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Bonesetting, Chiropractic, and Cultism

Chapter 13:
Chiropractic Specialists

©1963, Samuel Homola, D.C.

Division of labor in the rendering of medical services inevitably results from their variety and complexity. Hundreds of procedures of diagnosis and treatment exist today which were unknown forty years ago -- at the bedside, in the office, in the laboratory, in the record room, in the operating room. Technicians-laboratory, x-ray, medical record librarians, for instance -- have developed especially for some of these procedures. Some always remain in the physician's hands, like major surgery. Many are now performed by nurses and associated personnel.
                                                                                  MICHAEL M. DAVIS, PH.D. [1]

To say that the chiropractor treats the whole body when he only works on the spine sounds like "double-talk" to most of us. Yet, this is the impression conveyed in a critical analysis of the activity of the chiropractic general practitioner. Regardless of the fact that the causes of most diseases have been proven to be unrelated to the alignment of the vertebrae, and the fact that the majority of these diseases are best treated by methods other than manipulation of the spine, many chiropractors, in keeping with the chiropractic doctrine, continue to treat remote and unrelated disturbances simply by "adjusting the vertebrae."

"Double-talk" in the repertoire of some chiropractors seems to be evident also when such words as "analyzing" are substituted for diagnosis, "innate intelligence" for natural healing tendencies, or "nerve interference" for etiology of most disease.

In a previous chapter, we mentioned the fact that medicine is divided into numerous specialties, all working together, while chiropractic, for the most part, does not train specialists as such but rather attempts to treat the broader scope of disease with a single treatment method. As of recent, however, there have been attempts by individual chiropractors and groups to establish certain chiropractic specialties, most of which are somewhat self-conferred. A "Chiropractic Psychologist," for example, might specialize in that field simply because he "has had special study in psychology," building his practice and reputation as a "specialist" from a beginning status as a general practitioner (in much the same manner that medical physicians began to specialize in the early 1900s).

Under the demands of accumulating science, medical specialists have rapidly increased in numbers since 1917 when a specialty board for ophthalmology was established. Separated from the influence of changing medical science, chiropractic, on the other hand, has continued to pursue its rather unique course of "general practice" in competition with medical practice and all of its specialties. Only in recent days have there been indications that some chiropractors would advocate specialization in the treatment of disease, and most of this tendency seems to be found among more liberal practitioners who are no longer faithful to the fundamental chiropractic creed. Strangely enough, however, this specialization seems to center primarily around chronic diseases, "nerves," and prostate conditions, rather than upon a more logical specialization in back and spinal disorders. At least one chiropractic college offers a special postgraduate course for a specialty in proctology (diseases of the rectum) .

In any event, a specialist in the field of chiropractic does not earn the privilege of specializing as does the medical specialist who spends two to five years in additional training after completion of eight to ten years of academic and professional training.

In an attempt to broaden the chiropractors' rights as "physicians," the Chiropractic Research Education Ethics Society, Inc., a corporation formed by approximately 200 California chiropractors, is dedicated to "expand and improve chiropractic education in such a way as to 'prepare the doctor (D.C.) for general practice as a physician without restriction but endowed with a philosophy based on the chiropractic principles and concepts.'" [2]

Showing further tendency toward medical methods of practice, there are several "Chiropractic Educational and Specialty Societies" in California certifying 239 "chiropractic specialists." The societies are:

Sixty percent of the chiropractic specialists in California are "proctologists," a specialty that was popular among early, medically-prone osteopathic practitioners.

One wonders what additional practice in the field of orthopedics could be added to the practice of chiropractic when chiropractors are not allowed to set broken bones, reduce dislocations, use surgical technics, employ the use of orthopedic casts, and so on. In addition, chiropractors are, for the most part, limited to the confines of their offices in the treatment of orthopedic conditions, without so much as reciprocity with the physical therapist, and many do not even employ physical therapy. It would seem that a chiropractic "orthopedic specialist" would be allowed, by law if not by training, to do no more than the chiropractic general practitioner, and that any additional knowledge acquired by the specialist would be information that every chiropractor should have possessed from the beginning. It is difficult to understand how a chiropractor, without the use of drugs or surgery, could divide his service into specialties, even though the law does not designate what conditions the chiropractor may or may not treat. One would get much the same treatment at the office of the chiropractic specialist as at the office of the chiropractic general practitioner, regardless of the condition being treated.

We should bear in mind, however, that the chiropractor, as a competitor of the physician, at the present time, believes his vertebral therapy to be sufficient in itself, and his diagnostic and treatment abilities comparable to the physician's in most cases. All things considered, a chiropractic "orthopedic specialist" would probably be able to do little more -- in actual treatment -- than a licensed physical therapist (working under the direction of any one of the nation's 6,000 medical orthopedic specialists).

Although there is no substitute for manipulation in restoring mobility to a joint stiffened with adhesions, the greater part of the value of physical treatment as a whole lies in the restoration and rehabilitation of mechanical structures that have been disturbed by injury, disease, or surgery. Few orthopedic physicians have the time to personally perform the usually long and drawn-out program of treatment that is sometimes necessary in such cases, and, as a result, have relegated such forms of treatment to the physical therapist. Yet, the chiropractic orthopedic specialist, as a drugless practitioner, will necessarily be limited to the treatment of such conditions -- that is, if he is to attempt proper treatment of selected orthopedic cases, While there are many conditions that can be effectively treated by spinal manipulation, it is obvious that the value of manipulation would be severely limited over the entire field of orthopedics. It would seem that a chiropractic orthopedic specialist would be painfully embarrassed not to be able to set a dislocated finger, draw fluid from a swollen bursa, prescribe a narcotic for a painfully torn tendon, or to perform any other service outside that performed daily by licensed technicians who simply work under the prescription of a medical physician. The special attraction of chiropractic, however, is centered around the claim that most diseases are caused by vertebral misalignment, the detection and treatment of which are to be found only in the chiropractor's office.

This means that, today, 15,000 chiropractors are singularly competing with more than 265,000 medical physicians (about 90,000 of whom are certified specialists) who create the need for the services of approximately 504,000 registered nurses, more than 60,000 X-ray technicians, 50,000 laboratory technicians, and thousands of other workers in the fields of anesthesiology, psychology, nutrition, medical-social work, pharmacy (there are over 117,000 pharmacists), and so on.

Medicine and Chiropractic

In time to come, as the line grows thinner between what is chiropractic and what is medical, and as medical practice continues to recognize and employ the use of scientific manipulation, the chiropractor will point more and more to medical writings as supporting his doctrine on one hand, and the medical use of manipulation as an encroachment upon chiropractic on the other. As a change for the better creeps over each succeeding generation of chiropractors, however, along with a progressive rejection of the fundamental chiropractic philosophy, chiropractic shall, imperceptibly and by degrees, appear to have become more and more supported in modern medical writings.

A change in the attitude of some chiropractors is already apparent, for example, in the writings of a few chiropractic authorities who represent chiropractic on the front lines of inspection. In his 1958 Medicine and Chiropractic, Dr. C. W. Weiant, of the New York Institute of Chiropractic, states that:

To define the chiropractic attitude is a more difficult task, for chiropractors as a group are far less homogeneous in ideology than is the medical fraternity. It is rather true that the older generation among them tended to be unconventional, nonconformist, excessively individualistic people, else they would not have been attracted to their calling. Their precarious legal situation drove them to invent and uphold naive metaphysical foundations for their practice to bolster their claim that what they were doing was utterly foreign to the practice of medicine. Thus they were enabled to convince juries of laymen that they did indeed constitute a group apart, and that laws regulating the practice of medicine did not apply to their undertakings. Many still cling to their metaphysics, a crude dualism which they refer to as "the philosophy of chiropractic," and which they regard as a bridge linking the mentalism of Christian Science with the materialism of medicine. They defend themselves with the fervor of martyrs and the contagious enthusiasm of evangelists. No new theory, no fresh fact can long disturb their peace of mind. Either it can be incorporated into the established conceptual framework, or it is error. Failures never daunt them; they can be rationalized: the technic was incorrectly or inadequately applied. These are the extremists. They do not speak the language of science; with them medicine can hold no converse. Without them, however, chiropractic would never have gained the momentum which has carried it to its present position of prominence as the second largest healing profession in the world [3]

Dr. Weiant went on to say that there is a second and larger group in chiropractic "which has come to exert a controlling influence over the destinies of the profession. These people do not regard their chiropractic as a special revelation -- regardless of source -- nor do they hold it to be a panacea. . . . They do not dream of a day when chiropractic shall have displaced medicine from the face of the earth. They are keenly aware of their own limitations."

Even though Dr. Weiant referred to the "naive metaphysical foundations" underlying the development of chiropractic, and the "crude philosophy" responsible for the existence of the "2nd largest healing profession," he went on to present "medical evidence" upholding unchanged chiropractic claims that are still rejected by contemporary medical science but apparently still supported by many present-day chiropractors who "do not speak the language of science."

In reviewing the book Medicine and Chiropractic, for example, an associate of Dr. Weiant's, Dr. T.C. Peterson, President of the Chiropractic Institute of New York, offered, in part, this summary in the Journal of the National Chiropractic Association:

There are many surprises. We find here an exposition of the subluxation theory and a technic of spinal adjusting proposed by a British physician and surgeon in the year 1842. We read the pronouncements of some of the American physicians like Patchen and Fischer, who openly embraced chiropractic in the early years of its history. (Fischer relates his experience in saving the leg of a man suffering from gangrene and tells of his conviction that chiropractic is superior to antitoxin as a weapon against diphtheria.) We find an orthopedic surgeon from the Boston Polyclinic lecturing in 1912 before the New York Academy of Medicine on the merits of manual adjustment, and stating that the worst case of renal colic he had ever seen responded completely to a single vertebral adjustment.

When it comes to the German situation, we get the reports of the medical school professors on the efficacy of spinal adjustments in a wide assortment of clinical problems, and read their stimulating discussions of points in chiropractic theory. Altogether, eighty-three citations of favorable references to chiropractic are cited from the German literature.

There is not a physician in the country, other than a cultist, who would recommend chiropractic adjustments for such conditions as diphtheria, gangrene, and renal colic (especially without recourse to medical treatment methods). No doubt, in earlier days, there were many remedies thought to be of value in the treatment of conditions for which an effective prevention or cure had not yet been found. There were many early medical practitioners, some of whom had chiropractic degrees, who subscribed to the doctrine of D.D. Palmer. My own father had a 1920 diploma from the Palmer School of Chiropractic that was signed, with others, by "A.B. Hender, M.D., D.C., Ph.C."

Dr. Alfred Walton, M.D., quoted in the book Medicine and Chiropractic, wrote a book on chiropractic in the early 1900's that stated, in part:

It is very difficult for the conservative physician to grasp the one fundamental fact, that the spine is the only place to look for the cause of nearly every form of disease. The reason of his failure to accept this idea is because he has been taught to concern himself with effects, and not the adjustment of causes; therefore, the mechanics of the human body entirely escape him [4].

Dr. Walton was further quoted in Medicine and Chiropractic:

The condition of the spine is the keynote of the entire situation; if a careful digital and visual examination of the spine is made, it will reveal all that the patient complains of, which results in a great saving of time, as an examination of the spine reveals the actual cause of 95% of all diseases, therefore, why should it be necessary to concern oneself with a minute study of effects? What is to be gained?

If the cause of a serious interference with the function of the kidneys be due to a lower thoracic vertebra being out of alignment, from the standpoint of the clinician, does it make any material difference whether the pathological change is one of chronic interstitial nephritis, or whether it be chronic parenchymatous nephritis? . . . Adjustments require but a fraction of the time we now spend in investigating symptoms [3].

Considering the fact that Dr. Walton was an accredited medical practitioner, it is difficult to understand how he could have been convinced that 95% of all disease was due to subluxated vertebrae. Many of his writings on chiropractic are identical to old and present-day concepts of the chiropractic theory. If Dr. Walton were living today, I am sure he would withdraw his fundamental chiropractic contentions in light of contemporary scientific knowledge. Times change, and the most recent facts must be made the primary consideration in developing a science. Statements made by qualified practitioners 50 years ago can be found to support almost anything that has since been discarded under the direction of present-day science. Many chiropractors today, in holding to their basic school of thought, draw upon outdated sources of information -- some of which are still valid and others of which are thoroughly false -- and combine this information with any recent material that appears to be favorable. For example, it is just as true today as it was among 17th-century bonesetters that manipulation will relieve the pain of a binding sacroiliac joint. However, reference to old and new medical manuscripts attesting to this does not lend validity to old medical contentions or new chiropractic allegations that displaced vertebrae cause most disease. To use one school of thought in support of another is not progress in every case, it is sometimes vagary. It is like saying that the support given Valentine Greatrakes ("the stroker" -- a faith healer of the 17th century who extended his "curative touch" to almost every known malady) by Robert Boyle, the famous chemist, validates the practice of present-day "strokers" since much of Boyle's work underlies the practice of modern medicine.

Other sources of obsolete medical support of the chiropractic theory are taken from the writings of Dr. J. Riadore, an 1842 English surgeon "who actually speaks the language of the chiropractor." [3] Revealing the general lack of medical knowledge in his time, Dr. Riadore stated that ". . . medical men in general attribute most diseases to that ignis fatuus indigestion; making the stomach or the liver the lumber room for all undefined diseases . . . and seldom or never reversing their view and examining the spinal column." Writing on the subject of symptoms related to the spinal column -- both in the referral of symptoms from the organ to the spine, and the referral of pain from vertebral disturbances to the organ -- 53 years before D. D. Palmer "discovered" chiropractic and 25 years before Sir James Paget's article, "Cases That Bone-setters Cure," Dr. Riadore also described a method of adjusting "displaced vertebrae." Although much of what he proposed has been validated in modern medical science, there is no doubt that a general lack of medical knowledge in the mid-nineteenth century may have led Dr. Riadore and his associates to misinterpret some of the symptoms of referred pain, a subject now well discussed in any scientific text on manipulation. In any event, there seems to be no great scarcity of medical reference to the use of spinal manipulation -- both as a method of manipulative surgery and as a method of treating disease.

"It is indeed astounding to find that a physician, as early as 1842, recognized subluxated vertebrae as a cause of visceral disease and used many of the technics of chiropractic in detecting the condition and coping with it," commented the author of Medicine and Chiropractic. "Dozens of other physicians, it is true, gave some attention during the nineteenth century to spinal irritation, but no other, to our knowledge ever attempted mechanical correction with the single exception of the Swiss physician Otto Nageli (1894). The others relied upon chemical counter-irritation applied to the focus of irritation."

By 1904, however, Edgar Cyriax was to write a book on manual therapy with chapters on infectious diseases, diseases of the respiratory organs, diseases of the digestive organs, heart diseases, diseases of the blood, lymphatics and ductless glands, diseases of the nervous system, diseases of the locomotor system, and diseases of the genitourinary system and labor. Under infectious diseases he includes typhoid fever, whooping cough, measles, scarlet fever, parotitis (mumps), diphtheria, epidemic cerebrospinal meningitis, rheumatic fever, and various others. Chiropractors who have advocated the application of their method to conditions such as these have been called a menace to public health (and harsher names). Yet here we find a man high in the medical circles of Great Britain strongly advocating something which closely resembles it and chiding his colleagues for restricting the use of manual methods to nonvisceral conditions [3].

Needless to say, the chiropractor today who would attempt to treat such conditions as those listed above with spinal manipulation would still be called a menace to public health or "harsher names" (as would any physician who attempted to do such a thing). To say that a manual treatment used in 1904 for meningitis, scarlet fever, diphtheria, typhoid fever, and whooping cough "closely resembles" chiropractic is nothing short of a fantastic admission. One sentence, in a dissertation on chiropractic, supporting the use of spinal manipulation for such conditions as those just named would nullify any rational approach taken by the author. Physicians who "speak the language of the chiropractor" to this effect "do not speak the language of science."

When more qualified chiropractors do speak out as representatives of their group, it is unfortunate that they often lend support, if not by direct statement then by vague implication, to the creed underlying the wholesale treatment of infectious and organic diseases by licensed chiropractors. To do otherwise, it seems, would be to meet rejection by the profession they contend to support and represent. For the most part, there appears to be little evidence to support a contention that significant changes have taken place in the chiropractic viewpoint. I have never seen a chiropractic text limiting the use of spinal manipulation to values now outlined in dozens of medical textbooks. The literature being circulated in chiropractic realms still advocates spinal manipulation as a treatment for most disease, and the opinions of chiropractic's foremost authorities still embrace a scope of disease almost as broad as that claimed by the founder of chiropractic, although they may, in some cases, refer to the "cultist attitude" of many chiropractors.

Although it is well known that manipulation is not yet employed as extensively in medical circles as it should be, much of the basis for the excessive use of manipulation in chiropractic circles is found in misdiagnosis. Referring to the 1912 writings of R. Kendrick Smith, M.D., as "our star witness," for example, the book Medicine and Chiropractic quotes examples lending to the belief that spinal manipulation effectively treats angina pectoris, appendicitis, and renal colic. "Truly Dr. Smith would have been no stranger to chiropractic," the book commented. "He analyzed his patients chiropractically (or, as he says, 'mechanically'). He did not draw the line when he encountered visceral diseases and say: 'This is not a chiropractic case.' He corrected the vertebral displacements by hand, and the patient recovered." [3]

Quoting a 1940 reference to a 1933 study of "Spinal Curvatures -- Visceral Disturbances in Relation Thereto," by Dr. Neville T. Ussher, for a "stronger verification of the chiropractic hypothesis," we find considerable evidence of the now well-known existence of "symptoms" referred to various abdominal viscera -- sometimes simulating true organic disease -- from spinal disturbances. "Typical cases were presented in which symptoms of appendicitis, gall-bladder disease, ureteral colic or other manifestations of visceral disease were apparently relieved by correction of a spinal curvature or of the associated myositis," Dr. Neville was quoted as saying. "In the main I was convinced that the variations in the visceral symptomatology depended on the various spinal levels involved. Gall-bladder colic and cardiospasm, for example, were shown in some instances to be related to myositis in the middle dorsal area. Symptoms of appendicitis or pelvic inflammation were shown to be definitely associated with irritation of the lower dorsal segments."

It is now well known that obscure visceral symptoms and pains that are not associated with any obvious pathology are sometimes referred neurological disturbances (from an irritating joint disturbance). Mennell has advised that: "The nature of referred pain must find wider acceptance, and it is not much to ask that, when symptoms do not fit in with routine diagnosis, or do not respond to ordinary treatment, the movement of the joints should be examined for loss of mobility." [5]

We remember that Mennell, today's foremost medical authority on manipulation, has explained that true angina, or any real pathological condition, cannot be directly affected for the better by manipulation. Thus, while we see that manipulation is specifically valuable for the correction of actual joint disturbances and their related symptoms, there still remains no justification for the use of such treatment in all sorts of infectious and organic diseases. Yet, many chiropractors, who are not qualified to do so, continue to administer to such cases on the strength of the chiropractic doctrine alone, while, as we have shown, supporting their contentions, in part, by quoting both correct and incorrect medical opinions of manipulation (some of which are older than the chiropractic profession itself) , or by improvising an incorrect relationship between facts and theories.

Referred Pain

In times past -- and today -- many of the "marvelous cures" performed by manipulating the spine were simply the results of misdiagnosis. It is now common knowledge, for example, that acute pain from the sacroiliac area of the spine is often referred to the lower abdominal area to simulate the symptoms of appendicitis. In fact, a point on the lower, right abdominal area, very near "McBurney's Point" (where the symptoms of appendicitis are usually found), has been designated as "Baer's Sacro-Iliac Point" in charting the referred pain of a sacroiliac condition. No doubt, many of the "appendicitis cures" attributed to spinal manipulation were not such at all but simply a release or reversal of strain in the sacroiliac joint.

It is not uncommon for referred pain from a joint disturbance to be misdiagnosed as organic disease. This is especially true among those who are not schooled in the art of diagnosis and who do not make a differential diagnosis in proper utilization of modern diagnostic facilities and laboratories. The spinal manipulator who simply manipulates everything that comes along is not likely to differentiate intercostal neuralgia (simulating heart pain) from true anginal pain, or referred sacroiliac pain from acute appendicitis. Manipulation of the spine, relieving the pain, is thus likely to be given credit for impossible cures.

In the book Joint Manipulation, Volume 2, by James Mennell, M.D., there is an excellent chapter on referred pain (Chapter 8) and its origin in the joints. In discussing chest pain, for example, Dr. Mennell stated:

Passing down through the thoracic spine, we come to a region where joint manipulation has received credit for cures which are scientifically impossible. Pain radiated along one of the intercostal nerves from the 3rd to the 7th may be felt in the chest wall underneath the breast. The diagnosis of mastitis may be made. . . .

If the symptoms are referred round the left side along the 3rd to the 6th distribution, the precordial area may be involved. Often the patient is convinced that the pain is attributable to heart trouble.... A case of true angina can never be altered for the better by manipulation, but may easily be altered for the worse. Pseudo-angina is, however, a comparatively common complaint, often curable by manipulation [5].

Thus, scientific joint manipulation can be an effective treatment method in selected cases, the selection of which, however, depends a great deal upon proper diagnosis and the privilege (or knowledge) of recourse to other treatment methods.

In order to provide a typical example of a much-used chiropractic contention that medical science has approved the chiropractor's treatment for disease (on the basis of relief of referred pain), let us follow the reproduction of an article that appeared in a 1955 issue of Today's Health, published by the American Medical Association. The article, a summary of which also appeared in a later issue of Reader's Digest, presented the case history of a man who had suffered severe chest pains that seemed to be heart pains. Examination by specialists, however, revealed no obvious pathology of the heart, but doctors advised the patient to "take it easy" in event a heart condition existed that had not been discovered. Further examination by a medical internist reveaed that the man had a spinal curvature aggravated by a short leg, causing pressure upon a nerve trunk supplying the left side of his chest just over the heart. A lift under the left shoe permitted the man to carry his posture straighter, thus relieving the pressure on the spinal nerve. The patient was simply suffering from intercostal neuralgia, a condition far removed from heart disease. As evidenced by negative heart examinations in such cases, pressure upon a spinal nerve could hardly cause a disturbance of the heart.

Notwithstanding, a March 1959 issue of Healthways, a chiropractic magazine for lay consumption, published by the National Chiropractic Association, commented on the case above by stating:

If it is admitted, then, that nerve Pressure can appear at the upper portion of the thoracic spine to cause symptoms of heart trouble, it must be remembered that there are 24 movable segments of the spinal column, most of them below the area described by the AMA's article. A short leg, then, could affect the alignment of any of these segments and produce an irritation of the nerves of the area.

Thus could result the symptoms of many different diseases, depending upon the nerves involved. This is exactly the premise upon which the entire chiropractic profession is based. . . . it puts the official stamp of approval of the AMA upon the theories and methods of the chiropractor.

Here the mention of nerve pressure symptoms by medical authority is interpreted to mean a verification of the chiropractor's claim that nerve pressure at the intervertebral foramen is the cause of most disease. There is a great deal of difference, however, between the symptoms of an irritated nerve trunk and actual organic disease. This type of construed false connotation is a favorite method, of many chiropractors, of putting medical science on the side of the chiropractic creed.

It is common knowledge among physicians that irritation of a spinal nerve trunk can and does cause radiating pains over the course of the nerve. Such irritations are caused by a variety of conditions, most of which have already been discussed. This does not, by any stretch of the imagination, approve the chiropractic theory that most human disease is caused by pressure upon spinal nerves. One need only ask the medical authority whom the chiropractor quotes.

More about Chiropractic in Germany

Much has been said, by chiropractors in this country, of the research work being done by a group of German medical doctors on the subject of "Chiropraktik." Stimulated in 1951 with the appearance of Dr. L. Zukschwerdt's article on chiropractic in an October issue of the journal Hippokrates, and other articles and publications that followed, a group of about 200 physicians, many of whom were members of hospital and university staffs, organized the "Medical Research and Work Group for Chiropractic." Centering research work around the spinal column, annual meetings were held for presentation and discussion of individual findings and opinions. As a result, the attention of German medicine was drawn to many valuable uses of spinal manipulation ("under the proper indication") that were not theretofore recognized or employed. German physicians were quick to designate, however, that manipulative procedures should be done only under the supervision of a physician who has "left the doctrine to the chiropractor."

German physicians knew little or nothing about the American chiropractor. Much of the research was done from "scratch," and a good many of the doctors had not previously heard of chiropractic. Manipulation had long been a part of the folk medicine in many parts of Germany, however, and -- at one time a part of the official medicine of Germany -- was still being used by laymen in the Swabian Alps, Westphalia, and Friesland.

Dr. Zukschwerdt, now professor of surgery at Hamburg University, spearheaded the medical investigation of manipulation in Germany by frequent reference to the use of manipulation in his writings. In his surgical text on Vertebral joint and Discs, for example, published in 1955, he advised that manipulation rather than surgery should be used in treatment of disc conditions not presenting a complete collapse of the disc structure. In other writings, he also advises the use of manipulation or "chiropraktik" in vertebral fixations caused by subluxation, muscle spasm, osteochondrosis, and other disturbing influences of a mechanical nature in the spine. Although Dr. Zukschwerdt recommended the use of manipulation in a number of conditions related to vertebral pathology and narrowed intervertebral foramina (such as cervical migraine, muscle spasm, brachial neuritis, spinal curvature, and various nervous and mechanical pains and symptoms), he considered vertebral symptoms associated with actual pathology of the internal organs to be, for the most part, a reflex result rather than a cause of the disease -- an opinion that is shared by the majority of medical manipulators in this country.

In his book, Dr. Zukschwerdt explained that hernia of the intervertebral discs was not as common as they had formerly believed and that many cases diagnosed as herniated disc were, as surgery often revealed, not that at all. Seeking another explanation for back pain with referred neurological symptoms, he discovered that relative narrowing of the intervertebral foramina often took place as a result of chondrosis (thickening of the bone surface). In 1948, he had postulated that "blocking" or fixation of a vertebra under such conditions could set up a chain of symptoms resembling herniated intervertebral disc, and that manipulation of such disturbances could release the fixed vertebrae and widen the intervertebral foramina. "We were soon convinced of the high value of the chiropractic adjustment under the proper indication," Zukschwerdt explained. Carrying his recommendations to the therapy congress in 1948, he was met with considerable resistance as a result of what he called misunderstandings and arguments between chiropractors and M.D.'s that was often due to the aggressive attitude of the chiropractors, and a "preponderance of unprofessional reasoning" on the chiropractic side. "But this state of cold war was not much publicized," he wrote, "and the greater part of the medical profession did not even know about it. This might be the reason so many M.D.'s adopted the Chiropractic treatment after publication of our work in this field. The Chiropractic theory had more or less entered the medical field by the back door. General practitioners soon employed the manipulative technic. . . . We are aware of the fact that many problems are not yet solved, but it is of great value for everybody to recognize the difficulties involved. We know that many individuals, both professional and laymen, have good ideas but so many times we had to find out that they made their ideas a dogma with no scientific basis."

Thus, confining the use of manipulation to medical jurisdiction, many other physicians contributed literature on the subject of manipulation. While many of their findings are similar to orthopedic and physical medicine recommendations in this country, some of their theories on chiropractic seem to be much too liberal and inclusive. For example, while Dr. Zukschwerdt's recommendations for the use of manipulation in treating mechanical conditions of the spine are similar to recommendations made by Mennell, Fisher, and other famous medical manipulators, some of the German practitioners go so far as to recommend manipulation for such conditions as toothache, gout, urethritis, and varicosities, under the assumption that they might be caused by a "neurologically misdirected blood supply." One German physician writes that "chiropractic is the fastest effective therapy for most angina pectoris cases, with or without myocardial damage." This contention is the direct antithesis of what the more seasoned and experienced manipulator James Mennell proposed. Another reported that the use of chiropractic manipulation in 38 cases of chronic low back disability resulted in great improvement in 30, sixteen of whom remained entirely free from pain. With an average of only 2.3 adjustments per case, it was noted that 12 of the 16 cases obtaining complete relief received only upper cervical adjustments! This type of treatment has been called cultism by some chiropractors in this country.

As we noted earlier, there are many human factors that are responsible for the apparent effectiveness of a treatment that is not actually related to the disorder. "The success of the therapy is proved, whether there is a causal connection or not," contended one German physician who advised continued use of manipulation in medical practice. "I see in chiropractic no Science, but an excellent method of treatment, a handiwork, as the name implies. And 1 must state that I prefer a well understood handiwork to badly misunderstood science," said another.

Although opinions on the use of chiropractic manipulation (spinal manipulation) ranged from one extreme to the other in some cases, a considerable amount of evidence was accumulated supporting the use of spinal manipulation in a great number of mechanical and mechanically-related conditions. Recommending the use of such treatment over a broad field as an adjunct to scientific medical Practice is far removed from the substitution of such treatment for other procedures in the treatment of disease in general, as many chiropractors in this country are doing. Manipulation, in contributing to both the science and the art of healing, must be subordinated to medical science if it is to be used in its proper perspective, a concession American chiropractors are not ready to make.

Since literature on "chiropraktik" in Germany is all relatively new (presenting many varied opinions and theories), it is difficult to evaluate since time may alter many of these opinions considerably. In addition, theoretical application of manipulation in German medicine cannot be compared altogether with the activity of isolated American chiropractors who are competing with medical science as a whole. It is interesting to note that some German physicians believe that the "philosophical pretensions" of chiropractors in this country have created a great amount of unwarranted prejudice among American physicians on the subject of spinal manipulation and I agree.

Inasmuch as there are no chiropractors in Germany to speak of, however, physicians there were free to theorize excessively, in promoting the art of healing, without fear of suggestion-prone factions attempting to replace scientific medical procedures with mere speculation and theory. While such theorizing may be healthy for scientific progress, when it is exercised under scientific control that provides recourse to various facilities and treatment methods, it is dangerous when it lends excuse to the campaigns of antimedical factions that exist almost entirely on the strength of public opinion.

We have already mentioned the fact -- in an opening chapter -- that West Germany has an excessive number of physicians as an aftermath of World War II and communist infiltration of East Germany, resulting in acute competitive conditions among practicing physicians. As a result, a number of physicians have no doubt taken up the practice of chiropractic for an added attraction in the patient-market. Although I am sure that nearly all of these doctors limit the use of such treatment according to the specificity of other treatment methods in the medical armamentarium, there may be some who will exaggerate the values of spinal manipulation as a means of "beating competition." Literature from the pens of these practitioners, reproduced in American chiropractic journals, may make it increasingly difficult to enforce proper limitations upon such treatment in this country.

References

1. Davis, Michael M., Ph.D.: Medical Care for Tomorrow. Harper & Brothers, New York, 1955.
2. Chiropractic in California. Los Angeles: Stanford Research Institute and the Haynes Foundation, 1960.
3. Weiant CW. Medicine and Chiropractic. New York: New York Institute of Chiropractic,1958.
4. Walton A. Chiropractic. 1915.
5. Mennell J. The Science and Art of Joint Manipulation. Volume 2, The Spinal Column. New York: Blakiston Company, 1952.

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