveland (Central) Chiropractic College

Location

Davenport, IowaCedar Rapids, Iowa

Portland, OregonOakland, California

New York CityOttumwa, IowaOklahoma City

Davenport, IowaOklahoma City

Portland, OregonSan Antonio, TexasGrand Rapids, MichiganGuthrie, Oklahoma

Minneapolis, MinnesotaWichita, KansasSault Ste. Marie, OntarioPortland, OregonDavenport, Iowa

Newark, New Jersey

San Diego, CaliforniaLos Angeles, CaliforniaLos Angeles, CaliforniaPortland, Oregon

Los Angeles, California

Los Angeles, CaliforniaHamilton, Ontario

Newark, New Jersey

New York CitySt. Louis, Missouri

Kansas City, Missouri

Founder

DD PalmerSolon Massey Langworthy, DC

John E. Marsh, DCHarry D. Reynard, DCBenedict Lust, MD, ND, DCCharles Ray Parker, DCWillard Carver, LLB, DC &

Lee L. Denny, DCJohn FA Howard, DCDD Palmer & Alva Gregory,

MD, DCDD Palmer & LM Gordon DCJN Stone, MD, DC

NC Ross, DCTF Ratledge, DC

Robert Ramsay, DCJG Wilson, DCWJ Robbins, MDWilliam O Powell, DCJoy M Loban DCFrederick W Collins, DO, DC

FBC Eilersficken, DCTF Ratledge, DCCharles A Cale, DCJohn E LaValley, DC

Benson Bullis, DC & Andrew PDavis, MD, DO, DC

Albert W Richardson, DCErnst DuVal, DCCraig M Kightlinger, MA, DC

Frank E Dean, MB, DCHenry C Harring, DC, Robert

Colyer, DC & Oscar Schulte DCCarl S Cleveland, Sr., DC, Ruth R

Cleveland, DC & Perle BGriffin, DC

Dr. Ernst Duval Dr. Craig KightlingerAdjusting class at Cleveland Kansas City, c. 1925



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than university graduates, for the latter reputedly had no room for the simple truths Palmerwished to impart.

Chiropractic schools proliferated in the first few decades of the profession (see Table

3). Spurred by federal funding for vocational training of veterans following World War I, thenumber of chiropractic schools spurted tomore than 80 in the first half of the 1920s(Ferguson & Wiese 1988), and the PSC

boasted an enrollment of more than 3,000students. However, when veterans benefitsexpired, most of these schools evaporated,and the surviving institutions imploded. Bydecades end, the PSC student bodydeclined by as much as 90% (Schools1928). Unfortunately, among the survivorswere several correspondence schools, which

purported to prepare doctors through mail-

order instruction (Rehm 1992). Among themost notorious of these was the AmericanUniversity in Chicago (American 1919),which may have continued in operationuntil the mid-1930s. These sham schools,and a few of the more serious educationalenterprises which also briefly offered par-tial correspondence training, left a blackmark upon the profession that lingered fordecades.

Concern for the need to upgrade andstandardize chiropractic training was inevidence in the 1920s, and brought efforts by national organizations to try to imple-ment such changes. The National Collegein Chicago and the Metropolitan Collegeof Chiropractic in Cleveland, Ohio, tookthe initiative in introducing curriculawhich exceeded the 18-month limit insist-ed upon by B.J. Palmer. As well, innova-tions in chiropractic education includedenhanced diagnostic training and a fewexamples of hospital-based instruction; fora few years, students at the NationalCollege were granted observation privi-

leges at Cook County Hospital. These privileges were lost when students inter-rupted surgeries with cries of Have you


16

Dr. N.C. Ross foundedthe Michigan College ofChiropractic in 1908

Dr. Albert W. Richard-sonfounded the CaliforniaChiropractic College in

1913

Dr. B.J. Palmer demonstrates to a large group at the PSC in

the early 1920s.

Dissection class at the National College of Chiropractic,1920s



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tried chiropractic? In lieu of the hospital, National established itsChicago General Health Service, which still functions on an out-

patient basis today.

By the mid-1930s an educational reform campaign, launched by the National Chiropractic Association (NCA, predecessor oftodays ACA), had begun in earnest. This initiative stimulated greatfeuds within the profession. The NCA camp pressed for non-profitschools and a four-year curriculum with significant improvements indiagnostic and basic science instruction. Followers of B.J. Palmer,organized as the International Chiropractors Association (ICA),viewed the NCAs reforms as an effort to medicalize the profession,and predicted dire consequences, including a significant decline inenrollments and capitulation to organized medicine.

The NCA was not deterred bythis dissent, and in 1947 the societysdirector of education, 1922 Palmergraduate John J. Nugent, establishedthe NCA Council on Education, fore-runner of todays Council onChiropractic Education-USA (CCE-

USA). Many in the profession wereoutraged by Nugents efforts to combine small, proprietary schools into


17

C.O. Watkins, DC,established the first

NCA Committee onEducation in 1935; helater made repeatedcalls for research bychiropractors

Dr. John J. Nugent wasappointed NCA Directorof Education in 1941,and organized the NCACouncil on Education in1947

The Logan Lancers, c. 1956, were typical of chiropractic col-leges participation in sports.

Several chiropractic college leaders, c. 1939; standing (l-r): Drs. Carl S.Cleveland, Sr.; B.J. Palmer; Homer G. Beatty. Seated: Drs. GeorgeONeil; Hugh B. Logan; T.F. Ratledge; Henry C. Harring; James R. Drain



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larger, non-profit colleges of chiropractic. B.J. Palmer referred to Nugent as the anti-Christof chiropractic (Gibbons 1985). However, with student enrollments swelling due to the G.I.Bill following World War II, Nugent was largely successful in his consolidation efforts,

especially in New York and California (Keating 1996b; Keating and Phillips 2001). Hisefforts continued until his retirement in 1959; a new generation of chiropractic educatorswould carry on the quest for higher educational standards and federally recognized accred-itation.

PROSECUTION AND LEGISLATION

The earliest known prosecution of a chiropractor for unlicensed practice dates to1905 in Wisconsin, although earlier incidents may have occurred. D.D. Palmer was tried andconvicted of practicing medicine without a license in Davenport in 1906; he served 23 daysin Scott County jail. The legal basis for his conviction was an advertisement in his schoolmagazine in which he claimed to cure various diseases. This trickle of early cases would

become a torrent, and by 1931 it was estimated the DCs had collectively undergone 15,000prosecutions (Turner 1931), although there were probably no more than 12,000 chiroprac-

tors in practice in that era.B.J. and several other Palmer grads organized theUniversal ChiropractorsAssociation (UCA) in 1906 to providelegal services to chiropractors when arrested. Their first testcase came the following year in La Crosse, Wisconsin, whenPalmer alumnus Shegataro Morikubo was arrested for practic-ing medicine, surgery and osteopathy (Rehm 1986). Palmerhired former district attorney and state senator Tom Morris todefend the doctor, and Morris persuaded district attorney OttoBosshard to drop the charges of unlicensed practice of medi-cine and surgery on the grounds that Morikubo had only usedhis hands in treating his patients. The trial proceeded on thecharge of practicing osteopathy without a license.

To make the point that chiropractic and osteopathywere separate and distinct health careapproaches, Morris called to the standseveral chiropractor-osteopaths, whotestified that the theory and practice ofthe two schools were different.Osteopathy, it was argued, was based onthe rule of the artery, and DOs werenot interested in the nervous system.Chiropractic, they asserted, was basedon the supremacy of the nervous sys-tem, and DCs were not interested in theinfluence of the circulation upon health

and illness. Morris also entered into evi-dence the first text on chiropractic, writ-ten by Smith, Paxson and Langworthy of


18

Dr. Shegataro Morikubo

Otto Bosshard, district attor-ney for LaCrosse, Wisconsin,1907

Senator Tom Morris



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the American School of Chiropractic.The book suggested that chiropractors philosophy and practice were separate and

distinct from any other profession. On this basis, the jury required only 23 minutes toacquit Dr. Morikubo. Philosophy became a very significant term for chiropractors, andsoon thereafter the Palmer School began to award the Philosopher of Chiropractic (Ph.C.)degree. Morris was named chief legal counsel for the UCA, a post he held until his death in1928.

Morris and his law partners were very busy in the next few years. Prosecutions ofchiropractors grew increasingly common, often instigated by state medical boards that weredetermined to crush all challengers to their authority. Although Morris and his team won anestimated 75% of the cases they handled (especially when the verdict was rendered by a juryrather than by a magistrate), it was a harrowing ordeal for the chiropractors. Police officers


19

Dr. Herb Reaver, Sr., wasarrested repeatedly in Ohiofor practicing medicinewithout a license.

Dr. Courtney adjusting in the Los AngelesCounty jail, 1922

Dr. Eckols and Irish in theSan Diego County jail, 1921

North Dakotas first Board of Chiropractors, 1915. Standing l-r: GeorgeNewsalt, DC, of Fargo, Guy G. Wood, DC, of Minot and S.A. Danford, DCof Bismarck; seated l-r: A.O. Henderson, DC, of Mandan and S.A. Reed,DC, of Valley City

Anna M. Foy, DC, receivedlicense #1 in Kansas and servedfor many years on the statesBoard of Chirorpactic Examiners



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were repeatedly sent in plainclothes to pose as patients and gather evidence for politicalmedicine. Patients rarely agreed to testify against chiropractors, and often had to be sub-

poenaed to testify in court as hostile witnesses for the prosecution. In some jurisdictions,massive sweeps were made to round up chiropractors for trial, and DCs learned to dread theunknown knock at the door.

These mounting pressures prompted strenuous, grass roots, political campaigns byDCs to secure separate and distinct licensing laws and boards of chiropractic examinersas a means of staying out of jail. Ironically, they often found that going to jail, instead of

paying a fine when convicted of unlicensed practice, was an excellent strategy for securingchiropractic statutes. Doctors who chose jail instead of paying fines created a martyr imagefor public consumption, and deprived state medical boards of money that could be used toharass additional chiropractors. Palmer and attorney Morris initially opposed the introduc-

tion of separate licensing for chiropractors (Keating 1997a), but eventually acquiesced to theoverwhelming sentiment in the profession. The first state to pass a chiropractic statute wasKansas, but the governor refused to appoint a board of chiropractic examiners, on the


20

Table 4: Early chiropractic acts in the United States, based on Wardwell (1992, 110-111)

Dates of Enactment and Jurisdictions

19131913191519151915191619171917191819191919191919191919]192119211921

KansasNorth DakotaArkansasOhioOregon

Nebraska*Connecticut

North CarolinaMontanaFloridaIdahoMinnesotaVermontWashingtonArizonaGeorgiaIowa

19211921192119211922192319231923192319231924192519251925192719271928

New HampshireOklahomaSouth Dakota

New MexicoCaliforniaIllinois

NevadaRhode IslandTennesseeUtahMaineHawaiiWest VirginiaWisconsin*Indiana*MissouriKentucky

19291929192919321933193319371939194419491951195319591963196619731974

District of ColumbiaMarylandWyomingSouth CarolinaColoradoMichigan*DelawareAlaskaVirginiaTexas*Pennsylvania

New Jersey*Alabama

New YorkMassachusettsMississippiLouisiana

*Addenda to Wardwell's list:ILLINOIS: chiropractors were licensed in Illinois as "other practitioners" as early as 1905; a chiropractic statute may have

been passed in 1917 (American, 1927), the medical practice act was declared unconstitutional on grounds that the provi-sions for licensing chiropractors were "unreasonable and discriminatory" (Graduate, 1921).INDIANA: the 1927 amendment to the medical statute "grandfathered" a number of chiropractors (McIlroy, 1928), but

prevented licensure of additional chiropractors for decades (James Firth, D.C., quoted in Wardwell, 1992, p. 114).MICHIGAN: Some form of chiropractic legislation may have been enacted in 1913 (American, 1927).

NEBRASKA: the first chiropractic statute and BCE were created in 1915 (New, 1915; Palmer, 1922, p. 7).NEW JERSEY: a chiropractic statute providing for a Board of Chiropractic Examiners (BCE) was enacted in 1920, butthe law was repealed and the BCE abolished the following year (Dye, 1939, pp. 95-6; Reynolds, 1921; Vernon, 2003).TEXAS: an earlier chiropractic statute, signed by Governor Coke Stevenson in 1943 (Advertisement, 1943; Watkins,unpublished, p. 37), was ruled unconstitutional.WISCONSIN: a 1915 Wisconsin law did not license chiropractors, but permitted them to practice if the DC hung a signindicating the absence of licensure (American, 1927). This was known in chiropractic circles as the "Wisconsin Idea."



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grounds that all the DCs in the state had practiced illegally prior to the laws passage, andwere therefore ineligible to serve. North Dakota awarded the first chiropractic licenses in1915, and several other states soon followed suit (see Table 4). However, six more decadeswere required to secure chiropractic statutes in all 50 states.

By 1924 more than two dozen jurisdictions had authorized the practice of chiro-practic by statute. Alarmed at this encroachment on what had been a near monopoly, polit-

ical medicine devised new strategies to contain thechiropractic profession in those states where theyhad failed to block licensure. Basic science statuteswere first introduced in Connecticut and Wisconsinin 1925, and eventually spread to 24 American

jurisdictions (Gevitz 1988). Basic science laws cre-ated independent basic science boards of examin-ers who were charged with testing applicants for

licensure in several disciplines (chiropractic, med-icine, naturopathy, osteopathy) in such subjects asanatomy, bacteriology, physiology, and publichealth. These basic science examinations must be

passed before the applicant could sit for testing byher/his respective licensing board.

Chiropractors cried foul, noting that theexplicit purpose of basic science boards was to

prevent non-MDs from securing licenses. As well,they argued, the tests administered by boards wereoften biased in favor of medical practitioners. The

boards were often comprised of medical schoolfaculty members, and though the basic science examiners were not supposed to know the

professional identities of those they tested, this confidential information was often availableto them, thereby introducing bias in the scoring of the tests. The basic science statutes had


21

Louisiana was the final American state topass a chiropractic statute; the signing cer-emony in 1974 is pictured here.Chiropractic Association of LouisianaPresident John Flynn, DC, is second fromleft; Harwell Morris, DC, is third from left;Governor Edwin Edwards is at the micro-

phone; and Jimmy Parker, DC, is at farright. Two chiropractors, E.J. Nosser andB.D. Mooring, served time in jail evenafter the law was passed when they violat-ed a judges injunction not to practice fol-lowing their arrest for practicing medicinewithout a license.

This 1936 cartoon from the NCAs journal showschiropractic being held up by organized allopathicmedicine with the aid of politics. The payoff is theright to practice.



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their intended effect; in Nebraska, for example, no new chi-ropractic licenses were issued during 1929-1950 because nochiropractor succeeded in passing the states basic science

tests (Metz 1965).Basic science statutes had other effects on the profes-

sion. Although detested by most DCs at first, they later cameto be seen by chiropractic reformers as a source of motiva-tion for needed improvements in the training of chiroprac-tors. As well, the introduction of basic science laws in 1925

probably stimulated the formation of the InternationalCongress of Chiropractic Examining Boards (ICCEB) thefollowing year. [The ICCEB was reorganized in 1934 as theCouncil of State Chiropractic Examining Boards (COSCEB),which was renamed the Federation of ChiropracticLicensing Boards (FCLB) in 1972.] This council encour-aged improvements in chiropractic education and federal

recognition for the chiropractic colleges, assisted in securing legislation in additional states,and served as a relatively neutral forum for discussion of the professions problems over theyears. The National Board of Chiropractic Examiners (NBCE) was established by the FCLBin 1962-63 as a means of eliminating basic science examinations for chiropractors.

Basic science laws were eventually repealed, largely at the insistence of the medicalprofession, who found that its graduates were experiencing difficulty in passing the tests,and because the basic science boards limited licensing reciprocity among states for MDs aswell as other practitioners (Gevitz 1988). The last states to strike these laws were Texas,Utah and Washington in 1979. By this time, many states had accepted the test results of the

NBCE in lieu of basic science exams for chiropractors.Owing partly to the conflicting viewpoints among chiropractors about scope of prac-

tice, as well as to the influence of political medicine, licensing laws vary from state to state,sometimes rather greatly. Chiropractors in Washington, for example, have a fairly straightstatute which primarily permits subluxation-detection and correction by adjustment. Just

south in Oregon, on the other hand, the legalscope of practice is broader, even permittingminor surgery and obstetrics. These variationsin legal authority (Gatterman and Vear 1992;Lamm and Pfannenschmidt 1999) can be asource of confusion not only to patients, butto chiropractors themselves. However, thechallenge of changing dozens of states lawsin order to simplify and standardize chiro-

practic licensing is a daunting task, and anyeffort to change statutes opens up the possi-

bility of tampering by political medicine.Chiropractors are likely to live with this legal


22

Emblem of the Federation ofChiropractic Licensing Boards

Gordon L. Holman, DC,member of the COSCEBand co-founder of the

NBCE

Edward M. Saunders,DC, member of theCOSCEB and co-founder of the NBCE



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diversity for some time to come.

EVOLUTION OF

THEORY

, TECHNIQUE AND

INSTRUMENTATION

D.D. Palmers chiropractic theory and practice evolved from his work as a magnet-ic healer. During his 17-year chiropractic career, his ideas about the nature of disease andthe mechanisms of his healing art underwentmetamorphosis (see Table 5). However, hiscentral concern was always the inflamma-tion he detected in his patients, and which he

believed disrupted the healthy tone of cellsand tissues in the body. Palmers first theorysuggested that inflammation was a conse-quence of displaced anatomy: arteries,veins, nerves, muscles, bones, ligaments,

joints or any anatomic structure which was

out of its normal position. Palmer, who ini-tially designated himself a magneticmanipulator, used his hands to repositionthese parts, or as he would say, he manipu-lated in order to adjust them to their proper position.

In 1903, while teaching and practicing in Santa Barbara, California, Palmer reducedthe focus of his theory from any displaced anatomical part to exclusively the joints of the

body, especially those of the backbone. He came to believe that when these joints becamemisaligned (subluxated), they could pinch the nerve roots of the spine as the nerves exitedthrough the vertebral foramina (Keating 1995b). Slight pressure on nerves, it was hypothe-sized, caused excessive neural impulse to reach end-organs, causing them to become


23

Table 5: D.D. Palmers concepts during three periods of publications (from Keating 1993)

Concept:

circulatory obstruction?nerve pinching?foraminal occlusion?nerve vibration?therapeusis?method of intervention?innate/educated?religious plank?machine metaphor?tone?

The Chiropractica

(1897-1902)

YesYes

??

Yesmanipulation

absentabsent

Yes(vital)

The Chiropractorb

(1904-1906)

NoYesYes

?No

adjustmentnerves: Intelligence

absentYes

absent

The Chiropractor Adjusterc;The Chiropractors Adjuster

(1908-1910)

NoNoNoYesNo

adjustmentIntelligenceoptional?Yes & No

Yes

aThe Chiropractic was the title of D.D. Palmers journal during the early years of his practice in Davenport, IowabThe Chiropractor was published by D.D. and B.J. beginning in December 1904 from the Palmer School in Davenport

cThe Chiropractor Adjuster was D.D. Palmers journal published in Portland by the D.D. Palmer College of Chiropractic,while The Chiropractors Adjuster was the title of his book.

D.D. Palmer adjusting Shegetaro Morikubo, 1906



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inflamed. Greater pressure was thought to inter-rupt the nerve messages. Old Dad Chiro (as D.D.liked to refer to himself) may have had political

reasons for this change of theory, for he was bythen experiencing mounting criticisms from thefollowers of Andrew T. Still for having stolenosteopathy and re-packaged it as chiropractic.Whatever the reasons for his theoretical develop-ment, it was this second theory of chiropracticthat D.D. taught his son, and which B.J. Palmerwould accept as his fathers original chiropracticconcept. B.J. promoted this notion of subluxationas the foot-on-the-hose theory.

The transition from first to second theoryof chiropractic also saw a change from the mech-anistic model of disease to a vitalistic premise.

D.D. introduced the concept of InnateIntelligence circa 1904. Innate, he believed, wasan intelligent entity which directed all the func-tions of the body, and used the nervous system toexert its influence. Old Dad Chiro eventuallycame to see Innate Intelligence as an individualmanifestation of Universal Intelligence, or God(Donahue 1986, 1987).

Although father and son parted companyin 1906, this was not the end to D.D.s theoretical evolution. By 1908, when he opened theD.D. Palmer College of Chiropractic in Portland, Oregon, Old Dad Chiro had rejected hisearlier notion that subluxations caused nerves to be pinched in the spinal foramina (Keating1993). Instead, he argued, nerves were impinged when joints subluxated, causing them to

become too tense or too slack. Given D.D.s belief that neural impulses were vibrational innature, this meant that excess vibration would cause inflammation in end organs. A slack-ened nerve, on the other hand, would deliver too little nerve impulse to tissues, causingunder functionating and/or cold, hard tumors. Despite the book he authored while inPortland (Palmer 1910), whose content was drawn from his college periodical, chiropractorsdown through the ages have generally been unaware of Old Dad Chiros final theoretical for-mulations.

The Palmers are both considered segmentalists, in that they held to a view whichsuggested 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 spinalsegments to specific organs of the body. Old Dad Chiro posited that there were three caus-

es of subluxations: toxins, physical trauma and auto-suggestion; most chiropractors havecarried forward these etiological ideas. B.J. Palmer later claimed that the NCM he market-ed to the profession was the only valid means of identifying these subluxated spinal joints.


24

Cover of D.D. Palmers school magazine, TheChiropractor Adjuster, for March 1909



25/50

In the mid-1930s he further proposed that the only adjustment-worthy subluxationsoccurred 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 kymographicstrip chart) were used to monitor patterns of subluxations before and after HIO interven-tions.

Attorney-chiropractor Willard Carver offered an alternative view of spinal dysfunc-tion in which the behavior of the backbone is seen as a coordinated system. Termed thestructural approach to chiropractic, Carvers theories involved the idea of distortion pat-terns involving multiple segments, compensatory (secondary) subluxations, and the relent-less influence of gravity upon these structures (Cooperstein 1990; Levine 1964;Montgomery and Nelson 1985; Rosenthal 1981). Carvers ideas were perpetuated by hismany students (e.g., T.F. Ratledge, D.C.) and others theorists and technique developers, suchas Hugh B. Logan, D.C. (of theLogan Basic Technique), MortimerLevine, D.C., and Carvers brotherFred, founder of the PosturalMethod of chiropractic (Carver1938).

Logan Basic Techniqueinvolved the perspective that thesacrum provided a platform uponwhich the vertebral segments rested,and was therefore a determiner (thecentrum of the body in Logans

terminology) of subluxation pat-terns in the spine. The Logan tech-nique directed much attention to


25

B.J. Palmer, DC, c.1924 Mortimer Levine, DC, c.1957 Willard Carver, LLB, DC,c.1943 (NCA photo collection)

Hugh B. Logan, DC Arlan W. Fuhr, DC



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adjustments that would establish a levelsacrum. These ideas were taken up by 1961Logan College graduate Arlan W. Fuhr,

D.C., co-inventor of the Activator instru-ment and developer of the ActivatorMethods Chiropractic Technique (Fuhr etal. 1997). This technique involves repeatedinspections of relative leg lengths to identi-fy spinal and extra-spinal joints thought to

be adjustment-worthy; Fuhr proposes thatfunctional leg length inequalities depend

upon distortion patterns especially in the pelvic and sacral structures. The Activator instru-ment has become one of the most common of devices employed by chiropractors.

Chiropractic instrumentation had its earliest known innovations in the work ofThomas H. Storey, D.C., one of D.D.s early (1901) graduates in Davenport. Storey isremembered not only as one of the first instrument adjusters (he made use of a wooden chis-

el and mallet to tap spinous and transverse processes), but also as the inventor of the bifidtable, or nose hole in chiropracticcouches.

B.J. Palmer introducedthe profession to x-ray equipmentin 1910, and promoted the termspinography to refer to hisunique application of thesedevices: subluxation-detection.Although many were reluctant toinvest in the new technology,some even branding B.J. amixer for deviating from theoriginal meaning of chiropractic(done by hand), radiology

became a standard assessmentmethod for most DCs. Inspired byLogan Basic Technique, WarrenL. Sausser, D.C. of New York

expanded the DCs radiologic repertoire inthe early 1930s with his development of14x36 inch, full-spine, weight-bearing x-rays. Palmers emphasis on x-ray analysismay have distracted chiropractors from


26

Schematic of mechanism of an early Activator instrument

Plexor and pleximeter employed foreliciting the vertebral reflexes (fromAbrams 1910)

Joe Shelby Riley, DO, DC,graduate of Palmer-GregoryCollege of Chiropractic,employed a spinal concussorto adjust his patients (fromRiley 1919)

An early Hy-Lo adjusting table, which lowered the patient from the vertical to horizontal position forexamination and treatment.



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their earlier focus on the nervous system. However, his introduction of the NCM in 1924gave a renewed importance to neural function. Although Palmer initially threatened to sueanyone infringing on his patents, the NCM spawned a variety of spinal heat-sensingdevices (see Table 6). Generally reliable as thermometers, these instruments have not beenvalidated for the purpose of subluxation detection.


27

The McManis table was first patented in 1909 by osteopath-chiropractor J .V. McManis who served on the faculties of theAmerican School of Osteopathy in Kirksville, Missouri, and the National College of Chiropractic in Chicago. TheMcManis table is a precursor to chiropractor James Coxs contemporary flexion-distraction table.

James Franklin McGinnis, D.C., one of the earliest chiropractic radiologists, at work at thePalmer School in 1912

Table 6: Several devices used for subluxation detection

Accolade III

AnalagraphAnalyteChirometerDermathermograph

Dermathermoscribe

ElectroencephaloneuromentimpographEllis MycrodynameterNervometerNervoscope (Temposcope)

NeurocalographNeurocalometerNeurometerNeurophonometerNeurothermometer

Neuropyrometer

SynchrothermeVasotonometerVisual Nerve Tracer



28/50


28

Drs. Warren Sausser and Sol Goldschmidt with afull-body radiograph; from the NCAs Journal,

February 1935

Dr. C. O. Watkins of Sidney,Montana, demonstrates chiroprac-

tic use of fluoroscopy, c. 1935

LACC president Charles Wood, DC, ND (right),demonstrates his neuropyrometer, c. 1930

The Syncrotherme was developed and marketed by theCanadian Memorial Chiropractic College in the late 1960s andearly 1970s



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Chiropractors ingenuity in devising assessment and adjusting strategies has beenphenomenal, and today dozens of brand-name and generic techniques (see Table 7) aretaught 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 yetreceived the scientific investigation that can justify claims for effectiveness or superiority.

However, a specific procedure, side-posture lumbar manipulation, has enjoyed considerablesuccess in clinical trials for patients with low back pain and is highly regarded by expert


29

Table 7: Some of the many brand name techniques of chiropractic

Activator MethodsAnatomical Adjustive Technique

Applied Chiropractic DistortionAnalysis

Applied KinesiologyApplied Spinal Biomechanical

EngineeringAquarian Age HealingArnholtz Muscle AdjustingAtlas OrthogonalityAtlas SpecificBioEnergetic Synchronization

Technique (B.E.S.T.)Bloodless SurgeryBuxtons Painless ChiropracticCarver Body DropChiropractic Biophysics (CBP)Chiropractic Manipulative Reflex

Technique

Clinical KinesiologyConcept TherapyCox Flexion-DistractionCraniopathy/Cranial TherapyDerefield Leg Analysis

Directional Non-Force Technique(D.N.F.T.)

Endo-Nasal TechniqueGonstead TechniqueGravel Integrated Chiropractic MethodGrostic TechniqueHarrison Dynamic Visualization

Procedure (CBP)Howard System of ChiropracticHerring Cervical TechniqueHole-In-One (H.I.O.)Inverse Myotatic TechniqueKeck SystemLife Upper Cervical Adjusting TechniqueLogan Basic TechniqueMears TechniqueMeric SystemMicro-ManipulationMotion Palpation

Neural Organization Technique (N.O.T.)Neural-Vascular Dynamics (NVD)NeuropathyOrthodynamicsPainless Adjusting Technique

Palmer Full Spine DiversifiedParker System

Pettibon TechniquePierce-Stillwagon TechniquePostural Method of AdjustingRatledge TechniqueReceptor-Tonus TechniqueReflex TechniquesReflexologyRESULTS SystemSacro-Occipital Technique (SOT)Soft Tissue Orthopedics (STO/SOT)Spinal BalanceSpinal Touch TechniqueSpinologySpondylotherapyStressologyThompson Technique (drop-piece table)Toftness Technique

Total Body Modification (TBM)Touch for HealthTruscott TechniqueVector Point Cranial TherapyZone Therapy

Dr. Joseph Janse, presi-dent of NationalCollege of Chiropracticand member of the

NCA/ACA Council onEducation

Dr. George Haynes,administrative dean of theLACC and chairman ofthe NCA/ACA Council ofEducation

Dr. Rex Wright ofKansas, president of theCouncil of StateChiropractic ExaminingBoards and a strong sup-

porter of the CCE

Attorney-chiroprac-tor Orval Hidde ofWisconsin, chairmanof the CCEsCommission onAccreditation, 1975



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reviewers (Cooperstein et al., 2001;Gatterman et al., 2001).

LEGITIMIZING CHIROPRACTIC EDUCATION ANDBEYOND

When veterans educational benefitsexpired in the mid-1950s, chiropractic schoolsonce again saw dramatic declines in studentsand tuition revenues. Nevertheless, the NCAand its successor, todays ACA, continued to

press for higher educational standards, includ-ing one or two years of liberal arts college edu-cation as an admission requirement for chiro-

practic training. By the mid-1960s, the ACACouncil on Educations quest for federalrecognition of chiropractic education was in

full swing. Alarmed by this, several straightchiropractic college leaders organized theAssociation of Chiropractic Colleges (ACC; norelation to todays organization of the samename), and competed with the NCA/ACACouncil on Education (which was independ-ently chartered as the CCE/Council on

Chiropractic Education in 1971) for recognition by the U.S. Office of Education (USOE).The ACCs concerns about the activities of the CCE were several. The push for

higher admissions requirements threatened to diminish student enrollments, thereby dimin-ishing the number of new members of the profession. As well, for the impoverished andheavily tuition-dependent schools, a decrease in students meant even more difficult eco-

nomic struggles, and could threaten the survival

of some small schools. Moreover, most ACCcollege leaders perceived that the CCEs broad-scope mandate would require graduates to fulfilla role and scope of practice well beyond whatstraight chiropractors thought were legitimate.And at least one of ACCs accredited institutionswas still a for-profit, private business, whichalone probably rendered it ineligible for recogni-tion by a USOE-recognized accrediting agency.

Meanwhile, the USOE contended that it couldonly recognize one accrediting agency for anysingle profession; so long as chiropractors couldnot make a unified petition for educational

accreditation, the federal agency would ignoreapplications from either ACC or CCE. The


30

College presidents who organized the Association ofChiropractic Colleges were featured on the cover of the

Digest of Chiropractic Economics in May 1970.Pictured are Drs. Carl Cleveland Jr., David D. Palmer,Ernest Napolitano, William Coggins, William Harperand Carl Cleveland Sr.

In 1975, CCE president Leonard Fay, DC (right),congratulates LACC president George Hynes, DC,who headed the CCE committee which negotiatedwith USOE for recogition as an accrediting body forchiropractic education



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Council of State Chiropractic Examining Boards (COSCEB); now renamed Federation ofChiropractic Licensing Boards) sought to bring the two agencies together by creating aGeneral Committee of the Profession on Education (GCPE). This forum did produce some

agreement on curricular content, transfer of credits among schools, and reporting by col-leges to boards of licensure. However, the GCPE became less important as the CCE and its

schools grew closer to meeting most of thecriteria for accreditation set forth byUSOE. The COSCEB, recognizing thecontinuing gulf between ACC and CCE,

prevailed upon each to accept binding arbi-tration of their differences, so as to make asingle petition to USOE. However, beforethe arbitration was completed, the CCEsapplication for recognition as an accredit-ing body for chiropractic education wasapproved by USOE on 26 August 1974

(Keating et al. 1998a).The CCEs success in garnering federal recognition for its Commission on

Accreditation brought about a revolution in licensure for chiropractors, as many boards ofchiropractic examiners henceforth required applicants to be graduates of schools accredit-ed by the CCE or by a regional accrediting agency of higher educational institutions. All ofthe schools that had formerly comprised the ACC sought and eventually received accredi-tation from the CCE.

This might have been the end of the decades-long feud among institutions.


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Table 8: Chronology of the formation and renaming of chiropractic colleges in North America, 1973-2002 (based onKeating et al. 1998a; Musick 1979; Strauss 1994; Peterson and Wiese 1995)

1973 (Jan 11): Sherman College of Chiropractic

chartered in South Carolina; later renamed ShermanCollege of Straight Chiropractic

1973 (Jan 31): International College of ChiropracticNeurovertebrology chartered in California (laterrenamed University of Pasadena, College ofChiropractic; Southern California College ofChiropractic; Quantum University

1974 (Sep 12): Life Chiropractic College formed inGeorgia; later renamed Life University

1976 (Nov 9): Pacific States Chiropractic Collegechartered in California

1977 (Jul):ADIO Instit ute of Straight Chi ropracti cchartered in Pennsylvania

1978 (Aug 3): Northern California College ofChiropractic chartered in California

1978 (Mar 8): Parker College of Chiropractic charteredin Texas

1980(Sept 18): Northern California College of

Chiropractic renamed Palmer College of ChiropracticWest

1981: Pacific States College of Chiropractic renamed LifeChiropractic College-West

1984: ADIO renamed Pennsylvania College of StraightChiropractic

1991 (May): Palmer West and Palmer combine as PalmerChiropractic University

1991: University of Bridgeport College of Chiropracticformed in Connecticut

1992: Chiropractic program announced at the University ofQuebec, Trois Rivieres campus (UQTR)

1993: UQTR enrolls first class2001: Colorado College of Chiropractic opens and closes2002 (Oct): Palmer College of Chiropractic Florida enrolls

first class

Dr. Thom Gelardi, c.

1980

Dr. Reggie Gold, founder

of ADIO, in 1977



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However, the mid-1970s saw the emergence of several new chiropractic schools (see Table8), most importantly the Sherman College of Straight Chiropractic (SCSC), founded inSpartanburg, South Carolina, by Palmer graduate Thom Gelardi, D.C. The SCSC offered

non-diagnostic, adjustment-only training in chiropractic; its application to CCE in 1974 wasrejected the following year (Keating et al. 1998a, pp. 165-9; Strauss 1994). During the next20 years, SCSC was involved in a number of lawsuits challenging the CCE and various

boards of chiropractic examiners. As well, SCSC sparked the formation of the StraightChiropractic Academic Standards Association (SCASA), which briefly held status withUSOE as an accreditor of straight chiropractic educational institutions. Among SCASAsconstituent schools was the Above-Down-Inside-Out (ADIO) Institute (later PennsylvaniaCollege of Straight Chiropractic) and the Pasadena College of Chiropractic. ShermanCollege reapplied for CCE accreditation, which was granted in 1995; ADIO and PasadenaCollege have been closed.

IN MORAL DEFIANCE

In 1963 New York became the 47th state to authorize the practice of chiropractic by

statute. Only in Massachusetts, Mississippi and Louisiana were chiropractors still strug-gling for legal recognition; these last few hold-out states would see chiropractic legislativevictories in 1966, 1973 and 1974, respectively. Political medicines long campaign to pre-vent the legalization of the chiropractic profession seemed to be coming to an end.However, in November 1963 a new element was added to the fracas between chiropractorsand organized medicine when the American Medical Associations (AMAs) board oftrustees established its Committee on Quackery. The explicit purpose of the committee wasfirst the containment of chiropractic and, ultimately, the elimination of chiropractic(Trever 1972). To this end, the AMAs extensive resources were committed to an anti-chi-


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Table 9: Original co-defendantsin the Wilket al. anti-trust lawsuit, 1976 (Wardwell 1992,

p.168)

American Academy of Orthopedic SurgeonsAmerican Academy of Physical Medicine and

RehabilitationAmerican College of PhysiciansAmerican College of RadiologyAmerican College of SurgeonsAmerican Hospital AssociationAmerican Medical Association

American Osteopathic AssociationChicago Medical Society

Illinois State Medical SocietyJoint Commission on Accreditation of Hospitals

Medical Society of Cook CountyH. Thomas Ballantine, M.D.

Joseph A. Sabatier, M.D.James H. Sammon, M.D.

H. Doyl Taylor

ropractic campaign which enlisted state medicalsocieties and included:

Although chiropractors had achievedlegal recognition in all states by 1974, there were

several other arenas in which legitimacy and for-mal status were pursued. The USOEs delibera-

suppressing research favorable to chiro-

practic; undermining chiropractic collegesand postgraduate education programs; usingnew ethical rulings to prevent cooperationbetween MDs and chiropractors in education,research and practice; subverting a 1967United States government inquiry into themerits of chiropractic; and basing an exten-sive misinformation campaign against chiro-practic on the calculating portrayal of chiropractors as unscientific, cultist, and hav-ing a philosophy incom-patible with westernscientific medicine (Chapman-Smith 1989).



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tions over recognition of a chiropractic accrediting agency was one arena in which political

medicine sought to influence government (Accreditation 1973; Wardwell 1992, p. 163); asimilar exercising of political muscle took place in New York State when the NationalCollege of Chiropractic sought regional accreditation through the states education depart-ment (Beideman 1995). And when the Medicare program was introduced by Congress inthe 1960s, chiropractors were initially excluded.

Wilbur J. Cohen, secretary of the U.S. Department of Health, Education and Welfare(DHEW), was directed by Congress in 1967 to prepare a report on the inclusion of chiro-

practic and other non-allopathic, independent health care providers in the Medicare healthcare reimbursement program. Sociologist Walter Wardwell, Ph.D., was a participant in thesham investigation conducted by the surgeon general of the U.S. Public Health Service(USPHS), a division of DHEW. Early on, Dr. Wardwell recognized that the 22-membercommittee of scholars, professionals and businessmen assembled by the federal agencywould have no actual voice in the final report, which had already been prepared by staff

members of the USPHS (Wardwell 1992, p. 165). Secretary Cohens 1968 report,Independent Practitioners Under Medicare, dealt a serious blow to chiropractors, who wereexcluded from the Medicare program until 1973.


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Attorney George McAndrews,c.1981

Dr. Chester A. Wilk, c. 1990 Walter Wardwell, Ph.D.,c.1995

Michael D. Pedigo, DC (left), president of the ICAand co-plaintiff in the Wilk case, confers withKenneth Luedtke, DC, president of the ACA, duringa visit to Palmer College of Chiropractic West inSunnyvale, California, in 1986

Dr. Jerome McAndrews, future president of Palmer College ofChiropractic, c.1972



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In the meanwhile, a revealing book was published thatoffered a glimpse behind closed doors at AMAs headquarters inChicago. William Trevers (1972) In the Public Interest

reproduced scores of internal documents that had been surrep-titiously photocopied from the trade associations files, fileswhich detailed political medicines program to destroy the chi-ropractic profession. Armed with this information, ChesterWilk, D.C., of Illinois and five co-plaintiffs brought suit againstthe AMA and several co-defendants (see Table 9, previous

page).Representing the chiropractors claim that AMA et al.

had violated the Sherman Anti-Trust laws was attorney GeorgeMcAndrews, brother of Jerry McAndrews, D.C., executive vice

president of the ICA (McAndrews 1979). Mr. McAndrews spentthe next 14 years pursuing this case, which involved two trials (one by jury and one by mag-istrate) and innumerable appeals. And while McAndrews pressed in federal court on behalf

of plaintiff chiropractors, the attorney general for New York filed a similar suit in federalcourt against 13 medical organizations on behalf of the citizens of the Empire State. Soonadditional cases were brought to judicial attention in other states (Wardwell 1992, p. 170).

Wilk et al. vs. AMA et al. was not the first time that the AMA had been tried forfederal anti-trust violations (e.g., Dintenfass 1938; Rogers 1943), but the trade associationhad not learned its lesson. Before the case ended, many co-defendants had settled out ofcourt, and the AMA rescinded its ethical ban on professional collaboration between MDsand doctors of chiropractic (Gevitz 1989; Wardwell 1992, p. 171). When federal JudgeSusan Getzendanner ruled in favor of the chiropractors in August 1987 at the conclusion ofthe second trial, she noted that:

Although the conspiracy ended in 1980, there are lingering effects of the ille-gal boycott and conspiracy which require an injunction. Some medical physi-cians individual decisions on whether or not to professionally associate withchiropractors are still affected by the boycott. The injury to chiropractors repu-tations which resulted from the boycott have not been repaired. Chiropractorssuffer current economic injury as a result of the boycott. The AMA has neveraffirmatively acknowledged that there are and should be no collective impedi-ments to professional association and cooperation between chiropractors andmedical physicians, except as provided by law. Instead, the AMA has consis-tently argued that its conduct has not violated the antitrust laws

An injunction is necessary to assure that the AMA does not interfere with theright of a physician, hospital, or other institution to make an individual decisionon the question of professional association (Getzendanner 1988).

Published in the pages of the AMAs journal, the judges findings and injunctionsagainst the national medical trade association were forcefully brought to the medical pro-


34

U.S. District Judge SusanGetzendanner



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fessions attention. Although various appeals were filed, Getzendanners findings still stand.

THE RESEARCH ENTERPRISE (1975 TO PRESENT)

Although research in chiropractic legitimately claims its roots in the various theoriesand clinical techniques propounded throughout the chiropractic century, little more thansporadic efforts at meaningful data collection in the professions first 50 years are apparent(Keating et al. 1995). Gitelman (1984) suggested that the modern era, involving sustainedscientific investigation of the chiropractic healing art, may be dated to the 1975 conferenceon spinal manipulative therapy (SMT) hosted by the National Institute of Neurologic andCommunicative Diseases and Stroke (NINCDS) in Bethesda, Maryland, with funding pro-vided by the U.S. Congress. The published proceedings of this meeting (Goldstein 1975),which brought together chiropractors, osteopaths, manual medicine practitioners andresearchers, revealed the state of knowledge about SMT at that time. The consensus reachedwas that the clinical value of SMT was unproved, but merited serious investigation.

Although the first few randomized, controlled clinical trials (RCTs) of SMT were just getting underway in this period, chiropractic contributions to this scholarly literaturewere slow in coming. Not until 1978 did the National College of Chiropractic launch the

professions most scholarly and enduring periodical, the Journal of Manipulative andPhysiological Therapeutics (JMPT), and not until 1986 was the first RCT of chiropracticadjusting published (Waagen et al. 1986). However, if the content ofJMPT is any guide(e.g., Keating et al. 1998b), there has been a slow but steady expansion of clinical and basicresearch within the profession. By 1994, the volume of trials related to the benefits of SMT

for patients with low back pain, including studies by researchers and clinicians in severaldisciplines, prompted the federal Agency for Health Care Policy and Research to issue clin-ical practice guidelines which included manual therapies as one of a few recommendedmeans of helping low back pain patients in the acute stage of their disorder.


35

Clarence W. Weiant, DC, PhD,was appointed director ofresearch for the NCA in 1943and later served a similar rolefor the Chiropractic ResearchFoundation, forerunner oftodays FCER.

Cover of theNew England Journal ofChiropractic for Spring 1975 fea-tured the NIH site of the first federal-ly sponsored conference on theresearch status of spinal manipulativetherapy.

Drs. Andries M. Kleynhans and JosephJanse, director of research and president,respectively, of the National College ofChiropractic, 1975; they nurtured the infantresearch enterprise.



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The development of scientific inquiry in the profession has proceeded on several fronts (see Table 10), and in the 1990sinvestigators at several chiropractic colleges saw the first few

millions of federal dollars for chiropractic studies. Still a paltrysum in comparison with the billions of dollars in governmentgrants received annually by medical schools in the UnitedStates, this money has been a welcome addition to the moremodest funds available within the profession, most especiallyfrom the Foundation for Chiropractic Education and Research(FCER). The past decade has also seen the formation of theOffice of Alternative Medicine (OAM), a division of the

National Institutes of Health (NIH), which has funded a consor-tial research center at the Palmer College of Chiropractic inDavenport, Iowa. Collaboration with OAM and other NIHagencies bodes well for continuing expansion of scholarshipwithin the profession. As well, the proliferation of state-univer-

sity-based chiropractic colleges in several nations (e.g.,


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Dr. Roy Hildebrandt, foundingeditor in 1978 ofJMPT

Researchers and college administrators gather at Logan College of Chiropractic in 1977 for a seminar jointly sponsored by the Foundation for Chiropractic Education and Research and the Springwall Education and Research Trust(Springwall 1977)

Data Reportscontrolled clinical trialsmeasurement evaluationsclinical analogue studiesclinical series

Data Reportsnormative, survery and actuarial

reportcase reports

basic science studieshistorical research

Non-data Reportsreviews of the literaturetechnical reportseditorials and commentariesletters to the editor

Table 10: Several categories of research and scholarship appearing in the Journal of Manipulative and PhysiologicalTherapeutics, 1989-1996 (adapted from Keating et al., 1998b)



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Australia, Canada, Denmark, Great Britain, South Africa) suggests increased public fund-ing for training and research. However, training in the philosophy of science and in themethods of clinical research for chiropractors is still embryonic (Keating 1992).

Chiropractic research to date has helped to establish the benefit of SMT for a limit-ed 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 eti-ologies of these conditions. The scientific literature bearing on the possible benefit ofmanipulation for a broader range of health problems (termed Type O for organic or vis-ceral diseases) remains very limited, although not completely unexplored (Budgell 1999;Masarsky and Todres-Masarsky 2001). The scientific data base has also facilitated effortsto establish guidelines for clinical practice and for encouraging greater quality in the clini-cal services rendered by chiropractors (Haldeman et al. 1993;Henderson et al. 1994; Vear 1992).

A significant and continuing barrier to scientific progresswithin chiropractic are the anti-scientific and pseudo-scientific

ideas (Keating 1997b) which have sustained the professionthroughout a century of intense struggle with political medicine.Chiropractors tendency to assert the meaningfulness of varioustheories and methods as a

Historia de La Quiropraxia (Ingles)

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