Medicine’s About-Face

At the time D. D. Palmer began adjusting the spines of the first chiropractic patients, organized medicine was quick to denounce spinal adjustment as unscientific and worthless, as well as dangerous. That attitude has persisted. Curiously enough, however, over the decades many medical practitioners have not only “discovered” the existence of spinal subluxations and their influence on health, but they have made definite attempts to develop forms of spinal manipulation of their own.

Many a fairminded M.D. must have asked himself the question, “Are we trying to steal chiropractic without giving credit where credit is due? If imitation is the sincerest form of flattery, aren’t we demonstrating our belief in chiropractic’s value more and more while still condemning what we imitate?”

An examination of medical literature reveals amazing medical ignorance, until recent years, of the spine and of the effects of spinal subluxations upon the nervous system and the body’s resistance to disease. Early medical attempts to reduce subluxations were unbelievably crude by comparison with chiropractic techniques. This medical backwardness in the field of body mechanics has persisted to the present, afro praetors hold, and is due to the fact that the basis of medical practice is drug therapy.

Many medical authorities deny flatly that subluxations could occur, or, if they did occur, that they could be adjusted by hand. Mention has already been made of the responses by medical men to a New York State questionnaire specifically requesting their opinions of chiropractic; the overwhelming majority were opposed to both chiropractic theory and practice. Possibly their answers were colored by prejudice; but many such opinions must also be considered to have been the result of ignorance, and of failure to research the field scientifically.

Thus, Dr. Louis S. Reed asserted that vertebrae are dislocated only rarely and that pressure by them upon the spinal nerves is “practically impossible.” Dr. Dean Lewis, Surgeon-in-Chief of Johns Hopkins Hospital, stated that, in his opinion, spinal subluxations could not be reduced by hand. Dr. R. Bensley, Director of the Department of Anatomy of the University of Chicago, stated that in a period of 29 years he had never observed a single instance in which spinal vertebrae had caused pressure upon nerves. Dr. J. B. Roberts wrote that sacroiliac subluxations “must be rare” since the medical textbooks contained few instances of them. Magnuson and Coulter noted the general medical belief that the sacroiliac joint was immovable.

But—and often almost simultaneously—directly opposed viewpoints have been appearing with increasing frequency in medical literature. As far back as 1911, Dr. R. O. Meisenbach stated that sacroiliac “joint strain” was more common “than generally sup-posed.” In 1913, Dr. R. Fitch described a case of lumbo-sacral subluxation “accompanied by nerve pressure.” In 1914—in a Medical Record paper that attracted widespread attention and provoked a great deal of controversy—Dr. J. H. Radley wrote: “The possibility that not a single medical man has ever palpated a spinal subluxation or witnessed its correction and the results thereof is no proof at all that such a condition does not exist. One convincing, positive demonstration outweighs in evidential value all the speculation, yes, scientific negation that can be accumulated. In literature reaching the hands of the recognized medical profession, there is such a scarcity, as to amount to almost a complete absence, of matter dealing with spinal subluxations; and of that which comes to their notice, practically all of it is so misinforming and misleading as fully to account for the almost universal denial, by physicians, of the possible existence of such a condition … That spinal subluxations are of frequent occurrence; that they attend, if they do not precede and cause, disease in remote tissue; and that correction of these lesions is followed by restoration to normal condition and function of such remote tissue (at least subjectively to the patient, as evidenced by the disappearance of symptoms), are all matters of repeatedly demonstrated fact.”

Generally, however, orthodoxy, inertia, and a reluctance to investigate revolutionary new ideas continue to dominate medical thinking on the subject of subluxations. Dr. E. J. Carey noted that “too frequently” medical students neglected the anatomy of the back. Sardonically, Dr. T. A. Willis observed that in the course of dissections, very few students showed curiosity regarding spines while the average surgeon had a propensity for turning his female patients over and removing “some of the dispensable parts from the abdomen or female pelvis, concerning the anatomy of which his curiosity has naturally been more active.” The average surgeon “does not understand” back cases, wrote Dr. J. E. Goldthwait. Dr. G. Mitchell warned of “widespread ignorance of the anatomy of the lower back and the mechanics of the lower spine.” In no field of medicine was there “greater ignorance” than concerning backache, stated Dr. R. H. Paramore.

By the mid-1920’s, medical references to subluxations and their effects on spinal nerves and in disease were quite frequent. In 1935, Stimson and Swenson referred to “sudden and spectacular increase” in medical reports of subluxations. The following year, Pitkins and Pheasant reported finding sacroiliac subluxations in 326 (64 per cent) of 506 patients. Now the medical doctors were really commencing to look for subluxations—and finding plenty of them.

Belatedly, the medical viewpoint was coming around to resemble that promulgated by Palmer. A variety of ills as well as “multiple vague symptoms” were simply “phenomena of crooked spines,” wrote Atsatt and Atsatt. “Many disabilities, formerly classified as lumbago back strains, etc., are now being recognized as due to displacements,” stated Dr. H. J. Ullmannin in 1924. A decade later, Dr. A. B. Ferguson wrote that spinal displacements were “commonly associated with symptoms.” Over the years, various M.D.’s wrote of arthritis, rheumatism, neuralgias, adbominal pains, lumbago, headaches, nervous irritability, Iow-back pains, and a multitude of other ills being associated with subluxations.

Within the medical camp there was also growing recognition not only that subluxations can and do exist but that they also cause pressure on nerves, and that this pressure causes interference in the flow of nervous impulses which in turn results in the development of disease. As an example, Dr. J. Brailsford wrote of neuralgias of the trunk resulting from compression of nerves “where they traverse bony canals.” Dr. A. Oppenheimer noted “narrowing of cervical invertebral foramina” in 66 patients with a wide variety of symptoms. The sensory roots “may be pressed upon by various bones” at the foramina, wrote Dr. C. B. Chamberlain. Pressure on the spinal nerves, compression … in the invertebral foramina, mechanical nerve irritation, “strangling” certain spinal nerves at their exit from the spine, and disturbances in the spinal nerves are a few of the phrases that began to appear in a multitude of medical articles and textbooks and which completely supported chiropractic principles.

And as indication of growing realization of the frequency with which subluxations occur and the seemingly minor forces which in some instances bring them about, a great number of medical doctors mentioned subluxations as having been caused by such commonplace acts as turning the head or sitting up in bed.

Thus, from medicine’s own literature, the soundness of chiropractic was demonstrated. It might have seemed logical for the M.D.’s to develop techniques comparable to those of the chiropractors. This, however, has not been the case. Medicine has consistently lagged behind chiropractic and continues to do so today in the field of spinal adjustment, not only be-cause the medical profession places its chief reliance on drug therapy but also because manipulation is, in a sense, merely a “sideline” with most medical doctors while it is the basic therapy of chiropractors. There are medical specialists of many varieties ranging from eye through heart specialists and obstetricians to surgeons who operate in only one area of the body. By the same token, if the overall art of healing is considered, basically, to be a single field with many branches and subdivisions within those branches, then it is obvious why the chiropractor is more competent than the M.D. in the specialty of spinal analysis and adjustment. As a whole, medicine has not accepted the implications of the statement in the Baruch Report that “. . . medicine based exclusively on empirical use of pills and potions is becoming obsolete.”

The medical trend today, in fact, is toward greater and greater use of “miracle drugs” and vaccines. Numerous types of physical therapy are advocated by the Baruch Report—including “the employment of the physical and other effective properties of light, heat, cold, water, electricity, massage, manipulation, exercise, and mechanical devices . . .Practically all of these methods have been condemned out of hand many times over by organized medicine.

“Physical agents,” states the Baruch Report, “pro-duce striking biologic responses, including effects on psychic reactions more potent than the effects of many of the drugs gathered through centuries of trial and error . . The manner in which we use the hospitals and medical schools of today will largely determine the medical future of our country . . .”

The importance of the Baruch Report cannot be overestimated. It was one of the most comprehensive studies of so-called “irregular” methods of healing ever undertaken and it cost more than one million dollars. Hundreds of leading scientists participated in gathering information and preparing recommendations.

Regarding medical shortcomings in all aspects of physical therapy and in particular in the field of manipulation, the Baruch Report had plenty to say. It asserted that until recently (1944) there had been “little basic or fundamental research” in physical medicine. It stated that the general neglect of physical therapy in the curricula of our medical schools had resulted “in diverting this enormously valuable branch of therapeutics to irregular cults.” It expressed the hope that “changes in the medical curriculum now envisioned will constitute the beginnings of a return to the basic principles of the healing art; namely, to treat the patient and not the disease.”

This was pulling no punches. The Report went on to recommend the establishment of a center of physical medicine in one of the larger medical schools which would “place major emphasis on problems of the structural mechanics of the human body.” It warned that there was “a definite need for careful study of the various manipulative procedures which are employed therapeutically to alter the structural mechanics of the human body.” And it urged that manipulative therapy be taught in all medical schools of the United States.

Chiropractors would have given blanket endorsement to all this, except for the fact that the Report was ideologically eye to eye with organized medicine insofar as maintaining or attaining organized medicine’s goal of monopoly of all methods of healing was concerned. It spoke, for example, of nonmedical healers as “irregulars” while advocating medical adoption of their methods. It failed to mention chiropractic or chiropractors, although chiropractic is a legally recognized healing art in the overwhelming majority of the States of the United States; it spoke merely of manipulation in general terms. It recommended the training of many more “well qualified physical therapy technicians” who would work under the direction and supervision of medical doctors; thus it relegated physical therapy to the position of a subordinate branch of healing, like nursing. Its entire “slant” was in the direction of warning the medical doctors to wake up and become as proficient in “irregular” methods of healing as the irregulars were, so that these healing arts would be taken over and absorbed by the medical monopoly and would not develop independently of medicine.

This attitude was not surprising, since many of those who were influential in the planning of the investigation and preparation of the Report were leaders in organized medicine. They were not concerned with the development of new methods of healing which would compete on equal terms with medicine; rather they were concerned with preventing the development of these methods except when they were under the aegis of organized medicine.

The Baruch Report did not mention that chiropractic was not only the second largest healing art in the world but was also, in most places, as firmly established legislatively as medicine. The use of the blanket term “cults” to define and lump together all the “irregular” healing arts also tended to belittle chiropractic in the minds of those who had heard of it and knew that it was a form of physical therapy but did not know exactly what it was or the high educational requirements of its practitioners.

Following the Report the public was given proof of the overwhelming superiority of chiropractic to any form of spinal manipulation taught in the medical schools. The facts were revealed in this way: a letter was sent to the deans of the nation’s medical schools inquiring the extent of their teaching of physical medicine to undergraduate medical students. The indifference—or at least the apathy—revealed in regard to the new methods of healing was amazing.

For instance, almost all of the deans admitted that in their schools physical medicine was neglected woe-fully. A typical admission was to the effect that instruction “up to the present time has been most inadequate.” Another stated that “sixteen class hours” were devoted to the subject, another mentioned a course of 126 hours. Still another wrote that his school’s course had been “nothing to brag about.’ And still another admitted that, “This branch of instruction has been sadly neglected, and this neglect is in part responsible for the cults and for a woeful lack of appreciation of its importance by the general practitioner.”

The A.M.A. belatedly recognized physical medicine as a specialty within the all-encompassing field of medicine and established a special Section on Physical Medicine and Rehabilitation. One of the first activities of the new section was to send a questionnaire to the deans of the nation’s medical schools, inquiring the status of physical medicine and rehabilitation in their institutions. There were 67 replies, which indicated that, while progress had been made, physical medicine was still a nonentity or a stepchild insofar as many of the medical schools were concerned.

Ten medical schools, for example, did not even have departments of physical education and rehabilitation and were not particularly interested in entering the field. Another 14 were thinking about teaching physio-therapy but had done nothing concrete so far. Another 19 taught physio-therapy as a sideline course. Another 14 had separate departments of physiotherapy, but the course was still very much an adjunct to the instruction in drug therapy. Seventeen offered graduate courses, of short duration, to interested M.D.’s. Forty-five taught undergraduate courses, again short. Thirty-seven taught the subject as a major and graduated students as physio-therapists qualified to work under medical direction and supervision.

Contrast this meagre education in not only a sort of manipulation but also a wide variety of other healing methods ranging from the use of light through the employment of mechanical devices—a veritable hodgepodge of sketchy skills—with the chiropractor’s thorough education. Not only does the chiropractor study the same basic sciences as the M.D., but his chiropractic subjects (in accredited schools) total 1580 hours. His specific chiropractic subjects are palpation, spinal analysis, clinical instruction, chiropractic principles, X-ray interpretation and nerve tracing.

Chiropractors feel strongly that over the past six decades they have built steadily and surely on a sound theoretical foundation, and have accumulated a body of specialized knowledge and skills which medicine cannot even begin to approach. In the light of the evidence-millions of patients whom chiropractic has cured after medicine, including so-called “physical therapy,” has failed—there appears to be ample reason for their confidence.