subluxation to the stage of chronic disease with which the patient
usually approaches the Chiropractor for relief, disease develops by a
series of gradual steps. Successive changes take place from time to
time in the degree of subluxation as it is augmented by further jars,
strains, etc., or by the reaction of secondary causes upon it and with
these changes come corresponding changes in the development of the
disease.
Perhaps the first effect of the bad subluxation is irritation of a
nerve and acute functional disturbance such as pain, fever, etc. The
later effect may be paralysis and its attendant train of evils.
When the Chiropractor begins adjustment he does not at once return the
long-displaced and misshapen vertebra to its normal position. He merely
_tends_ to do so, his adjustments making slight and gradual changes
from the abnormal back to normal.
Thus it is that the subluxation passes back in reverse order through
the successive stages of its development, following a process which
may be called the involution of the subluxation. At the same time
the morbid process resulting from the subluxation tends to retrace
its steps, passing in reverse order through the stages by which it
developed. Pains which have not been felt for years may unaccountably
return under the reawakening of the long dormant nerves. Headache, long
absent but once a prominent feature of the disease, may again make its
appearance. The patient _feels_ worse.
These changes, however, take place much more rapidly during the
correction than during the development of the disease. To a certain
extent they are probably always present, although in many cases they
occur so rapidly or are modified so much by changed environment as to
be unrecognizable. In many cases it is possible by securing an accurate
history and by careful observation of the patient’s progress to
observe a definite reappearance, in reverse order, of every important
event in the history of the disease. For instance, if the patient has
at one time had a severe fever, perhaps lasting many weeks, and has
later developed a chronic weakness marking the increase in degree of
subluxation, the fever may reappear during adjustments, last a day or
two, and disappear forever, having been corrected beyond that stage.
If explained in advance to patients with chronic diseases, the facts
of retracing may not cause the patient to become discouraged as he
would if he failed to understand them. If he knows before your work is
commenced that he may expect such phenomena but may possibly escape
them he meets them as necessary parts of the process of cure. If they
are not explained in advance he is likely to feel that you are doing
him injury and to discontinue your service just at the time he most
needs them. In fact, it occasionally happens that if adjustments are
stopped at some irritant stage of the cure that condition will remain
and do great damage.
This theory of retracing has been much abused. Chiropractors have used
it to cover a multitude of errors in practice. With some it becomes a
habit to call all unfavorable events which occur during adjustments
retracing, thus shifting the blame from their own shoulders to
Nature’s. This is a pernicious practice because it deceives the patient
and also because too frequent repetition of this explanation finally
deludes the practitioner into the belief that all such events really
_are_ retracing. This view withdraws his attention from his own technic
and he ceases to discover his own mistakes by ceasing to look for them.
It is best in the face of any painful or apparently unfavorable
development always to examine our own work thoroughly to detect any
possible error in diagnosis, palpation, or selection of move for
correction. It is always possible for us to err and our cases should be
observed at every stage with the most minute care to insure accuracy in
detail.
Limitations of Chiropractic
There are many things which can be done better by others than by a
Chiropractor. There are others for which the Chiropractor’s training
does not fit him at all and to which his methods do not in any
sense apply. Knowledge of these limitations is just as essential as
acquaintance with the powers of the vertebral adjustment.
Bony dislocations other than vertebral, fractures, wounds causing, or
likely to cause, hemorrhage or severe internal injury, should at sight
be diverted into the hands of a surgeon. The Chiropractor receives no
training in handling such cases and has neither legal nor moral right
to attend them. In obstetrics likewise no practical training is given
which would prepare the practitioner for delivery and he is unprepared
to use necessary asceptic or antiseptic measures.
Some individual cases of disease usually curable will have advanced
so far as to require surgical interference. Abscesses or suppurative
diseases internally located or having any liability to discharge
internally must be avoided. Gangrene, cancer, the advanced stages of
tuberculosis (usually) are incurable.
Quarantinable diseases as a class yield readily to adjustment unless
some serum treatment has been administered, when the chances of
recovery are greatly lessened. But such cases must be reported in
conformity with the laws of the state and will probably then be taken
out of the hands of the Chiropractor--unfortunately. The laws of the
various states should be modified to permit Chiropractors, with
precautions required of physicians to safeguard the public health,
to pass quarantine. Every effort should be put forth to secure such
legislation but until it is secured in any state and the Chiropractor’s
work is brought under the supervision of the authorities, the laws must
be respected strictly.
Syphilis and gonorrhoea, communicable diseases, should be recognized
and refused in practice. The former in the primary and secondary stages
(not tertiary) and the latter in all stages is corrective by adjustment
but the liability of transmission of the disease warns against contact
with it unless all precautions known to science be used to avoid
possible transmission.
Congenital anomalies of structure do not yield to Chiropractic and are
best let alone although no harm is likely to arise through any attempt
to correct them by vertebral adjustment.
Relation of Chiropractic to Other Methods
There are certain other methods which present a superficial resemblance
to Chropractic which leads many to believe them closely related. Such
methods are Spondylotherapy, Osteopathy, etc. There is a system called
Napravit or Naprapathy which may be dismissed with the statement that
it is Chiropractic, renamed.
Spondylotherapy, on the other hand, is a system of treating disease
which takes no account of the vertebral subluxation as its primary
cause and seeks to cure disease by stimulating or inhibiting nerve
action through the use of mechanical, thermic, or electrical means.
Its resemblance is due solely to the fact that most of the treatment
is applied to the spine. As well might we say that serum injection for
meningitis is Chiropractic because the serum is introduced by lumbar
puncture into the spinal canal.
Osteopathy, since the profession has become aware of the superior
results obtainable by vertebral adjustment, is rapidly adopting many
Chiropractic methods and counterfeiting it as far as possible. Perusal
of their literature of various periods clearly shows that this is a new
growth and that they have never adopted in theory what they sometimes
use in practice. In fact both the above methods _treat disease_,
following the theory of medicine with the use of different remedies
only, while Chiropractic _adjusts the cause_ of disease and avoids
treatment of any kind. Chiropractic is not a branch of medicine, never
can be a branch of medicine because it is inherently and fundamentally
antagonistic to the very basic principles of medicine, and no statute
can change the fact of such antagonism. But unless we adhere strictly
to the fundamental principles of our own practice and limit ourselves
to the methods which grow from those principles Chiropractic _may
become_ a part of medicine. Which brings us to
The Use of Adjuncts
There are many methods of treating disease which are more or less
beneficial to the patient just as there are some which are always
injurious. Shall we employ such of these methods as are beneficial as
adjuncts to the practice of Chiropractic? Or shall we adhere to the
principle that the treatment of disease is erroneous and the adjustment
of its cause the only logical method of procedure? There is much to
be said on both sides of this question which has so long agitated the
profession.
In the class of beneficial adjuncts may be placed massage,
hydrotherapy, spondylotherapy, dietetics, osteopathy, Christian
Science, suggestive therapeutics, mechano-therapy, and many others.
Each of these has its field of usefulness; each taken alone is
productive of some good in some cases at least. Each might possibly
augment the results of Chiropractic, or hasten them in some cases,
if judiciously used. By judiciously used we mean the avoidance of
any method which would in the least interfere with proper vertebral
adjustment or its results or which might carelessly cause subluxation.
Osteopathy and mechano-therapy frequently cause subluxation because of
the ignorance on the part of their users; they need not do so.
Among the pernicious adjuncts, or those which are harmful if combined
with adjustments or harmful whenever and however used, may be mentioned
drug medicine, serum therapy, and electricity. The first two may
sometimes prove the lesser evil if used alone. With Chiropractic they
are always unnecessary and always tend to lessen the good effect
of adjustments. The latter alone is beneficial but in combination
with Chiropractic proves a double stimulant to the nerves and should
be avoided. The effect of these methods when used with Chiropractic
can never be accurately predicted. One can only be certain that some
unfortunate effect will follow.
As a secondary consideration the Chiropractor has neither legal nor
moral right to practice medicine unless he has received a state license
to do so.
Having admitted that the forms of “mixing” indicated as beneficial to
the patient may be sometimes justifiable on the score of immediate good
to the patient, let us consider another side of the question.
Just as surely as we admit into our practice any method which attacks
the disease itself, or which treats any other than the primary cause of
the disease, or which seeks to stimulate or inhibit the functions of
the body without freeing the natural channels through which the natural
healing power of the body should be manifested, just so surely are
we adopting the medical theory and making our profession a branch of
medicine. Medicine uses many remedies for the cure of disease. Medicine
is now broader than the mere administration of drugs. And no matter how
we vary the remedy, or what treatment we select, we are denying the
truth of the Chiropractic theory and admitting the truth of the medical
principle when we use adjuncts in our practice.
Nor are these adjuncts necessary. It has been demonstrated by repeated
observations that the Chiropractors who use only the vertebral
adjustment secure just as high a percentage of results as those who
combine one or more other methods with it. This is due to various
reasons: the greater perfection attained in Chiropractic by those who
apply themselves with concentration to the task of settling every
problem by that means; the fact that adjuncts often detract from the
effect of adjustment as much as they add results of their own; the
tendency of the patient to prefer and to insist upon the easier and
less painful methods rather than the adjustment.
The lay patient and the ignorant public are inclined to give credit for
results obtained to the best known method used upon them. Thus in spite
of the fact that Chiropractic alone obtains a far greater percentage
of results than any other combination of methods, the patient is prone
to believe that the change of diet or the massage effected a cure and
to overlook entirely the least pleasant part of his “treatment,” the
adjustment. He does not understand and cannot understand with a mind
divided for the consideration of several methods, the connection of the
spine with his disease. Often he fails to understand if Chiropractic
is used alone but he is forced to conclude that the spine _has_ such
connection because adjustment of the spine cured him.
The use of adjuncts has done more to hold back the advance of the
profession in the public mind than any other single factor except
ignorance within the profession. Furthermore, the Chiropractor who
knows that he can rely upon various other methods if his adjustment
fails does not feel impelled to _study his Chiropractic_ as he should.
He weakens in practice, relying more and more upon adjuncts.
It has been repeatedly proven that the Chiropractor who uses _only_
Chiropractic becomes the better practitioner by necessity. It has also
proven that the man who is expert in Chiropractic needs nothing else,
providing only that he refuses those cases to which Chiropractic cannot
apply at all.
The only _real_ problem in Chiropractic is the problem of _adjustment_.
All failures may be attributed either to lack of knowledge and proper
application of Chiropractic or to the fact that the patient has
not vitality enough to recover from the disease. Do not shift the
responsibility for failure upon the system, since with one or two
exceptions every known disease has been cured by _some_ Chiropractor,
thus proving its possibility. Realize that the work can be done and
that its doing depends upon your own skill in diagnosis and technic.
It is inevitable that at some future time Chiropractic will be used
in connection with other beneficial methods which will enable us to
get results _sooner_, though not more surely. It is also inevitable
that Chiropractic will fail to receive its proper place among healing
methods unless we force the world to believe in it as we believe; to
know it as we know it. If we develop our system in its purity until
it obtains general recognition at its true valuation we shall have
accomplished an infinite good for humanity for all time.
We should endeavor to accomplish the greatest good for the greatest
number, laboring rather for the ultimate recognition of the subluxation
theory and its application at its real value than for immediate slight
good or personal gain.
Personality
He who would succeed in Chiropractic must have, in addition to a
thorough education in his profession, a proper personality. This is
the medium through which his education becomes effective, the channel
through which he reaches the public, gaining their confidence and
approval that he may utilize his knowledge to their good. Many skillful
and well-educated practitioners have failed because they lacked the
proper personal qualities for attracting patients.
Elements of Personality
The most essential elements of a proper personality are Courage,
Conviction, Confidence, Honesty, Sympathy, and Aggressiveness.
Courage, not recklessness or carelessness but a fearless willingness to
assume responsibility--the heavy responsibility of our profession--is
indispensable. He who accepts the easy case or the chronic and slowly
progressive one and refuses to face the appalling rush of a dangerous
and acute malady; he who shrinks through fear for his reputation from a
grave risk, has no right in Chiropractic. He has mistaken his calling.
While we acquire the knowledge of Chiropractic we acquire also a great
responsibility for its use; we must utilize it wherever and whenever
it is best for the patient, whenever our chances of effecting a cure
are the best chances, without regard to ourselves or any personal risk.
By _conviction_ is meant a firm and well-grounded _belief_ in the
greatness and efficiency of Chiropractic. Sincerity in one’s practice
is a prime requisite for success. A belief grounded in _knowledge_
girds the Chiropractor with an armor so strong that no adversity can
pierce it. He who practices Chiropractic without believing in it is in
his own mind a cheat and a fraud and cannot expect ultimate prosperity.
Confidence in one’s own ability and knowledge, in one’s power and skill
to contest with disease, begets confidence in others. Not conceit, not
exaggerated egotism, but a healthy and sane assurance and faith in
oneself, engender that steadiness of mind and of hand which make for
accuracy and excellence.
Without honesty with oneself, one’s profession, and one’s patients, one
forfeits public confidence--and justly. If we promise that which we
cannot perform, if we deceive our patients by misleading explanations
of untoward events, we deserve failure. It is not intended here to
refer to the cheerful and optimistic manner and habit of speech which
often aids in the sick room to keep the patient’s mind at rest. This
may sometimes deceive the patient as to the gravity of his condition
and such deceit may be justifiable; but it should never be extended to
the family or to those who have a right to know the real condition and
cannot be harmed by such knowledge. Strict honesty, whenever harmless
to others, should be the fixed policy of all practitioners.
The weak, strained minds of the very ill require and demand _sympathy_;
not the sort which expresses itself in fixed words or phrases of
condolence with the unfortunate and at once forgets their needs and
sorrows, but the deeper, unspoken feeling of desire to aid, which
springs from the heart and finds its best expression in active
assistance. If you do not care whether your patient is or is not
benefited, if you have no other feeling for him than a business
interest in holding a case, you lack the strongest impulse to hard work
and study, the desire to aid.
Chiropractic is new. Its principles are yet unknown to the general
public. Also this is an age of keen competition and it is our duty
to our profession and to the world that instead of hiding our light
under a bushel we proclaim our mission to all who will hear. We must
be intelligently and wisely _aggressive_. We must bring ourselves into
contact with the public in every legitimate way, compelling it by force
of logic and personality to see the reasonableness and greatness of our
work.
Question yourself in regard to these things. Examine your own
characteristics to discover whether any of these essential elements
of personality are lacking. If one be found wanting cultivate it
assiduously. Having chosen Chiropractic as a life vocation, _work at
it_ not alone for the acquisition of ever-increasing knowledge but for
the unfoldment of a powerful and winning personality.
CHIROPRACTIC PROGNOSIS
=Prognosis= is the determining, in advance of the fact, of the probable
course, duration, or outcome of a disease. A Chiropractic prognosis is
a prediction as to the changes which will take place in a case during
and after Chiropractic adjustments.
=General Prognosis= is an opinion expressed of a disease without
reference to any particular case. It is based upon the experience of
the profession and the average result obtained with the disease. It
furnishes only a basis for consideration of the =special prognosis=
of an individual case. This latter must be based upon the general
prognosis of the disease and upon study of every modifying factor
present in the case, as general vitality, living habits, facility of
adjustment, apparent response to early adjustments, and especially
an estimate of the amount and kind of damage done to tissue and the
probability of its repair.
Only general prognosis can be set down as a guide to others. To state
even this with certainty and safety many precautions must be observed.
All cases included as a basis of conclusions must be handled under
standard test conditions (see index) as far as may be; in accepting
the observations of others one must be sure that they are sufficiently
trained and sufficiently careful and veracious to render their
statements reliable.
In order to introduce the subject to the literature of the profession
and to invite comment and discussion looking toward the ultimate
development of a complete Chiropractic prognosis we shall set down,
without further preliminary, the general prognosis of those commonly
described diseases concerning which we feel qualified to speak. No
statement is made without the gathering of reliable evidence.
GENERAL PROGNOSIS
=Abscesses.=--Those abscesses which would tend to discharge externally
may be adjusted for with success and will rapidly develop, point, and
discharge, with quick recovery. Those which might break internally
absolutely forbid adjustment because of the almost certain occurrence
of peritonitis, pyaemia, or other grave condition.
=Acne.=--Good, but usually slow.
=Addison’s Disease.=--Few cases reported, and these slow cures.
=Adenoids of Pharynx.=--Prognosis so good as to contraindicate
operation in every case. The lymphoid growths gradually and slowly
absorb under adjustment.
=Adiposis Dolorosa.=--Only one case seen, the Derkum case. This reduced
in six months of adjustment from 360 to 280 lbs. in weight, and was
improved in every particular. No final report received.
=Alcoholism.=--Adjustments greatly aid a cure if alcohol be
discontinued at once, or if the daily consumption is gradually and
steadily decreased. No permanent cure can be secured without the aid of
the patient. Acute alcoholic intoxication may be lessened at once by
the aid of a single adjustment.
=Amenorrhoea.=--Prognosis excellent. One to several months required.
Conservative amenorrhoea, as in tuberculosis or other wasting disease,
disappears only with the occasion.
=Anaemia.=--If primary, yields slowly but surely. Secondary anaemia
depends upon some disease process and its prognosis is that of the
disease which produces it.
=Angina Pectoris.=--A case for careful diagnosis. False angina
recovers with general building of nervous system. True angina,
usually associated with arteriosclerosis, is frequently fatal and
death may occur during any adjustment. If this does not happen most
cases recover, though slowly. Let me repeat, there is great danger in
handling true angina pectoris.
=Anidrosis.=--Usually responds to adjustments for the kidneys.
=Ankylosis.=--Almost any ankylosis, except that in which there is
gross deformity of the bones, would yield to repeated applications
of force along right lines. Only vertebral ankyloses are amenable to
Chiropractic adjustment and those are usually broken in time.
=Anterior Poliomyelitis.=--Chiropractic experience with “infantile
paralysis” has been very extensive and gratifying. During the febrile
stage the disease may be aborted by one or several adjustments with
only slight and transient paralyses resulting. The chronic paralysis
which follows an unadjusted case is curable, but restoration of the
motor function and trophic tone of the paralyzed members is delayed
while the ventral horn cells are regenerated, the axons rebuilt, and
the atrophied muscles redeveloped. Often no apparent results will be
obtained for one or several months, after which gradual improvement
progresses to a complete cure.
=Aphonia.=--Prognosis excellent. No failures reported.
=Apoplexy.=--The occasional case in which a premonitory partial
paralysis precedes real hemorrhage responds remarkably to adjustment
so that with care the hemorrhage may be averted. After hemorrhage the
absorption of the clot is slow and tedious, but about 50 per cent
recover.
=Appendicitis.=--In the early stages of the acute form, and in nearly
all chronic cases, recovery is almost certain under adjustments. Signs
of suppuration indicate immediate operative interference and drainage,
and failure to read the signs may lead to rupture, peritonitis, and
death. Acute cases yield very quickly as a rule.