User:Dematt/Chirohistory2

This is the second Chirohistory page for Dematt

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Version transferred 06/15/06

History

In 1885, the world was well into the second industrial revolution, marked by innovation and creativity. Health care had recently emerged from the drastic practice of heroic medicine and was well into an age of alternatives. All varieties of treatments and cures including scientific medicine, vitalism, herbalism, magnetism and leeches, lances, tinctures and patent medicines were developing and competing to be the new method for the century. Neither consumers nor many practitioners had much knowledge of either the causes of, or cures for, illnesses. Allopathy, fueled by Louis Pasteur's refutal of the centuries old spontaneous generation theory in 1859, was growing rapidly. German bacteriologist, Robert Koch formulated his postulates bringing some much-needed scientific clarity to what was then a very confused field.[9] 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 [10], ventured into magnetic healing (meaning hypnotism then) and bonesetting in 1875. He opened the American School of Osteopathy (ASO) in Kirksville, Missouri in 1892.[11] Daniel David Palmer (DD Palmer), a teacher, grocer turned magnetic healer opened his office of magnetic healing in Davenport, Iowa in 1886. After nine successful years, DD Palmer gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard, on September 18,1895.

The first Chiropractic adjustment

Harvey Lillard 1906

Palmer and his patient Harvey Lillard gave differing accounts of when and how Palmer began to experiment with spinal manipulation. Palmer recalled an incident in 1895 when he was investigating the medical history of a deaf man, Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years earlier, he felt a 'pop' in his back, and had been nearly deaf ever since. Palmer’s examination found a sore lump which indicated spinal misalignment and a possible cause of Lillard's deafness. Palmer corrected the misalignment, and Lillard could then hear the wheels of the horse-drawn carts in the street below. Palmer said there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude" about this adjustment; it was specific so much so that no chiropractor has equalled it.[12]

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

Early growth

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."

Rev. Samual Weed

DD Palmer asked a patient and friend, Rev. Samuel Weed, to help him name his discovery. He suggested combining the words cheiros and praktikos (meaning "done by hand") to describe Palmer's treatment method, creating the term chiropractic. In 1896, DD added a school to his magnetic healing infirmary and began to teach others his method. It would be become known as Palmer School of Chiropractic (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 would move to Cedar Rapids, Iowa and open the second chiropractic school in 1903, the American School of Chiropractic & Nature Cure (ASC & NC) combining it with naturapathy cures and Osteopathy. DD Palmer, who was not interested in mixing chiropractic with other cures, turned down an offer to be a partner.

Changing political and healthcare environment

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

Licensing for healthcare professionals had all but vanished around the Civil War, leaving the profession open to anyone who had the inclination to become a physician. The market alone determined who would prove successful in the field and who would not. Medical schools were plentiful, inexpensive and mostly privately owned. With free entry into the profession possible and education in medicine cheap and readily available, large numbers of men entered practice. This led to a overabundance of practitioners which ultimately drove down the individual physician's income and standard of living. In 1847, the American Medical Association was formed and established increased standards for the preliminary medical education and for the degree of MD. At the time, most medical practitioners were not able to meet the stringent standards so a grandfather clause was included. The net 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 in regard to the nature and danger of such remedies. Relationships were developed with pharmaceutical companies in an effort to curb the patent medicine crisis and consolidate the patient base around the medical doctor. By the turn of the century, the AMA had created a Committee on National Legislation to represent the Association's interest in Washington and re-organized as the national organization of state and local associations. 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 most every state requiring licentiates to provide a diploma from an AMA approved medical college. By 1910, the AMA was a powerful national force; this was the beginning of organized medicine.[13].

Just before 1881, the teaching profession had begun significant changes as well. Advances in chemistry and science in Germany, were creating strong incentives to create markets for the sale of their new products. By 1895, the new "Kulturopolitik" ideology of "First teach them; then, sell them" had begun creating the political pressure necessary to emphasize and improve teaching methods in science and math in schools and colleges in the US. The medical schools were the first to suffer the attack. They were ridiculed and frowned upon as being obsolete -- inadequate -- and inefficient. The crisis attracted the attention of the world's richest men. In 1901 the "Rockefeller Institute for Medical Research" was started by the John D. Rockefeller. By 1910, as a direct result of the Flexner Report financed by the Carnegie Foundation, hundreds of medical and homeopathic schools were forced to close their doors.

Osteopathy vs Chiropractic

As there was no constitutional protection or patent for new discoveries in the fields of knowledge, 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 effect a drugless cure. Both professed to effect 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. As word spread about the new doctor of drugless healing in Iowa, osteopaths began a campaign to protect what they perceived as their rights to their profession. Political efforts on the state level resulted in laws protecting the practice of osteopathy.

Medicine vs Chiropractic

In September, 1899 a campaign against all drugless healers in Iowa was initiated by Davenport MD, Heinrich Matthey. 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 the doctor of medicine. (lerner pg 46) Osteopathic schools across the country responded immediately by developing a program of college inspection and accreditation pg11. DD Palmer, whose school had just graduated its 7th student, insisted that his new science did not require the same courses or license as medicine as his graduates did not prescribe drugs or evaluate blood or urine. However, in 1901, DD was charged with misrepresenting to a student a course in Chiropractic which was not a real science. He persisted in his strong stance against licensure citing freedom of choice as his cause. He would be arrested twice more by 1906 and though 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 foreman) and interrupted the nerve energy. In 1906, Dr. Langworthy published the very first book on Chiropractic, which was 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 even managed to get 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 circa 1904. Innate, he believed, was an intelligent entity which directed all the functions of the body, and used the nervous system to exert its influence. (Keating et al., writing for the Association for the History of Chiropractic)

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

BJ Palmer re-develops chiropractic

File:BJPalmer2.jpg

BJ Palmer Developer of Chiropractic 1882-1961

Prosecution of DCs for unlicensed practice after the conviction of DD Palmer and a previous charge against BJ Palmer resulted in BJ and several Palmer graduates creating the Universal Chiropractic Association (UCA). It's initial purpose was to be a protective mechanism for its members by covering all legal expenses should they get arrested.[14] 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 was able to legally differentiate chiropractic from osteopathy based on the differences in the philosophy of chiropractic's "supremacy of the nerve" versus osteopath's "supremacy of the artery". Morikubo was freed and the victory would forever reshape the development of the chiropractic profession. From that point on, chiropractic was called a science, an art and a philosophy and BJ Palmer became the "Philosopher of Chiropractic".

The next 15 years saw the opening of 30 additional 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. Concerning the more than 15000 prosecutions of chiropractors fought the first 30 years, BJ would later note:

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

His influence over the next several years further defined the Mixers of chiropractic and those who practiced it Straight..

Straight vs Mixer

State laws to protect the practice of chiropractic eventually occurred in all fifty states in the US, but it was a hard fought struggle. Certainly 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 B.J. Palmer, opposed state licensure altogether. Palmer feared such regulation would lead to allopathic control of the profession. The UCA eventually caved in, but B.J. 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 to present to all states that did not yet have a law.[15] 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 created the American Chiropractic Association (no relation to today's ACA) whose purpose was to advance education and research and was designed according to standards set by the National School of Chiropractic.[16] and supported by other practicing mixers. Years later the ACA and UCA would join to form the National Chiropractic Association (today's ACA) while BJ Palmer would move on to form the Chiropractic Health Bureau (today's ICA). The differences in state laws that exists today can be traced back to these early legal struggles.

Before his sudden and controversial death in 1913, DD Palmer frequently voiced his concern for BJ Palmer's management of chiropractic. He openly challenged BJ's methods and philosophy and made every effort to regain control of his science of chiropractic. In his last book 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 lad claim to that, NOT EVEN B.J. Exemption clauses instead of chiro laws by all means, and LET THAT EXEMPTION BE THE RIGHT TO PRACTICE OUR RELIGION. But we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and other who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase. Now, if chiropractors desire to claim me as their head, their leader, the way is clear. My writings have been gradually steering in that direction until now it is time to assume that we have the same right to as has Christian scientists."

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

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

Wilk et al. vs the American Medical Association

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

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

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

some thoughts

I don't doubt that there is a movement for reform and has been in one way or the other since 1904. It was the movement for reform during the 1920s - 1930s that created the union of the UCA and ACA to become the NCA to increased education standards and follow the scientific method to prove subluxation. Twenty years later 1963 was Homola's book (Bonesetters, chiro..)(BJ died in 1961) who suggested dumping all the philosophy stuff and basically becoming an allied medical healthcare provider with spinal manipulation for low back and neck pain as chiropractic's field of expertise. This effort was apparently vehemently suppressed by ICA and the new ACA (NCA transformed) as hogwash and fringe. Ron Slaughter, DC, who had possibly already started the NACM, and Stephen Barrett both wrote letters to Homola asking him for his research papers. Louis Sportelli, in 1989, offers Homola an olive branch and asks him to rejoin the ACA. 1990 Wilk settles against AMA. To me this shows that reform has been going on since 1904. All players were important. Do we know if Homola is a member of NACM, No. Do we know if Barrett is an associate member of the NACM, No. Do we know if the NACM has had anything to do with the slow and constant reform of chiropractic, No. Do we know if chiropractic is reformed, yes. It is not the same practice as it used to be. There is no more bloodless surgery. There is no more curing cancer. There is no more curing diabetes. Ninety percent of chiropractic patients are back and neck patients. Is there research to back it up, yes. Is there research, both inside and outside the profession that may shed light on physiological responses to spinal manipulation, yes. Does the battle continue, yes. Should chiropractic let go of subluxation and just go to manipulation just for the sake of low back pain and neck pain.. Not yet if ever, there's not enough research to tell. But it's coming. --Dematt 20:21, 6 September 2006 (UTC)

Hi Mccready, I agree that the constuction of the current sentence is not optimal:

• Chiropractic (from Greek chiros and praktikos meaning "done by hand") is an alternative health care profession whose purpose is to diagnose and treat mechanical disorders of the spine and musculoskeletal system with the intention of affecting the nervous system and improving health.

The problem is that yours isn't any better and therefore is not worth changing without reaching a new consensus. Specifically, this sentence (and yours) is really not grammatically correct. A diagnosis is not something that anyone "aims" to do or "whose purpose" is to perform. You either diagnose or you don't diagnose. Here's the definition of diagnosis:

1. The act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data.

2. The opinion derived from such an evaluation.

1. A critical analysis of the nature of something.

2. The conclusion reached by such analysis.

A person doesn't have a purpose to have an opinion derived from an evaluation. A person just has an opinion. A person doesn't aim to make a critical analysis of the nature of something. They just make the critical analysis. The word "diagnosis" already encompasses the "opinion" portion of the educated guess. It in no way assumes that any doctor's opinion is correct, only that he has stated his opinion based on the information at hand. The diagnosis is constantly changed as more information is advanced, i.e. the working diagnosis is the temporary diagnosis that we work with until new information causes us to change it. For example, if I diagnose non-specific low back pain, I have made a preliminary diagnosis. I haven't aimed to make a diagnosis, I just made it. As things don't progress as hoped, I might order an MRI and find a protruded disc. At that point, I would upgrade my diagnosis to lumbar intervertebral disc syndrome. This says nothing about whether this is what is causing the patient's problem, only my educated guess. So when we say that an medical doctor aims to make an educated guess, that just rubs me as not only wrong, but makes the writer look ignorant - just as if we were to say a medical doctor's purpose is to diagnose and treat something. That is not his purpose, he just diagnoses and treats. He may be totally wrong and his treatment may be totally crankish, but we have no idea what his purpose is. If we were to evaluate what his purpose was, I would think it is more accurate to say that his purpose is to help people in the best way he knows how.

So you see, this is not my sentence. This is a consensus sentence that was forced last year by someone wanting to add "aim" and others finally gave in to "whose purpose" as an olive branch. But I would be glad to drop "aim" and "whose purpose" and just leave it as "Chiropractors diagnose and treat ..."

I hope that helps. ---- Dēmatt (chat) 04:18, 26 January 2008 (UTC)