Table of Contents ||| Chirobase Home Page

Bonesetting, Chiropractic, and Cultism

Chapter 5: Legal Headaches
and Legal Diversity

©1963, Samuel Homola, D.C.

In the beginning, everything was in confusion, then Mind came and reduced all to order.
                                                   ANASAGORAS

All is not well with chiropractors, even in those states where they are legally licensed. In a few states they are not allowed to call themselves "doctor." In other states the "mixers" squabble with the "straights" in an effort to change the law one way or the other. (We recall that "straight chiropractic" is performed without the use of measures other than the chiropractic adjustment, whereas "mixed chiropractic" employs the use of various physiotherapeutic methods along with the chiropractic treatment. The chiropractic adjustment -more fully explained in a later chapter-is a manipulation designed to "realign" the vertebrae.) In Washington, for example, where some "straight" chiropractors "do not attempt to diagnose," the use of a heel lift (a lift simply placed in or under the shoe) is a basis for dissension. Argued a "straight" Washington chiropractor:

The various Chiropractic laws in other states may provide for the legal use of heel lifts. I would take it for granted that any graduate of the well-known Logan School is properly trained, and qualified to use heel lifts. My point was that the Chiropractic law in the State of Washington does not include their use. It would be wrong for me to say it did! [1]

In reading over the various arguments, definitions, and limitations of opposing chiropractic factions, one is struck with the tremendously shallow and narrow basis upon which some of these doctors hinge their title.

Wisconsin passed the first basic science law in 1925. This law requires that all applicants in the healing arts take an examination in the basic sciences prior to examination by their respective professional boards. After 34 years of licensing under this law (although the practice of a chiropractic was not defined by the Wisconsin statutes), the Supreme Court of that state limited the practice of chiropractic to a "system of treating the sick through the manipulation by hand of the spinal column." No vitamins, heat, or diet. The amazing thing about this new law was that the Wisconsin Board of Chiropractic Examiners itself was in agreement with limiting the chiropractor's practice to "hands only."

Most "straight" chiropractors who attempt to limit the chiropractor's method of treatment are disciples of the Palmer School of thought and the International Chiropractic Association, while those who attempt to broaden their treatment methods are usually followers of the National Chiropractic Association (which recommends a "mixed" form of chiropractic).

Until quite recently, the laws of Wisconsin did not contain a definition of the practice of chiropractic. A check of the laws, as recorded in 1957 (May 1st) , revealed that "the protection of chiropractic, establishment of the state board of examiners, applications, examinations, issuing of licenses, etc. No definition!" [2] On October 7, 1958, a Supreme Court decision upheld a Wisconsin Circuit Court ruling that the use of the title "Dr," "Doctor," or "D.C." by the chiropractor is improper under the law, and restricted the chiropractor to the practice of "straight" chiropractic. The chiropractor was allowed to use the X-ray, instruments for detecting nerve impingement, and hot towels or heat lamps preparatory to "specific adjustment by hand, without drugs or surgery, of abnormal deviations of bony articulations." (State of Wisconsin vs. Robert Grayson, 1958.) The reference to "abnormal deviations" of bony articulations does not, of course, include dislocations. With the exception of the restriction placed upon the chiropractor's use of the title "doctor," these limitations were in accordance with the definition of chiropractic offered by Wisconsin chiropractors! Yet, Wisconsin law requires that a chiropractor have two years of preprofessional college training plus four years of chiropractic training for licensure, which is, of course, a necessary minimum requirement for those who would treat human disease. Unless one believed, however, that misaligned bones caused most human disease, the study of such, whether for three years or for six years, would hardly be attractive to the qualified individual who aspired to be a physician.

It is interesting to note that, in the case of the Wisconsin Supreme Court decision, chiropractic was defined and limited to "straight" chiropractic in spite of the fact that representatives from the National Chiropractic Association testified that the practice of chiropractic now included the use of physiotherapy and other measures, "as indicated." The rational definition of chiropractic put forth by the N.C.A. also states that the practice of chiropractic consists of the diagnosing of human ailments by the use of "all diagnostic procedures recognized by the various schools of the healing arts." Regardless, the Wisconsin decision limited the chiropractor's diagnostic measures to the use of the X-ray and other devices designed to detect "nerve impingement." Here we have an example of chiropractic being limited to chiropractic.

In Louisiana, where chiropractors are not yet licensed, chiropractors are preparing, with help from all chiropractic organizations, to take their case to a federal court in seeking a chiropractic law. In giving the chiropractors an opportunity to present their case, the court stated:

We judicially know that the healing art in general has made further enormous progress away from the ancient days when barbers did the blood letting. Can we say without hearing the evidence that chiropractic is no more entitled to recognition today than it was thirty years ago? [1]

The chiropractors, in presenting their case, must offer a demonstration that the courses of study in chiropractic are comparable in length and equal in quality to the courses taught in medical colleges.

Essentially, it seems that "straight chiropractic," in the treatment of human disease, is much the same today as it was in the bonesetting days of "Crazy Sally Mapp," and is exactly the same in today's four-year chiropractic course as it was in the early days of the Palmer School (in philosophy), regardless of the addition of other subjects to the curriculum. The "mixed" form of chiropractic, however, in adding other procedures to the practice, has withdrawn considerably from the original tenets of chiropractic. The definition and recommendations for chiropractic licensure as put forth by the National Chiropractic Association would probably more closely approach the requirements the court would ask for chiropractic recognition. According to the late B.J. Palmer, however, the National Association, in attempting to lengthen the course of education for chiropractors and add other therapeutic measures to the practice of chiropractic, has diluted the practice with unnecessary basic science and medical subjects, which is contrary to the chiropractic founded at the Palmer School. Thus, according to Palmer, real chiropractic has not changed and never will change as long as chiropractic is chiropractic.

In setting up the laws regulating the practice of chiropractic around the country, it has become a battle for supremacy between the National Association recommending "mixed" chiropractic, and the International Association representing "straight" chiropractic. As we noted elsewhere, the Supreme Court of Wisconsin, in drawing a line between what is chiropractic and what is medical (August, 1958), restricted the chiropractors to "straight chiropractic" in spite of the recommended definition of the more advanced National Association, which is more liberal in its views. (In a similar ruling in Nebraska, osteopaths were restricted to a limited system of healing after the Nebraska Supreme Court pointed out that teaching medicine and surgery in an osteopathic school still did not entitle the osteopath to apply such measures, since osteopathy is basically defined otherwise. "Since 1948 osteopaths are licensed to practice a limited system of healing only." [3]) In any event, until the evolution of chiropractic weighs favorably on an analytic scale, no form of it can justifiably compete with the practice of medicine in the treatment of disease. In the meantime, those chiropractors who do heed the recommendations of medical science shall have to bear the cross of their more chiropractically orthodox colleagues.

It would seem that restricting the practice of chiropractic to "straight chiropractic" would ultimately assure the extinction of that practice, since, due to the ever-broadening field of medical science, the chiropractic treatment for disease would become more and more obviously limited. Also, due to the progressive accumulation of medical knowledge, the courts shall have to require that all who treat human disease should equally qualify in their course of study. I doubt whether the chiropractor, treating most human disease by simply manipulating the spine, could possibly comply with these standards. In fact, it is quite inconceivable that he could survive at all. On the other hand, if the chiropractic profession continued to incorporate accepted medical procedures into its practice, and is licensed to do such, there is a possibility that it might change sufficiently to be recognized in a department of medical practice. In event chiropractic fails to become a recognized and limited specialty in physical treatment, there is a possibility that it might develop into a Class C medical practice in the treatment of disease. If such should be the case, chiropractic schools in competition with medical schools will probably always remain below the standards of medical schools in order to attract students.

Irrespective of the progress and specialization taking place in the realm of medical science, the fundamental chiropractic treatment, among chiropractors, remains universally applicable -- today as yesteryear. The "President's Page" of the April, 1959, issue of the Journal of the International Chiropractic Association, for example, commented:

I have been watching the Chiropractic parade from a point of vantage for 52 years and the present day chiropractors are no more competent in getting sick people well than were the graduates of the earlier years when Chiropractic and its superior philosophy of health were taught every hour of every school day and proved by the facts of anatomy, physiology, biology, etc., together with immediate demonstration of the merits of adjusting the subluxations of the vertebral column.

A good example of the difficulties encountered in the licensing of chiropractors is probably found in the Indiana situation. Since 1927 , the requirements for chiropractic licensure in Indiana have been that the chiropractor pass an examination by the State Board of Medical Registration. No chiropractors were licensed. Recently, with chiropractors in agreement, a new law was passed requiring that a chiropractor have two years of preprofessional college training in addition to four years of chiropractic training. The chiropractor would then submit to examination by a "mixed" board (composed of both M.D.'s and chiropractors). The definition of chiropractic for the purpose of licensing, as agreed upon by Indiana chiropractors, was that "chiropractic shall mean the separate and distinct science of locating and adjusting the articulations of the spinal column for the Purpose of treating human ailments by removal of nerve interference."

The scope of practice was defined as:

Any person who is licensed ... to practice chiropractic shall not be permitted to prescribe or administer any medicine or drug for any Purpose, to perform major or minor surgery, to practice obstetrics or any other branch of medicine or to practice osteopathy. Any licensee ... shall be permitted to employ X-ray and all necessary procedures, to arrive at a chiropractic analysis. [2]

This law was passed, I think, in 1955. I found it hard to believe that chiropractors would voluntarily limit themselves to adjustment of the spine with no provisions made for the use of any other form of therapy. I would suspect that few qualified individuals would care to study for six long years and then graduate to "adjust the spine by hand only" as a competitor of the medical physician.

Needless to say, Indiana chiropractors soon found the mixed board a little too stiff and the trouble started. Further, the medical profession prepared a physical therapy law that would prevent the use of physical therapy by any person other than one licensed to do such under the "prescription and supervision of a physician." Under the chiropractors' own definition they would not be legally entitled to employ the use of physical therapy, but would be allowed simply to "adjust the articulations of the spinal column." It followed, of course, that some chiropractors then organized to seek their own examining board.

A few states that license chiropractors do not even have a definition of the practice in their laws. In those states that do contain such definitions, the laws are about divergent as one might suspect; no, two states have exactly the same definition of chiropractic in their laws. Almost uniformly, however, it is agreed that chiropractic is not the practice of medicine. Yet, all but four states (Georgia, Alabama, Ohio, South Dakota) and the District of Columbia permit the chiropractor to care for contagious and infectious diseases [4].

In nine states, he is allowed to practice obstetrics (Alabama, Arkansas, California, Montana, New Mexico, Oklahoma, Oregon, Utah, and Wyoming) [4].

In 31 states, the District of Columbia, and Puerto Rico, chiropractors are permitted to use physiotherapy. (24-C) In checking the laws of the District of Columbia, as compiled by the American Medical Association, May 1, 1957, it was revealed that

The code does not contain any definition of chiropractic, but it mentions the licensing of it in Par. 2-120/20:140. 'Drugless method of healing' is defined in par. 2-101/20:121 as "any system of healing that does not resort to the use of drugs, medicine, or operative surgery, for the prevention, relief, or cure of any disease." [2]

In 12 states, the chiropractor is allowed to sign birth certificates, and in 33 states he is allowed to sign death certificates [4].

In Michigan, North Dakota, and South Dakota, chiropractors have been given the legal right to use tax-supported hospitals. Whether they are successful in getting permission from the hospitals or not I do not know. In Iowa, whether or not the chiropractor uses the hospitals in caring for his patients is up to the discretion of the trustees of the hospital [4].

In two states (Washington and Wisconsin), chiropractors are not allowed to use the title "doctor." In 13 other states, they may use the title "doctor" only if "D.C." or "Chiropractor" follows their name. Tennessee chiropractors use only the letters "D.C." with their name [4].

Chiropractors are not permitted to examine applicants for insurance in 17 states and the District of Columbia [4]

In a number of states, the medical examining boards are so difficult that the number of licensed chiropractors has been reduced to few or none. New Jersey, for example, passed the McClave Act in 1939 to establish uniform licenses for all persons who practice any branch of medicine. After that act was passed, no chiropractors were licensed in New Jersey.

New Jersey has probably had more ups and downs in chiropractic legislation than any other state. In 1920, a law was passed to permit chiropractors to be licensed by a Board of Chiropractic examiners. Chiropractic was defined at that time as "the name given to the study and application of a universal philosophy of biology, theology, theosophy, health, disease, death, the science of the cause of disease and the art of permitting the restoration of the triune relationships." This definition was apparently taken from the original definition of chiropractic by D.D. Palmer, whom we have quoted elsewhere. The definition obviously had little meaning. Under this law, however, 597 chiropractors were licensed in New Jersey.

In 1921, one year after the law was put into effect, the Chiropractic Board of Examiners was abolished and chiropractic was specifically defined as a system of "detecting and adjusting, by hand only, vertebral subluxations." The Board of Medical examiners was then authorized to issue limited licenses to chiropractors after successful examination of the applicants. One chiropractor was appointed to the Board of Examiners. It was specified, however, that chiropractic applicants must have a high school diploma and a degree from an approved four-year medical college. In 1923, the law was amended to permit chiropractors who graduated from chiropractic schools on or before March 31, 1921, to be examined by the Board of Medical Examiners, since those already practicing obviously could not comply with the requirements of the 1921 law. In 1925, the law was further amended to exempt World War I and Spanish American War veterans from the specific requirements of that law. In the period from 1921 to 1939, about 131 chiropractic licenses were granted in New Jersey.

In 1939, the McClave Act was passed, which abolished limited licenses and established commensurate standards for all those who would practice the art of healing. The educational requirements were raised to include two years of preprofessional training in an accredited college of arts and sciences, graduation from a school approved by the board, plus one year of internship in a hospital approved by the board.

In 1949, Governor Alfred Driscoll of New Jersey appointed a committee to study the question of chiropractic and to report its conclusions. This committee concluded that both the chiropractors and the medical profession seemed to be in agreement on the importance of adequate basic training. The question was then resolved into the issue of whether or not students enrolled in chiropractic colleges were receiving adequate training to be licensed to treat the sick. The committee gave a categorical "No" as an answer and listed three reasons:

1. No prechiropractic training on the college level is required before admission to a chiropractic school.... Their teaching of such sciences as biology and chemistry must begin on the lowest level. . . .

2. The approved chiropractic schools do not give the same quality of instruction as medical schools. . . . The quality of instruction can hardly compare with that in medical schools when men with no degrees except D.C. are teaching such fundamental subjects as organic chemistry, biochemistry and anatomy. A faculty of 26 for a student body of 276, even if a third or more are in night classes, is about one tenth the number one would find in a medical school of comparable size. . . .

3. The chiropractic student receives practically no clinical training. No chiropractic school has any kind of hospital affiliation. . . . The chiropractic student learns from lectures and books what the symptoms for a particular disease or condition or malfunctioning may be. In some instances, he may see the outcome by dissection on a cadaver, but not at the New York School. The fact remains that he does not actually see patients with such symptoms until he may be in practice [5].

In 1953, however, the law in New Jersey was again amended, and chiropractors were allowed to apply for licensure before a mixed board composed of 9 M.D.'s, one osteopath, one chiropractor, and one chiropodist. The practice of chiropractic was limited to "straight" chiropractic and defined as follows:

"A system of adjusting the articulations of the spinal column by manipulation thereof." A licensed chiropractor shall have the right in the examination of patients to use the neurocalometer, X-ray, and other necessary instruments solely for the purpose of diagnosis or analysis. No licensed chiropractor shall use endoscopic or cutting instruments, or prescribe, administer, or dispense drugs or medicines for any purpose whatsoever, or perform surgical operations excepting adjustment of the articulations of the spinal column [6].

After June 30, 1953, those who were graduated from a legally incorporated chiropractic school that required personal attendance of four years of lecture courses of nine months each (in four different calendar years) could apply for licensure by passing an examination in the following subjects: Anatomy, including neurologic and histologic anatomy; physiology; pathology; bacteriology; nonsurgical diagnosis; chemistry; hygiene; and the therapeutics of chiropractic [6].

After December 31, 1957, chiropractic applicants were required to have one year of preprofessional college training; and as of December 31, 1958, all applicants were required to have two years of preprofessional training.

If my theory is correct (that no healing art could exist in competition with medical practice by employing a limited therapy under commensurate standards), it will probably not be long before the New Jersey legislature is again besieged by chiropractors who want the laws changed to permit them to employ a wider variety of treatment methods. Six years of college as a requirement for the practice of "adjusting the articulations of the spinal column," pending examination by primarily a medical board, will probably take its toll in chiropractic licenses, for it seems that few qualified doctors would undertake such a limited treatment method (in a general practice) without the privilege of recourse to the medical armamentarium. Ultimately, such requirements for a highly restricted method of healing will, in themselves, create a scarcity of chiropractors, with their number further diminishing in direct proportion to the expansion of medical knowledge and medical science.

Within the chiropractic profession, a crisis is arising. There are some who see the dying inadequacy of the spinal adjustment as a sole treatment for disease, and who are attempting to add other therapeutic measures to the practice while there is still time. The fundamental chiropractor, on the other hand, fights to keep chiropractic as it has always been: "straight" chiropractic in competition with general medical practice. It is significant to note that nowhere among the different schools of chiropractic thought is there a tendency to specialize chiropractic in the treatment of mechanical disorders. The entire direction and efforts of chiropractic groups remain concentrated upon the treatment of disease (as "physicians") in competition with the medical physician -- whether it be with a "mixed" form of chiropractic or with "straight" chiropractic.

References

1. Palmer, BJ. Shall Chiropractic Survive? 2nd Edition, Davenport, IA: Palmer School of Chiropractic, March, 1959.
2. Scope of Chiropractic Practice in the United States. American Medical Association, Washington Office, May 1, 1957.
3. Legal Status of Osteopathy. Law Division, American Medical Association, June 1, 1959.
4. Compilation of State Laws Governing the Practice of Chiropractic. Webster City, IA: National Chiropractic Association, November 1, 1959
5. Boyd CE. The Cult of Chiropractic. Louisiana State Medical Society, 1953
6. Department of Law and Public Safety, State of New Jersey, Chapter 233, Laws of 1953 (An act concerning the practice of medicine and surgery and chiropractic).

Next Chapter ||| Table of Contents
Chirobase Home Page