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- To smite all humbugs, however big; to give nobler tone to science; to set an example to abstinence from petty personal controversies, and of toleration of everything but lying; to be indifferent as to whether the work is recognized as mine or not, so long as it is done.
- HUXLEY, 1856
There are some who contend that the opposition of the medical profession to chiropractic stems solely from the sensitivity of the physician's "pocketbook nerve." To assume, however, that the entire medical profession is jealous or fearful of the chiropractic profession from a competitive or financial point of view is, of course, sheer folly. It should be obvious to the most stubborn reader at this point that the basis of the disagreement between the chiropractor and the medical physician goes much deeper than the flap of a pocketbook. The chiropractic profession could hardly offer competition (in the treatment of disease) of any great degree to the medical profession today. Perhaps during the time of Sir James Paget, when bonesetters abounded and medical remedies were few, it was with some effort that the medical physician overcame the competition of the bonesetter next door. Today, however, with all that medical science has to offer, compared with the relatively unchanged methods of bonesetting in chiropractic, few physicians are concerned about the competition of the chiropractor unless it be for
the welfare of their patients. Any competition with medical science as a whole, as offered by many chiropractors today, is supported primarily by public ignorance, not by superiority of treatment methods. In every state but five (in those states where chiropractors are licensed), a person may take his infectious and contagious conditions to a chiropractor for treatment. If a father wishes to take his child to a "drugless" healer for the treatment of diphtheria, for example, he is allowed to do so by law. There are few conscientious physicians, however, who would not publicly speak out against such misdirected faith, regardless of how "professionally jealous" they might be accused of being. Aside from this, the chiropractor is actually quite insignificant as far as the continued prosperity of medical practice is concerned.
As a general rule, the average physician is so busy that there is an increasing tendency for him to neglect those with chronic conditions and those who would seek periodic check-ups for the simple maintenance of health. According to Dr. Lester Breslow, chronic disease chief of the California State Health Department, there are not nearly enough physicians in the country to give everyone a simple annual check-up. In addition, the busy physician quite often becomes too impersonal and sometimes too expensive to suit many people. In spite of the shortage of badly needed physicians, however, the chiropractors still seem to be having a difficult time acquiring patients, even though they claim to offer a comparable service in treating a wide variety of diseases. In America, where they continue to compete with general practitioners in the treatment of disease, there seems to exist little possibility that they will ever qualify, even as technicians, in the field of medical science.
While disagreement between chiropractic and medical science continues, medical practice continues to employ the use of manipulation with increasing frequency. The stigma long associated with the use of such treatment by unqualified practitioners, however, and the ignorance of many medical practitioners of its actual value, has created a rather difficult situation for those medical practitioners specializing and promoting the practice of physical medicine. In the book Physical Medicine in General Practice, for example, Dr. William Bierman, et al., expressed the situation as follows:
A large number of physicians have come to employ some of the methods of physical medicine, for instance, those utilizing heating lamps, diathermy, and ultraviolet light machines. Many seem to be unaware of other divisions of this branch of medicine both old and new, such as hydrotherapy, spa and climatotherapy, exercise, manipulation and occupational therapy. These phases of the subject offer valuable therapeutic possibilities in the treatment of many common diseases seen by the practitioner. It is unfortunate that ignorance of these possibilities on the part of members of the profession has caused many a sufferer to turn to the irregulars who have not hesitated to apply these methods even though they cannot do so with adequate appreciation of their limitations. The field included in the subject of physical medicine is enormous, covering as it does nearly all divisions of medicine. For its proper practice, a thorough knowledge of diagnosis is necessary and also an appreciation of other methods of treatment so that the practitioner may better understand when to apply physical measures and when to withhold them because some other therapy is more effective 
Other medical writers, realizing the ignorance of many medical practitioners of the use of manipulation, and the ignorance of many manipulators of medical science, recognize a difficult situation.
Philip Lewin, M.D., in his recent book, The Back and Its Disc Syndromes, stated:
Patients ask: "Doctor, how does it happen that the 'manipulation experts' are doing so well?" The answer is: "It is due to inertia of many members of the medical profession, i.e., disinterest and ignorance." There is no doubt that some "manipulators" are very skillful but everyone gets the same general type of mechanical treatment, which cannot always be correct.
In direct proportion to the improvement of regular practitioner's service, the "success" of the irregulars will be diluted .
The Handbook of Physical Medicine and Rehabilitation states:
The possibilities of manipulation in the treatment of orthopedic cases need to be brought to mind occasionally, for there is a tendency to neglect them. Fortunately the teachings of Mennell in the United States have done much to offset this tendency, as has the appearance of the fifth edition of Fisher's book on the subject .
James Mennell, M.D., in his book, The Science and Art of Joint Manipulation, stated:
One point requires emphasis, namely that the faith of those who rely on manipulative treatment as a sole remedy is unjustifiable. At its best, treatment by manipulation is only one of sixty-odd remedies-many with subdivisions-that are employed in Physical Medicine alone, while other remedies outside this field of medical science, are countless. Choice of the one remedy that will be of service is the great difficulty that besets medical practitioners, and treatment by manipulation should occupy a more prominent place in the armamentarium than it has hitherto done .
A.G. Timbrell Fisher, M.D., in introducing his book, Treatment by Manipulation, commented:
This book has been written with the object of again drawing the attention of the medical profession to the great importance and value of manipulative treatment in the treatment, in carefully selected cases, of certain sequelae of injuries and diseases particularly affecting the joints, muscles, tendons, and fasciae. The attitude of many of our profession towards this realm of surgery has perhaps, in the past, savoured a little of apathy and indifference, or even of incredulity.
Dr. Fisher goes on to point out the need for further study in the field of manipulation in order to place it in its proper department and aid in stamping out "unqualified practice." He emphasizes his point by stating:
If the osteopathic theories were harmless, the cult might be safely ignored and allowed to die a natural death, but they are in many cases extremely dangerous. Osteopaths pay little or no attention to scientific methods or diagnosis. Consequently, patients with malignant disease or other serious conditions often waste precious time and, incidentally, much money in this futile treatment, while the conditions from which they are suffering are steadily deteriorating and cancer cases may thus become inoperable. Many of us see almost daily in our practices the futility and danger of osteopathic treatment. As an example of its futility, many patients have received long courses of manipulative treatment to a normal spine, while some joint stiffened by adhesions has been completely overlooked. . . .
The danger of building up a revolutionary system of medicine upon such a slender hypothesis, unsupported by scientific evidence, is so incalculable that it is our duty as guardians of the public health to fight against this menace .
We should note that the setting for the statement above by Dr. Fisher was England, 1948. We should also remember that osteopathy has since withdrawn from the doctrine of Andrew Taylor Still and is now primarily devoted to medical practice in conjunction with manipulative procedures. Chiropractic, a younger profession still guided by theories similar to old osteopathic theories, maintains that osteopaths have simply given up their stand for "superior treatment methods" by letting their practice be absorbed by medical practice.
From the quotations given, we see that while scientific medical practice is recognizing the value of manipulation in its proper perspective, it still does not in any way place the stamp of approval upon chiropractic theories. Yet, many chiropractors quote from these books in support of their theories (which are in no way related to the use of manipulation as recommended by medical science). As Dr. Fisher pointed out in his book, the use of manipulation by a chiropractor for reasons other than those outlined in the doctrine of D.D. Palmer (treatment of disease by removing nerve interference) might even be interpreted as an encroachment upon medical methods of treatment. Since there are values in manipulation that are not readily obtainable from medical sources, however, it is easy to see why some persons prefer to depend upon osteopaths and chiropractors for such treatment. Taking all of this into consideration, one may begin to fathom the difficulties besetting practitioners of physical medicine in promoting the use of scientific manipulation while, at the same time, exercising opposition to chiropractors.
The clarion call for the very existence of chiropractic is, according to the chiropractor, not cooperation with or recognition by medical science but "public relations." The rising number of physical therapists trained in manipulative procedures, and the medical investigation of manipulative therapy, has "posed a real threat to the continued advancement, perhaps even the future existence of the chiropractic profession," warned the National News, a publication of the National Chiropractic Association . It is not a question, for chiropractic, of seeking the support of medical science, but simply a problem of maintaining the support of the lay public. It must be obvious, however, that any recognized and permanent science shall have to build its support on a foundation more substantial than the legs of ephemeral public opinion.
Occasionally a physician encounters a case of hyperacute, extremely painful back with excruciating pain radiating down one or both legs and distortion of the torso and pelvis, the patient being in such agonizing pain, and his tissues so sensitive, that a satisfactory examination cannot be made. . . . Few orthopedic conditions evidence such severe symptoms and physical signs. The lesion is usually a protruded intervertebral disc or a subluxation of an intervertebral articulation. . . . A gentle examination, manipulation and traction carried out while the patient is under the anesthetic .
It would seem that few people would have a spinal subluxation without at least being aware of the disturbance. Pressure on a nerve can, of course, occur without a vertebral subluxation, but that, too, usually causes obvious or severe symptoms. In any event, it does not seem likely that subluxation or nerve pressure occur with such frequency as to be considered a common cause of organic disease -- if a cause at all.
The definitions of subluxation given by many chiropractic authorities are often similar to those given by medical authorities. The difference in the two definitions, however, is found in the described symptoms and frequency of the disorder. The chiropractor who contends, for example, that subluxated vertebrae, capable of causing most any disease, are found in the spinal column of every individual could not use the same guide for detecting their presence that an orthopedic specialist might use. While an orthopedic specialist will be guided primarily by the existence of pain and disability, the chiropractor might simply X-ray and measure the vertebrae corresponding to diseased areas. Thus, the subluxations found by the chiropractor often do not exist at all in the medical sense. It is difficult to understand how anyone could define a subluxation as a partial displacement of a vertebra, as do orthopedic authorities, and still contend that the condition occurs, as a cause of disease, with sovereign frequency, even though there may be no obvious symptoms to indicate its presence. In any event, resort to the consideration of misplaced vertebrae as a cause of any disease should be preceded by the elimination of other known causes. Only by denying the existence of many known and proven causes of disease can a chiropractor continue to maintain that vertebrae out of their normal position cause most human disease.
The definition of subluxation given in chiropractic literature is usually much like the following:
A subluxation is simply a slight change in the relative position of a vertebra with its contiguous vertebrae. That is to say, instead of the entire surface area of a vertebra being approximated, with die-like precision and accuracy, to its fellows above and below, it is moved slightly from this position. There is not an absolute and entire separation of the articular processes of two vertebrae; on the contrary, the greater portions of their surface area still oppose each other; there simply has been a slight shifting of one vertebra upon the other .
Considering the somewhat asymmetrical development of bone structure that often occurs in the spinal column, and the presence of cartilage and periosteum, unseen by X-ray, covering the surface of all bones and joints, it seems that it would be difficult indeed to determine whether a vertebra was "slightly misplaced" unless so indicated by physical disability. On the other hand, cartilage irregularities might cause symptoms of joint disturbance or nerve pressure in areas that appear to be perfectly normal on X-ray examination.
Descriptions of spinal subluxations are more numerous in medical literature than one might suspect. Limiting our references to more recent publications (taken from the shelves of my own library), we provide a few descriptive examples:
A so-called "sprain" may well be a subluxation of an articular facet almost indistinguishable even on the most complete roentgenographic examination .
The word subluxation is to be found in many surgical textbooks, but the meaning of it is not always plain. In this condition the apposition of joint surfaces is not altogether lost, but some pathological condition maintains a fixed relationship between them which is abnormal or causes pain on movement. . . . Radiology often fails to demonstrate these minute defects, but as theoretical explanation of the symptoms coincides with clinical evidence, there can be little doubt that these lesions do exist. . . . It is not unjustifiable to presume that, if an external force has caused a binding of the joint surfaces, the correct remedy is to apply a mobilizing force to free them again .
Unilateral cervical subluxation is a partial displacement of one of the lateral articulations. Similar displacements occur in the thoracic or lumbar spine ... skillful manipulation, sometimes under anesthesia, may be required .
Subluxations of the apophyseal articulations of the lumbar spine are considered a cause of pain because of the production of tension on the capsular ligaments, encroachment of the articular facets on the lumen of the intervertebral foramens, and because of erosion and sclerosis of the apposing joint surfaces .
Manipulation, then, is designed to restore to a joint mobility that has been lost and to do so in such a manner as to inflict no unnecessary trauma on the tissues that are being subjected to forced movement 
Subluxations are of great industrial, military and civil importance. Many cases of chronic lumbago are actually residual painful backs following subluxations that were automatically replaced, leaving sore contused muscles and joint surfaces .
And so it goes, with an endless array of references in medical literature describing the spinal subluxation and its treatment. Only the most naive chiropractor could assume that the orthopedic specialist could not recognize a "subluxated vertebra" if it were really present.
It is of passing interest to note that chiropractic literature often quotes a statement favorable to chiropractic that has been erroneously attributed to Dr. James Brailsford. The statement, as it often appears in chiropractic publications:
It is quite easy to replace the vertebrae with a moderate amount of manipulation, and many patients find relief in the hands of the chiropractors.
The statement, taken from context, actually referred to the use of manipulation in forward displacement of the 5th lumbar vertebra, and was quoted by Brailsford from a 1929 British Journal of Surgery. Dr. Brailsford apparently denied the statement was his lest it appear that he recommended the chiropractic treatment. While I doubt that he would deny that manipulation is of value in the treatment of certain joint conditions, he obviously denied any intimation that he held a favorable view of chiropractic for the simple reason that he does not support the chiropractic doctrine. The fact that chiropractic literature has repeatedly quoted him in promoting the treatment of disease by spinal manipulation is evidence enough of Dr. Brailsford'g reason for denying the statement. It is this type of misrepresentation -- by chiropractors -- that has given the field of manipulative therapy a hard road to travel.
In my own critical discussion of chiropractic, many will probably be surprised to discover that manipulation actually does have a great amount of value. Others who believe excessively in the values of manipulation will probably consider my discussion very much the same as "grinding an ax." In any event, those who employ manipulation should depend more upon factual guides in applying their treatment, widening their scope as facts permit, lest poor judgment or ignorance result in much unnecessary death and misery.
More often the chiropractor does not get an opportunity to treat the true spinal subluxation, and is, for the most part, quite unaware of the condition as it is known by the orthopedic specialist. There is considerable difference between the symptoms of those patients manipulated by the chiropractor for the "removal of nerve interference," and the symptoms of an acutely locked vertebral joint. The majority of the "subluxations" commonly found by many chiropractors are likely to be painless and imaginary. In replacing these imaginary subluxations, the practitioner places his hands upon the patient's back and applies a sudden thrust, causing the bones to "come together, making a noise like the crushing of an old basket." This thrust, with "popping" of the vertebrae, has a tremendous psychological influence over the mind of the healthy patient as well as over the mind of the sick patient.
The "popping" sound associated with manipulation of the joints
(such as "cracking" the knuckles) is simply a sudden separation
of joint surfaces that are held in close contact by fluidic attraction in
a vacuum. Movement of the joints might be compared to the action of two
pieces of smooth, wet glass placed against each other; while the two pieces
of glass may be moved back and forth on each other, it is with some difficulty
that they are pulled apart While the popping itself is quite meaningless,
this influence might possibly be used to advantage in curing psychosomatic
conditions -- provided the patient is informed that the bone is "back-in-place"
and will stay there. By the same token, however, such treatment used on
the mentally unstable and nervous person can cause a great deal of harm;
that is, by perpetuating a psychosomatic condition or even creating a new
It is interesting to note that in a case of true hypochondria it is quite impossible to rid the patient of symptoms, regardless of the type of treatment used. If the patient is positively convinced that the cause of his condition has been removed, he quickly develops a new condition. Probably, one of the most effective ways of changing a hypochondriac's symptoms is to tell him that the "bone-out-of-place" (causing his condition) has been found, and then proceed to "put it back-in-place," causing an audible "pop" in the process. With the bone "back-in-place," there is no longer an excuse for the existence of those particular symptoms -- although the patient is likely to assume that any "pop" occurring in his spine, during the course of his normal activities, is signal evidence of a vertebra "popping back-out-of-place." This, obviously, is a powerful form of suggestion.
The influence of psychology over illness, while being somewhat more evident in chiropractic manipulation, can be conveyed through any form of treatment in which the patient believes, In the treatment of nervous patients, for example, doctors have long used "placebos" (colored sugar pills) as a form of suggestion. In doing SO, they simply provided the patient with a "cure" without creating an erroneous and morbid fear of the cause of disease. The chiropractor, on the other hand, by repeatedly demonstrating and treating imaginary subluxations of the vertebrae, provides the patient with an ever-present "cause" of disease and a constant fear of the position of his vertebrae. Under the typical chiropractic examination, there is no one, at any time, who will not present "one or more subluxated vertebrae" in his spine. Thus, a chiropractic patient often becomes a lifetime patient.
Needless to say, the vertebrae will continue to "pop" as long as an effort is made to do so, which, in the patient's mind, indicates that a person is never quite safe from the ravages of disease unless he continues to take regular chiropractic adjustments. For this reason, many healthy people submit excessively to spinal manipulation in order to "stay healthy."
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