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The integrity of the nervous system is a primary and indispensable requisite to normalcy. Chiropractic attempts to assure this end and is indicated in all cases. . . . The entire gamut of human disease can be embraced in this concept.
-- THE SCIENCE AND LOGIC OF CHIOPRACTIC 
Public Health Service officials know of no scientific evidence that chiropractic methods are effective in the treatment of disease.
-- UNITED STATES PUBLIC HEALTH SERVICE 
The most favorable publication of any significance in America that I have seen concerning the practice of chiropractic is a pamphlet published by the Public Affairs Institute of Washington, D. C., entitled "The Present Day Doctor of Chiropractic," by Dewey Anderson, Ph.D. The pamphlet states that:
The present-day doctor of chiropractic is equipped both by training and experience to treat successfully many of the ills besetting mankind. Primarily certain legalisms, imposed by a competitive profession, limit the practice of the best-trained chiropractors. . . .
There has been a strong and continuing attack upon the practice of chiropractic. It has been in some measure attributed to the natural antipathy of an existing profession toward a newcomer. It may be tinged with the fact that the newcomer has made such startling advances and increased his number of patients so fast as to strike a certain economic fear into the older profession of medicine .
Further supporting the capacity of the chiropractor as a "general practitioner," Dr. Anderson published these findings in a booklet entitled "Chiropractic in California -- And the Nation" after sending questionnaires to a "representative" number of chiropractors:
Diseases or conditions from which patients were suffering -- 101. These 101 specific conditions were divided into eighteen broad groups as follows:
Neuro-muscular Injuries Arthritis Kidney diseases Circulatory Skin Respiratory Ulcers Digestive Hernias Throat Children's diseases Hypertension Glandular disorders Women's diseases Mental conditions Pregnancies Cancer (referred)
Manifestly, the practice confronting today's doctor of chiropractic is about as varied as that found in the work done by any general practitioner, whether he be an M.D., D.O., or D.C. People have come to regard the chiropractor as a practitioner capable of helping them when they are ill. As they become attached to a particular chiropractor, and have confidence in him, they consider him their "doctor," and when anything is wrong with them, he is the first person to whom they go. . . . It should be apparent that the practice of chiropractic is as broad as the nervous system, which controls and regulates all organs, glands, and tissues of the body. Therefore, chiropractic care is applicable to a wide variety of dysfunctions, and diseases which afflict the human body and mind .
Published and distributed by the National Chiropractic Association, Dr. Anderson's booklet "Chiropractic in California -- and the Nation" is designed to combat the unfavorable conclusions of the Haynes-Stanford Report (Chiropractic in California) regarding the practice and the future of the chiropractic profession. (I discuss this report in Chapter 15.) Dr. Anderson is presently executive director of the Public Affairs Institute of Washington, D.C.
When one considers the intimation, by those who represent chiropractic, that chiropractic is in competition with medical practice, and further considers the background, scope, training, and nature of the practice of the chiropractor, it is easy to understand why the "older profession of medicine" opposes the practice of chiropractic. Nothing is more ridiculous, however, than to assume that chiropractors are "running the medical men out of business." I have already demonstrated the fallacy of this contention in another chapter. I have also already made a comparative study of chiropractic and medical education, which, as I can see, totaled up to relative inadequacy on the side of the chiropractic physician. In any event, regardless of quality of education, no concession can be made that chiropractic manipulation in the treatment of disease is comparable in value to medical practice, although I have conceded that there is considerable value to be found in discriminate use of spinal manipulation. If the chiropractor's treatment were limited to this value, then his education -- being obviously inferior to medical education -- might be considered adequate. Like the old practice of osteopathy, however, any withdrawal from the fundamental teaching that misaligned vertebrae are the cause of most disease is a withdrawal from chiropractic and the teachings of its founder.
When one weighs the overall good and bad in the present-day status of chiropractic, a more accurate description of the practice might possibly be found in the Public Affairs Pamphlet, "Science vs Chiropractic," by Kathleen Cassidy Doyle, of the Public Affairs Committee of New York. Contrary to the previously mentioned publication, this pamphlet states, in part, that:
A chiropractor is a cultist -- in the medical sense, a person who assumes all disease stems from one cause or can be cured by a single method. According to the chiropractor, there is one common denominator in all disease-nerve interference; and one panacea for every ailment -- the spinal "adjustment" that removes such interference. . . . The largest and most widely patronized cult in the United States today is chiropractic -- that "splinter fragment of the healing art" based on the unproved assumption that "pinched" nerves are at the root of all disease. It uses no drugs, medicine, or surgery .
In comparing the two pamphlets, "The Present Day Doctor of Chiropractic," and "Science vs Chiropractic," it is interesting to note that the United States Public Health Service recognizes the latter which describes chiropractic as pure cultism, in spite of the fact that the other publication originated in Washington, D. C. The Public Affairs Committee of New York seems to be a more recognized publisher of public affairs material. "The similarity of the name, 'Public Affairs Institute,' to that of the well-established Public Affairs Committee, Inc. of New York," commented one medical observer, "may have some effect on the value of his [Anderson's] propaganda for the chiropractors."  In personal correspondence with the Public Affairs Committee of New York, inquiring as to the difference in opinion found in the two publications, a representative for the organization replied:
The Public Affairs Committee is a nonprofit, tax-exempt educational organization which has been engaged in publishing popular summaries of research findings for some twenty-three years and has earned, I believe, the highest respect for accuracy and reliability. All of our manuscripts go through a complicated process of checking by numerous authorities, and their accuracy has never really been challenged by anyone .
The other pamphlet (The Present Day Doctor of Chiropractic), published by the Public Affairs Institute of Washington, D. C., contending that the chiropractor is equally qualified to compete with the physician, does indeed appear to be the opinion of the author alone. Notwithstanding, thousands of copies of the pamphlet have been purchased and distributed by support-starved chiropractors all over the world (25¢ a single copy). The pamphlets are also included in literature sent to prospective chiropractic students. The author is a frequent guest speaker at chiropractic conventions and gatherings.
Another pamphlet, published by the Public Affairs Committee of New York (1959), entitled What's in your future-A Career in Health?, distributed by the United States Public Health Service, does not even mention chiropractic as a prospective health career. Seventy-six fields of health work were listed for consideration. "Out of every 100 people in the health field," the pamphlet states, "89 are not physicians. All 100, though, are members of the same team." 
As chiropractic stands today, there is not one recognized American medical authority who will approve of it as a primary treatment for disease. Yet, many chiropractic "physicians" continue to administer to the broad scope of disease with widely divergent and seemingly capricious claims that are, at best, almost entirely theoretical. As we brought out earlier, there is a tendency for chiropractors to claim a cure for conditions they have never actually had an opportunity to observe or handle. They simply make such claims on the authority of other chiropractic writings, even though such writings can show little evidence of their validity. It seems that the explanation of "nerve interference" as the cause of disease applies as well to one disease as to another, which, for many chiropractors, is sufficient and convenient explanation.
The drawing shown here is a popular illustration used by many chiropractors to demonstrate how a subluxated vertebra "pinches a nerve." While the caption under the original drawing stated that the example was exaggerated, it would very likely take such a severe displacement to bring about bony pressure upon the nerve trunk, since, with few exceptions, the spinal nerve occupies only one-half to one-third of the intervertebral foramen which is padded with fat, blood vessels and other tissue. The drawing, however, shows the spinal nerve filling the entire diameter of the intervertebral foramen. Enough displacement of a normal vertebra to press directly upon the spinal nerve, thus "pinching" the nerve between two vertebrae, would be incapacitating in itself. Degeneration of an entire intervertebral disc does not often bring two healthy vertebrae close enough together to pinch a spinal nerve, although an osteo-arthritic spur, a herniated disc, and other abnormal conditions that encroach upon the intervertebral foramina can press upon or irritate a nerve trunk quite easily.
Only in special cases are spinal nerves actually compressed in the bony channels between the vertebrae; more often they are irritated. An exceptional and very common example of a "pinched" nerve is found in the condition commonly called sciatica (a severe nerve pain radiating down the leg). The 5th lumbar nerve, contributing to the large sciatic nerve (which is a combination of several lumbar and sacral nerves), is the largest of the spinal nerves, yet it passes through the smallest of the intervertebral foramina. This means that this very important nerve fits so snugly in the canal between the 5th lumbar vertebra and the sacrum that "it would be compressed, with sciatic pain the result, by even the slightest amount of edema or exudate; and this, a minor trauma, as a strain or contusion, or a mild grade of arthritis of the lower lumbar spine might easily cause."  Needless to say, while nerve pressure of this type is an extremely painful condition, it is not a cause of organic disease.
According to recent orthopedic text books, there is another type of nerve irritation that occurs in the spine, and that is irritation of spinal nerves by rib heads that have been twisted or distorted by faulty body mechanics. "Also, since there is a sympathetic ganglion connected with the nerve adjacent to the head of the rib, some circulatory disturbances find their explanation in irritation of this ganglion. . . . A great many obscure thoracic and abdominal symptoms can be explained on the basis of pressure on the nerve roots." 
Many chiropractors who fail to draw a line between what can or cannot be handled chiropractically often use such material as that we have quoted from as proof of the validity of the chiropractic doctrine. We must note, however, that such "proof" is usually already accepted in scientific medical practice and has little or nothing to do with the theory that most disease is caused by displaced vertebrae. In any event, there is a great deal of difference between an "obscure thoracic or abdominal symptom," the referred pain of a compressed or irritated nerve trunk, and actual organic pathology.
Although many chiropractors continue to maintain that all disease is caused by "nerve interference," there are others who limit themselves to say that "most disease" is caused by such interference. I could not agree, however, that "most" is any more correct than "all" if the two words are simply exchanged in the chiropractic vernacular. Actually, it seems, if a line were drawn between those conditions caused by "nerve interference" as opposed to those that were not, it would be quite difficult to apply the theory to specific cases without the whole gamut of medical diagnostic procedures for selecting such a case, as well as convenient recourse to other treatment methods. As we shall see, the very nature of the chiropractic theory seems to defy various selective and diagnostic procedures -- a fact that has made progress in the chiropractic profession a highly painful and controversial course.
In the late 1950s -- a period during which the American Osteopathic Association distanced itself from Andrew Still's original concepts -- the National Chiropractic Association modified its rhetoric and embraced additional treatment methods. N.C.A.'s rational definition" of chiropractic stated that "Chiropractic is a science of healing based on the premise that disease is often caused by the abnormal functioning of the human nervous system." Its most recent definition, however, adopted by its House of Delegates in June 1961, makes no mention of vertebral misalignment:
Definition: Chiropractic is a branch of the healing arts devoted to the promotion of the public health and welfare.
Scope: Chiropractic is a science and art of healing which emphasizes the relationship between structure and function in the human body, particularly the musculoskeletal and nerve systems in the restoration and maintenance of health. Its practice includes the use of all recognized diagnostic methods. Its therapy is concerned with manipulative procedures, and the use of the beneficial qualities of natural phenomena, such as heat, light, air, water, and rehabilitation procedures, as indicated. Doctors of chiropractic place great reliance on the inherent recuperative powers of the human body and their practice is conducted with due regard to environmental, nutritional and psychological factors, as well as hygiene, sanitation, first aid, and related procedures.
The International Chiropractic Association, on the other hand, in contending that it will "no longer tolerate those persons hiding behind the D.C. degree in order that they may practice their own special brand of medicine, physiotherapy or quackery," defines chiropractic contrarily. The Representatives Assembly of the I.C.A., for example, during its August, 1962, assembly, adopted the resolution that:
Intra-professional efforts adhere to the premise and only the premise that chiropractic philosophy, science and art deals with the adjustment by hand of the spine and pelvis for the purpose of correcting vertebral subluxations and that the force released into the body by the adjustment is utilized by innate intelligence to effect restoration and maintenance of health within the body's recuperative powers. Chiropractic is not physiotherapy, medicine, vitamin therapy or other adjunctive procedures. This statement is not to be construed to eliminate analytical procedures commonly employed by doctors of chiropractic to locate vertebral subluxations .
Those who stick to "straight chiropractic" treatment methods and offer spinal manipulation as a superior treatment for all or most disease processes are not, as a rule, "bothered" with the difficulties of precision diagnosis and complicated "medical" treatment methods.
"Why should one limit himself to the use of these complicated conservative methods (medical), when we have such a simple method in hand to reduce subluxations (chiropractic), which will result in subduing the disease process in the quickest way?" Strangely enough, this statement was made by a German medical physician in a recent publication entitled Fundamentals of Chiropractic From the Standpoint of A Medical Doctor. His advice is remarkably similar to that given by a medical physician in 1915 in a publication entitled Chiropractic .
Any alteration of the chiropractic theory, however, must be accompanied by an encroachment upon the realm of medical care. In contrast to many chiropractors' narrow though confident attitudes, the qualified physician is not likely to be too positive in the treatment of conditions about which little is known-if his mind is to remain open for the discovery and development of better treatment methods. "To be able to diagnose what a person has from the history and the symptoms he presents requires the highest skill and the longest training of any of the professions," advised a medical journal. "Even so, and with the help of all the accessory sciences and arts he can utilize, the physician is not always right, nor, in all probability, can he ever be."
In the early years, when public patronization of chiropractors began to necessitate their licensure, legislators found that the very definition of chiropractic permitted its practitioners to embrace the entire scope of human disease with a single treatment method. Unable to alter the fundamental and popular concept of the chiropractic theory, some states passed basic science laws requiring all practitioners (who applied for a license to practice the healing art) to pass an examination in the basic sciences prior to examination by their respective professional boards. Legislators and medical authorities felt that such requirements would surely put an end to chiropractic in those states adopting these laws. B.J. Palmer, the leader in chiropractic at that time, felt that the basic science law spelled the end of chiropractic. "Chiropractic is doomed," he warned his colleagues in 1928. "You have drifted so far from the basic principles of chiropractic that you have lost your identity and brought the basic science bills on our heads. . . . You cannot defeat the ends of science. The basic science bills are the buckshot we deserve for trespassing. When chiropractors preach and practice and try to become physicians, then it is justifiable for the medical men to educate the chiropractors."  Although Palmer proved to be wrong in his prediction, the basic science examination proved to be a real deterrent to chiropractic licensure. On the other hand, however, it also proved to be a constructive filter in weeding out the more incompetent practitioner -- much to the satisfaction of the more ethical and progressive chiropractor.
While the quantity of chiropractors was reduced considerably by the basic science examinations, the quality, of necessity, was somewhat improved. Thus, the examinations actually proved to be an aid -- by forcing an elevation of professional standards. About half the states now have requirements for basic science examination. Connecticut and Wisconsin, in 1925, were the first states to put such laws into effect. Between 1927 and 1950, about 1,984 chiropractors took the examinations (in all states where they were being given) and only 33 percent managed to pass. During that same period, 37,447 students and graduates of medical schools also took the examinations, and of this number 86 percent passed successfully. Although a certain number of chiropractors are able to pass the basic science examinations in most states where they are given, there are a few states in which they pass with great difficulty, if at all. In Tennessee, for example, not one chiropractor has passed the examination during the 10 years it has been used. According to Public Affairs Pamphlet No. 191 (1953):
Basic science laws have not raised chiropractic education to an acceptable level. Even today standards do not measure up to the requirements considered essential for those who would treat the sick. After fifty years chiropractic is still a short cut for the would-be professional man who has the ambition but neither the time, the money, nor the ability to become a qualified doctor. 
Obviously, basic science laws do not make a doctor. Compared with the standards of medicine, the basic science law was not too stiff a requirement for many prospective chiropractors who wanted to become "physicians" in the shortest possible time. Rather, some chiropractors simply concentrated most of their time and effort in the study of the basic sciences -- sacrificing valuable time that should have been spent in the study of the healing sciences. But why not? Adjustment of the spine, in a general practice, was a relatively easy, simple, and uncomplicated procedure, without responsibility, when compared with the practice of medicine. If you didn't know what to do in a difficult case, you just adjusted the spine, as was done in every other case. Nothing to worry about. No court would convict you since you were practicing as you were taught to do in school, and as you were licensed to do by the state. In most cases you didn't diagnose, you "analyzed." And people still called you "doctor." No wonder the number of chiropractors increased, especially if the chiropractor was well-received by enough patients to make a decent living.
In addition, the theory of chiropractic, though simple, was so all-inclusive as to provide a lucrative field in which to work. For the thousands of conditions that medical science had admittedly not yet found a cause or cure, "chiropractic had the answer." Further, the chiropractic theory was so "logical" that both chiropractor and patient alike could easily believe it. For the opportunist, it was the ideal theory and method for evading legal responsibility in the exploitation of the sick. For the more informed and conscientious student, chiropractic was simply an opportunity to prescribe and administer physical treatment for what value it had, with a wide-open gate for leaders in the development of a new profession. In those early years, however, the panacea of chiropractic, not being the practice of medicine, found excuse in the simplicity of chiropractic for maintaining short-term schools. During the period of the "eighteen-month chiropractor" (from 1895 to 1950), large numbers of chiropractors were graduated from short-term schools -- especially the Palmer School (up until 1950). The Palmer School claims to have "graduated over half the chiropractors in the field today." 
The figures above on boils, bronchitis, and dysentery were taken from chiropractic literature being sold and distributed to the chiropractic profession by a private concern. The figures were supposedly obtained from a tabulation of 93,039 cases of various types of disease handled by 412 chiropractors. While diphtheria and other "contagious fevers" were not mentioned in the survey figures, due to "restrictive laws in a number of states," such conditions are, however, discussed in other sources of chiropractic information. Questioning the ability and the right of the chiropractor to treat such conditions, an article in the June, 1946, issue of Reader's Digest, condensed from Hygeia (now Today's Health) , entitled "Can Chiropractic Cure?," by Albert Q. Maisel, stated in part:
There are nearly 30,000 chiropractors in the United States today -- men who treat all sorts of serious ills on the theory that the seat of all our trouble lies in the spine. If you suffer from boils or bronchitis, from dysentery or diphtheria, you can find a chiropractor willing to "cure " you by pressing your backbone and thus "adjusting" an alleged "subluxation" of some vertebra .
In a subsequent article in Reader's Digest, Dr. C.W. Weiant, chiropractor and Ph.D. of the Chiropractic Institute of New York, presented a reply to Mr. Maisel's article. The reply, entitled "Chiropractic Presents Its Case," stated, in part:
By manipulating or adjusting the bony structure, particularly the spinal column, the chiropractor seeks to remove the factors that interfere with the normal flow of nerve impulses. Nature does the rest. But remember that chiropractic says that this is the most important, not the only, factor in the cause of disease.
The chiropractor, meanwhile, is quite willing to let his own patient the former patients of medical doctors -- provide the answer to the imposing question, "Can Chiropractic Cure?" 
Such argument, of course, proves nothing, but seems, in essence, to be a repetition of what chiropractors have been accused of all along. Regardless of what might be said about chiropractic education, one could not agree with the popular idea that the chiropractor is qualified to treat the entire scope of human disease, or even "most" disease, unless he simply agreed with the chiropractor that vertebral alignment is the "most important cause of disease." Although there is no evidence to indicate that this might be true, the chiropractor, believing spinal manipulation to be the most important treatment for disease, usually considers his training and his method to be quite adequate. With this impression, he has little use for many medical procedures that are considered by most medical authorities to be basic necessities. We have already discussed the chiropractor's opinion of vaccination, drug therapy, and the medical treatment of infectious disease in our review of a pamphlet entitled "The Chiropractor Looks at Infection," co-authored by the same chiropractic authority who wrote the aforementioned article, "Chiropractic Presents Its Case." To reiterate an opinion of this authority: "Beyond the scope of personal hygiene and chiropractic, there is no prophylaxis worthy of the name, except that furnished by the sanitary engineer. Medicine has nothing to offer that can withstand careful scrutiny."
In a more spirited reply to the critical article, "Can Chiropractic Cure?," Dr. H. L. Trubenbach, then Director of Chiropractic at the Chiropractic Institute of New York, wrote in "An Open Letter to Mr. Albert Q. Maisel":
Sure we reject the use of serums, sulpha drugs and penicillin. The osteopath would, too, if he dared. We of the chiropractic profession treat human ailments by another method-with, incidentally, a definite set of principles from which we can build a definite hypothesis upon which to work, a basic thing that medical doctors have never had, and of which they are highly envious-a method not at all consonant with the use and action of such things. We like to deal with methods that, if they fail in their purpose, at least do not leave a trail of misery and death behind them. Always remember, Albert, that the vaccines, serums, sulphas and potions did not work out; that is why chiropractic came into existence, and why it grew to the place it was expedient for someone to hire you to try to eliminate it. . . .
On the whole, my bellicose critic, it is eloquently obvious that you have failed to make out your case, and it seems to me that your conscience should be good and sore. The "effective psychiatric service" you admit for chiropractic makes it seem rather singular that thousands of babies, who would be scarcely old enough to accept suggestion of a psychotherapeutic nature, should have been treated by chiropractic, a fact that your investigation surely revealed, and which you seem to have carefully forgotten. And if you think that mere suggestion can cure pneumonia, Bright's disease, scarlet fever, and the like, which are types of diseases in which chiropractic is supreme among the therapeutic methods, you must still believe that story about the stork bringing babies .
This reply, being quite obviously off the deep end, would probably be considered, by medical men, as being quite typical of the chiropractor's attitude. Although it did not appear in a national magazine such as Reader's Digest, it did appear in the Journal of the National Chiropractic Association, and copies of the reply are still to be found in the offices of many present-day chiropractors.
Every healing cult has a basic principle upon which it can construct a "definite hypothesis" of the cause and cure of most disease. One wonders, however, where the author above got his information that vaccines and serums "did not work out." He mentions that "whatever is scientific in chiropractic today" owes its origin to Dr. Willard Carver, one of the original founders of chiropractic, who "developed that original principle into the beautifully clear set of tenets which is the foundation of whatever is scientific in chiropractic today." In his book, Chiropractic Analysis, Carver stated that: "The therapeutic theory of germs as a causation of disease is about fifty-five years old. ... There is nothing in the whole experience of the human race to sustain it." Drs. Weiant and Verner, in a recent edition of the pamphlet The Chiropractor Looks at Infection, echo the sentiments of Carver with the statement that: "In no case is the dogma of Pasteur (that body plus germ equals disease) tenable." 
It is interesting to note that Dr. H. L. Trubenbach was Director of Chiropractic at the Chiropractic Institute of New York -- when he wrote his "Open Letter" -- at the same time that Dr. C.W. Weiant, author of the article "Chiropractic Presents Its Case," was dean of that school. If Dr. Trubenbach's revealing description of chiropractic is another way of saying that "interference with the normal flow of nerve impulses is the most important factor in disease," then there seems to be more beneath the surface than meets the eye. Doctors who treat babies stricken with pneumonia, scarlet fever, and Bright's disease by manipulating their spines shall probably always have to appeal to a credulous portion of the American public for support and licensure, since they obviously will not get it from accredited authorities who work in the realm of medical science.
Many of the chiropractors' contentions -- or arguments -- seem to be based upon old and new arguments and theories of qualified medical men who work in the field of microbiology. Regardless of the final outcome of the "germ theory" of disease, there seems to be little doubt that little or nothing can be said for spinal manipulation in the treatment of such conditions as "pneumonia, Bright's disease, scarlet fever, and the like." Although occasional chiropractors and journalists refer to the "new chiropractor" who no longer denounces the germ theory (which calls for the use of artificial immunization, antibiotics, and drugs, in addition to measures of personal hygiene and sanitation), perusal of chiropractic literature and first-hand observation of the practice of a recent graduate does not seem to bear out the alleged modernization of chiropractic theories and methods. While it is true that considerable change has taken place in the chiropractic approach (in the use of certain medical instruments, in the chiropractic curriculum, and in methods of public relations), these changes still lag far enough behind the progress of medical science to permit the illusion in chiropractic circles that misplaced vertebrae are the cause of most disease.
This illustration is an old but still commonly used piece of promotional literature used by those chiropractors who continue to maintain that most disease is caused by vertebral misalignment:
of all the Diseases
Although medical authorities are continually searching for better ways of controlling or removing the cause of disease, no credence is placed in the chiropractors' theory that misplaced vertebrae are responsible for the susceptibility of individuals to certain disease. Yet, many chiropractors quote, from context, the opinions of medical authorities in such a manner as to lend their support to the most obvious falsehood. Until such time a way is found to permit man and microbes to live in complete and harmonious ecological equilibrium (if this is possible), the methods presently used by medical science will continue to be both useful and necessary. In large cities like New York City, or Chicago, where thousands of people live in daily close contact, breathe the same air, eat in large restaurants, and where transportation or communication is such that ,an individual can cover miles in minutes, or reach another state or continent in hours, laxity of any one of the measures daily used in the prevention and control of disease could be disastrous. Poor sanitation, for example, would permit the spread of disease for which medical science has no cure or method of prevention. On the other hand, good sanitation without the use of immunizing procedures would also permit the spread of certain incurable diseases (such as smallpox), even in the cleanest surroundings. Without the use of specific antibiotics and antimicrobial drugs, contagious diseases might flare up in hospitals, or in schools, following the occurrence of a single case of infection; routine delivery of a child would then once again be accompanied with threats of infection and death.
Obviously, all of the methods presently used in the prevention of disease play important roles. Although many mysteries surround the resistance of some individuals to certain diseases, there is little doubt that subluxations of spinal vertebrae have nothing to do with the occurrence and spread of epidemic-type disease. The very fact that sanitation has been so effective in controlling the spread of disease, and the fact that those artificially immunized can go into areas where sanitation is poor and disease prevalent without contracting these diseases, is considerable proof of the theory that germs can be a primary cause of disease. The thought of conceding to the proposal of some chiropractors that "medicine has nothing to offer," and submitting the health problems of a city like New York to spinal manipulators, makes my blood run cold. Although most chiropractors are aware that such proposals in chiropractic literature go no further than printer's ink, it is a terrible doctrine that should not be repeated before suggestible persons. The more progressive chiropractor, lest he should inadvertently promote such a doctrine in referring to real values found in spinal manipulation, should make a careful and positive delineation of what is implied in his contentions for the sake of those who have entrusted their health to him.
The chiropractic profession has achieved a certain amount of recognition that is remarkable under the circumstances.
The Official Directory of Insurance Companies of America, compiled by the National Chiropractic Association, 1958, provides a directory of insurance companies that "have granted the chiropractic profession recognition of one type or another." The directory listed a total of 515 insurance companies, 49 of which were designated as Class "A-1,- or "insurance companies which grant full recognition to chiropractic by specifically stating in their policies that policy holders may have necessary chiropractic treatment on the same basis as medical treatment."
422 were classified as Class A, or "companies which approve chiropractic services for their policyholders or insureds and pay legitimate chiropractic claims but do not so indicate in all of their policies."
44 of the listed insurance companies were classified as Class B, or companies which pay some claims submitted by licensed chiropractors, but do reject claims which are considered to be justified by chiropractors submitting them."
There are about 1800 insuring organizations in America (which includes 839 insurance companies) offering health insurance against the hospital, surgical, and medical expenses resulting from illness or injury. Many of the larger insuring organizations-such as Blue Cross-Blue Shield-do not cover the services of the chiropractor. With the major part of health insurance provided by group plans (as at places of employment), which are comprised primarily of Blue Cross-Blue Shield plans and other medical society-approved plans, the overall effect, so far, has been the relative exclusion of chiropractic services from health insurance. In 1961, for example, about half of more than 136 million Americans who had health insurance (about 75% of the civilian population) were covered by medical society-approved plans.
According to the Group Health Federation of America (343 South Dearborn Street, Chicago 4, Illinois), "No group prepayment plan affiliated with Group Health Association of America [consumer sponsored -- of which there are about 70 -- includes chiropractic care among its services." Although it was stated that: "Group Health in St. Paul, Minnesota may pay cash indemnities for this type of care, but they do not actually provide such care in their own health center."
Typical of consumer-sponsored medical group practice is the Health Insurance Plan of Greater New York. In 1958, almost 500,000 members were receiving full medical-care benefits from more than 1,000 physicians practicing in 32 medical groups. Paying an annual premium for medical care, the insured also purchases Blue Cross insurance to cover the cost of hospital care.
As group health services, national health insurance plans, and other forms of "socialized" medical care become more popular as a result of greater demand for such coverage, the situation of the chiropractor will indeed become more precarious. Legislation has already been passed to provide Government-supported medical care for the indigent portion of more than 15 million people 65 years of age and over. More than 2 million Federal employees, with 2-1/2 million dependents, were covered by health insurance that is partially government paid when the Federal Employees Health Benefits Act became effective in July of 1960. Seven of the plans (out of 39) under this Act (covering postal employees in some areas) included the services of chiropractic.
If health insurance programs covering such large numbers of people do not include the services of chiropractic as a whole, the chiropractor may soon find himself hard-pressed to find patients who will pay for his services out of their own pockets. Although a good number of insurance companies have included coverage of chiropractic care primarily because of its value as a method of treating certain physical disorders, the chiropractic profession as a whole continues to push its efforts to achieve recognition as physicians in the treatment of disease. As long as chiropractic is in direct competition with medical practice, however, both the lower standards and the method of chiropractic will prove to be major deterrents in the full insurance recognition of chiropractic.\
Ironically enough, most chiropractors feel that it would be professional suicide to specialize and limit their practice to the treatment of "back conditions." Yet, it is well known that back trouble is one of man's most common complaints. In 1959, for example, according to a 1960 edition of Health, Education, and Welfare Trends, "orthopedic back impairment" was third on a list of selected chronic conditions causing the greatest activity limitation: "The chronic conditions most often reported by the National Health Survey as causes of activity limitation last year  were heart disease, arthritis and rheumatism, orthopedic back impairments, hypertension (without heart involvement), mental and nervous disorders, and impairment of vision." 
Thus, as chiropractors attempt to establish themselves as "general practitioners" in competition with the medical physician, trained physiatrists and physical therapists devote more and more of their time to the care of back conditions as outlined in increasingly larger numbers of orthopedic textbooks dealing with such conditions.
Workmen's compensation laws in most states provide for payment to any "recognized" or licensed practitioner -- who is selected by the employer or the insurance carrier -- for service rendered in cases the particular practitioner is qualified to handle (twenty states Permit the worker to select the doctor). In the State of Florida, for example, the Chairman of the Florida Industrial Commission stated in January of 1957 that "The Medical and Surgical Fee Schedule makes no distinction between M.D.'s, osteopaths, chiropractors, naturopaths, Christian Science practitioners or other 'recognized practitioners.'" Although chiropractors, naturopaths, and Christian Science practitioners are licensed to treat disease, most injuries sustained "on the job" are of the type requiring physical treatment. However, no positive limitations could be placed upon the scope of any of these practices. Thus, control (with limitations) of practitioners in the various healing arts is the responsibility of the individual state. At the present time, it is apparent that state licensure and "recognition" of practitioners who treat disease does not necessarily substantiate the scientific validity of the services offered by such practitioners.
Chiropractic is included in Social Security plans to aid indigent persons over 65 years of age in meeting medical bills. The most recent and significant recognition extended to the chiropractic profession was found in the Social Security Amendments of 1960. Signed into law on September 13, 1960, the bill is designed to provide Federal-State assistance to persons over 65 years of age who are not able to meet the cost of personal medical care (to "provide grants for medical care for aged individuals of low income"). Amended in the Senate to include chiropractic care, the bill was hailed by chiropractors as being "the first major piece of federal legislation in which chiropractic is included."
"The Federal law specifies," advised the Social Security Administration in a personal communication to me in 1960, that medical care for the aged include, "in addition to medical care, 'any other remedial service recognized under State law.' The report on the bill by the Senate Committee of finance specifies that this may include services provided by optometrists, osteopaths and chiropractors as well as services provided by Christian Science practitioners. However, they are included only if the State elects to put them in the items of care to be provided and they are recognized under State law."
The Federal Employees Health Benefits Act of 1959, covering postal employees, approves several health insurance plans that include chiropractic care. There are seven plans offered under this program which cover chiropractic services. Although Federal postal employees were given a choice of plans, only about 10% selected plans that included chiropractic. Of the remaining 90%, a large number selected the medically-sponsored Blue Cross-Blue Shield plans.
"The Commission's regulations do not bar payment to any class of practitioner of the healing arts," said the U.S. Civil Service Commission in letter to me in September 1960,, "and a carrier choosing to do so may recognize any practitioner, including those you mention [chiropractors, naturopaths, and Christian Science practitioners]."
Approval of courses taken under the G.I. Bill of Rights is delegated by law to the appropriate State Approval Agency and is not actually a function of the Veterans Administration. Schools that are below the level of higher learning (as determined by lack of approval by the U.S. Office of Education) can be approved for G.I. training by various state organizations. Since the chiropractic colleges are not listed by the United States Office of Education, a letter to the Veterans Administration in Washington, D.C., inquiring of criteria upon which approval of chiropractic colleges for G.I. training is based, referred me to the State Approval Agency for Private Schools of the Florida Industrial Commission. This organization informed me, in part, that:
One of the primary requirements of the Law is that a school must have been operating in its present location for two years immediately prior to applying for an approval.
In respect to chiropractic colleges, this agency would first ascertain from the Florida State Board of Chiropractic Examiners if the school is currently approved by that Board prior to considering an application for approval by this agency.
Few veterans, applying for training in chiropractic colleges that are "approved for training under the G.I. Bill of Rights," are aware of the fact that chiropractic credits have no reciprocity with accredited educational institutions. However, at the Texas Chiropractic College of San Antonio, Texas, chiropractic students take their basic science courses at nearby (fully accredited) San Antonio College. Unlike courses taken in a chiropractic college, these credits are, of course, transferable to other accredited colleges.
According to a leaflet published by the United States Office of Education:
In a few States practically no public control is exercised over the establishment of institutions with respect to their educational legitimacy. In such States almost any person or group can set up and operate an educational enterprise, granting diplomas and degrees of all kinds, without meeting any standards regarding the availability of resources and equipment for a sound program of instruction. This absence of control in certain States has encouraged the establishment of a number of so-called "diploma mills," which sell degrees, diplomas, and credentials for a price, without requiring the usual academic attainments. . . . Until these States see fit to provide closer supervision over educational enterprises, the only protection a prospective student may have is a warning note to be on his guard against a prospectus that offers educational credentials without the usual academic effort .
Thus, approval of a school for G.I. training, by some state organizations alone, offers the prospective student no assurance that the school is on a high academic level if it is not approved by the U.S. Office of Education. Some states, in order to raise the educational standards of all colleges operating in their borders, accredit only those colleges that meet general university requirements. As far as I have been able to determine, none of the chiropractic colleges have raised their standards to the level of such requirements. A few states have attempted, unsuccessfully so far, to pass legislation requiring that all practitioners licensed in those states meet the standards of their universities. In Wisconsin, for example, a bill is being introduced (at this time) that will require all chiropractic schools to come up to the standards of the University of Wisconsin by July 1, 1964, if their graduates are to be licensed in that State. If, according to the evaluations of the registrar of the University, a chiropractic school does not measure up to the standards of the University in that State, its graduates would be refused licensure. Chiropractic opposition described the bill as "a dictatorial system with one man as a sole judge," with some stating that "the bill would spell the end of chiropractic in Wisconsin."
"In Russia they call it brain-washing," commented one chiropractic spokesman. "In the United States you call it education." When an attorney in favor of the bill noted that "the osteopath has elevated himself above the cult level" by acquiring an education equivalent to that of a university medical school, a representative for the chiropractors replied that "the osteopaths had really wanted to be doctors and that it was only fair to have required equivalent courses for them." 
Thus, while some chiropractors claim to be physicians treating disease in competition with the medical physician, they also claim that they are not "doctors" in the same sense as are medical doctors, therefore they need less education. This peculiar philosophy precludes any reciprocity with other healing arts that have been uniformly accredited under universal standards.
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