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History of Chiropractic

From Wikipedia, the free encyclopedia

The history of chiropractic began in 1895 when Daniel David Palmer of Iowa performed the first chiropractic adjustment on a partially deaf janitor, Harvey Lillard. While Lillard was working without his shirt on in Palmers office, Lillard bent over to empty the trash can. Palmer noticed that Lillard had a vertebra out of position. He asked Lillard what happened, and Lillard replied, "I moved the wrong way, and I heard a 'pop' in my back, and that's when I lost my hearing." Palmer, who was also involved in many other natural healing philosophies, had Lillard lie face down on the floor and proceeded with the adjustment. The next day, Lillard told Palmer, "I can hear that rackets on the streets."[1] This experience led Palmer to open a school of chiropractic two years later. Rev. Samel Weed coined the word "chiropractic" from Greek roots. Chiropractic's early philosophy was rooted in vitalism, naturalism, magnetism, spiritualism and other constructs that are not amenable to the scientific method, although Palmer tried to merge science and metaphysics.[2] In 1896, Palmer's first descriptions and underlying philosophy of chiropractic echoed Andrew Still's principles of osteopathy established a decade earlier.[3] Both described the body as a "machine" whose parts could be manipulated to produce a drugless cure. Both professed the use of spinal manipulation on joint dysfunction/subluxation to improved health. Palmer distinguished his work by noting that he was the first to use short-lever HVLA manipulative techniques using the spinous process and transverse processes as mechanical levers. He described the effects of chiropractic spinal manipulation as being mediated primarily by the nervous system.[4]

Despite the similarities between chiropractic and osteopathy, the latter's practitioners sought to differentiate themselves by seeking licensure to regulate the profession, calling chiropractic a "bastardized form of osteopathy".[3] In 1907 in a test of the new osteopathy law, a Wisconsin based chiropractor was charged with practicing osteopathic medicine without a license. Practicing medicine without a license led to many chiropractors, including D.D. Palmer, being jailed.[3] Ironically the Palmers legal defense of chiropractic consisted of the first chiropractic textbook 'Modernized Chiropractic' published in 1906, written by "mixer" chiropractors Longworthy, Smith, et al., whom the Palmers despised. Although the chiropractors won their first test case in Wisconsin in 1907, prosecutions instigated by state medical boards became increasingly common and in many cases they were successful. In response, chiropractors conducted political campaigns to secure separate licensing statutes, eventually succeeding in all fifty states, from Kansas in 1913 through Louisiana in 1974.

Division within the profession has been intense, with "mixers" combining spinal adjustments with other treatments, and "straights" relying solely on spinal adjustments. A conference sponsored by the National Institutes of Health in 1975 spurred the development of chiropractic research. The American Medical Association called chiropractic an "unscientific cult"[5] and boycotted it until losing a 1987 antitrust case.[6] For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as subluxation.[6] By the mid 1990s there was a growing scholarly interest in chiropractic.[6]


In 1895, the world was in the Second Industrial Revolution, marked by innovation and creativity. Health care had emerged from the practice of heroic medicine. All varieties of treatments and cures including scientific medicine, vitalism, herbalism, magnetism and leeches, lances, tinctures and patent medicines were 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.[7] The theory of modern medicine, fueled by Louis Pasteur'srefutation of the centuries-old spontaneous generation theory in 1859, was growing as Charles Darwin published his book on natural selection. The German bacteriologist Robert Koch formulated his postulates, bringing scientific clarity to what was a new field. Drugs, medicines and quack cures were becoming more prevalent and were unregulated. Concerned about what he saw as the abusive nature of drugging, MD Andrew Taylor Still[8] ventured into magnetic healing (meaning hypnotism) and bonesetting in 1875. He opened the American School of Osteopathy (ASO) in Kirksville, Missouri in 1892.[9]

The first chiropractic adjustment

(Harvey Lillard 1906) Daniel David Palmer (D.D. Palmer), a teacher and grocer turned magnetic healer, opened his office of magnetic healing in Davenport, Iowa in 1886. After nine years,[4] D.D. Palmer gave the first chiropractic adjustment to Harvey Lillard, on September 18, 1895.[10] According to D.D. Palmer, adjusting the spine is the cure for all diseases for the human race.[3]

Palmer and his patient Harvey Lillard gave differing accounts of when and how Palmer began to experiment with spinal manipulation. Palmer recalled an incident in 1895 when he was investigating the medical history of a partially deaf man, Harvey Lillard. Lillard informed Palmer that while working in a cramped area seventeen years earlier, he felt a 'pop' in his back, and had been nearly deaf ever since. Palmer’s examination found a sore lump which he believed was a spinal misalignment and a possible cause of Lillard's poor hearing. Palmer claimed to have corrected the misalignment and that Lillard's hearing improved.[1]

Palmer said "there was nothing accidental about this, as it was accomplished with an object in view, and the expected result was obtained. There was nothing 'crude" about this adjustment; it was specific so much so that no chiropractor has equaled it."[11]

However, this version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and, Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make [something of] it, then they both would share. But, it didn't happen."[12]

Since D.D. Palmer's first claim of restoring hearing to Harvey Lillard, there has been controversy about whether a link actually could exist between the spinal adjustment and return of hearing. Critics asserted that a spinal adjustment cannot affect certain areas – like the brain – because the spinal nerves do not extend into the encephalon. Years later, V. Strang, D.C. illustrated several neurological explanations including the recognition that sympathetic nerves arising in the lateral horns of the upper thoracic levels of the spine form the upper cervical ganglion with postganglionic fibers ascending to supply, among other things, blood vessels of the brain,[13] but still with no connection to hearing. Others, though, talked about vertebral subluxation.

Early growth

(Rev. Samuel Weed) 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."[1]

D.D. Palmer asked a patient and friend, Rev. Samuel Weed, to help him name his discovery. He suggested combining the words cheiros and praktikos (meaning "done by hand") to describe Palmer's treatment method, creating the term "chiropractic." D.D. initially hoped to keep his discovery a family secret,[14] but in 1896 he added a school to his magnetic healing infirmary, and began to teach others his method. It would 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, B.J. Palmer (D.D.'s son), Solon M. Langworthy, John Howard, and Shegataro Morikubo. Langworthy moved to Cedar Rapids, Iowa and opened the second chiropractic school in 1903, the American School of Chiropractic & Nature Cure (ASC & NC), combining it with what would become naturopathic cures and osteopathy.[6] D.D. Palmer, who was not interested in mixing chiropractic with other cures, turned down an offer to be a partner.

D.D. Palmer established a magnetic healing facility in Davenport, Iowa, styling himself ‘doctor’. Not everyone was convinced, as a local paper in 1894 wrote about him: "A crank on magnetism has a crazy notion that he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method…he has certainly profited by the ignorance of his victims…His increase in business shows what can be done in Davenport, even by a quack."[15]

Changing political and healthcare environment

The early 19th century had seen the rise of patent medicine and the nostrum remedium trade. Although some remedies were sold through doctors of medicine, most were sold directly to consumers by lay people, some of whom used questionable advertising claims. The addictive, and sometimes toxic, effects of some remedies, especially morphine and mercury-based cures (known as quicksilver or quacksilber in German), prompted the popular rise of less dangerous alternatives, such as homeopathy and eclectic medicine. In the mid-19th century, as the germ theory began to replace the metaphysical causes of disease, the search for invisible microbes required the world to embrace the scientific method as a way to discover the cause of disease.

In the U.S., licensing for healthcare professionals had all but vanished around the time of the Civil War, leaving the profession open to anyone who felt inclined to become a physician; the market alone determined who would prove successful and who would not. Medical schools were plentiful, inexpensive and mostly privately owned. With free entry into the profession, and education in medicine cheap and available, many men entered practice, leading to an overabundance of practitioners which drove down the individual physician's income.[16] In 1847, the American Medical Association (AMA) was formed and established higher standards for preliminary medical education and for the MD. At the time, most medical practitioners were unable to meet the stringent standards, so a "grandfather clause" was included. The effect was to limit the number of new practitioners.

In 1849, the AMA established a board to analyze quack remedies and nostrums and to enlighten the public about their nature and their dangers.[17] 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 20th century, the AMA had created a Committee on National Legislation to represent the AMA in Washington and re-organized as the national organization of state and local associations.[17] Intense political pressure by the AMA resulted in unlimited and unrestricted licensing only for medical physicians that were trained in AMA-endorsed colleges. By 1901, state medical boards were created in almost every state, requiring licentiates to provide a diploma from an AMA-approved medical college.[16] By 1910, the AMA was a powerful force; this was the beginning of organized medicine.[18]

In 1880, the teaching profession had begun significant changes as well. Advances in chemistry and science in Germany created strong incentives to create markets for their new products. By 1895, the new "Kulturopolitik" ideology of "First teach them; then sell them" had begun creating the political pressure necessary to improve teaching in science and math in schools and colleges in the US. The medical schools were the first to suffer the attack; they were ridiculed as obsolete – inadequate – and inefficient. The crisis attracted the attention of some of the world's richest men. In 1901, John D. Rockefeller created the "Rockefeller Institute for Medical Research".[19] By 1906, the AMA’s Council on Medical Education had created a list of unacceptable schools. In 1910, the Flexner Report, financed by the Carnegie Foundation, closed hundreds of private medical and homeopathic schools and named Johns Hopkins as the model school. The AMA had created the nonprofit, federally subsidized university hospital setting as the new teaching facility of the medical profession, effectively gaining control of all federal healthcare research and student aid.[16]

Osteopathic medicine vs chiropractic medicine

In 1870 Palmer was '"probably" a student of metaphysics, became a student of science in 1890 while practicing magnetic healing and after "discovering" chiropractic in 1895 attempted to merge science and metaphysics.[2] In 1896, D.D. Palmer's first descriptions and underlying philosophy of chiropractic was strikingly similar to Andrew Still's principles of osteopathy established a decade earlier.[3] Both described the body as a "machine" whose parts could be manipulated to produce a drugless cure. Both professed the use of spinal manipulation on joint dysfunction to improve health; chiropractors dubbed this manipulable lesion "subluxation" which interfered with the nervous system. Palmer drew further distinctions by noting that he was the first to use short-lever manipulative techniques using the spinous process and transverse processes as mechanical levers to spinal dysfunction/subluxation.[4] Soon after, osteopaths began an American wide campaign proclaimed that chiropractic was a bastardized form of osteopathy and sought licensure to differentiate themselves.[3] Although Palmer initially denied being trained by osteopathic medicine founder A.T. Still, in 1899 in papers held at the Palmer College of Chiropractic he wrote:

"Some years ago I took an expensive course in Electropathy, Cranial Diagnosis, Hydrotherapy, Facial Diagnosis. Later I took Osteopathy [which] gave me such a measure of confidence as to almost feel it unnecessary to seek other sciences for the mastery of curable disease. Having been assured that the underlying philosophy of chiropractic is the same as that of osteopathy...Chiropractic is osteopathy gone to seed."[2]

Medicine vs chiropractic

Since its inception, chiropractic was controversial amongst the established medical orthodoxy. Chiropractors were jailed for "practicing medicine without a license" which the profession designed a legal and political defense against prosecution arguing that chiropractic was "separate and distinct from medicine", asserting that chiropractors "analyzed" rather than "diagnosed", and "adjusted" subluxations rather than "treated" disease.[6] In 1963 the American Medical Association formed a "Committee on Quackery" designed to "contain and eliminate" the chiropractic profession. In 1966, the AMA referred to chiropractic an "unscientific cult" and until 1980 and held that it was unethical for medical doctors to associate themselves with "unscientific practitioners".[5] Then in 1987, the AMA was found to have engaged in an unlawful conspiracy in restraint of trade "to contain and eliminate the chiropractic profession."[20] In the 1980s, spinal manipulation gained mainstream recognition[21] and has spurred ongoing collaboration into research of manipulative therapies and models of delivery of chiropractic care for musculoskeletal conditions in the mainstream healthcare sector.[22][23][24]

In September 1899, a medical doctor in Davenport named Heinrich Matthey started a campaign against drugless healers in Iowa, demanding a change in the statute to prevent drugless healers from practicing in the state and claiming that health education could no longer be entrusted to anyone but doctors of medicine.[19] Osteopathic schools across the country responded by developing a program of college inspection and accreditation.[4] D.D. Palmer, whose school had just graduated its 7th student, insisted that his techniques did not need the same courses or license as medicine, as his graduates did not prescribe drugs or evaluate blood or urine. In 1901, D.D. was charged with misrepresenting a course in chiropractic which was not a real science.[19] He persisted in his strong stance against licensure, citing freedom of choice as his cause. He was arrested twice more by 1906, and although he contended that he was not practicing medicine, he was convicted for professing he could cure disease without a license in medicine or osteopathy. Dr Solon Langworthy, who continued to mix chiropractic at the ASC&NC, took a different route for chiropractic. He improved classrooms and provided a curriculum of study instead of the single course. He narrowed the scope of chiropractic to the treatment of the spine and nervous system, leaving blood work to the osteopath, and began to refer to the brain as the "life force". He was the first to use the word subluxation to describe the misalignment that narrowed the "spinal windows" (or intervertebral foramina) and interrupted the nerve energy. In 1906, Langworthy published the first book on chiropractic, Modernized Chiropractic" – "Special Philosophy – A Distinct System. He brought chiropractic into the scientific arena.

B.J. Palmer re-develops chiropractic

(B.J. Palmer, developer of chiropractic) D.D. Palmer's student and son, B.J. Palmer, assumed control of the Palmer School in 1906, and promoted professionalism and formal training in chiropractic, expanding enrollment to a peak of above 1,000 students in the early 1920s. Chiropractic leaders of the time often invoked religious imagery, and B.J. seriously considered declaring chiropractic a religion, deciding against this partly to avoid confusion with Christian Science. B.J. also worked to overcome chiropractic's initial resistance to the use of medical technology, by accepting diagnostic technology such as spinal X-rays (which he called spinography) in 1910.[14]

Prosecution of DCs for unlicensed practice after the conviction of D.D. Palmer and a previous charge against B.J. Palmer resulted in B.J. and several Palmer graduates creating the Universal Chiropractic Association (UCA). Its initial purpose was to protect its members by covering their legal expenses should they get arrested.[25] 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 Morris legally differentiated chiropractic from osteopathy by the differences in the philosophy of chiropractic's "supremacy of the nerve" and osteopathy's "supremacy of the artery".[26] Morikubo was freed, and the victory reshaped the development of the chiropractic profession, which then marketed itself as a science, an art and a philosophy, and B.J. Palmer became the "Philosopher of Chiropractic".

(John F.A. Howard, DC, founder, National College of Chiropractic)

B.J. Palmer believed that their chiropractic school was founded on "…a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it".[15][27] The next 15 years saw the opening of 30 more chiropractic schools, including John Howard's National School of Chiropractic (now the National University of Health Sciences) that moved to Chicago, Illinois. Each school attempted to develop its own identity, while B.J. Palmer continued to develop the philosophy behind his father's discovery. Fueled by the persistent and provocative advertising of recent chiropractic graduates, local medical communities, who had the power of the state at their disposal, immediately had them arrested. There were only 12,000 practicing chiropractors with more than 15,000 prosecutions for practicing medicine without a license in the first 30 years.[28] D.D. Palmer was also jailed for practicing medicine without a license.[3] Tom Morris and his partner, Fred Hartwell, were able to successfully defend 80% through the UCA. B.J. would later note about those battles:

"We are always mindful of those early days when UCA...used various expedients to defeat medical court prosecutions. We legally squirmed this way and that, here and there. We did not diagnose, treat, or cure disease. We analyzed, adjusted cause, and Innate in patient cured. All were professional matters of fact in science, therefore justifiable in legal use to defeat medical trials and convictions."[29] His influence over the next several years further divided the mixers, or those who mixed chiropractic with other cures, from the straights who practiced chiropractic by itself.[6]

D.D. Palmer's last years

While B.J. worked to protect and develop chiropractic around the Palmer school, D.D. Palmer continued to develop his techniques from Oregon. In 1910, he theorized that nerves control health.[1]

Before his sudden and controversial death in 1913, D.D. Palmer often voiced concern for B.J. Palmer's management of chiropractic. He challenged B.J.'s methods and philosophy and made every effort to regain control of chiropractic. He repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or too slack, affecting the tone(health) of the end organ and noted, "A subluxated vertebra . . . is the cause of 95 percent of all diseases. . . . The other five percent is caused by displaced joints other than those of the vertebral column."[1][30]

During the long-fought battle for licensure in California, in 1911 he wrote of his philosophy for chiropractic, and hinted at his plan for the legal defense of chiropractic.[31]

In "The Chiropractor", published posthumously in 1914, D.D. Palmer revisits the topic of chiropractic as religion, quoting F.W. Carlin as saying "The Religion of Chiropractic is absurd". He continued: "I fully agree with Dr. Carlin. To say or think that the science, art and philosophy of Chiropractic, or that Chiropractic, the three combined, has a religion, is really absurd and ridiculous".[32]

The 2008 book Trick or Treatment states that in 1913 B.J. Palmer ran over his father, D.D. Palmer, at a homecoming parade for the Palmer School of Chiropractic. Weeks later D.D. Palmer died. The official cause of death was recorded as typhoid. The book Trick or Treatment indicated "it seems more likely that his death was a direct result of injuries caused by his son." There was speculation that it was not an accident, but instead a case of patricide.[33] Chiropractic historian Joseph C. Keating, Jr. has described the attempted patricide of D.D. Palmer as a "myth" and "absurd on its face" and cites an eyewitness who recalled that DD was not struck by BJ's car, but rather, had stumbled.[34] He also says that "Joy Loban, DC, executor of DD's estate, voluntarily withdrew a civil suit claiming damages against B.J. Palmer, and that several grand juries repeatedly refused to bring criminal charges against the son."[34] They had become bitter rivals over the leadership of chiropractic. B.J. Palmer resented his father for the way he treated his family, stating that his father beat three of his children with straps and was so much involved in chiropractic that he hardly knew his children.[33] D. D. claimed that his son B. J. struck him with his car.[35]

Straights versus Mixers

State laws to regulate and protect chiropractic practice were introduced in all fifty states in the USA. 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 complicated the process. Initially, the UCA, led by B.J. Palmer, opposed state licensure altogether. Palmer feared that such regulation would lead to MD physician control of the profession.[36] 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 in 1922 to present to all states that did not yet have a law.[36] They warned state associations to purge their mixing members or face competition by the formation of a new "straight" association in their state.

Although D.D. and B.J. were "straight" and disdained the use of instruments, some early chiropractors, whom B.J. scornfully called "mixers", advocated the use of instruments. In 1910 B.J. changed course and endorsed X-rays as necessary for diagnosis; this resulted in a significant exodus from the Palmer School of the more conservative faculty and students.[14]

The mixer camp grew until by 1924 B.J. estimated that only 3,000 of the U.S.'s 25,000 chiropractors remained straight.[14] That year, B.J.'s invention and promotion of the neurocalometer, a temperature-sensing device, was highly controversial among B.J.'s fellow straights. By the 1930s chiropractic was the largest alternative healing profession in the U.S.[14]

Mixers, disturbed by the edicts of the PSC having so much influence in their daily practice, created the American Chiropractic Association (one of the early precursors to today's ACA). Though born out of necessity to defend against the UCA attacks, the ACA's stated purposes