Articles by JCS
The Sixteen Major Events in Chiropractic History
WALTER I. WARDWELL*
*Professor Emeritus of Sociology, The University of Connecticut
Delivered at the Chiropractic Centennial, Washington, D.C., June 61 1995
Address correspondence to Dr. Walter Wardwell at 33 Oak Hill Road, Storrs, CT 06268
1996 Association for the History of Chiropractic, Chiropractic History Vol. 16, No. 1-1996
Reprinted with permission of the Association for the History of Chiropractic
A centennial is the time for chiropractic to take stock, review its past, and plan for the future. "Major events" are those that define what chiropractic has become, turning points or obstacles overcome, without which chiropractic would not be what it is today. I identify what I consider the sixteen most important events in the chiropractic history, note relevant names and dates, place each event in its historical context, and discuss its significance. I discuss the events chronologically rather than in order of their importance.
The "discovery" of chiropractic by Daniel David Palmer (DD) in 1895 is of course the starting point. His evolution from magnetic healing to chiropractic was not instantaneous but gradual. It resulted partly from the astute observations he made when practicing magnetic healing and also from his sound and detailed knowledge of anatomy, physiology, neurology, and pathology. Self-educated in these fields, he had read widely and well understood the best medical and scientific works of his time. From them he developed a theory and a philosophy to explain his clinical successes.
DD accepted his first student in 1898 and soon was graduating students from his Palmer School and Infirmary both to practice and teach chiropractic. After being jailed in 1906 for practicing medicine without being officially registered, he sold the school to his son Bartlett Joshua Palmer (BJ) and moved West, where he later began the schools in Oklahoma, Oregon, and California, some with MDs, but with little success. His fame now rests primarily on his 1000 page magnum opus, The Chiropractor's Adjuster: A Textbook of the Science, Art, and Philosophy of Chiropractic for Students and Practitioners (1910). Clearly his "discovery" and elucidation of chiropractic in his writings is the beginning and the most important event in chiropractic history.
The second most important event was arrival on the academic scene of DD's only son-Bartlett Joshua Palmer (BJ). The title BJ gave himself-"Developer" of chiropractic-describes exactly what he did. He developed the science, art, and philosophy of chiropractic in new directions, and he developed the Palmer School of Chiropractic into the largest health practitioner college in the nation, which by graduating thousands of chiropractors. Without BJ chiropractic might not have survived. He made chiropractic into a distinctive profession. A colorful multimedia salesman for chiropractic, he used lectures, pamphlets, 27 books, and his own radio station to spread the word about chiropractic to students, patients, and the public. He also published a successful text on radio salesmanship (1942).
Charismatic in the extreme, he motivated students to want to save the world through chiropractic and to become martyrs if necessary. He traveled the country testifying before courts and legislatures on chiropractic's behalf.
The third major event in chiropractic history was the trial of Shegataro Morikubo in 1907 in La Crosse. Wisconsin, who was charged with practicing medicine and osteopathy without a license. BJ rushed to his defense and retained a prominent attorney-Thomas Morris-to defend him and chiropractic. Morris persuaded the court to amend the charge to "practicing osteopathy without a license," argued that chiropractic is not osteopathy but a new and different mode of treatment. The jury quickly acquitted Morikubo. Morris based his argument on A Textbook of Modernized Chiropractic by Solon Langworthy. Oakley Smith, and Minora Paxton (1906), which differentiated chiropractic from osteopathy, first used the terms "subluxation" and "vertebral foramina," and first referred to the supremacy of the nerves in contrast to the osteopathic claim of supremacy of the blood. BJ began changing his chiropractic philosophy to incorporate these new principles, referring to the brain as the "source of all nerve force." When he republished The Science of Chiropractic: Its Principles and Adjustments, which he had co-authored with his father in 1906, he dropped his father's name as co-author, changed the title to The Science of Chiropractic: Its Principles and Philosophies (1910) and incorporated in it the new straight philosophy of chiropractic that he continued to develop throughout the rest of his life.
Simultaneous with the Morikubo trial and BJ's rivalries with Langworthy were several related developments: the Palmers rushed out their 1906 text so as to compete with the earlier Langworthy text; they began a new chiropractic journal, The Chiropractor to compete with Langworthy's Backbone; and organized the Universal Chiropractic Association (UCA) to rival Langworthy's American Chiropractic Association. Although Langworthy's school, journal, and association did not last long, their impact on chiropractic was therefore very great. BJ retained Tom Morris's law firm as legal counsel for the UCA, which by 1915 had 2500 members and by 1927 had defended chiropractors in 3300 court cases. BJ became UCA's permanent Secretary and "Philosophical Counsel." Although he had stated his opposition to licensing in 1912 (Martin 1918,70-71), he later testified for licensure in many states. His legislative strategy was to insist that chiropractic is neither medicine nor osteopathy but a new and different system of healing that required its own licensing boards, examinations, and colleges. He (1958) went to extremes in arguing that chiropractic is the antithesis of medicine:
"The dividing line is sharply drawn; anything given, applied to, or prescribed from outside-in, below-up, comes within the principle and practice of medicine. None of this does Chiropractic do! Our principle is opposite, antipodal, the reverse, for everything within the chiropractic philosophy, science and art works from above-down, inside-out. Anything and everything outside that scope is medical whether you like it or not."
The Morikubo court trial and Morris's rationale for distinguishing chiropractic from osteopathy started BJ on his straight philosophical journey in which he always insisted on "s, p, and u" (specific, pure, and unadulterated) straight chiropractic.
The fourth major event in chiropractic history was the impact that Willard Carver had on the profession. Educated as a lawyer, he was a friend and sometime legal advisor of DD. But because he disliked BJ, he chose to study chiropractic at Charles Ray Parker's school in Ottumwa, Iowa, graduating in 1906. Carver taught a broad "structural" approach to chiropractic, naming himself the "Constructor" of chiropractic. He called his college in Oklahoma City, which in 1908 was the first to receive a state charter, the "Science Head" in contrast to Palmer's Fountainhead." He established other colleges in New York City, Washington, D.C., and Denver, the last of which became the University of the Natural Healing Arts and awarded doctoral degrees in chiropractic, naturopathy, and physical therapy. Author of eighteen books, some on psychology, Carver exerted great influence on the new profession.
The fifth major event was precipitated by John F. Howard, who resigned from the PSC faculty because he felt its curriculum was deficient in chemistry and human dissection. He organized the National School of Chiropractic in Davenport in 1906 and moved it to Chicago in 1908. After bringing MDs onto the staff, he sold the school in 1914 to one of them-William Charles Schulze. By 1912 the school had added physiological therapeutics (the forerunner of modern physical therapy) to its curriculum. The National College of Chiropractic later became one of the strongest "mixer" schools and as such was the special target of BJ's invective. In 1940 its president Joseph Janse and Frederic Illi began publishing their research on spinal and pelvic mechanics, explicating the functioning of the sacroiliac joint. From 1943 to 1915 Illi continued this pioneering research in Geneva at his Institute for the Study of the Statics and Dynamics of the Human Body, which his son Claude still heads. Joseph Janse remained the leader of mixer chiropractors until his death in 1985.
The sixth major event involved another disaffected PSC faculty member-Joy M. Loban-who had been personally selected by BJ to teach his beloved philosophy course. In 1910 Loban led 40 to 50 students from his classroom and organized another Davenport school-Universal Chiropractic College. In 1918 he merged, it with the Pittsburg Chiropractic College, and with Leo J. Steinbach as Dean pioneered in research in the early 1920s using upright full-spine x-rays.
The seventh major event involved the activities of Tullius Ratledge in California. A student of Carver and an employer of DD for a short time, he wrote:
“I was fortunate in knowing D.D. Palmer and having the fundamentals from Dr. Carver. I was in position to compare their thinking patterns. I believe their thinking was more similar than any of the other school men.” (Smallie 1990,48)
However, he also wrote: “From 1913 until the time of his passing, I regarded B.J. Palmer as the President of the Chiropractic World.” (Smallie, 1990,44) He moved his college from Kansas to Los Angeles and was its president until 1955, when Carl Cleveland purchased it and renamed Cleveland Chiropractic College. A powerful voice for straight chiropractic in California, Ratledge served seventy-five days in jail in 1916 and was active in the 1922 statewide public referendum which won chiropractic licensure after the Alameda Chiropractic Association adopted the slogan "Go to jail for chiropractic" rather than pay a fine. In one year 450 chiropractors marched to jail singing "Onward Christian Soldiers." After victory in the referendum Governor Fred W. Richardson pardoned all the chiropractors then in jail because he believed they had been "unjustly accused. " The Los Angeles Chiropractic College absorbed 13 other colleges in its struggle to survive as the preeminent mixer school in California.
The eighth major event was not a step forward but a disaster for BJ and his leadership of the profession. Dossa Evins, a Palmer graduate and an electrical engineer, had developed a diagnostic instrument to measure heat differentials on the skin between the two sides of a vertebra. Called the neurocalometer, or NCM, it was designed to identify scientifically the "hot boxes" caused by a subluxation. BJ decided to market it to the profession on a rental basis and summoned his supporters for a startling announcement at the 1924 Lyceum (homecoming) and UCA convention. Insisting that his loyal supporters use the NCM, he wanted no one on his faculty who opposed it. The cost was variously reported as from $1200 to $500, plus a monthly rental charge of $5. Although over 2000 NCMs were leased within the first year, many chiropractors became disaffected and refused to use it. Four of his strongest professors-Stephen Burich, Harry Vedder, James Firth, and Arthur Hendricks, all authors of widely used chiropractic texts-left PSC and formed the renowned Lincoln College in Indianapolis. Within five years PSC suffered a decline in enrollment to 400, while Lyceum attendance dropped from over 8000 in 1921 to 700 in 1926. At the same time Morris Fishbein became Editor of the Journal of the American Medical Association and began his vitriolic anti-chiropractic campaign.
BJ never regained his dominance of the profession. Although he remained its titular head and continued to publish books and tracts, he took a world tour and concentrated mainly on his business ventures. In the early 1930's he developed a new treatment doctrine focused on upper cervical adjusting which he called HIO (hole-in-one). And he established the B.J. Palmer Chiropractic Clinic in 1935 to treat difficult referred patients and to carry out chiropractic research; it gathered and published reams of data but little solid research. (Palmer, B.J. l95l; Quigley 1988) He staunchly resisted increasing the curriculum to four years until 1949. Although he continued as president until his death in 196I, he left day-to-day administration of the school to others. Nevertheless, many chiropractors still consider Palmer College the Fountainhead of chiropractic.
The ninth major event in chiropractic history was organization of the National Chiropractic Association (NCA) in 1930 and its later impact. It resulted from a merger of a mixer American Chiropractic Association. Organized in 1922 by Frank Margetts, with the remnants of the UCA, which BJ had left in 1926 to form the Chiropractic Health Bureau. The new NCA quickly became the largest national association as it moved to defend arrested chiropractors, to improve education, and to work for better licensing laws and public relations. In 1941 BJ renamed the Chiropractic Health Bureau the International Chiropractors Association (ICA), which is still the principal organization of straight chiropractors. An effort to merge the two national associations in 1963 resulted in a new American Chiropractic Association (ACA) and a smaller ICA. In 1981 a new effort to merge the ACA and ICA produced great expectations and their first joint national convention, but the ICA, led by Sid Williams, voted down the proposal and remains separate. Hence the straight-mixer split keeps chiropractors divided organizationally, although their cooperation on political issues has improved.
The tenth major event, actually a series of events, is the continuing improvement in student education. Early chiropractic education was poor. Even the 18-month course did not become standard until about 1920. By 1932 the four-year program existed at Lincoln, Western States, and National. The NCA established its Committee on Educational Standards in 1935 and appointed as its chairman Claude O. Watkins, a Montana practitioner with a vision of a chiropractor as a physician-scientist. Watkins condemned cultism and pushed for more clinical research with the colleges taking the lead, but became frustrated at the lack of response. In 1941 John Nugent became Committee chairman and NCA's Director of Education, and in that yet NCA provisionally approved twelve colleges under criteria established by Nugent (1946). Russell Gibbons (1985) has labeled Nugent the "Abraham Flexner of Chiropractic" because for many years he traveled the country encouraging colleges to teach four years of nine months each, to become non-profit and professionally-owned, and to strengthen their faculties, facilities, and clinics. He persuaded many colleges to dissolve or merge, and eight colleges received full accreditation. In 1947 the Committee was renamed the Council on Chiropractic Education (CCE), and in the 1950s it made the four-year curriculum standard. The two-year pre-professional requirement, which had been established by William Alfred Budden at Western States in 1953, and later by Frank Dean at Columbia Institute in Baltimore, was adopted by CCE in 1968. Currently at least three states require a bachelor degree prior to a four-year course for licensure.
In 1974 the U.S. Office of Education recognized the CCE as the official accrediting agency for all chiropractic colleges, a result of the strenuous efforts of Joseph Janse at National, George Haynes at Los Angeles, Jack Wolfe at Northwestern, and Orville Hidde, an attorney-chiropractor from Michigan. When the ICA accepted its designated seat in CCE in 1980 (after PCC was accredited), CCE's status was consolidated. Accreditation by regional associations of schools and colleges was achieved by most chiropractic colleges after they began offering B.S. degrees in biology and M.S. degrees in anatomy, nutrition, and/or sports chiropractic.
The eleventh major event in chiropractic history was the long campaign by the American Medical Association (AMA) to "contain and then eliminate chiropractic.” It began in the 1920s and accelerated in 1963 when the AMA established its Committee on Quackery (first named the Committee on Chiropractic). After chiropractors sought inclusion by Congress in Medicare, the AMA in 1968 masterminded a "stacked" investigation by the U.S. Surgeon-General (Cohen 1968) which recommended that chiropractic not be included, arguing that chiropractic is "not based upon the body of basic knowledge related to health, disease, and health care that has been widely accepted by the scientific community," and that "the scope and quality of chiropractic education do not prepare the practitioner to make an adequate diagnosis and provide appropriate treatment." The AMA next launched an aggressive chiropractic campaign in media such as Reader's Digest, Consumer Reports, Good Housekeeping, and other widely read periodicals, and it sponsored Ralph Lee Smith's At Your Own Risk: The Case Against Chiropractic (1969). It even persuaded non-medical groups like the American Bar Association and the elderly to join in condemning chiropractic.
The AMA's vitriolic campaign against chiropractors brought the ACA and ICA closer together in the political arena. Jointly they published Chiropractic's White Paper on Health, Education, and Welfare Secretary's Report (1969), contesting its data and conclusions. In 1983 they held their first joint Legislative Conference in Washington, D.C. Various health care proposals have further united them to fight against threats to the profession.
The twelfth major event in chiropractic history was the NINDS Conference, held at the National Institutes of Health (NIH) in Bethesda, Maryland, in 1975. The U.S. Congress had urged that up to $2 million be used for an "independent, unbiased study of the fundamentals of the chiropractic profession," and for the first time in history leading scientists and clinicians-MDs, osteopaths, and chiropractors assembled to discuss spinal manipulative therapy (SMT). On the way to the conference the topic was changed from "chiropractic" to "SMT," which gave osteopathic and medical practitioners an acceptable role to play. Most of the 40 participants agreed that spinal manipulation (Goldstein 1915,6) “provides relief from pain, particularly back pain, and sometimes cure, and may be dangerous, particularly if used by non-physicians; . . (there was) a difference of opinion focusing on the issues of indications, contraindications, and the precise scientific basis for the results obtained.”
Apart from the scientific exchanges and conclusions, even more significant was the fact that the meeting took place at all. In the following years additional interdisciplinary conferences on the spine resulted in significant publications edited by Buerger and Tobis (1977), Korr (1978), Haldeman (1980), and Greenman (1984). An MD organized the American Back Society in 1982 to promote interdisciplinary conferences of MDs, osteopaths, chiropractors, and physical therapists. In the following decade began true interdisciplinary research and the awarding by NIH of significant grants to chiropractic colleges for research on chiropractic scientific principles. Also began recognition of chiropractic's benefits (Pran et al.).
The thirteenth major event in chiropractic history, a most significant one, was victory in the anti-trust suit launched in 1976 by Chester Wilk and several other chiropractors against the AMA and ten other medical organizations (Wilk et al vs. AMA et al. 1976). It took fifteen years, two court trials, two appeals, and two petitions to the U.S. Supreme Court to find the AMA guilty of violations of the Sherman Anti-Trust Act in a criminal conspiracy in restraint of trade for preventing MDs from interacting professionally with chiropractors. In response to the suit the AMA in 1980 adopted the first major revision of its code of ethics in 23 years, permitting MDs to have all kinds of professional relationships with chiropractors.
However, Judge Susan Getzendanner in 1991 noted that the AMA had not really changed its stance and that an injunction to desist was necessary and she required the AMA to publish her decision. (American Medical News, January 13, 1992). Although the AMA has ceased its most blatant anti-chiropractic propaganda, it continues to allege that chiropractic theories are invalid and to oppose pro-chiropractic legislation like that which recently authorized their commissioning in the military. Since their victory in the anti-trust suit, chiropractors have achieved better relations with MDs and DOs in consultations, referrals, hospital staff appointments, students' training in hospitals, and joint collaboration in research on SMT. (see Wardwell 1992)
The fourteenth major event in chiropractic history was Congressional authorization to commission chiropractors in the military on the same basis as it does podiatrists, optometrists, and psychologists. Due to opposition by entrenched MDs, the military has been slow to commission chiropractors, but that will eventually come, as did federal acceptance of chiropractors in Medicare and Medicaid.
The fifteenth major event is the access to hospitals that chiropractors have achieved since 1985, a clear result of the Wilk anti-trust suit. Over 100 hospitals and surgical centers now have chiropractors on staff. They co-admit with an MD or DO who treats the patient's medical needs. Chiropractors give adjustments to patients and also order diagnostic tests, diets, and physical therapy. In some hospitals manipulation under anesthesia (MUA) is performed by chiropractors following anesthesia given by an MD or DO. Although many chiropractors may choose not to seek hospital privileges, those that do will learn how to collaborate with MDs and that should lead to better understanding by MDs of what chiropractors can do. When chiropractors and MDs work together the patient is the ultimate beneficiary.
A sixteenth major event was official recognition in Great Britain, Canada, and the United States of the benefits of chiropractic, which followed closely and depended upon the Mercy Conference Guidelines developed by chiropractors in 1992 (Haldeman et al. 1992). First came Meade et al (1991) in Great Britain, Manga et al. (1993) in Canada, then in 1994 release by the U.S. Agency for Health Care Policy and Research of its Clinical Guideline number 14: Acute Low Back Problems in Adults, which denigrated the use of medical and surgical interventions, bed rest, corsets and belts, and most physical therapy modalities, but recommended spinal manipulation for most cases of low back problems, along with mild analgesics, moderate exercise, and proper diet. Although the term "adjustment" was not used, that guideline was clearly the first official endorsement by the U.S. Government of chiropractic as the treatment of choice for low back pain. Hence this is the most important event in recent chiropractic history.
Buerger, A.A. and J.S. Tobias . 1917. Approaches to the Validation of Manipulative Therapy. Springfield, IL: Charles C. Thomas
Chiropractic's White Paper on Health, Education, and Welfare Secretary's Report. 1969. Cheyenne,. WY: ACA, ICA, and Council of State Chiropractic Licensing Boards.
Clinical Guideline Number 14: Acute Low Back-Problems in Adults. 1994. Washington, DC: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services.
Cohen, Wilbur J. 1968 . Independent Practitioners Under support for chiropractic students, and research grants to chiropractors from NIH.
Medicare: A Report to Congress, Washington, D.C.: U.S. Department of Health, Education, and Welfare.
Fishbein, Morris. 1925. The Medical Follies. New York: Boni and Liveright
Goldstein, Murray. 1915. (Ed.) The Research Status of Spinal Manipulative Therapy. A Workshop Held at the National Institutes of Health, Feb. 2-4, 1915. National Institute of Neurological and Communicable Diseases and Stroke. Bethesda, MD: DHEW pub. No. (NIH76-998).
Greenman, Philip E. 1984. (Ed.) Concepts on Mechanisms of Neuromuscular Functions: An International Conference on Concepts and Mechanisms of Neuromuscular Functions. New York: Springer-Verlag Vol. 16,
Haldeman, Scott. 1980. (Ed.) Modern Developments in the Principles and Practice of Chiropractic. New York: Appleton-Century -Crofts
David Chapman-Smith, and Donald Petersen. 1992, (Eds.) Guidelines for Chiropractic Quality Assurance and Practice Parameters: Proceedings of the Mercy Center Consensus Conference. Aspen: Gaithersburg, MD
Illi, Frederick W. H. 1940, The Sacro-Iliac Mechanism Keystone of Body Balance and Body Locomotion. Chicago: National College of Chiropractic.
Korr, Irvin M. 1978. The Neurobiologic Mechanisms in Manipulative Therapy. New York: Plenum Press
Langworthy, Solon M., Oakley G. Smith, and Minora Paxson. 1906. A Textbook of Modernized Chiropractic. Cedar Rapids, IA: American School of Chiropractic
Manga, Pran, et al. 1993. The Effectiveness and the Cost Effectiveness of Chiropractic Management of Low-Back Pain. Toronto: Ontario Ministry of Health
Martin, Steven C. 1918. Chiropractic Licensing in the Midwest, 1910-1920. Senior Honors Thesis in History and Science, Cambridge, MA: Harvard University.
Nugent, John. 1946. Chiropractic Education: Outline of a Standard Course. Webster City, IA: National Chiropractic Association
Palmer, Bartlett Joshua. 1910. The Science of Chiropractic: Its Principles and Philosophies. Davenport, IA: Palmer School of Chiropractic.
Chiropractic History: Radio Salesmanship. Davenport, IA: Palmer School of Chiropractic.
Chiropractic Clinical Controlled Research. Davenport, IA: Palmer School of Chiropractic.
Shall Chiropractic Survive? Davenport, IA: Palmer School of Chiropractic.
Palmer, Daniel David. 1910. The Chiropractor's Adjuster: A Textbook of the Science, Art, and Philosophy of Chiropractic for Students and Practitioners. Portland, OR: Portland Printing House
B.J. Palmer. 1906 . Science of Chiropractic: Its Principles and Adjustments. Davenport, IA: Palmer School of Chiropractic
Quigley, W. Heath. 1988. "The Saga of the Classroom Building Continues." Dynamic Chiropractic 6(10) :24-25
Smallie, Paul. 1990a. Introduction to Ratledge Files and Ratledge Manuscript. Stockton, CA: World Wide Books.
Encyclopedia Chiropractic. Stockton, CA:1990. World Wide Books.
Smith, Ralph Lee. 1969. At Your own Risk: The Case Against Chiropractic. New York: Pocket Books.
Wardwell, Walter. 1992. Chiropractic: History and Evolution of a New Profession. St. Louis, Mo: Mosby Year Book
Wilk, C.A. et al. vs. AMA et al. L916. Complaint#76C3717 filed Oct. 12 in the U.S. District Court for the Northern District of Illinois, Eastern Division.