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Bonesetting, Chiropractic, and Cultism

Chapter 4: The Scope and
Requirements of Chiropractic

©1963, Samuel Homola, D.C.

With five million people in the United States ill on any given day, 70 million in the course of a year, and over a million physicians, nurses, and others caring for the sick . . . it is not necessary to argue for public welfare as a major sector of "general welfare." Here again, silence of the federal constitution throws responsibility primarily upon states and localities [1].

It should be remembered, in the course of our discussion, that there is no argument about the value of manipulation, as indicated, in selected cases. The stand of many chiropractors, however, is that most of the diseases afflicting mankind can be treated by manipulation of the spine. In comparing the practice of a qualified osteopath, who practices both chemotherapy and manipulation, with the practice of the chiropractor, we note what seems, in observing, to be the obvious failure of manipulation to cure those conditions for which the osteopath now administers modern medical therapy. Possibly the higher standards of the osteopath have allowed him to abandon, to a great degree, the basic principle that vertebral misalignment is the cause of most disease.

The chiropractor does not claim to be just a specialist with a limited practice; he is a competitor of the general physician. The chiropractor is limited only in his methods of treatment, not in the type of cases he may treat. The theory of his practice does not place limitations upon the scope of his practice, The request of the chiropractor that he be extended a "limited license" and still be granted the right to treat the broad scope of disease seems, considering the standards governing medical practice, to be quite unreasonable. In New York, for example, where chiropractors have not yet been successful in obtaining licensure, Dr. Philip Allen, then president of the New York Medical Society, stated in a newspaper editorial entitled "The Doctor's Case Against Chiropractic":

The public through the State Board of Medical Licensure, has ever been firm in its belief that no physician should be licensed on a limited basis to treat some special branch of disease. instead the state rightly demands that all persons licensed in medicine must have the finest and most difficult education in all the basic sciences, plus education in both scientific and clinical medicine. Physicians may specialize, as they do in later years, but no physician ever received his license because he was a specialist first. . . . The chiropractors seek to break this pattern by having the state license them to treat only the human spine and on the basis of unproved methods and concepts of disease which would have been laughed at by healers of the 17th.century. . . . They want to replace doctors and not work under them [2].

Dr. C. W. Weiant, a chiropractic educator of the Chiropractic Institute of New York, stated, in part, in reply to Dr. Allen's editorial:

Chiropractors should have a limited license. Such a license would define the scope of their practice, protecting the public (as well as the physician) from any illegal encroachment on the medical field.

In reviewing the manner of practice of the chiropractor, and the laws enforced by the chiropractors themselves in states where they have their own examining boards, one would have to assume that Dr. Weiant meant, by his expression, "illegal encroachment on the medical field," that the licensed chiropractor would not employ medical methods of treating disease, for few, if any, state laws stipulate what conditions the chiropractor may treat but only how he may treat them. (In four or five states, however, the chiropractor is not allowed to treat contagious and infectious diseases.)

The chiropractors' efforts to treat disease by limited and nonmedical methods form the basis of most of the argument against chiropractic. This is apparently why New York has refused to license them-a refusal based on a double-edged argument that the chiropractor, promulgating an essentially false theory, does not receive sufficient training to treat human disease regardless of how he might attempt to do it. To grant chiropractors a license to treat disease, so that they may not encroach upon medical methods of treatment, does not, of course, validate the basis of their treatment. Considering the information given in the foregoing chapters, the treatment of joint conditions by manipulation has always been a legitimate part of medical practice. If chiropractors were strictly prevented from "encroaching upon the medical field," it seems that they could very well be confined to the treatment of disease by manipulation of the joints only (as provided for in the chiropractic theory), without the use of any other form of therapy and without the right to treat joint conditions Per se. Many of today's chiropractors, however, in assuming that their limited method of treatment is sufficient in the care of most disease, argue for their licensure on that basis; they simply maintain that their practice is not the practice of medicine and that medical practice laws and medical organizations have no jurisdiction over their method of healing. Thus, on the basis of their existence in numbers, chiropractors are licensed as competitors of the medical physician, even though they are restricted by law and by creed to a limited method of healing. Under the public's right to free choice of a doctor, there often seems to be no alternative but to license services patronized by substantial portions of the public, changing the law as the practice changes, or repealing the law as the practice dies.

It is difficult to say whether a practice that is thought to be cultism should be restricted by law to the fundamental tenets of that cult, or whether that cult should be allowed to incorporate methods from other fields of healing in order to stimulate progress toward higher standards. One argument against allowing cults to incorporate legitimate medical methods of treatment is based upon the fact that the development of a secondary Class C medical practice would necessarily dilute the high quality of modern medical care-making it difficult for the public to distinguish between low-grade and high-grade medical practice.

For many impatient individuals who aspire to be "physicians," however, there probably never has been or never will be an easier way of getting around difficult medical standards in applying for a license to treat human disease than through the chiropractic theory. In addition, the bloodless, drugless, and often attractive method of chiropractic sometimes provides an alternate course for those squeamish individuals who may have personal objections to medical treatment methods -- regardless of what is or is not the correct method of treatment. Since chiropractors will not or cannot qualify according to medical standards in the treatment of disease, licensing bodies are forced to allow separate professional examinations in order to permit chiropractic physicians to treat many of the same diseases the medical physician would treat by different means.

A practitioner who wishes to employ manipulation could ideally do so as a physical medicine specialist. Those who do not want the responsibility of a physician and who still desire to work in the field of manipulation could find excellent opportunity in the field of physical therapy. Many chiropractors, however, whose training is little more extensive than that of a physical therapist, assume the responsibilities of a general physician while working in competition with medical practice and all of its specialties. For these chiropractors to argue that they do not need a knowledge of the use of drugs and surgery in order to conduct their practice is to say that they will ignore or will not be aware of the correct method of treating disease in many cases, and that they will simply apply the chiropractic adjustment to a progressive illness that could possibly be better treated by another method. The very fact that a chiropractor would apply for a license to treat human disease in a general practice, without a knowledge of medical treatment, and with the intention of treating all such diseases chiropractically, seems to label him the cultist he is accused of being.

When legislative bodies are forced to license the practice of chiropractic (which defines itself as a method of treating disease by adjusting the spinal column), they have no alternative but to make special, provisions for chiropractors and then restrict them to the practice of chiropractic as taught in chiropractic schools. This, at least, prevents the chiropractor from encroaching upon methods of treatment in which he has had little or no training. When he begins to add methods of treatment outside simple adjustment of the spinal column, the chiropractor begins to get close to the practice of medicine as defined by law, and thus becomes more subject to licensure by medical standards. This fact has provided many headaches for those in chiropractic who want to elevate their profession above the "one cause, one cure" level. In this respect, the low standards of chiropractic practice maintain themselves to a great degree. When the standards of chiropractors do begin to approach those of the practice of medicine (with chiropractic in general competition with medical practice), I would imagine that qualified students would rather undertake the practice of medicine than to suffer the stigma and the limitations of chiropractic regardless of whether chiropractic remained pure chiropractic or whether it adopted medical methods of treatment.

In spite of the fact that medical science does not recognize the chiropractor's treatment for disease, chiropractors have been successful in obtaining a license to treat disease in most states. In addition to legal recognition in 46 of the 50 states, chiropractic is also recognized in the District of Columbia, Mexico, Switzerland, Puerto Rico, Australia, and parts of Canada. Outside these countries and the United States, however, legal recognition is nil.

Minimum educational requirements for the chiropractic degree, as recommended by the National Chiropractic Association, consist of four years of nine months each with a total of 4,000 or more class hours. The National Council on Education of the N.C.A. also recommends that chiropractic boards of each state enact laws requiring two years of preprofessional study or "additional college credits" as a licensing requirement for the practice of chiropractic in each state. It seems, however, that the great majority of chiropractors do not want a law designating two years of undergraduate college work as a prerequisite for chiropractic education.

As of January 25, 1962, educational requirements for licensure, as compiled by the National Chiropractic Association, showed that 25 states (and the District of Columbia and Puerto Rico) required preliminary education varying from "college credits" to two years of college preceding three to four years of chiropractic training. In 30 states and the District of Columbia, basic science examination or a combination of both medical and chiropractic practitioners on the examining board play a part in the licensing of chiropractors.

(In Alabama before 1959 the examining board was strictly medical. A chiropractor who could pass the medical requirements could be licensed, although his practice would be restricted to the practice of chiropractic. By 1953, a total of two chiropractors had passed the medical examination and were licensed. Only one of these was still licensed as of April, 1959, although there were three hundred chiropractors practicing illegally throughout the State! As of January, 1960, however, for the first time since 1923, provisions were made for the licensure of chiropractors in Alabama by special examination. Under the supervision of a healing arts board, governing the licensure of both the medical profession and the chiropractic profession, chiropractors are examined by a basic science board and then by their professional board.)

About 22 states and the District of Columbia have basic science boards; five have mixed boards (combination of both medical and chiropractic examiners); three states have a mixed board combined with basic science examination. Sixteen states (and Puerto Rico) license chiropractors solely through chiropractic examining boards. In four states -- Louisiana' Massachusetts, Mississippi, and New York -- chiropractic is either not prescribed or not regulated.

According to a recent report by a representative of the National Chiropractic Association, 28 states now have laws requiring preprofessional. college credits for licensure as a chiropractor; this figure apparently includes those states that have laws becoming effective at a later date.

Thus, with about 27 jurisdictions presently requiring preprofessional college training for chiropractic licensure, and a few others scheduled to enforce such requirements, only Western States College of Chiropractic requires that applicants have two years of college prior to undertaking chiropractic studies. This would seem to indicate that, by far, the majority of chiropractic students are scarcely above high school level.

Even though fewer than half the states (21 and the District of Columbia) presently have laws requiring that chiropractic licensees have two full years of preprofessional college training, the enrollment in chiropractic colleges has been reduced considerably by these requirements, and the number of chiropractors in those states having such requirements has diminished drastically. As noted in 1959 in the second eition of B.J. Palmer's book Shall Chiropractic Survive!:

The Lincoln Chiropractic College Bulletin for March, 1958, after mentioning the enactment of a two year preprofessional requirement in many states, informed us, "These requirements for licensure have created an economic problem for all chiropractic colleges, and the Lincoln College is no exception."

The state of West Virginia was one of the earliest (if not the first) states to enact a two year preprofessional requirement for chiropractors. We have been told that West Virginia once had between 80 and 90 chiropractors. The I.C.A. Review for July, 1958, stated, West Virginia, with a population of over 2,000,000 has fewer than 30 chiropractors in active practice [3].

As a general rule, those states requiring two years of preprofessional training, basic science or medical board examination, show decreasing numbers of chiropractors, while those states licensing chiropractors through chiropractic examining boards show numbers somewhat constant or, in some cases, decreasing. The number of licensed chiropractors in each state varies considerably, depending largely upon the nature of the examination and the requirements for licensure. The location of the state and the legal definition of chiropractic may have much to do with the number of licensed chiropractors in a particular state. In Florida, for example, an especially attractive state requiring basic science examination, the legal definition of chiropractic permits the chiropractor to enjoy a rather broad field of practice. As a result, large numbers of chiropractors may take the Florida examination in preference to many other states requiring only a chiropractic examination. The overall picture, however, seems to show a definite tendency toward a continued decrease in the number of chiropractors in most states.

In considering the small number of chiropractors in those states presently requiring two years of preprofessional training, we probably get a fair idea of the ultimate course of the "second largest healing profession" (chiropractic); for it seems very likely that, as long as the chiropractor continues to treat the entire body in a general practice in competition with the medical physician, it will not be too long before every state will require uniform standards for those who treat the same diseases. Whether or not the chiropractic profession survives such requirements will probably depend upon the changes made in its method (and its standards) in time to come.

Evidence of the fact that the requirement of two years of preprofessional training is a factor discouraging the enrollment of chiropractic students is well exemplified in the course of events following the enforcement of such requirements at the Los Angeles College of Chiropractic in 1952. From 522 students enrolled at that school in 1950, for example, the number dropped to 93 in 1955; an 80% reduction of the student body in only three years. When the school rescinded this self-imposed rule (requiring two full years of preprofessional study) in 1955, the enrollment increased to 224 the following year (1956).

It is interesting to note that there are at least four chiropractic colleges in California -- one approved by the National Chiropractic Association, one approved by the International Chiropractic Association, and two others not approved by either of these organizations. The graduates of all four, however, are permitted to take the California examination for licensure. At one time or another, about 39 chiropractic schools have conducted classes in California. Out of the hundreds of chiropractic schools that have "opened shop" in the United States since the beginning of chiropractic, there are probably about 20 still in operation; eight are approved by the National Chiropractic Association and seven by the International Chiropractic Association. A 1959 N.C.A. journal stated: "The NCA membership . . . represents doctors of chiropractic who have graduated from 72 different educational institutions." [4] The 1960-61 Membership Roster of the International Chiropractic Association names 91 different chiropractic colleges from which its members are drawn.

Interestingly enough, a good many of the unapproved chiropractic schools (not approved by the N.C.A. or the I.C.A.) are in New York where the practice of chiropractic is illegal but where, nevertheless, many chiropractors practice. In 1952, for example, there were 2,676 chiropractors in New York! Today there are more than 3,000!

Preprofessional Training of Chiropractic and Medical Students

With the exception of one chiropractic college that has pre-college entrance requirements, it seems that the chiropractic colleges are thoroughly against entrance requirements above high school education, since, as we have noted, there is already a shortage of students in chiropractic colleges and a resulting decline in the number of chiropractors in most states. Chiropractic colleges feel that further elevation of educational requirements for the study and practice of chiropractic would only further decrease the number of chiropractic students and practitioners. Although this may be true, it is also true that such low educational standards do not permit accreditation by the United States Office of Education. As a result, unapproved chiropractic colleges fail to attract the attention of thousands of students enrolled in general undergraduate training in hundreds of accredited colleges.

The situation of the chiropractic schools in being unsought by increasing numbers of college applicants and college graduates is revealingly significant, and is discussed in other parts of this book. Many chiropractors who are against enacting a two-year pre-college requirement for chiropractic education and licensure maintain that this length of time is not necessary to learn the practice of chiropractic. They further insist that six years of training required for chiropractic education is too closely approaching the requirements for medical education, which they feel are quite unreasonable inasmuch as they "have caused a shortage of medical doctors."

Actually, the shortage of medical doctors seems to be due to a lack of the facilities needed to train the number of physicians required to fill public need and demand. While the overall number of applicants for medical education may have decreased because of higher educational requirements and the passing of recent war years, the medical schools have never had a shortage of students in their classes. In addition, the number of students applying for medical education is expected to rise considerably in the near future, in spite of the fact that it is becoming increasingly difficult to get into a medical school without first having four years of premedical training. Thus, while there may be a shortage of medical physicians in meeting public need, the chiropractic profession seems to suffer from lack of students because of public apathy toward chiropractic in general -- regardless of the fact that any high school graduate can easily enroll in a chiropractic college. A 1962 National College of Chiropractic solicitation advised prospective students, for example:

What must I do, you ask, to get started in this work? Can I do as well as your other graduates? Yes, you can! A 36 months' course (including externship) at the National College of Chiropractic, a foremost and fully accredited college of chiropractic, adequately prepares you.

Medical schools, on the other hand, select students from those in the "upper-half" grade bracket and turn away the rest. About two-thirds of the first-year medical classes have a grade average of "B," while approximately one-fifth have a grade average of "A." The May 9, 1958, issue of U.S. News and World Report, commenting on the shortage of medical physicians, stated:

Only half of the applicants for admission to medical schools were accepted in 1956, the last year for which figures are available. The colleges did not have room for more [5].

In determining the scale of selection for medical students, applicants for medical training are given national Medical College Admission Tests. Students in the upper half are accepted and those in the lower half are rejected. Medical educators say that medical courses are too difficult for "all but the upper-group students."
Due to the responsibility and the difficulty of learning and conducting a qualified medical practice, it shall always be necessary to select students from the top half of all those who apply for medical training. The larger the number of students who apply for medical education, the higher the quality of the selected students. While it seems unfortunate that a student might spend four years in premedical education only to be rejected by the medical colleges, this is sometimes necessary if the nation's medical services are to be maintained on a Class A level. There are many other attractive fields into which a rejected premedical student may extend his training. Perhaps the development of more schools and hospitals for training large numbers of physicians would increase the number of top-rank students applying for medical education, since they would be more reasonably assured of being accepted. (There are more than 2,000 Americans studying medicine in foreign schools because the schools in this country are too full to accept them.) Thus, the number of physicians per population could be increased (or at least keep pace with population increases) and still permit the quality-ratio of student selection to be maintained.

Almost without exception, the student who gains entrance to a recognized medical school has already completed four years of college training. The school may require this in spite of the fact that statutory law might require that a medical student have only two years of pre-medical training for licensure in a particular state. A graduate physician will have completed 10 to 12 years of training before he is released to private practice.

Four years, or even six years of training for chiropractic licensure, is considerably less than the time required for medical education. The failure of chiropractic schools to fill their classes directly from high school, and the retrogression resulting from statutory laws requiring two years of preprofessional training, seems to reflect considerably upon what chiropractic is thought to be -- or not known to be -- by those both qualified and unqualified. Apparently, of the thousands of students refused admission to a medical school because of insufficient grades or lack of openings, even though they have completed four full years of premedical training, few consider applying for admission to a chiropractic college. A considerable number of them do, however, apply for admission to an osteopathic school.

In any event, there is not a shortage of prospective students who have had some academic training -- and they are increasing in number. In fact, due to steadily increasing numbers of students applying for college training, it has been estimated that the number of students applying for medical training will rise from 15,000 today to about 33,000 by 1965. In order for the present ratio of physicians to population to be maintained, however, (132 physicians for each 100,000 persons) at least 22 additional medical schools will have to be in operation by 1975 -- if the present population trend continues.

The Doctor Shortage

In discussing the possible shortage of medical physicians, there is one alarming point to be considered: that is the possibility of second-rate doctors filling the needs of those not cared for by Class A physicians. It might be relatively easy, for example, for any licensed "drugless healer" to progressively step over into the realm of medical practice, thus offering substandard medical care. If a shortage of medical physicians should become more acute, without sufficient facilities for training more physicians, Dr. Ward Darley, of the Association of American Medical Colleges, warns that "The medical schools would be under great pressure to admit more students than they could properly teach. They might be pushed into taking students who are not qualified to study medicine." Dr. Darley also stated that, "The licensing boards . . . would be under pressure to lower their standards. There are thousands of graduates of foreign schools who are not considered sufficiently qualified at present to be given a license to practice. If conditions became worse," he continued, "the bars might be lowered enough to let them in." The U.S. News & World Report commented, following Dr. Darley's statement: "In the future, some medical leaders believe, the public may not only find it more difficult to get a doctor when one is needed, but the doctor who answers the call may not be as competent as those now available." [5]

Although chiropractic, with its stigma of cultism, its short-term education, and its limited method of treating "most human disease," seems to be having a difficult time surviving, in spite of what is happening in the medical field, there is, of course, the possibility that it might sufficiently alter its definition to permit progressive encroachment upon medical practice as demands for more general medical care mount up. Barring any change in the fundamental doctrine of chiropractic, however, two or more years of preprofessional training would add little to the competency of one who believes that most disease is the result of one or more subluxated vertebrae, Chiropractors and other drugless or sectarian practitioners, adopting Class C medical methods in order to survive, might be perpetuated by the patronization of persons who are not able to distinguish one type of doctor from another.

It is interesting to note that the Utah naturopaths, before a hearing by the Welfare and Education Standing Committee in Utah, recently, sought the right to "administer drugs, perform minor surgery, and practice obstetrics" on the grounds that there were not enough physicians in rural areas to care for the sick. Any possible shortage of qualified physicians in the future might well encourage the existence of "second-rate" doctors. As yet, however, a supposed shortage of medical doctors does not seem to have encouraged the existence of the chiropractor to any great extent, although many chiropractors, in some areas, are filling the capacity of "family physician" by using "drugless methods." Chiropractors are often encouraged, by leaders in their profession, to step in as "general practitioners" when medical specialization fails to provide the services of a family doctor. In the October 1960 issue of Harper's magazine, Dr. David A. Rutstein commented: "For lack of a family doctor, many people are taking their problems to such advisers as Christian Science practitioners, marriage counselors, chiropractors, or naturopaths." [6]

It seems, however, that many chiropractic colleges do not look forward to attracting a sufficient number of students from a college level, for in a chiropractic publication we find this statement:

What about recruitment of students from colleges or junior colleges? It is not likely that this will produce any significant increase in the number of Chiropractic students in view of the intense competition for scientists and engineers, to say nothing of keen competition in all other healing arts. With prejudice against Chiropractic which exists in many colleges, it is not expected that college experience will lend any encouragement to one's plans to be a chiropractor. Unless, therefore, the college student has a strong conviction about Chiropractic to begin with, the chances are he will end up in some trade or profession which offers more hope of public acceptance with less personal sacrifice. Even if he has a predisposition toward Chiropractic, his interest is likely to become diluted after two years of college. . . . What has been the effect of the two year requirement in those states where it has been in existence for a number of years . . . there has been no increase in the size of the profession since the early 1920's. If requirements are further increased, all indications point to a dying profession [7].

Thus, it seems that chiropractic is not much more attractive to the high school graduate than to the college student. In any event, it might be considered somewhat misleading to lure an uninformed high school graduate directly into the profession of chiropractic and have him avoid the proper undergraduate training because of the "prejudice against chiropractic which exists in many colleges." Certainly the prospective student should be well-grounded and informed of all the advantages, disadvantages, and conditions under which he may conduct a chosen profession. The ability of a student to make a proper choice depends a great deal upon proper undergraduate training. It should be considered quite improper for a chiropractic college to guide a prospective student away from the fundamental education so necessary and standard in America's program of professional education.

Since chiropractic colleges have no reciprocity with other accredited colleges or organizations, a graduate of a chiropractice college who might decide to change his professional career will find himself in the category of a high school graduate when he places his application for further college training or for college-dependent employment. A graduate of any accredited college, however, may transfer his credits from one college to another for extension of his training into another field if he should so decide. This is one reason why most accredited professional practices require certain fundamental undergraduate training, and another reason why every student who wishes to be a professional man should first attend an accredited liberal arts college.

Two years of undergraduate study should not, of course, be considered too rigid a requirement for entrance into a chiropractic college (when compared with the more rigid requirements of medical schools), especially for those chiropractors who would consider themselves on a level with the medical practitioner. Yet, preprofessional training for chiropractic trainees and licensees is a subject of great controversy among chiropractic educators and leaders.
Actually, two or more years of academic college training is becoming quite a common possession; a fact that, when considered, reflects unfavorably upon the status of the struggling chiropractic colleges. If the present trend of education continues, for example, it is likely that the number of bachelor's degrees awarded annually will be more than double the current figure by the late 1960's. Projections prepared by the U. S. Office of Education in March, 1956, indicated an increase from 311,000 bachelor's degrees granted in 1956 to 437,000 in 1960; to 567,000 in 1956; and to 766,000 in 1970. In addition, there are increasing numbers of students taking graduate training for master's and doctorate degrees. The number of master's degrees is expected to rise from about 58,000 awarded in 1955 to more than 100,000 in 1965. The number of doctorate degrees awarded (8,800 in 1955) may also double in the same ten-year period. The Office of Education of the United States has suggested that by 1970 the number of master's degrees conferred may exceed 160,000 and doctorate degrees may approximate 20,000 [8].

In the health professions offering degrees (according to the U. S. Office of Education), 25,750 degrees were conferred in the year of 1957-58. The degrees were distributed, in part, as follows:

 Chiropody or Podiatry

 120

 Dentistry

 3,065

 Medicine

 6,861

 Occupational Therapy

 416

 Optometry

 337

 Osteopathy

 443

 Pharmacy

 3,963

 Physical Therapy

 473

 Veterinary Medicine

 845

The remainder of the degrees were distributed among other health professions, not including the profession of chiropractic. No mention was made of the chiropractic schools [9]. When we recall the fact that there are about 800 chiropractors graduated each year, this figure seems to compare favorably with many of the figures given above. The chiropractor, however, as a competitor of the medical physician, expresses consternation over static chiropractic figures as compared with the growing figures of medical practice. In any event, the great majority of chiropractic applicants have had no pre-college training,, and their number decreases in direct proportion to the enactment of such requirements for licensure in the various states. Since it seems likely that requirements for preprofessional training in the healing arts will soon become law in most states, many chiropractic colleges will probably have to amalgamate their classes and facilities in order to survive. The difficulty besetting chiropractic would then be found in competing with other health professions having nearly the same requirements. This might prove to be disastrous for the chiropractic profession if its practice and theories remain unapproved by the nation's health and educational institutions. The only sensible alternative would seem to lie in a specialization in cooperation with medical practice, although it would mean a reduction in the number of schools and graduates, even after chiropractic had achieved better recognition. The magnitude of the chiropractic problem will become more apparent as the reader covers the material of this book.

Medical Education

In 1948, approximately 25,000 students applied for training in medical colleges. Of these, approximately 7,000 were accepted and the other 18,000 rejected. There were 3.6 applicants for each freshman vacancy. In 1956-57, 15,918 students applied for entrance into medical schools. Of these, approximately 7,824 were selected for medical training, 83% of whom had a "B" grade average or better. Seventy-three percent had degrees. In 1957-58, 15,791 applied for training in medical colleges and 8,030 were admitted. The ratio of applicants to places in the freshman class was 1.9 to 1, as it was in the previous year [10].

Today, because of the expense of medical education and the difficulty of gaining entrance into a medical college that has limited training facilities, the applicant ratio for each vacancy in medical schools has dropped from 3.6 in 1948 to about 1.9. This means that about half of those who apply for medical training will be admitted. It might also mean that, of the 7,000 students selected today, compared with the 7,000 selected in 1948, the student quality might be slightly less since the field of selection has been cut somewhat. The year of 1948, however, was a postwar period with large numbers of veterans applying for education under the GI Bill of Rights. Requirements for admission to the medical colleges were necessarily more demanding at that time, considering the number of applicants, than they would be with a lesser number of applicants. Today, however, larger numbers of medical students have four years of premedical training, which means that those accepted are better prepared to undertake the complicated study of medical practice.

Although there has been a steady increase in the number of students enrolled in medical schools (in 1930-31 there were 21,982 medical students enrolled in 76 schools; in 1944 there were 24,666 enrolled in 77 schools; in 1960-61 there were 30,288 enrolled in 86 schools), the ratio of physicians to population has been about the same over the past 50 years or so. There is little question, however, considering the rapid rate of population growth and the present number of medical schools, that there might well be a shortage of physicians in the near future if more medical schools are not constructed. Perhaps additional medical schools, with more Federal assistance to cut the cost of medical education, would encourage a larger number of applicants for medical training and the acceptance of a greater number of students.

Primarily, it seems, any present shortage of physicians is probably due to a lack of the necessary facilities needed to train larger numbers of physicians. As we have noted elsewhere, there seems to be no question that there will be increasing numbers of students applying for medical training in the future, since enrollments in colleges around the country are increasing at a rapid rate.

In demonstrating the need and demand for medical physicians, I merely wish to expose the contrasting unpopularity of the chiropractor as a physician. In any event, the medical schools are full, and to refer to a shortage of medical doctors is not to compare the situation of the chiropractic colleges (that cannot get enough students from the high school level) with the inability of the medical schools to train an adequate number of physicians. The struggling chiropractic physician seems to be waning in popularity and numbers, in spite of the fact that there seems to be a shortage of doctors.

Today, the nation's 86 medical schools graduate more than 7,000 physicians a year, and, in order to maintain the existing physician/ population ratio, at least 12 new medical schools were being planned as of November, 1962.

All of the medical schools require at least three years of college training as an entrance requirement, and about nine schools require four years of college work. About 73% of all medical school applicants have academic degrees, however, and it is becoming increasingly difficult to get into medical school without four years of undergraduate work. In 1955-56, only 69% of the freshman classes had college degrees, but in 1956-57 approximately 73% had degrees and 77.5% had four years of college. By 1958, the percent of the entering class with four years of college had increased to 79.2. Each year, more schools enroll freshman classes of which more than 90% have degrees. In addition to a trend toward greater college preparation before entering medical school, plans are now being made to lengthen the study required for the general practice of medicine [10].

In view of the tendency of medical practice to lengthen preprofessional requirements and hospital training, preceding and following four years of medical school, it is difficult to understand how a chiropractor with only four years of training beyond high school could attempt, with any conviction, to compete with the medical physician in the treatment of disease. While the chiropractor seems to be reluctant to spend any additional time in training, the medical student, on the other hand, seems willing and even desirous of extending his education. In questionnaires received from 3,269 interns and residents, for example, all but about 105 expressed desire to seek a specialty board certification (which would entail additional study). Approximately two-thirds wanted additional training in research regardless of future specialization [10]

In 1923, only about 11% of the nation's 146,000 physicians were full-time specialists. As of May 22, 1959, about 44% of 228,295 physicians were specializing (21,877 part-time specialists and 77,655 full-time specialists) . Since many of the specialty boards are of recent origin, only about 56,910 had specialty board certifications. By June of 1962, there were more than 90,000 certified specialists in the United States . (Although there are about 32 specialties in medical practice, there are only 19 specialty boards approved by the Council of Education of the A.M.A.)

Probably a longer preparation for the study of medicine has enlarged the medical student's capacity to understand and absorb the more detailed and extensive medical sciences. In addition, years of study in the fundamental sciences and in medical practice per se no doubt provides the student with an understanding sufficient to stimulate his interest in research and new thought. It is interesting to note that, in 1912, two years after Abraham Flexner's report revealed the existence of low standards in many medical schools, Henry S. Pritchett wrote:

The medical curriculum . . . has reached the limits of its capacity: it can contain no more. . . . It is clear that educationally we have come almost to an impasse, that the load not only cannot be increased, but for the sake of good teaching it must be simplified. The medical student . . . must have a timely opportunity to ground himself in fundamental studies, and to learn how to think, how to observe, how to apply. Every pedagogical consideration, therefore, points to the conclusion that the elementary underlying sciences must be learned by the student of medicine . . . before he enrolls himself in the professional school [10]

As time passed, however, the inclusion of more basic science study in premedical training in turn permitted enlargement and lengthening of the study of the ever-expanding scope of medical practice. A student not thoroughly grounded in basic studies before embarking upon the study of medical practice could not hope to absorb or understand the medical sciences. In the chiropractic colleges, where high school graduates and those with two years of undesignated college training undertake studies to become chiropractic physicians, the student can be expected to absorb very little outside the basic sciences, since such studies are undertaken at the same time therapeutic measures are studied. A well-grounded medical student might have less difficulty in complicated medical studies than a chiropractic student would have in the basic sciences. In addition, it would seem that the wider and more specific responsibilities found in medical practice would spur the medical student into more active participation and study of the medical skills, while the chiropractor, who finds an answer to his questions and his needs in the chiropractic adjustment, might be quite content to rationalize the use of a single treatment method.

In acquiring knowledge, especially for the duties of a physician, there is a certain point below which a rational understanding is quite impossible and any further study quite inconceivable. (This may be just another way of saying that "a little of knowledge is a dangerous thing.") As the medical student, enlightened by years of fundamental study, expresses a desire to extend the course of his technical studies, the chiropractor, generally confused in his "accelerated" course to become a physician, refuses to lengthen his course of study, since the chiropractic curriculum seems to have "reached the limits of its capacity." In addition, the chiropractic theory nullifies the need for extensive studies and the use of various medical skills, and the simplicity of the chiropractic treatment makes up for any lack of understanding of the medical sciences. In the acquisition of knowledge, there is probably a certain point above which the chiropractic student would tend to abandon the spinal adjustment as a treatment for most disease.

It is significant to note that, in medicine, as in other accredited branches of the healing arts, the requirements of its schools considerably exceed those put down by the state law. The majority of the chiropractic schools, however, are still below the standards set by a considerable number of states, and the student is compelled to meet these requirements of his own choice. For example, a student who has two years of college training may attend a chiropractic college that does not have preprofessional (college) entrance requirements and still apply for licensure in a state that requires six years of training. As a general rule, chiropractic standards in a particular state seem to be maintained only at the level of the law, while the chiropractic schools might maintain standards equal to or less than those demanded by law. In most other fields of healing the situation is quite the reverse. The average medical graduate, for example, will have spent about ten years in training before he becomes a full-fledged physician, regardless of the fact that statutory law in a state in which he seeks his license might not require a period of training that long. If he studies a specialty lie will have to study an additional two to five years. It is possible to spend a total of 14 years studying for a surgical specialty. A specialty in general surgery requires four additional years of training following medical school, for example, while five years is required for a specialty in neurosurgery. Yet a state law might stipulate that a physician have only six years of education for licensure.

Medical Care and the Population

The question of whether or not there is a shortage of physicians is debatable in some circles of thought. Some contend that the better-trained physician of today can take care of a larger number of patients due to a modernization of technics, facilities, hospitals, and so forth, and that the population growth has not exceeded the capabilities of the modern physician to care for it. However, the scope and knowledge of medical science has so widely expanded in the past 50 years that some physicians have been forced to limit their practice to certain specialties in order to effectively meet their responsibilities, This, in itself, has created a need for a larger number of physicians, both specialized and general.

The population has increased tremendously in the last 50 years. In the United States alone, the birth rate and death rate are such that, if continued, the population will double its number in the next 40 years. This fast increasing count is due largely to the fact that medical science has drastically cut the death rate while, at the same time, the population has not exercised reasonable control over its birth rate in order to balance the scale. Between 1910 and 1956, for example, infant mortality decreased about 78%, while the death rate in children of preschool age dropped 92%. The mortality rate of children in other age groups decreased by 75%. In addition to the increase in population count as a result of reduction of the child death rate, there are increasingly larger numbers of adults over the age of 65. In the United States, the percentage of the population over 65 years of age is about twice that of 1900. In 1950, there were 12,269,537 persons over 65 years of age. By 1960 this number had increased to 15,708,000. In addition to creating a greater need for the medical specialty of geriatrics (study of old age and its diseases) , increased numbers of older persons will create a greater demand for general medical care. According to the National Health Education Committee, the general death rate has declined about 11.3% since 1944, due, in part, to the use of such drugs or antibiotics as penicillin, streptomycin, and so forth, in the treatment of infectious diseases. This decline in death rate represents a saving of almost two million lives. If an explosive population count should lead to a shortage of physicians, the patient load of physicians will be increased tremendously.

According to Health Statistics in the United States, July 1957 to June 1959, as compiled by the U. S. Public Health Service, the number of visits to the physician averaged five per person per year. "A physician visit was defined in the survey as a consultation with a physician, either in person or by telephone, for examination, diagnosis, treatment, or advice. . . . For the purposes of the survey 'physicians' were defined as doctors of medicine and osteopathic physicians." Thus, in spite of the increasing patient load being placed upon physicians, inferior qualifications of "chiropractic physicians" bar them from recognition.

The Cost of Chiropractic and Medical Education

The quality of chiropractic education (in the study of human disease and its treatment), as compared with medical education, is probably best reflected in the cost of education per student in each college, The cost of medical education has risen considerably over recent years, while the cost of chiropractic education has risen only slightly. In a bulletin of the Chiropractic Institute of New York, of 1953-55, for example, we note that the charges are approximately the same, in that school, as those reported by a committee from New Jersey in 1949. This was about $400 per year. During that time, the cost of medical education at the Louisiana State University of Medicine, per year, was approximately $2,500, and the cost of four years. about $10,000. In 1958, the tuition-supported Chiropractic Institute of New York charged $250 per term ($500 per year), while the cost of medical education at the Louisiana State University School of Medicine had risen to approximately $3800 per year. The actual tuition charged by state-supported medical schools, however, is only a fraction of the actual cost of the student's education, since such schools receive teaching grants and other forms of aid to balance the books. The average cost (to a university) of educating a medical student is about $12,000, yet the student's tuition for the course may average only about $2,532, Other factors involved in the education of the medical student, however, result in considerably more cost to the student over the complete course of medical education and training. It has, been estimated, for example, that medical education up to 12 years in length (including the necessary preprofessional training and internship) would cost the student or family about $15,000. The total cost of training a medical specialist is about $67,000. Without outside aid, medical education would obviously be too expensive for all but very few to undertake.

In addition to receiving teaching grants from federal and state sources, medical schools also receive much outside help from private sources in conducting education and research programs. From 1940 to 1957, the amount spent for medical research alone increased from $45 million to $330 million. About half of this went to medical schools and universities, and laboratories, while the rest went to government research organizations and industry engaged in medical research. The proportion of all medical research financed from federal sources has risen from about 10% immediately before World War II to about 50% in recent years. Of the total amount of medical research conducted in medical universities, about two-thirds was financed by the government (1957). The chiropractic colleges, on the other hand, receive no outside grants or aid and must run the schools primarily on student tuition, support from the profession, and returns from the schools' clinic activities.

The quality of chiropractic and medical education might also be revealed by comparing the tuition in each school against income per student. The Los Angeles College of Chiropractic, for example, primarily a tuition-supported school, charged $438 a year for tuition in 1957, with an income per student of only $709. Nearby public-owned UCLA Medical School, however, charged only $178 per year for tuition, with an income per student of $13,942 [11]. The tuition in privately-owned medical schools would be considerably higher, since their income per student may be less than that in public-owned schools. According to the November 17, 1962, issue of the J.A.M.A., 87 medical schools reported total expenditures of $436,053,795 in 1960-1961, an 82% increase over 1956-57.

Chiropractic Education

"The curriculum of all the approved chiropractic schools has been copied hour for hour from the American Medical Association's requirements for medical schools," observed a medical author in his study of the chiropractic profession [12]. In addition, the Director of Education of the National Chiropractic Association stated: "Nothing in these subjects should be withheld from the chiropractic student. There should be no difference in the scope of the knowledge imparted. It is only in the application of the knowledge that the education in chiropractic schools should differ from that in the schools of other healing arts."

It is difficult to understand how the chiropractic student could study the same basic sciences as the medical student and then restrict his treatment to spinal adjustment. It would seem that a chiropractor would have to ignore his studies in pathology, for example, to prescribe spinal adjustments for an organic disease, or to assume that chiropractic "science" is more correct than the present-day medical sciences. If chiropractors were technicians applying their treatment under prescription, then a lengthy education would not be necessary. As long as they are competitors of the medical physician, however, their standards of education will necessarily have to be as high as those of the physician in order to select and treat diagnosed human disease -- a difficult thing to do requiring the best of training -- regardless of the simplicity of the method of treatment.

For the most part, the chiropractic method of treatment is rather simple and uncomplicated. If nerve interference were the cause of most disease, then lengthy education would not be necessary in the field of diagnosis and treatment-at least not for those who practiced chiropractic. As we have noted, however, at least one chiropractic educator has admitted that the scope of knowledge imparted to medical and chiropractic students should be the same, although different in application. Assuming that there may be different interpretations of the same science, it would then be necessary to compare the teaching capacity of the two different schools of thought in order to determine whether one was as pedagogically qualified as the other.

An 1957 article in the New York State Journal of Medicine commented on the condition of the chiropractic schools:

A tabulation of five of the eight approved colleges shows that of a total listed faculty of 111, only three have the Ph.D. degree. Total faculty members shown for the five colleges ranged from a high of 35 to a low of nine.

The ratio of faculty to students in chiropractic colleges cannot be determined readily. However, two catalogues reviewed gave current student lists. From these it was determined that one college had a faculty of only 35 and a student list of 323. The other showed an even lower ratio; for 330 students it lists a faculty of only 20 [13].

A more recent tabulation of all eight chiropractic colleges approved by the National Chiropractic Association revealed a total faculty number of 165. About 37% of this number had academic degrees (as shown in catalogs). Seven had Ph.D. degrees, six of whom did not have the D.C. degree. The total number of faculty members in each college ranged from a low of nine to a high of 38.

According to the Haynes-Stanford study of chiropractic in California, about one-third of the school faculty members (in California chiropractic schools) indicated that they had college degrees in addition to the chiropractic degree. However, only 60% of those who claimed academic degrees were verified when the registrars of the colleges and universities named were contacted by Haynes-Stanford researchers.

Only 38% of those in teaching positions in chiropractic colleges stated that they had some college training, and "many of those with prechiropractic college training had majored in education, business, sociology, and other fields not directly related to the healing arts." [11]

One college had a faculty of 15 for 198 students, and another a faculty of 32 for 193 students (showing a decrease in faculty and student body since 1957). The Palmer School of Chiropractic, approved by the International Chiropractic Association, claimed 32 instructors for 1,000 students. Tuition in all eight of the schools approved by the National Chiropractic Association averaged about $484 a year.

As a competitor of the medical physician, it would appear that ,he chiropractor does indeed reflect his shortcomings in his roster of instruction.

Contrast, for example, the conditions found in any chiropractic school with those found in any medical school where all faculty members have M.D. or Ph.D. degrees, or both. Practically every medical student today has a bachelor's degree, a degree that seems to be quite scarce among the faculty members of most chiropractic colleges.

One should not, of course, be so naive as to assume that the high quality of medical training depended upon larger and larger numbers of instructors. Since the staffing pattern varies from medical school to medical school, there may be varying number of instructors in the best of these schools; in all of them, however, a ratio of faculty to students sufficient to teach the difficult medical sciences is maintained above a certain level. In addition, the number of full-time faculty members in a medical college is supplemented by full-time members of hospital staffs (who instruct the student in hospital and clinical procedures) .

Since chiropractic college catalogs do not usually state how many of the listed faculty members are full-time instructors, it is difficult to determine the student-teacher ratio on a full-time basis. In a study of chiropractic schools in California, however, the Haynes-Stanford report revealed that -- in the number of students for each full-time instructor -- "the osteopathic school ratio was 4.3 times lower and the medical school ratio 8.1 times lower than that of the chiropractic schools." [11]

The Western States College of Chiropractic, of Portland, Oregon, approved by the National Chiropractic Association ' is the only chiropractic college presently requiring two years of college work as an entrance requirement. Although its catalog states that "the two years of college constitutes the minimum which is required," a letter from the Registrar said that ". . . we will waive this requirement if you intend to practice Chiropractic in a state where this is not a legal requirement for licensure" (May 17, 1962). Of 22 members on its faculty, about eight had academic degrees; none had Ph.D. degrees. In 1946, the Western States College offered D.C., N.D., B.T.A., and B.T.Sc. degrees with only 13 members on its faculty (see Appendix, Degrees Issued in Chiropractic Colleges). The school includes the instruction of physiotherapy in its regular curriculum, thus teaching "mixed" chiropractic.

The Bulletin of the Los Angeles College of Chiropractic states that a candidate "should present certified transcripts of records show ing that he has completed, with a satisfactory record, two full academic years of pre-college work." [14] A letter from the Registrar (December 26, 1962), however, stated that: "All that is necessary is a high school education. We prefer that students have had college work, but it is not mandatory." The Los Angeles College rescinded its pre-college requirements in 1955. Its 1963-64 catalog listed 38 active instructors, 18 of whom had academic degrees (three of these had Ph.D. degrees, but did not have D.C. degrees). Approved by the National Chiropractic Association, the Los Angeles school teaches "mixed" chiropractic.

The Level of a Profession

Unlike the practice of medicine, prospective chiropractic students are not familiarized with the practice and the doctrine of chiropractic through regular academic channels. In addition, there are no accredited educational, medical, or public health organizations that recognize or recommend the chiropractic colleges. There is little or nothing to be found in public libraries that is favorable to the practice of chiropractic. Inquiry outside the bounds of the chiropractic profession is likely to result in a negative or unfavorable reply. The United States Commissioner of Education, for example, of the United States Department of Health, Education, & Welfare, Office of Education, does not recognize any chiropractic or naturopathic organization or association whose job it is to accredit the chiropractic and naturopathic schools. The Commissioner is required by Federal law to "publish a list of nationally recognized accrediting agencies and associations which he determines to be reliable authority as to the quality of training offered by an educational institution. . . . Inclusion on the list of a nationally recognized accrediting organization is generally accepted as the most significant available indication of institutional quality."[16]

Of the healing arts, the accrediting agencies of anesthesia, chiropody, dentistry (and dental hygiene), medicine (and medical technology), nursing (and occupational therapy), optometry, osteopathy, pharmacy, physical therapy, public health, veterinary medicine, and X-ray technology are included on the commissioner's list, but the accrediting agencies of chiropractic and naturopathic schools are not included. Recalling our discussion concerning the reluctance of chiropractic schools and organizations to adopt requirements for two years of preprofessional college training, and the fact that such requirements seem to hinder the growth of the profession where they are in effect, it seems that a difficult situation is presented insofar as approval of the chiropractic schools is concerned -- especially since approval will not be forthcoming until higher and more uniform educational standards are adopted among the chiropractic colleges.

The more intelligent chiropractors have recognized the dire needs of their profession, and, usually as individuals, recommend higher educational standards. The Director of Education of the National Chiropractic Association, for example, spoke out in 1941 for higher standards:

Parenthetically I might say that, if the statement is made anywhere that this effort to elevate educational standards has for its ulterior motive the destruction of chiropractic, that statement is false, without foundation or logic. There is not a single school in this country -- "straight" or "liberal" -- which could not adopt our standard without benefit to their particular philosophy or brand of chiropractic.

Commenting on this statement, in 1953, Dr. C.E. Boyd, author of the booklet The Cult of Chiropractic, said:

We can see that the more intelligent chiropractors, realizing the extremely low standards, have been trying to raise the standards to some extent. John J. Nugent, D.C., has even suggested that the State Boards raise their' requirements to the standard of their "approved" schools. Assuming Mr. Nugent's good faith, and also assuming that chiropractors were chosen with an intellectual level average to other professions, and assuming further that the basic sciences taught in the chiropractic schools were as good as those taught in the medical schools, assuming all of these things which are certainly not all true, the end result would still be, even according to Mr. Nugent, a man who still believed that disease of the human body could be treated by manipulation of the vertebral column, by the "chiropractic thrust." [12]

Dr. Nugent's referral to "particular philosophies or brands of chiropractic" in his plea for higher chiropractic educational standards probably demonstrates as well as anything the difficulties besetting those who take the initiative to raise the quality of practitioners who, according to the author above, "still believe that disease of the human body can be treated by manipulation of the vertebral column, by the 'chiropractic thrust.'"

Thus, a quite impossible situation comes to light, for it seems that any true betterment of chiropractic will have to come from a change in chiropractic itself. This, however, would do away with chiropractic, as many chiropractors practice it, since the profession presently maintains its independence by adherence to its original philosophy of the cause and cure of disease . . . a philosophy that is still thoroughly rejected in medical circles. Louis S. Reed, Ph.D., for example, author of The Healing Cults (1932), stated: "The chiropractic theory of disease runs counter to so many of the established facts of medical science that it is not entitled to serious consideration." Today, these sentiments are still echoed by medical authorities when chiropractic is presented as the "most important treatment for disease." As long as chiropractic schools continue to teach a single and "sovereign" method of treating human disease, they will, perhaps, never measure up to the recommendations put down by a New Jersey Legislative Committee in 1949:

The fullest possible understanding of the human body by a practitioner is an absolute requirement. This means that he must not only know ... the basic sciences, but also how to apply this knowledge in diagnosing the ills of people. A practitioner, the committee believes, ought to be acquainted with all the known means by which a bodily condition can be cured or alleviated, so that lie may use his best judgment in choosing therapy [16].

Steadily increased educational requirements would probably trend the better-educated chiropractor to a more scientific manner of thought and practice, with the recipient of such training ultimately abandoning his background of cultism. But what does this mean for chiropractic -- change or extinction? So far, any worthwhile change in chiropractic methods has come about by the simple addition of accepted medical procedures and courses in a few schools with somewhat higher educational standards. Although it seems that such changes would continue to be stimulated by standards that will inevitably be required for all practitioners who treat human disease, the efforts of many in the chiropractic profession are directed toward preventing any change in chiropractic methods and standards. The late Dr. B.J Palmer, for example, son of the founder of chiropractic and owner of the largest chiropractic school in the world, stated in his 1959 book, Shall Chiropractic Survive?:

It is MY heritage to protect, defend, and preserve my father's brilliant world-wide discovery of the ONLY principle of the cause and cure of all disease, locating THE KEY which restores health from Innate above-downward, inside-out, which fills the vacuum made by medical failures. To see the NCA drag him in the mud, washed down the sewer thru the machinations of three or four men who don't care what happens TO ChiropracTIC or ChiropracTORS, preaching, practicing, poaching on the legitimate territory of other professions. You unsuspecting ChiropracTORS should refuse to be made SLAVES with those detestable schemes [17].

Naturopathy and Chiropractic

As of 1958, only five states (Arizona, Connecticut, Oregon, Virginia, and Utah) separately classified and provided licensing provisions for naturopaths. A few states, however, did permit licensing of drugless healers following examination by a medical board. The licensed practitioner was then restricted to the practice of his designated field, whether it be chiropractic, naturopathy, or mechanotherapy. (A good number of states have repealed their laws licensing naturopaths within recent years.)

Chiropractic schools that employ the use of physiotherapy teach a course that is very similar to the practice of naturopathy. Likewise, the three or four naturopathic schools still operating today have a curriculum very similar to that of many chiropractic colleges. In fact, at least four chiropractic colleges awarded naturopathic degrees along with the chiropractic degree before they came under the jurisdiction of the National Chiropractic Association, which prohibited them from issuing naturopathic degrees. This practically amounted to a death-dealing blow to the profession of naturopathy.

The Los Angeles College of Chiropractic, before it was approved by the National Chiropractic Association, to take an example, granted naturopathic degrees up until sometime in 1948. When the school discontinued the teaching of naturopathy, no change was made in the curriculum except to discontinue approximately 240 to 400 hours of training in herbology. The graduates of the Los Angeles School, or any other chiropractic school, who wish to have a naturopathic degree, can, however, attend a graduate naturopathic school, take a course in "botanical medicine," and be awarded the N.D. degree. A naturopathic school in Los Angeles, California, for example, requires approximately 140 hours of training in addition to the training received at a chiropractic school. This school, the Sierra States University, was originally chartered to grant chiropractic, naturopathic, physical therapy, and psychology degrees. According to a California Legislative Committee, there is evidence that the school has issued at least two Ph.D. degrees; one in 1947 and one in 1954 [18].

As recently as 1950, graduates of the National Chiropractic College, a school approved by the National Chiropractic Association, were awarded the degree of "Doctor of Naturopathy" along with the title of Doctor of Chiropractic. The Western States Chiropractic College, also approved by the National Chiropractic Association, awarded naturopathic degrees until recent years. Although this school no longer offers this degree, 21 out of 33 faculty members claimed degrees in naturopathy in its 1957-59 catalog.

While the National Chiropractic Association has included the use of physical therapy and other measures in its definition of chiropractic practice, the International Chiropractic Association, in refusing to approve the use of other forms of therapy in conjunction with the chiropractic treatment, contends that the National Association, in approving such "mixed" schools as the Los Angeles College and the Western States College (in attempting to widen the scope of the chiropractor's treatment methods), has headed the chiropractic profession toward the equally "terrible" fate of osteopathy (absorption by medicine) or naturopathy (extinction). Whatever the final outcome of chiropractic might prove to be, it seems quite improbable, in any event, that the chiropractor could continue to treat human disease in competition with medical practice simply by manipulating the spinal column. While chiropractic factions continue to argue among themselves as to what is or is not chiropractic, some states have, in order to settle the question, simply passed laws limiting the chiropractor to the fundamental practice of chiropractic, making no provisions for the use of anything but the spinal adjustment. Although some chiropractors have voluntarily placed such limitations upon themselves in certain states, there are other states in which the majority of chiropractors have agreed to include a wider variety of treatment measures -- depending upon existing statutes.

Most of the chiropractic schools (those approved by the National Chiropractic Association) are restricted to the issuance of chiropractic degrees, but the naturopathic schools may award a degree in "drugless therapy" by such title as that needed for licensure in a particular state. The school in Ohio (the Central States College of Naturopathy), for example, may award a degree of Doctor of Mechanotherapy for licensure in Ohio, or the degree Doctor of Naturopathy for registration in other states. According to its catalogue:

The several practices in the field of naturopathy are known by many names, such as "movement cure," "nature cure," "osteopathy," "natural therapeutics," "mechanotherapy," "chiropractic," sanipractic," "drugless healing," and many other names. Obviously, this multiplicity of names has resulted in considerable confusion in the minds of the general public, and even more so in the minds of the several states' legislative bodies. The result is that the practice of naturopathy is styled by one or more of these names in laws regulating its practice [19].

In comparing the course of study given in the chiropractic, naturopathic, and medical schools, the impression is conveyed that all three schools teach a similar course. The quality, however, is revealed in the faculty of instruction and the facilities available for such instruction.

Although chiropractors contend that they are not practicing medicine, naturopathy, a practice that also teaches "spinal diagnosis and treatment" (most of the instructors in a naturopathic school have chiropractic degrees), claims to be "the oldest system of medical practice in existence," and that it is part of the "four great branches of the 'medical tree,' i.e. the allopathic, the homeopathic, the eclectic, and the naturopathic branches." [19] Thus, according to the naturopath, chiropractic is a practice "specializing in just one phase of naturopathy under a special name" and, as such, is the practice of medicine. We recall that the bulwark of the chiropractor's existence is based upon the contention that chiropractic is not the practice of medicine and is therefore not subject to the control of medical licensing bodies.

References

1. Ogg FA and others. Essentials of American Government. 7th Edition. New York: Appleton-Century Crofts, 1952.
2. Allen P. The Doctor's Case Against Chiropractic. Editorial, New York Herald Tribune, March 29, 1958.
3. Palmer BJ.,Shall Chiropractic Survive? 2nd Edition, Davenport, IA: Palmer School of Chiropractic, March,1959
4. Liss EG. An Open Letter to the Chiropractic Profession. National Chiropractic Association, August 5, 1959.
5. Shortage of Doctors?" U.S. News & World Report, May 9, 1958, p 66.
6. Do you really want a family doctor? Harpers, October 1960.
7. Fountain Head News. May 1, 1959, & June 15, 1959, Palmer School of Chiropractic, Davenport, Iowa.
8. Occupational Outlook Handbook. Washington, DC: U.S. Department of Labor, 1961.
9. Earned Degrees Conferred by Higher Educational Institutions. U. S. Department of Health, Education, and Welfare, Office of Education, Washington 25, D. C., May, 1959.
10. Medical Education in the United States and Canada, 1957-58. Education Number of the Journal of the American Medical Association. pp. 1459-1550, November 15, 1958.
11. Chiropractic in California. Los Angeles: Stanford Research Institute and the Haynes Foundation, 1960.
12. Boyd CE. The Cult of Chiropractic. Louisiana State Medical Society, 1953.
13. What's New in Chiropractic?" New York State Journal of Medicine. January 1, 1957.
14. Bulletin of the Los Angeles College of Chiropractic. Glendale, California, 1963-64.
15. Accredited Higher Institutions. Washington, DC: U.S. Department of Health, Education, and Welfare, Office of Education, 1956-62.
16. Doyle KC. Science vs Chiropractic. Public Affairs Pamphlet No. 191, Public Affairs Committee, New York, 1953.
17. Palmer BJ. Shall Chiropractic Survive? 1st Edition, Davenport, IA: Palmer School of Chiropractic, 1958.
18. Study of the Healing Arts. (With emphasis upon naturopathy.) A Report to the Utah Legislative Council. November, 1958.
19. Catalogue of the Central States Gollege of Physiatrics (Naturopathy). Eaton, Ohio, 1959.

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