My Chiropractic School Experience
Samuel Homola, D.C.
This article reflects chiropractic in the 1950s and what happened to a misguided kid who was simply looking for a better life. In 1948, upon graduating from high school, I had no idea what I wanted to do in life, so I joined the U.S. Navy. I was discharged in 1952 after a tour of duty off the coast of North Korea. With the G.I. Bill available to pay for a college education, I decided to train for a profession. Because of my background in bodybuilding and weightlifting, I considered becoming a physical therapist; but because my father was a chiropractor, I also ordered catalogs from chiropractic colleges. I knew that chiropractic was controversial, but the catalogs assured that chiropractic had changed for the better and was now well-accepted and growing in popularity. I was also lured by the prospect of a private practice that would allow me to implement many of my ideas about building better health. It turned out, however, that my chosen path was far from rosy. After a few semesters at Lincoln, I realized that chiropractic had changed very little from the time my father had graduated in 1920.
My Arrival at Chiropractic School
A senior student from Lincoln Chiropractic College met me at the bus terminal in Indianapolis. It was his job to see that I was properly enrolled and to help me find a place to stay. He was a nice enough fellow, nicely dressed and driving his own car. His father was also a chiropractor, but obviously more prosperous than my father ever was. "You have chosen the best chiropractic college in the nation," he assured me. "Chiropractic is the healing art of the future. You'll get the best possible training here at Lincoln. We have about 250 students. I understand that there will be about 45 students in your class." He explained that the first two years would be spent mainly on the basic sciences, but after that I would find out what chiropractic could really do.
My driver told me of the wonders of chiropractic as he drove me around. He took me by the building at 46th Street and Keystone Avenue, near the edge of town, where I would begin my first class. The sign over the front door said "Lincoln Chiropractic College." The building was a three-story brick structure that was once a grade school. "This is where our freshmen, sophomore, and junior students attend classes," he explained. "We have new laboratories in pathology, dissection, bacteriology, physiology, chemistry, histology, and embryology, making Lincoln the best equipped chiropractic college in the nation." I was impressed. We then drove to a building in downtown Indianapolis, about five miles away, where I would spend my senior year. In addition to classrooms, x-ray facilities, and an outpatient clinic, the building also housed the school's business offices, where my paperwork was completed. The four-story stone structure was obviously very old, with wooden floors and stairs. The windows and eves on the front of the building were trimmed with ornamental masonry that resembled 19th century architecture.
He then took me to a residential area about midway between the school and clinic buildings. I unloaded my luggage at a nice two-story private home where I and another student, Earl St. Denis, would share an upstairs bedroom and bath. Earl seemed to be a quiet, serious person and usually wore a tie. I knew he would be a good roommate.
My landlords, who lived downstairs, were a retired couple. Their son, a pharmacist, had many questions about "chiropractors who don't believe in drugs." The father played Hoagy Carmichael's "Ole Buttermilk Sky" on a piano in the living room. That was the only piece of music I ever heard him play. Although meals were not included with our room, Earl and I would be invited to dinner on special occasions such as Christmas.
The neighborhood, which was nice, was a typical middle-class suburban residential area. It included a movie theater, a small family-owned restaurant, and a drugstore with a soda fountain. Indianapolis had a good bus system, allowing me to get around quite well. Each morning I ate breakfast at the restaurant and then took a bus to school.
Behind Lincoln College there was a golf course with acres of grass and trees that gave me the feeling of being out in the country. The school had no lunchroom, but there was a small snack stand in the basement. Most of us preferred to go next door to the golf course lunchroom which offered a selection of sandwiches and soups. Students who had a car could drive to a nice restaurant.
I had saved a little money while in the Navy. Under the G.I. Bill, I received a monthly government check, most of which I used for books and tuition. I was on a pretty strict budget. Any money left after graduation from Lincoln would be needed to buy equipment and open an office. The more I could save, the better.
I worked in the Indianapolis post office during the Christmas holidays. Long hours of sorting mail were tiring and boring. Hundreds of sacks of mail piled up. My back hurt terribly, just as it had when I worked in the bowling alley at Camp Rucker during World War II. My experience as a postal employee strengthened my resolve to complete my studies and open my own office.
During my first year at Lincoln, I concentrated on my studies, choosing not to work after school. My grades were good—nearly all A's. I enjoyed the courses in anatomy and physiology, which were familiar and interesting. Much of what I had learned in my bodybuilding and from reading books while in the navy helped me understand what I heard in the classroom. The pocket medical dictionary I had studied while in Korea had familiarized me with medical terminology.
After the first year, I took a job at a funeral home, where I lived rent-free and received a small salary. I shared a room with another student. One of us had to be there at night to answer the phone. When someone needed a body picked up for delivery to the funeral home, we would call an ambulance service, wait for the body to arrive, and then call the undertaker. This job did not interfere with my studies. And since I was usually in my room at night studying, it was ideal employment for me.
My roommate was a college dropout who had little or no previous knowledge about chiropractic. He looked studious and always wore a suit and tie. He carried a briefcase with him everywhere he went. He was tall, with slumped posture that thrust his head and neck forward. He had a long nose with close-set eyes. He looked like an eccentric college professor. He took over the little snack stand in the basement of Lincoln College. In addition to his briefcase, he would carry around a bag of coins while attending classes, always ready to open up the snack bar. He was an easy-going fellow, and seemed to get along with everyone. But his grades weren't good. I didn't know if he was unintelligent or just preoccupied.
One of the nice things about working at the funeral home was that it was located next door to a beauty college where female students were learning hairdressing and other grooming skills. From the window of our upstairs room, we could look into the windows of the dormitory next door and see the girls, who were often looking back at us. Just down the street was a Toddle House where we could meet to eat eggs, hamburgers, homemade soup, and other foods prepared before our eyes while we sat at a counter. I had most of my meals there.
Working in the funeral home also augmented my study of anatomy. I often saw bodies ravaged by disease and mangled by injury. Bodies that had been through autopsy at the hospital would be delivered opened up like a watering trough, along with a bucket filled with internal organs. Seeing the bodies of elderly persons destroyed by age, and the bodies of young people deprived of life by disease or injury, was a sobering reminder of the inevitability of death. I felt fortunate to be alive and healthy. I realized that I didn't have much time to make the most of my life on earth—and maybe only one chance. I was thankful to be learning a profession. I resolved to learn as much as I could while I had the chance to do so.
I was repulsed by the embalming process. An artery and a vein were opened in the neck, under the arm, or in the groin. Embalming fluid was pumped into the artery until the flow of blood and "chicken fat" from the vein was replaced by clear fluid. A sharp, pointed pipe (trocar) was used to inject embalming fluid into the chest and abdominal cavities and to release gas from the intestines. Excessive gas could bloat the abdomen and produce sounds when escaping from the mouth and anus. Lips were sewn shut from the inside to keep the mouth closed. Cosmetics were used to hide the pallor of death. Then, in a final insult, the body was sealed in a metallic coffin and placed in a concrete tomb where natural decomposition was impeded by formaldehyde and a sterile environment, producing a horrible-looking corpse. I resolved then and there that I would never allow my body to be embalmed and viewed in such a manner. Cremation without viewing would be kinder, cleaner, and more practical. Immediate burial in a wooden box would be more environmentally friendly, contributing to the cycle of life by returning the elements of the body to the soil.
Bebout Chiropractic College was located just across the street from the funeral home in a small two-bedroom-size house that could accommodate about two dozen students. You could get a chiropractic degree there after only a year and a half of study. Lincoln students considered Bebout graduates to be quacks. But there was little difference in the theory and the techniques taught in the two schools. Debates between Lincoln and Bebout students on the streets of Indianapolis should have alerted me to some of the pitfalls I might be facing as a chiropractor, but I failed to see the handwriting on the wall.
During my first year at Lincoln, I learned a lot about the human body. Most of the instructors were chiropractors, some of whom had a bachelor's or master's degree. None had a Ph.D. degree. Some of the instructors with only a D.C. degree started teaching immediately after graduation from Lincoln. One of the psychology instructors had a phony degree.
Before the end of my freshman year, I attended classes in "chiropractic philosophy" and "chiropractic principles." There I was told that the body has an innate capacity to heal itself and that chiropractors could facilitate healing simply by adjusting the spine to remove nerve interference caused by vertebral subluxations. Physiotherapy was not taught because "it treats symptoms and does not locate and remove nerve interference." At that point, I was glad that I had chosen to study chiropractic rather than physical therapy. I felt that I was on the right track. I told everyone I knew that it was much better to get a chiropractic adjustment than to take medication for most ailments. I argued with a nurse I was dating, telling her that, unlike medical doctors who treat only symptoms, chiropractors treat the cause of disease. The nurse recognized my naivety and eventually dumped me.
During my first winter in Indianapolis, the city was blanketed by a heavy snowfall. The landscape was white and beautiful, especially at night when there was a full moon. Within a few days, however, the melting snow mixed with soot released from the chimneys of coal-burning homes, forming a dingy slush. When the temperature dropped again, the slush froze into slippery ice formations that threatened life and limb. I reminded myself that when I graduate from Lincoln I would be moving to the Gulf Coast of Florida to practice chiropractic in my own office.
During my second year at Lincoln, I took a part-time job doing janitorial work at the Grain Dealers Mutual Insurance Company building, which was nearby. Each day, after school, I worked a few hours cleaning one floor of the building. The company also sold me a repossessed 1949 Ford for only a few dollars.
In the middle of my sophomore year at Lincoln, I began to have doubts about its teachings that adjusting the vertebrae would cure or prevent most ailments. My pivotal experience occurred in the classroom of James Firth, D.C., professor of chiropractic, president emeritus of the college, and author of the prominent textbook Chiropractic Diagnosis. One day a student suddenly fell to the floor with an epileptic seizure. Since Firth's book specified which vertebrae to adjust for epilepsy, I was anxious to see the master at work. After some hesitation, he walked over to the student and popped his neck. Then he left the room, leaving the student convulsing on the floor. As far as I could tell, this "treatment" had no beneficial effect whatsoever.
We dissected human cadavers to further our knowledge of anatomy. We knew the bodies had arrived when a bad smell permeated the building. Rope marks were still visible on the bodies, which had apparently been fished from a vat of formaldehyde. One body was missing a foot, which had been removed for study by podiatry students. A dental college had removed a head from one of the bodies. We were told that the cadavers were unclaimed bodies with no known family connections. While dissection was interesting, it did little to support the use of spinal adjustments. One student took a hand from one of the cadavers and hung it in a fig tree behind someone's home, resulting in a visit from the police. Another was initiated into some kind of club by carrying out orders to jump rope with a section of small intestine. I couldn't help but think that few well-meaning persons who donate their bodies to science would want to end up in the dissection lab of a chiropractic college.
Studying on My Own
To expand the basic knowledge necessary to practice in a rational manner, I began visiting the medical library at the Indiana University School of Medicine in Indianapolis where I read and purchased books on back pain (Lewin), spinal manipulation (Mennell), physical medicine (Bierman & Licht), and orthopedics (Howorth). I learned that spinal manipulation was useful in treating some types of back pain. The only books that focused on what I thought was appropriate use of spinal manipulation were written by orthopedists and physical medicine specialists, not by chiropractors. Only books written by chiropractors like Firth claimed that spinal manipulation was effective against disease. I also concluded that spinal manipulation for back pain was useful but not readily available in medical practice. I resolved to make a special effort to learn all I could about the medical aspects of back pain. And I vowed that when I opened my office I would treat only back pain, using manipulation as my primary treatment method. I was sure that this service was needed and would be well received by physicians and patients alike.
As I became more convinced that "vertebral subluxations" were not a cause of disease and that spinal adjustments were not an appropriate treatment for any organic disease or infection, I photocopied pages from The Science and Art of Joint Manipulation, Volume II, The Spinal Column, by James Mennell, M.D., and distributed them to my classmates. Mennell was a physical medicine specialist. He recommended spinal manipulation for muscle and joint problems but not as a treatment for disease or illness. Needless to say, my professors were not happy with my views. This was the beginning of my reputation as a "chiropractic heretic" and the seeds for my 1963 book Bonesetting, Chiropractic, and Cultism.
To obtain a license in Florida where I planned to practice, I would first have to pass an examination in the basic sciences at the University of Florida in Gainesville. Although this exam could be taken anytime, it was customary to take it after graduation and then take the chiropractic board. But I felt that if I could pass the basic science exam early and get my "Certificate of Proficiency in the Basic Sciences" before graduation, I could spend more of my time at Lincoln studying books on back pain. I concentrated very hard on my basic science studies, often reading far ahead of classroom work. At the end of my first two years at Lincoln, I rode down to Gainesville with a carload of seniors, took the basic science exam and passed! I could now concentrate on preparing to be a back specialist. I didn't have to accept the notion that I could compete with physicians by adjusting the spine as treatment for disease. I could fill a niche offering spinal manipulation as a treatment for back trouble.
At the end of my junior year, I decided to take the summer off and find a job so that I could save a little extra money. Since I now had a car, I could look for work a considerable distance from where I lived. I found a job at a Chevrolet plant where pickup trucks were being assembled. I worked on the assembly line fastening door panels with screws. It was a miserable job. The insides of my thighs were raw from rubbing together as a result of walking to my left hour after hour. I watched the clock constantly, counting the minutes until quitting time. I felt sorry for workers who had to continue employment of this type to support their family. I would much rather be back in the Navy than do this kind of work for a living. I was glad that I could leave the factory at the end of the summer and was preparing to enter a profession that would allow me to be self-employed.
Narrow Clinical Experience
In September, I returned to Lincoln to begin my senior year. I would be attending classes and working in the clinic on Pennsylvania Street in downtown Indianapolis. Since I had learned manipulative techniques in my junior year, much of my senior year was devoted to clinical subjects. Using fellow students as patients, we did urinalyses and tested blood obtained by pricking a finger. We took blood pressure and listened to the heart and lungs. A Heartometer was used to record heart beats. We were taught to take and interpret x-rays, how to do a neurological exam, and how to do a simple physical exam, including use of an otoscope and ophthalmoscope. We observed a cursory gynecological exam performed on a student's wife. In nother class, we watched as the instructor did a breast and pelvic exam on a clinic patient who volunteered to be a study subject. While the exam was in progress, the patient made eye contact with most of us, obviously enjoying our interest in her body while acting out her exhibitionism.
When we started seeing patients in the clinic, we did a basic physical exam, which usually included an x-ray exam. But the primary approach to examining the patient was to palpate the spine and make a listing of “vertebral subluxations” as determined by the positions of prominent bony structures, such as the spinous processes (the bumps visible on the back of the spine). No matter what our findings were, the treatment was always the same: a spinal adjustment. If a spinous process deviated to the left, it meant that the vertebra was rotated to the left and needed to be adjusted on the right side to restore proper alignment, and so on. I was never able to determine that I made any corrections or changes in the spine by adjusting the vertebrae. Most of us simply made a listing of the spine and then manipulated the vertebrae in predetermined directions, using the same listing over and over. We were taught that if the vertebrae popped and the patient felt better, we had done our job. I eventually decided that the subluxations we were supposed to be adjusting did not even exist. It mattered little which vertebrae I adjusted. It was necessary only to loosen the spine with general manipulative techniques that were comfortable for the patient. Popping the vertebrae had a powerful placebo effect, producing “miraculous cures.”
In the clinic, there were rows of cubicles, each cubicle containing only a treatment table. There were no physical therapy modalities or treatment aids of any kind, not even a heat lamp or a compression bandage. A few enterprising interns sold vitamins to patients. Those who believed that spinal adjustments were effective in the treatment of most ailments had the most patients. Their enthusiasm, bolstered by a positive attitude, was helpful in soliciting patients. My father had already warned me that if I did not believe in chiropractic, I would not succeed in practice.
It was easy to see that the chiropractor who believed that spinal adjustment was the only treatment needed would probably be the busiest and the most successful. I had already determined that I would not use spinal adjustments as a treatment for disease. And I felt that spinal manipulation should be used primarily as a treatment for back pain. So I had a very negative attitude as an intern in the Lincoln Clinic. But before I could graduate, I had to meet my clinic requirement by seeing a certain number of patients. To do so, I would have to palpate and adjust the spine of every patient who came to the clinic, regardless of what their problem might be.
Patients were scarce at the Lincoln Clinic. In order to meet clinic requirements, we had to work on each other and solicit friends. Many of the patients we saw were regular chronic patients who returned year after year. We saw none of the diseases and infections that we were told could be cured with chiropractic adjustments. The epileptic patient I saw Dr. Firth treat in that classroom fiasco when I was a sophomore was the closest thing I saw to a patient who really needed help. Few patients were acutely ill or painfully injured; most had the subjective symptoms of a chronic problem. I was a doctor by proxy, based on classroom instruction.
Starting Practice on a Shoestring
With my Certificate of Proficiency in the Basic Sciences in hand, I journeyed to Miami, Florida, where I took the Chiropractic Board's examination. In January 1956, the State Board of Chiropractic Examiners awarded me a "License to Practice Chiropractic in the State of Florida." I graduated from Lincoln Chiropractic College 11 days later. I had survived a four-tear attempt to indoctrinate me in a false theory . I would not be able to practice the way I had been taught—the way my fellow graduates would be practicing. I planned to offer a unique service by combining manipulation with physical therapy as a treatment for back pain in a way that would benefit patients and fit with mainstream health care. But I felt like I did when the Navy handed me my discharge papers: I was unsure about my future and my ability to fit in and earn a living.
Taking over my father's practice was not an option. When I graduated from Lincoln College, licensure in Alabama required a medical degree. Only two chiropractors with medical credentials had ever been licensed; all the rest, about 300, were not licensed and practiced illegally. Many of them were little more than quacks. Chiropractors would not be licensed in Alabama until 1959, with a grandfather clause to allow my father and other old-timers like him to continue practicing.
With my sights set on practicing on the Gulf Coast in Panama City, Florida, and already fully licensed, I had everything I needed but money. I applied for a few jobs with the idea that I might work for several months and save a little money. But when these applications fell through, I knew that I would just have to start on a shoestring and keep my fingers crossed. I had saved several hundred dollars that might be enough to get me through the first few months, until I could establish a practice. I had to try. I worried that I might not be able to make enough money to sustain my practice, much less get married and support a family.
My worries were justified. During my early years in practice, I was barely able to withstand the stigma and the poverty involved. During my 43-year career, I criticized improper chiropractic practices and often was shunned by my colleagues. I finally succeeded by earning the respect of patients as well as the local medical community. Today, although chiropractic schools have improved considerably, the profession remains marginal because it has not renounced its basic concepts that have been rejected by the scientific community. For this reason, I cannot recommend that anyone invest the time and money needed to earn a degree in chiropractic.
Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida. This article was excerpted from his privately published autobiography.
This article was revised on January 2, 2012.