Technic and Practice of Chiropractic

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Title: Technic and Practice of Chiropractic
Author: Loban, Joy Maxwell
Language: English
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*** Start of this LibraryBlog Digital Book "Technic and Practice of Chiropractic" ***

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TECHNIC AND PRACTICE
OF
CHIROPRACTIC

BY
JOY M. LOBAN, D. C., PH. C.

Professor of Anatomy and of Theory and Practice of Chiropractic
at the Universal Chiropractic College. Formerly
Professor of Chiropractic Analysis at the
Palmer School of Chiropractic

SECOND EDITION
_Revised and Enlarged_

PUBLISHED BY
UNIVERSAL CHIROPRACTIC COLLEGE
DAVENPORT, IOWA
1915

HAMMOND PRESS
W. B. CONKEY COMPANY
CHICAGO

THIS BOOK IS

=Dedicated=

TO THE GIRL WHO HAS BEEN MY STAFF
AND LANTERN, AIDING AND LIGHTING
ME ON MY WAY IN THIS NEW FIELD

=My Wife=

TABLE OF CONTENTS

PAGE

=Preface to First Edition= 9

=Preface to Second Edition= 11

=Introduction= 13

=Vertebral Palpation= 15
Definition 15
General Propositions 15
Habits of Palpation 15
Facts Concerning the Spine 16
Preparation of Patient 22
Position of Patient 22
The Record 23
The Count 29
Atlas Palpation 35
The Group Method 37
The Individual Subluxation 40
Palpation in Position B 46
Palpation in Position C 48
Transverse Palpation 49
Curves and Curvatures 53
Difficulties in Palpation 59
Landmarks 61
Mental Attitude 63

=Nerve Tracing= 64
Organ Tracing 64
What Nerves are Traceable 64
Suggestion 67
Place in Diagnosis 67
Technic of Nerve Tracing 68

=Subluxations= 76
Definition--How Produced 76
Law Governing Location of 78
Varieties of Subluxations 80

=Technic of Adjusting= 89
General Principles of Adjusting 89
Special Technic (Thirty-two Moves) 99
Preferable Adjustments 155

=The Cause of Disease= 165
Simple Subluxation Disease 184
Secondary Causes 185
Germ Diseases 185
Diet 192
Poisons 194
Exposure 198
Bodily Excesses 201
Inflammation 202
The Process of Cure 208
Adjuncts 215

=Spino-Organic Connection= 217
General Discussion 217
Special Nerve Connections 235
Table of Diseases and Adjustments 257

=Practice= 276
Office Equipment 277
Schedule of Examination 292
Necessity for Correct Diagnosis 298
Frequency of Adjustments 302
Specific vs. General Adjusting 303
Talking Points 306
Promises to Patients 308
Retracing of Disease 309
Limitations of Chiropractic 312
The Use of Adjuncts 315
Personality 319

=Chiropractic Prognosis= 322
General Discussion 322
Practical Prognosis 323

Preface to First Edition

This little work is offered to the profession without apology for its
brevity or its form. It has been prepared because of an immediate and
pressing need for such a guide in our colleges, and is offered abroad
under the impression that many practicing Chiropractors feel the same
need.

It is intended for handy reference and clinical use and is arranged
as systematically as possible, style being everywhere sacrificed to
utility.

The author lays no claim to the origination of any of the subject
matter of this book nor to having invented any of the movements
described under Technic of Adjusting. The arrangement and phraseology
are in the main original. The intention has been merely to condense
into practical and convenient form for students and practitioners
certain knowledge now held and utilized in our profession.

The author feels himself indebted to the entire profession for the
information embodied in this work, and to scientists of all time upon
the results of whose infinite and painstaking research are based our
present day advancement; to the many friends and co-workers whose
valuable criticisms and suggestions have aided in this labor; and to
his students, past and present, who have furnished the necessary
encouragement and inspiration for the achievement of this, the author’s
first text-book.

The chief merit of this effort--if merit there be--is its honesty. The
author has endeavored to set forth fairly and simply the facts and
hypotheses with which we have to deal. Its chief offense, in the eyes
of many, will lie in its being just what it purports to be--a book on
Chiropractic. Constructive criticism and suggestion are invited from
all sources, for by our interchange of thoughts we grow.

J. M. L.

Preface to Second Edition

The republication of this book has been made possible by the sustained
friendship of the profession for it, and the author’s thanks are due
its many buyers and readers who, by their recommendation, have made it
both possible and necessary that this book should live and grow.

The new edition has been somewhat enlarged by the introduction of
additional matter into each section and by the addition of two entire
new chapters on “Preferable Adjustments” and “Chiropractic Prognosis.”
New plates have been added and old errors corrected. In every way an
attempt has been made to express with conservatism the real advance
made by Chiropractic since the first edition was put on the press.

J. M. L.

INTRODUCTION

No two students, approaching for the first time the study of
Chiropractic, approach from the same angle. Their viewpoints differ. In
order that all may gain as nearly as possible the same viewpoint from
which to consider in turn the sections of this book, it will be well
if each student reads the entire book before beginning to memorize its
parts and convert them into practical working knowledge.

An effort should be made, abandoning all other, to acquire the
_Chiropractic viewpoint_. This accomplished, the rest of the task
requires time and patience alone, without waste labor. The section
on Vertebral Palpation should be studied step by step, the study of
each step being combined with practice in it. Likewise the section on
Nerve-Tracing, theory preceding practice. The study of the Technic
of Adjusting should occupy those months immediately preceding the
commencement of actual adjusting practice and continue during such
practice. The chapters on Practice are intended for the student about
to enter the field. The table of Spino-Organic Connection can be best
understood by those who have studied or are studying the anatomy and
physiology of the nervous system.

Let every page be studied with a good medical dictionary open at the
elbow of the reader. Pass no word without comprehension, no detail
without mastery. He who would seek to modify the life processes of the
human body must fortify himself against fatal error with every bit of
knowledge he can acquire.

VERTEBRAL PALPATION

Definition

Vertebral Palpation consists in the use of the tactile sense to
determine the position, relation, size, shape, and as far as possible
the condition, of the segments of the spinal column, in order thus to
discover the primary causes indicative of disease.

Or, Vertebral Palpation is the name given the manual examination of
spinal vertebrae.

General Propositions

Every palpation should be made with the adjustment of the vertebrae in
mind. The record of palpation should be a correct guide as to direction
of adjustment. No subluxation impossible of adjustment should be
recorded.

The two essentials of correct palpation are _accurate perception_ and
_correct reasoning_. To secure the first, a certain approved manner
of using the hands is herein laid down and a considerable amount of
tactile sense development by practice is required. Correct reasoning
depends upon knowledge of all the important facts concerning the spine
and of the rules governing palpation.

Absolute concentration is required and to this end many of the
following rules are directed.

Habits of Palpation

Every palpater unconsciously forms habits of thought and action. These
habits may be good or bad. We deliberately form a habit of holding the
first three fingers closely together or the habit of using a downward
glide, but we should avoid the habit of finding certain subluxations
because they are usual and expected rather than because they are
actually there. For instance, one may easily form a habit of listing
every other vertebra in the spine, his whole record thus depending upon
his first choice.

Because of this perfectly natural tendency to establish a routine
of thought and action and to follow it precisely, it is best not to
attempt palpation without the aid of an experienced teacher until after
correct habits have been formed. Once formed, a palpation habit, right
or wrong, is very hard to break. Many a teacher has expended himself
uselessly in the effort to undo some technical fault acquired by the
student in a blundering undirected trial.

Facts Concerning the Spine

The spinal column is composed of twenty-six segments called vertebrae,
twenty-four movable and two fixed. The movable vertebrae are divided
for convenience in study into three sections. There are seven Cervical
vertebrae, twelve Dorsal, and five Lumbar in the normal individual.
The number of Dorsals or Lumbars may vary by one in a rare case. These
variations occur in about one spinal column in each five hundred
and are usually in the Lumbar region, which may contain four or six
vertebrae. A prominent first sacral spinous process may be mistaken for
an extra Lumbar.

Five vertebrae have special names. The first Cervical is called Atlas;
the second Cervical, Axis; the seventh Cervical is commonly known as
Vertebra Prominens on account of its long and large spinous process,
although this long process belongs to the sixth Cervical or first
Dorsal instead in 35% of all cases; the large, irregularly fusiform
vertebra just below the Lumbars and between the ilia is called the
Sacrum; and the smaller one below it, the Coccyx. The latter is
occasionally missing.

Each vertebra except the Atlas is composed of a body and an arch; the
arch is made up of two pedicles, short, thick plates of bone extending
outward and backward from the postero-lateral surface of the body
nearer its upper than its lower border, two laminae, thin plates of
bone extending backward and inward from their union with the pedicles
and joining behind to form the spinous process, and has projecting from
it seven processes, two transverse, one spinous, and four articular,
two of which are superior and two inferior. The foramen enclosed by
the body, pedicles, and laminae is called the neural or vertebral
foramen and the canal formed by the connection of these foramina
and completed by the ligaments which unite the arches is called the
neural, vertebral, or spinal canal. It contains the spinal cord with
its membranes and the roots of the spinal nerves. By means of the four
articular processes each true vertebra except the first articulates
with its fellows above and below.

The body of the vertebra is its largest portion and is joined to its
fellows by fibrocartilaginous disks which are sufficiently elastic to
permit some torsion and compression. Nine sets of ligaments, including
the intervertebral substance just mentioned, bind the vertebrae firmly
together. Many muscles are attached to the spinal column.

The intervertebral foramina are openings at the sides of the vertebrae,
formed by the notching of apposed pedicles. These openings are
surrounded by bone, cartilage, and ligaments and vary in shape in
different sections of the spine. They permit the exit of the spinal
nerves and their sheaths, the re-entrance of some nerve fibres into the
neural canal, and the passage of blood-vessels to and from the cord.
The entire philosophy of Chiropractic focuses at the intervertebral
foramen because there we find the primary cause of all pathological
changes in the body.

The spinous and transverse processes merit particular description
since they are the levers by which vertebrae are adjusted and nerve
impingements at the intervertebral foramina corrected. But it will
be found easiest to describe these processes separately in different
sections of the spine and before proceeding to this description, a
brief picture of the peculiar vertebrae will be presented.

The _Atlas_ is a bony ring composed of two arches, an anterior and a
posterior, separated in the recent state by a transverse ligament. Its
body is detached and appears as a tooth-like projection upward from
the body of the Axis, the odontoid process, which articulates with the
anterior arch of the Atlas and around which the Atlas rotates, a ring
around a pivot. The Atlas supports the head upon its lateral masses,
two wedge shaped bodies between the anterior and posterior arches,
thinner internally than externally. It has no spinous process but
merely a tubercle where the laminae join, so that it can be palpated
only from the sides upon the tips of its long transverses. The first
Cervical, or suboccipital, nerves emerge by a groove above the pedicles
instead of through a foramen.

The _Axis_, or second Cervical, is distinguished by its large, strong
spinous process, which is bifid at its tip, by its superior articular
processes which rest upon body, pedicles, and transverses, and by its
odontoid process, upreared from the body.

The _Seventh Cervical_, or Vertebral Prominens, usually has a large
spinous process, presents no foramina in its transverse processes, or
only one, the left, and shows no facets on body or transverse for the
rib articulation, as do the Dorsals.

The _Sacrum_ is the largest vertebra; is curved with its convexity
backward; is commonly made up of five fused segments; has only
rudimentary spinous and transverse processes except the first; and
shows sixteen openings, eight anterior and eight posterior, or four
on either side of the median line in front and the same number and
arrangement behind. These openings permit the exit of the anterior and
posterior primary divisions of the sacral nerves separately.

The _Coccyx_, usually composed of four fused segments, is a triangular
bone which articulates with the Sacrum above and is free at its distal
extremity. Its portion of the neural canal is open posteriorly and
contains merely the thread-like termination of the cord membranes.
It is frequently ankylosed to the Sacrum, sometimes in an abnormal
position so as to impinge the single pair of coccygeal nerves.

The different regions of the spine show decided differences in
structure, though all resemble each other. The Cervicals are smallest,
the Dorsals next in size, and the Lumbars largest and strongest of
the movable vertebrae. The Dorsals have facets and demi-facets for
the articulation of the twelve pairs of ribs with their bodies and
intervertebral substance, as well as oval facets upon the anterior
aspect of their transverses for articulation with the tubercles of the
ribs.

The _spinous processes_ are smallest and usually bifurcated down to
and including the fifth. The sixth may show a plain bifurcation, or on
any Cervical the bifurcation may be so small as to be imperceptible to
touch. The spinous process of the second overlies that of the third so
as to make the latter very difficult of detection. Indeed, all cervical
spinous processes down to the sixth are harder to palpate than those in
other regions, owing to the anterior cervical curve. The processes lie
in a groove between prominent muscle ridges.

Dorsal spinous processes are usually single, although the last four,
three, two, or one may show plain bifurcation in certain individuals.
They are somewhat pointed and overlap, except the lower ones, the
obliquity being greatest in the mid-dorsal region and least at the
first and last dorsals.

Lumbar vertebrae have broad, flat-tipped spinous processes much larger
than the others. The last Dorsal may sometimes appear like a Lumbar in
shape, so that the change in shape commonly supposed to mark a division
between Dorsals and Lumbars is not always an infallible guide.

The _transverse_ processes in the cervical region are very short
and lie close in front of the articular processes. They are pierced
by foramina for the vertebral artery and vein, except the seventh,
which may have one foramen or none. They are difficult of access for
palpation because of their shortness and the amount of overlying
muscle, but may be reached from the front and side by drawing back the
sternomastoid. They increase in length from the second to the seventh.

In the dorsal region the transverses are larger and stronger and
more constant in size, shape, and direction, serving to support rib
articulations. They extend in a curved direction outward, backward, and
slightly upward from the union of laminae and pedicles and terminate
in a large subcutaneous club-shaped extremity which may be readily
palpated. The eleventh and twelfth dorsal transverses do not articulate
with the ribs and must therefore be used with caution or not at all
as levers for adjustment. The dorsal transverses are located on a
higher level than the spinous processes. In the case of the upper three
dorsals the transverse lies in a plane which would cross the mid-spinal
line between its own and the next superior spinous. In the mid-dorsal
region the transverse is even with the spinous of the vertebra above,
though the relation may vary slightly. The lower dorsals return to the
same relation as the upper.

The transverse processes of the Lumbars are relatively light compared
with the general structure of the vertebrae and are found just even
with the interspace between their own and the adjacent superior spinous
process. They vary greatly in size, length and strength and may be used
as levers for adjustment only when they are large enough to be clearly
palpable through the muscle mass which separates them from the body
surface.

Preparation of Patient

In all cases where a complete spinal examination is intended the
preparation is essentially the same. Have patient arrange clothing so
that the spine is exposed to the touch throughout. Avoid bands of cloth
across the spine, as these interfere with the necessary continuous
gliding movement of the fingers. Advise the patient, if a female, to
wear waist or dressing sack, reversed, and have skirts loosened at the
waist. If a man, he should strip to the waist and wear coat or coat
shirt reversed.

Position of Patient

This varies widely according to circumstances but for general purposes
use position:

(A) Place patient on stool, feet even on floor and body in an easy,
relaxed position. This may be modified by asking him to lean forward
and rest elbows on knees, evenly, to facilitate Lumbar palpation.
Patient’s head may be erect or flexed forward or backward but should
never be rotated or laterally flexed during Cervical palpation except
for the purpose of locating some particular transverse process.

(B) In emergency cases, where haste is urgent or patient is unable
to assume a sitting posture, or as a means of re-verifying previous
palpation, place the patient on adjusting table prone, face down. (See
Fig. 2.) Remember that with the head lying upon its side the upper
dorsal vertebrae will assume a curve with its convexity away from the
face. Palpation in position (B) should precede every adjustment and, to
guard against error, should be considered as a necessary preliminary to
the movement of any vertebra.

(C) For palpation preparatory to using the Rotary, the Break, and other
moves, have patient lying on his back with his head projecting beyond
upper end of bench and resting on the hands and wrists of the palpater,
or have the patient’s head rest on the bench, a less accessible
position.

General Observation

Each spinal examination should begin with a general survey by which
curvatures, marked prominences, etc., may be appreciated. Frequently
some very important fact may be noted which would escape attention upon
minute examination.

THE RECORD

The record of spinal palpation, when completed, should be an accurate
history of the irregularities found in the spine and an accurate
guide to adjustment. It must be brief and concise as well as readily
comprehensible. One should be able to see at a glance any desired
point on the record, so that it may be used during the adjustment
without undue loss of time or attention. Obviously the introduction of
any useless mark or sign, such as the inclusion of a number and blank
space for each vertebra of the spine, or all possible subluxations with
indications as to which do or do not exist in the given case, is a
mistake.

The record should contain three parallel columns. In the first column
place the number of the vertebra chosen for adjustment. In the second,
place the direction of subluxation. In the third, place the word or
sign which stands for the indicated movement for correction.

Number of Vertebra

The letter C is used to indicate Cervical, D Dorsal, L Lumbar, and S
Sacrum in the record. Immediately following the letter which designates
the region, place the number which shows the position in that region
occupied by the vertebra in question, the _relation_ of that vertebra
to its fellows. For instance, the third Cervical vertebra is C 3, the
eleventh Dorsal D 11. To the S for Sacrum append B or A to indicate
that the Base or Apex is described as to position. This _locates_ the
subluxation. For a record of full spine palpation it is unnecessary
to use the letters C, D, or L more than once, as subluxations are
recorded in the order of their occurrence from above downward. A dash
should always follow the number of the vertebra to separate it from the
letters in the second column for convenience in reading.

Direction of Subluxation

The directions considered in palpating or recording subluxations are
six in number, namely:

Name Abbreviation Meaning
Posterior P Toward the rear (Dorsad)
Anterior A Toward the front (Ventrad)
Right R Toward the right hand
Left L Toward the left hand
Superior S Toward the head (Cephalad)
Inferior I Toward the feet (Caudad)

As the fingers glide down the spine the _posterior_ vertebra is the one
which interposes itself in the path of the fingers, forcing them to
describe an outward curve. It is the hill on the automobile road which
forces the surmounting of a curved departure from the evenness of the
road. It is _relatively_ posterior to its fellows above and below.

The _anterior_ vertebra, to the gliding fingers, means a depression,
a valley. It causes the fingers to dip inward from the level of their
course.

The _right_ or the _left_ subluxation is appreciated by running the
tips of the fingers down the sides of the spinous processes. It really
indicates rotation of the whole vertebra more often than any other
malposition.

We say that a vertebra is _superior_ when its spinous process is nearer
the one above than the one below. It requires a measuring of relative
distances. The degree to which a vertebra is superior is measured, not
by its actual closeness to its fellow, but by the relation between the
space above and the space below.

Likewise a vertebra is _inferior_ when it is closer to its fellow below
than to its fellow above.

_Anterior_ subluxations are rarely recorded as such, except of the
Cervicals or the last Lumbar, because no means of properly adjusting
them is known to Chiropractic.

Order of Letters

In the second column, that devoted to direction of subluxation, the
letter P or A should appear, if at all, as this antero-posterior
relation is the first thing to be determined concerning any individual
subluxation chosen except the Atlas. With the Atlas the first letter
will be R or L. Next the laterality or rotation is indicated by R or L
in every case except Atlas subluxation. Finally the S or I indicates
the last point to be determined, the _approximation_ of the vertebra to
its fellows. This last letter usually shows thinning of intervertebral
fibrocartilage, which will be discussed elsewhere.

If you desire to emphasize any direction as being more important than
another, underscore the letter which stands for that direction with
a single line. If two directions are to be emphasized, one more than
another, underscore the one with two lines and the other with one. For
example, if a vertebra is found to be quite decidedly posterior, _more_
plainly to the right, and _slightly_ superior, the record will show it
thus: _P R S_.

Movement for Correction

This is indicated in the third column, separated from the second by a
dash, by means of some brief word or words which describe a certain
movement used in adjusting. The descriptive words and terms used in
this work are all given and explained under Technic of Adjusting. (See
p. 89.) Each word or term stands for a definite method of procedure.
The best movement for the correction of any subluxation of any vertebra
may be found by reference to the section on Preferable Adjustments,
p. 155. If other terms are more familiar to the student, or in time
replace those which are now common usage in the profession, they will
be brief and clear and may be easily substituted for those given.

Palpation, fixing in the mind of the palpater the manner and direction
of the subluxation, should also suggest as the obvious correction a
movement calculated to reverse the procedure by which the subluxation
was first produced. In other words, a certain kind of subluxation
stands as the effect of a certain application of force along definite
lines determinable by examination. Its correction should be made in a
reverse direction along the same lines. By recording with the record
of subluxation the desired correction, the adjuster may be reminded
daily without new palpation of the movement best fitted to the case.
If on trial it is decided that some other movement than the one first
indicated will better overcome the abnormality, the record should be
changed to correspond to the decision, and thereafter followed.

Complete Record

The completed record in three columns separated by dashes can be
conveniently read. It contains no superfluous mark of any kind. It
conveys all the necessary information leading to adjustment except
diagnosis and case history. This palpation record should be a part of a
more comprehensive record concerning the case in full and is best kept
on a card, the reverse side of which carries case history. If kept in
an indexed card file it may be referred to daily without loss of time
and an accurate handling of each case be assured.

Have card perfectly blank on palpation record side. For convenience
in reading draw a heavy line beneath the last Cervical subluxation
recorded and another beneath the last Dorsal, thus dividing the record
as the spine is divided, into three divisions.

Below follows a sample palpation record. It will be seen that here in
a very small space may be recorded a great deal of information, for
this record contains an accurate list of the primary causes of every
disease, weakness, or tendency to disease with which the patient is
afflicted, together with the methods for their removal.

Sample Record

C 1 R Break
4 P L S Double Contact
7 L I Rotary
——————————————————————————————————————————————
D 3 P R Recoil
7 L S Pisiform Single Transverse
10 P S Heel Contact
——————————————————————————————————————————————
L 1 P L I Recoil
4 R Lumbar Single Transverse

Use of Record

The above record is made with patient sitting. It is to be used while
patient is lying upon the adjusting bench. The most convenient way is
to begin palpation in the Dorsal region after patient has been placed
for adjustment, in this way. If first subluxation recorded is D 2--P R
I, find the vertebra in the region of D 2 which appears P R I to the
touch. To avoid error, let the fingers then glide downward to the next
recorded subluxation. If this be found to agree in number and direction
with the record, it is safe to assume that the first one found was
correctly numbered in the palpater’s mind; if not, that an error was
made. This can be quickly done. Before each adjustment the vertebra
adjusted should be found to agree with the record; by doing this
constant accuracy may be assured.

THE COUNT

Having described the preparation of the patient and the different
positions in which he may be palpated, noted that all records should
be made in position A, mentioned that general observation which should
immediately precede actual palpation, and interpolated a description of
the record to be made during the palpation, with its use afterward,
we are now ready to consider the technic of the palpation itself. This
should begin with a count of the vertebrae and continue with Atlas
palpation, general examination of a group of vertebrae, and special
examination of individual subluxations in the group. Each of these
tasks will be considered in turn.

Position of Palpater

This depends upon the position of the patient. The letters which follow
correspond to the letters describing the position of the patient. q. v.

(A) If you desire to palpate with the right hand stand at patient’s
left and face toward him with left hand resting on his shoulder
or supporting his forehead as you palpate Dorsals or Cervicals
respectively. To use left hand stand similarly at patient’s right. Have
palpating arm relaxed and easy, extending as nearly as possible so that
the forearm and hand make a right angle with the patient’s spine. Let
the arm and hand remain close to the patient’s body at all times. Keep
the elbow close to your own body and avoid flexion of wrist on forearm,
or of forearm on arm at more than a right angle, since such flexion
would bring about too great muscular tension for close appreciation of
tactile impressions. If necessary lean sidewise and elevate shoulder
and palpating arm in order to preserve the proper relation between hand
and arm when hand must be elevated as in palpating upper Cervicals.

(B) As above, if you desire to use right hand stand on left side of
patient and if left hand stand on right. If the patient lies on a bench
so constructed that the head lies on one side, his face must be toward
the palpater in order that the same hand may be used in Cervical as in
other regions. It is inadvisable to change hands except when absolutely
unavoidable. If the patient’s head must be turned from you palpate the
Cervicals by standing with feet pointed away from patient and turn your
body with one hand resting on patient’s head to hold it steady and the
other palpating as if you were standing on the other side. This is
difficult and it is rarely necessary to count Cervicals in position B
if the record be used as advised on page 29.

(C) Palpation preparatory to the Cervical adjustment will be made in
this position or in position A, according as you intend adjusting the
Cervicals in the prone or the sitting posture. For the prone position
have the patient’s head supported by either hand, while the other
hand is applied with the tips of the first three fingers resting on
the tips of the spinous processes, from which position they may glide
smoothly down, noting deviations from normal in position as well as
mentally numbering the vertebrae. While this method of palpation is
not so accurate as those given elsewhere, and should be used only as
an additional means after record has been made, it will always be
necessary to make a count before adjusting any Cervical.

Use of Hands

In general it may be stated that the first three fingers of one
hand are used with an easy downward gliding movement in which only
the _tips_ of the three fingers, evenly placed, are in contact with
the patient’s body. This concentrates the attention upon a very
small tactile surface which may become extremely sensitive by the
concentration. Indeed, it may be said that vertebral palpation only
became an art through the application of the principle of concentration
in practice. The gliding movement is always _downward_, because to
palpate upward will mass the superficial tissues under the fingers
and confuse the palpater. If there is uncertainty in the mind of the
palpater, as he proceeds, as to the identity of any vertebra he should
go back to the second Cervical, or to any certainly recognizable
vertebra previously fixed in mind, and recount.

The use of the hands for Atlas palpation differs from their use
elsewhere and will be described under separate head. The use of the
hands with the patient lying face upward is also different. If the
patient be lying prone, the same three fingers are used and the same
downward glide as with patient sitting.

[Illustration: Fig. 1. Position of hands in palpation for record.]

With patient sitting, the palpater should step from side to side,
changing hands frequently and usually palpating each vertebra with
each hand before reaching a conclusion. There are three reasons for
this. More accurate records may be made by combining two different
impressions on each vertebra; with frequent change of hands one may
prevent tiring and consequent loss of sensibility of fingers; this
practice develops the tactile organs of both hands equally so that if
occasion demand the use of either hand alone it is fitted for the task.
To be ambidexterous in all departments of Chiropractic is an invaluable
attainment, too often neglected.

The Count

Commence at the second Cervical, the first spinous process below the
occiput, and let the fingers glide smoothly downward over the tips or
along the sides of the spinous processes, _without interruption of
motion_, until they reach the Sacrum. The palpater notes each vertebra
passed and its number--mentally--so that when he reaches the Sacrum
he knows that he has passed every intervening vertebra and received a
touch impression from each. The Sacrum itself may usually be recognized
by its peculiar shape and also by its articulations with the ilia.

If the fingers are raised from their contact during the count, the
palpater must recommence at the second Cervical. It is impossible to
be accurate in replacing the hand, once removed, until the count has
been established and the peculiarities of certain vertebrae remembered,
together with their numbers.

To determine the location of the fourth Lumbar where, on account of
obesity, lipoma, Cervical lordosis, etc., the count of Cervicals or
Sacral palpation is difficult, drop on heels behind the patient and
place the second finger of each hand on the crest of the ileum. Then
let the thumbs meet in the mid-spinal line in the same horizontal
plane as the two second fingers, which spot should correspond to the
interspace between third and fourth Lumbars. This measurement is
accurate in about 98% of all cases, when patient sits erect; when it
varies it will vary by about half the width of a Lumbar spinous process.

The count should be repeated until the palpater is certain that he
is able to palpate every spinous process distinctly or to locate
accurately any impalpable one. In making the count, palpater may note
the number of some very prominent and easily recognizable Dorsal or
Lumbar vertebra to be referred to as a starting point for a recount if
confusion arises later. This recounting from some prominent vertebra
is permissible only after the first accurate count has been made, but
then will save the full count, especially when the patient is in an
unfavorable position, as lying on table during adjustment.

Difficulties in Counting

The commonest difficulties met with in counting are the following:

Inaccessibility of third Cervical, which lies closely beneath the
spinous process of the second and, unless unusually large or somewhat
out of its proper position, cannot be readily felt.

An occasional anterior fourth or fifth Cervical which may escape notice
unless the head is flexed far toward or the transverse processes
examined.

Lipoma or other adipose tissue covering part of the spine.

A missing epiphyseal plate resulting from fracture and absorption,
which absence may simulate a wide interspace and be overlooked without
careful and detailed observation.

Cervical or Lumbar lordosis. This difficulty may be at least partially
overcome by having head bent far forward or body leaning forward with
elbows resting on knees and a deliberate attempt on the patient’s part
to render the dorsolumbar spine convex backward.

An anterior fifth Lumbar.

The occasional extra vertebra which confuses the palpater.

Finally, the greatest of all difficulties is the imperfect touch of the
untrained palpater or the imperfect concentration of the trained. And
this is always remediable.

ATLAS PALPATION

With patient in position A stand _behind_ him and place the tips of the
second fingers on the tips of the transverse processes of the Atlas, or
first Cervical. It can be felt on each side just anterior and inferior
to the mastoid process of the temporal bone. Let the first and third
fingers rest respectively above and below the transverses and determine
whether the Atlas is subluxated as a whole to the Right or to the Left.

Another convenient method is:

Place first fingers on mastoid processes, second on Atlas transverses,
and third on angle of jaw. The three fingers of each hand then
constitute the points of a triangle. Imagine the base line between
the first and third fingers and measure the altitude as a line at
right angles to this base line and reaching to the tip of the second
finger as the apex of the triangle. The relation of the two altitudes
determines the laterality of the Atlas. Thus, if the altitude of the
right triangle is less than that of the left, the Atlas is laterally
displaced to the Right.

The second matter to determine is the _rotation_ of the Atlas. This is
done by using the first and third fingers as probes to determine the
amount of space between the transverse and the mandible in front or the
mastoid behind. The intention is to compare the laterally prominent
side with the other so that the letter A or P on the record will
indicate the position of the prominent transverse compared with its
fellow.

Next decide as to _tipping_. Still comparing the prominent transverse
with the other, decide whether it is above or below the level of the
other by the following method. Placing first three fingers one above
the other with the second finger on the tip of the process, note which
transverse is highest in the space beneath the ear. List the prominent
side as S or Superior, I or Inferior.

Atlas palpation is rendered especially difficult by the special technic
and by the interposing tendons of the sterno-cleido-mastoid muscle.

Position of Head

There are three head positions for Atlas palpation. Head erect, face
forward; head flexed forward on chest; head flexed backward. Sometimes
it is necessary to test in all three positions in order to reach a
decision, but ordinarily the first is sufficient.

THE GROUP METHOD

In general palpation of the spine the author has had the greatest
success and attained the greatest accuracy through which is called the
Group Method. This consists in dividing the spine mentally into five
groups or sections, each of which overlaps its fellows except the end
groups. This is of advantage for several reasons.

It limits somewhat the attention of the palpater so that he may examine
thoroughly and in detail the various vertebrae without holding his
attention so closely to one that he fails to perceive its relation to
its surroundings. It furnishes five or six vertebrae at a time for
comparison so that one may determine which is _most_ subluxated, and
therefore most in need of adjustment, and then allows one to reason
upon the remainder of the group with this major subluxation in mind.

The use of the Group Method may best be understood by the study of
certain didactic instructions, which follow:

Never record or adjust two subluxations of contiguous vertebrae except
in those unusual cases where they are equally subluxated and in the
same direction; even then it is wisest to adjust them on alternate
days. Let it be understood that only in _exceptional_ circumstances
should two adjacent vertebrae be listed. The Group Method is chiefly
valuable because of this rule, to prevent the overlooking of the most
important subluxation by selecting that one _first_.

Consider the spine as divisible into five groups; in the first group
belong the Cervicals below the Atlas; in the second, the seventh
Cervical and first five Dorsals; in the third, the vertebrae from the
fourth to the eighth Dorsals inclusive; in the fourth, the last five
Dorsals and sometimes first Lumbar; and in the last group, all of the
Lumbars and the base of the Sacrum. Consider the first Sacral spinous
process here rather than the whole Sacrum and remember that this
process should seem to complete the regular Lumbar curve. This grouping
may be modified somewhat by the exigencies of palpation in any given
case, but the group considered should always include from four to seven
vertebrae.

In each group proceed in the same manner to select subluxations. Let
the fingers glide over the group, first on the tips and then along
the sides of the spinous processes, and note that some one vertebra
stands out as the sharpest, most abrupt deviation in the group, thus
indicating its selection. Remember that neither the one above this nor
the one directly below may be adjusted. This narrows your field of
observation for this group to two, three, or four remaining vertebrae.

Select then such others in the group as need to be listed yet do
not conflict with the rule against adjacent subluxations. Proceed to
discover and record the exact direction of each. When this is done
examine the next lower group in the same way and continue until the
whole spine has been palpated.

The Atlas must be considered alone and not as a part of any of the
above mentioned groups and its position is judged rather by its
relation to the head than to other vertebrae; the Sacrum also requires
individual attention, being compared with the Lumbar curve and with the
ilia.

The one most pronounced subluxation in a group is often mentioned
as the “key” to the group, since its correction would effectually
loosen the entire group and sometimes partially correct the apparent
abnormalities of the rest. It has also been called “major subluxation”
to distinguish it from “minor subluxations” which are the others of
less importance in the group. This term is not a good one because
it suggests what is not always true, namely, that the mechanically
greatest subluxation is more potent than any other. Occasionally a
slighter subluxation irritates nerves so as to produce a disease more
serious and immediately alarming than the condition following the
greater displacement.

Example of Group Method

If, in the Cervicals, it is noticed upon gliding downward over the
spinous processes that the fifth is badly subluxated and must be
adjusted, this fact is held in mind for a moment while the palpater
remembers that he cannot adjust and must not list the sixth or fourth.
This leaves only the second, third and seventh for consideration, the
Atlas having been separately examined. The seventh may best be included
in the next group when such a selection is made, so that the palpater
need only decide between the second and third Cervical, providing Atlas
has not been chosen, as to which, if either, most requires attention.
If Atlas has been listed, then there remains instead only the question
as to whether the third is or is not subluxated.

In using the Group Method no preference is given to subluxation in
any particular direction, save only that below the Cervicals we
discriminate against the anteriors, because we cannot adjust them.
The Group Method has to do with determining the points of greatest
pressure on nerves and this depends upon one’s impression as to the
interrelations between all the members of the group. (See p. 80 under
Subluxations.)

THE INDIVIDUAL SUBLUXATION

Having prepared our patient, surveyed the entire spine, carefully
counted the vertebrae to secure a proper orientation, and specially
examined the Atlas, then divided the spine into groups and selected the
vertebrae to be adjusted with regard to their degree of malposition,
let us confine our attention definitely for the first time to the
_single_ vertebra below the Atlas.

Reread “Direction of Subluxation” under “The Record,” p. 25. Also read
article on “Subluxations,” p. 76.

Bear in mind that each subluxation recorded is intended for adjustment
and indicate nothing impossible on your record. For instance, an
anterior subluxation in the Dorsal region cannot be corrected and
should not be recorded for correction.

Remember the six capital letters used in describing a subluxation.

Use only the _downward gliding movement_ of the three palpating fingers.

Keep in mind the count as you have established it for that particular
spine, recalling one or two very prominent and noticeable vertebrae
whose numbers you have noted.

Use a light touch. If necessary, change the patient’s position to make
the vertebra more accessible instead of pressing with more force.

When in doubt as to direction, change sides and use the other hand. If
still in doubt, take a longer glide, covering six vertebrae instead of
three or four.

Keep your mind on your work, forgetful of everything else.

And picture to yourself the entire vertebra and its surroundings;
its body, pedicles, and laminae, its transverse processes and all
articulations; above all, _mentally visualize the foramina and nerves_.
Estimate from the position of each vertebra the pressure at each
foramen. Decide whether the vertebra is rotated, tipped, laterally
displaced, anterior or posterior, or whether the subluxation partakes
of several of these directions.

Decide in what direction movement of the vertebra would release most
pressure and list accordingly.

Never hesitate to change your opinion if you discover evidence that you
have made a mistake. Keep at all times an open mind in palpation.

Cervical Palpation

The third Cervical, lying under the projecting spinous process of the
larger second, may be hard to find, and therefore the full count is
always required before listing any vertebra. By requiring the patient,
who is in position A, to drop his head forward and rest its weight
in the hand which is not palpating, the Cervicals may be more easily
palpated. Remember that this posture widens the interspaces and also
makes the spinous processes appear more posterior than they really are,
this difference being most noticeable at the fourth.

One bifurcation of a Cervical spinous process may be longer than the
other and prove confusing unless care be taken always to palpate
both bifurcations and note their form. This can almost always be
successfully accomplished.

Sometimes the posterior neck muscles and ligaments will be rigid
so that they interfere with palpation and at the same time make it
impossible for the patient to flex his head forward. Having found that
this is due to real _contracture_ and is therefore not susceptible of
voluntary relaxation by the patient, support the head in front and push
aside the muscles with the fingers, gliding _underneath_ the muscle
layers as much as possible and close to the spinous processes.

Transverse palpation in the Cervicals is used to verify findings from
the spinous processes or to differentiate between rotated and laterally
displaced vertebrae and bent spinous processes when the spinous swerves
to right or left.

Dorsal Palpation

The Dorsals are usually considered in three groups. It must be
remembered that the form and obliquity of spinous processes vary
considerably in this region. The upper processes are very slightly
oblique, slanting downward, the middle Dorsals very oblique, and the
inferior ones again only slightly so. There is a form change, most
commonly at the eighth Dorsal, which may be mistaken for a posterior
subluxation. The process here becomes more horizontal and more blunt.

Among the first four Dorsals a bad lateral or rotated vertebra may
be listed as well as a posterior one, since we can readily adjust
it. In the middle group either the posterior or rotated vertebra is
chosen according to the estimate as to which causes greatest nerve
impingement, either being adjustable. In the lower group, however,
preference is usually given the posterior vertebra when possible,
because rotary subluxations indicate transverse adjustments and it is
somewhat dangerous in this region to use the transverses as levers.

Lumbar Palpation

The Lumbars and Sacrum are considered in one group. The Lumbars, with
patient erect, _should_ curve anteriorly and the first Sacral spinous
process should complete the regular curve. This is rarely found,
however; the normal is the exception in any part of the spine.

In the Lumbars we usually choose the rotated rather than the posterior
vertebra, but solely because rotation here produces the greatest
degree of impingement. The laterality of spinous processes, indicating
rotation of the whole vertebra around an axis lying in the transverse
line between the articular processes, can best be perceived, as a
rule, with patient sitting quite erect. If in doubt, have patient lean
forward and rest elbows on knees, which posture separates the Lumbars,
rendering the individual spinous process easier to discover but the
_relative_ position more difficult of determination.

The fifth Lumbar, if anterior, may be so listed, forming an exception
to the general rule.

Sacral Palpation--Pelvis

First palpate Sacrum as if part of Lumbar region. Note whether the base
(upper portion) is posterior or not. Then stand behind the patient and
use both hands to examine the sacroiliac articulations. Use palmar
surfaces with the flat hand toward patient’s body, and carefully
compare the two sides to detect inequalities, which indicate iliac
subluxation, or rotation of Sacrum between the ilia on a transversely
disposed axis passing through the two articulations, in which case
the Sacrum is to be adjusted. Do not mistake a dislocated hip with
compensatory tilting of the whole pelvis, or faulty sitting posture
with only one tuber ischii supporting the body, for pelvic subluxation.

Be not in undue haste to record pelvic subluxations lest your haste
bring its immediate reward in the difficulty of adjustment.

The Coccyx

The Coccyx may be detached from the Sacrum by various accidents and
later re-ankylosed thereto in an abnormal position so as to impinge
upon the rectum or other structures. Impingement of the coccygeal
nerves is usually unimportant. Chronic and intractable rectal
constipation, with its attendant train of evils, _may_ result from
coccygeal displacement with ankylosis. In spite of numerous treatises
to the contrary, the writer avers that other symptoms are extremely
rare.

To examine the Coccyx use a rubber covering on the second finger. Place
patient face down and insert second finger per rectum with the palmar
surface upward. If subluxated Coccyx be found, it must usually be
fractured with a sharp jerk, in order to relieve the condition. After
fracture, it may be absorbed or may re-ankylose to the Sacrum in a
better position, or it may remain freely movable.

PALPATION IN POSITION B

This is the position for the majority of adjustments, and as the
palpation of each vertebra to be adjusted is a necessary preliminary to
the adjustment, this method, though not so accurate as the one already
described, must also be used.

The use of the first three fingers of each hand and the relation of
hands to patient’s body is the same as in Position A, except for
palpating Cervicals when the patient’s face is turned away. It will be
found very difficult to make a correct full count, especially to count
Cervicals, in this position, and is better to use a record already
prepared.

Dorsals

Begin at, or near, the first Dorsal to palpate in this position.
Find the vertebra which agrees in direction with the first Dorsal
subluxation recorded; let the fingers glide downward until they reach
the vertebra which, according to the first decision, would correspond
in number with the _next_ subluxation on the record. If this also
agrees in direction with the record it may safely be assumed that you
are accurate in your numbering. Thereafter, during that adjustment, the
count can be made or repeated from any prominent vertebra the number
and identity of which are easily recognized.

[Illustration: Fig. 2. Palpation in Position B, preparatory to
adjustment.]

Lumbars

It may be difficult to count or otherwise to palpate the Lumbars in
this position because of the increase in the normal anterior curve
when patient is suspended between the two sections of the bench. This
will be obviated if a roll be placed under the thighs or if the bench
has an adjustable rear section.

Cervicals

If a solid front bench is used remember the spiral turn in the
Cervicals, which occurs because of the resting of the head on one side.
The curve due to this rotation of the head is compounded with the ever
present anterior curve to make a spiral. Do not expect the vertebrae in
this position to agree in apparent direction with a record made with
the head straight. It is better to make all decisions as to direction
of Cervicals in position A and merely to _count_ them in other
positions.

In position B, if the patient’s face be away from the palpater it will
be necessary to stand with back toward patient and body twisted, and to
change hands for counting, resting the free hand on patient’s head to
insure its steadiness.

Disagreements

If there be any apparent disagreement between findings in positions B
and A, re-examine carefully in both positions, whereupon that which
seemed a disagreement will probably prove to have been an error in
one or the other palpation. If apparent disagreement persists after
searching examination, position A furnishes the safest guide to
adjustment because the patient is in his most usual attitude as regards
the spinal curves, muscle tension, etc. But it is usually wisest when
in grave doubt not to adjust the doubtful vertebra at all.

PALPATION IN POSITION C

Since palpation in this position, patient lying on his back with head
supported by palpater’s hands, cannot be so reliable as that done in
position A, the chief point to be observed is an accurate count. Only
the Cervicals below the first can be properly palpated in this position.

Induce the patient to relax the neck muscles as much as may be, and use
in palpation the first three fingers of one hand if the count alone is
desired or the first three fingers of _both_ hands if you desire to
ascertain the _direction_ of any vertebra. In the former case let the
fingers press aside the muscles and glide _downward_ from the second
Cervical, being careful to lift the head high enough so that the third
Cervical is not overlooked beneath the overlapping second. In the
latter case let the fingers of both hands glide gently downward while
the patient’s head rests upon the palpater’s wrists or knee. Palpate
the transverses in much the same manner, paying special attention to
their _laterality_, felt as a prominence on one side lateral to a
transverse process and a corresponding depression on the opposite side.
Do not be deceived by exceptionally long transverses where both project
outward to an equal degree.

[Illustration: Fig. 3. Locative palpation of Cervical spinous processes
in Position C, preparatory to Rotary or Break.]

Since the greater mass of the vertebra is divided with fair equality
by the intertransverse line, laterality of transverses indicates
laterality of the whole vertebra with the possible exception of the
anterior portion of the body. Laterality of a Cervical _spinous_
process may indicate laterality of the entire vertebra or merely
rotation around its vertical axis, in which the one articular process
is separated from its fellow of the adjacent vertebra while the other
remains in partial apposition.

Disagreements

If disagreements appear between palpation made in positions A and C,
re-palpate in both positions. If still uncertain call a consultation or
follow finding in position A. The Rotary adjustment may sometimes aid
in deciding difficult questions if gently attempted and free movement
secured. With this adjustment a vertebra will not usually move without
rather extreme force unless the articular process on the side sought
to be moved has lost its apposition with its fellow of the adjacent
vertebra. In any case of disagreement nerve-tracing, the discovery of
sensitive nerves on one side only may aid in decision. A knowledge of
probabilities, previous experience, and the diagnosis may also serve as
partial guides.

TRANSVERSE PALPATION

Palpation of the transverse processes is easiest in the Cervical and
mid-dorsal regions and most difficult in upper Dorsal and Lumbar
regions. It has two uses: first, to assist in making a record by
verifying the work done on the spinous processes; second, to locate
a given transverse process in order to use it as a lever for the
adjustment of the vertebra.

It will be seen that fulfillment of the first purpose requires careful
examination of the _direction_ and _position_ of the transverses as
compared with each other and with the spinous process of the same
vertebra, while the second requires only the discovery of the exact
_location_ of some particular transverse. It will be best to consider
the three divisions of the spine separately, excluding from the present
chapter Atlas palpation, which has been thoroughly described.

Cervicals

These can be best palpated in the position for Atlas palpation; that
is, standing behind the patient and using the palmar surfaces of the
fingers of both hands. From the Atlas transverses follow the anterior
border of the sternomastoid muscle downward, and opposite each spinous
process draw the muscles backward and inward until the tips of the
transverses are found with the middle fingers. Their position on the
two sides may then be easily compared as well as their relation to
those above and below them.

[Illustration: Fig. 4. Locative palpation of Dorsal transverse
processes.]

The transverses of the second Cervical may sometimes be so prominent
laterally that they are, or one of them is, mistaken for an Atlas
transverse. As a rule, however, the width of the Cervicals increases
from the second downward, the second being narrowest. Chassaignac’s
tubercle, on the transverse process of the sixth Cervical and opposite
the lower border of the cricoid cartilage, is a prominent point easily
felt as a rule. The transverses of the fourth are usually opposite the
upper border of the thyroid cartilage.

The Cervical transverses lie very close to the articular processes and
the determination of their relation is a better guide to the condition
of the articulation than is spinous process palpation. It is also more
difficult.

Palpation of Cervical transverses to determine laterality of the
vertebra as a whole or its rotation is possible in position C and has
been described under that head.

Dorsals

Palpation for _direction_ can be done best in position B. Use three
fingers with a gliding movement along the line of the transverses,
passing over several to determine which is most posterior. Then
repeat the glide on the other side of the spine to determine whether
the transverse corresponding to the anterior one is posterior or
vice versa, showing that the entire vertebra is merely rotated or
is displaced backward. Some palpaters prefer using both hands and
palpating both transverses at once and there is no serious objection
to this method, if confined to palpation in position B. In many cases,
however, it leads to similar palpation of spinous processes, a most
execrable habit.

It should be remembered that with the first two Dorsals the transverse
will be found in a transverse plane which would pass between its own
spinous process and that above. This is also true of the last three
Dorsals, while in the middle Dorsals the transverse is usually (not
always) level with the tip of the spinous process of the next superior
vertebra.

Before adjusting, to determine the _location_ of a transverse process
in order to direct an adjustment against it, first palpate spinous
process and hold it with the tip of the middle finger. Then approximate
with the first finger a point even with the tip of the spinous process
above and about one inch from the spine--this of course in mid-dorsal.
Then let second and third fingers follow the first so that all three
rest on or near the transverse to be palpated. Pressing gently, but
firmly, move the three fingers until the process can be felt beneath
them. Hold the process with the middle finger so as to direct with
it the contact of the adjusting hand to a point exactly over the
transverse process.

Lumbars

The transverses of a Lumbar vertebra lie just even with the interspace
between their own and the adjacent superior spinous process. They are
deeply embedded in muscle tissue and very hard to palpate. They may
vary considerably in size or length and the last one or two may be
absolutely impalpable. It is sometimes advisable to adjust a rotated
Lumbar by using the transverse as a lever, but this should never be
attempted unless the process can be distinctly felt. The method of
locating in Lumbar is practically the same as in the Dorsal region.

Transverse Palpation with Patient Sitting

Palpation of Cervical transverses in position A has been described and
is frequently done. Palpation of Dorsal or Lumbar transverses in the
same position may sometimes be desirable. It can be done with the same
movement as spinous process palpation, and may serve to detect a bent
spinous process.

If it is necessary to palpate both transverses at the same time,
stand in front of the patient and lean over his shoulder, letting his
shoulders rest against your body. Use palmar surface of fingers of both
hands and note which transverse is posterior to its fellow, if either,
or whether both are posterior to the line of the others above and below
them.

It is rarely possible to find if a transverse process be superior or
inferior to its normal position, except the Atlas transverses, although
this may occasionally be detected. Fortunately this is a rare form
of subluxation, or appears rare, although it must be said that this
apparent rarity may be due to our comparative inability to detect it in
the living subject.

CURVES AND CURVATURES

For convenience, _curve_ is used to denote the normal curvilinear
deviation from a straight line naturally present in the normal spine
or naturally assumed in response to the need for equilibrium during
the erect position of the body: _Curvature_ means either the abnormal
increase of any normal curve or the appearance of any abnormal
curvilinear deviation of vertebrae from their normal position.
Deviations from normal must contain at least three vertebrae to be
considered curvatures.

Visual Examination

The general inspection of the spine which precedes the count should
bring to light, in addition to prominent subluxations, and general
symptoms observable by inspection of the back, any _marked curvatures_.
Their general locality and direction will be noted by this observation
and their details left to be discovered by closer examination.

During palpation with a long and rapid glide one may also note these
general points with respect to any curvature.

Do not mistake the four normal curves, the anterior Cervical and Lumbar
and the posterior Dorsal and Sacral, for curvatures. The normal Lumbar
curve is so unusual in practice that a novice has been known to name it
a lordosis.

Description of Curvatures

Four varieties of curvature are commonly described. _Kyphosis_ is
a curvature with its convexity directed backward, usually, but not
always, found in the Dorsal region. _Lordosis_, the opposite of
Kyphosis, is an anterior curvature, usually in the Lumbar in which
case it is an accentuation of the normal curve. _Scoliosis_ has its
convexity directed laterally either to the right or the left. It is
commonly also _Rotatory_, having its vertebrae rotated around their
vertical axes so as to make the outer or the inner transverses more
prominent than those on the other side.

In a Scoliosis the rotation may swing either the bodies or the spinous
processes toward the convex side of the curvature; the latter is much
the easier of adjustment while the former furnishes one of the most
intricate problems of adjustment.

Cause of Curvatures

Without entering here into a discussion of those disturbed metabolic
processes--themselves the result of subluxation--which result in
curvature by general softening of the bone, as in rachitis or
spondylitis deformans, we will simply state the general proposition
that almost all curvatures which are in any degree _angular_ result
from a single subluxation to be found at the point of the angle. It
has been demonstrated in such cases that adjustment at that point
will correct the curvature in time but it is usually wiser to hasten
matters by selecting other points of attack by a method to be presently
suggested.

Long, regular, but not pronounced, Scoliosis, usually in the Dorsal,
may be an example of _occupation curvature_, following the continued
use of muscles in a fixed position and not due to subluxation. Another
example is the mailman’s Lordosis. These in themselves are not
detrimental to health and are negligible unless some special point of
impingement through individual subluxation exists within them.

The sharp, angular kyphosis of Pott’s Disease, tubercular caries of the
vertebrae, the curvature involving three or four vertebrae which are
extremely tender to palpation, should warn against adjustment unless
one can be very certain that the vertebrae are sufficiently intact.
Fracture of a decayed vertebra is easily possible under adjustment. The
cause of Pott’s Disease is usually at the angle point, most frequently
the tenth Dorsal but possibly any Dorsal from fifth to twelfth.

Record on Curvatures

If it is the purpose of the examiner to straighten the curvature he
should choose for adjustment a series of non-adjacent vertebrae which
are most prominent in the direction of the curvature; thus in a right
scoliosis he should choose only those vertebrae most prominently out
to the _right_, and in a kyphosis only posterior ones. A lordosis as
such cannot be properly adjusted except in the Cervicals, but lordosis
is usually a compensating curvature (see below) and can be otherwise
corrected.

If the patient suffers from some disease which assumes more importance
than the curvature and demands attention, select the one vertebra
which is causing the disease, without reference to its position in the
curvature, and adjust that vertebra into a proper relation with the
adjacent ones, even though you adjust directly toward the convexity
of the curvature. Disease may often be relieved by _making a curvature
regular_ more quickly than by eliminating the entire curvature.
Sometimes both considerations may influence the selection of vertebrae.

In a curvature there is not necessarily pressure on nerves at every
foramen. In fact, such pressure is the exception rather than the rule
in curvature and a careful study of the spine must be made in order
that adjustments may be accomplished without _causing_ temporary
impingement here and there.

A foot-note describing curvature may be appended to the record of
palpation. It should contain the special name of the curvature, whether
simple or compound, and the numbers of the first and last vertebrae in
it. For instance, note may read: “Right rotary scoliosis from D 3 to L
1 inclusive.”

Compensatory Curvatures

When a primary curvature is present one or two secondary curvatures
usually appear to preserve the equilibrium of the body. With a Dorsal
kyphosis there is often a Lumbar lordosis and sometimes less marked
lordosis in both Cervical and Lumbar. With a primary right scoliosis
in the Lumbar there will be a secondary left scoliosis above. The
secondary curvature is called compensatory. In selecting vertebrae for
adjustment it is well to neglect the compensatory curvature as much as
possible, leaving it to right itself as the primary one is corrected.
If, however, the primary curvature be a lordosis, and not adjustable,
work on the secondary curvature may gradually aid in reducing the
primary, to a certain extent at least.

Ankylosis

This topic is discussed here partly because it is so often associated
with curvature.

Ankylosis can be appreciated only by detecting the lack of normal
movement between adjacent vertebrae. Place a finger in the interspace
between suspected vertebrae and ask the patient to perform the movement
calculated to separate the spinous processes in a normally movable
spine. If in the Dorsals, ask him to drop the head and shoulders as far
forward as possible without bending at the hips. Alternate repetitions
of this movement with straightening and the spinous processes should
alternately separate and approach each other. Test several successive
vertebrae so as to note that all change their position except two.

In the Lumbars have the patient repeatedly bend the body forward from
the hips striving to make his spine convex backward. In the Cervicals
forward flexion of the head will serve. Occasionally general ankylosis
is found with curvature, as in Spondylitis Deformans.

Many Chiropractors mistake failure to move a vertebra with an attempted
adjustment for evidence of ankylosis. In nine cases out of ten such
failure is due to other reasons, ankylosis being very infrequent. It is
a much abused excuse for incapability. Free movement between spinous
processes is _absolute proof_ that the vertebrae are not ankylosed.

DIFFICULTIES IN PALPATION

The chief difficulty arises from failure to observe some of the rules
herein laid down.

Carelessness or inattention precludes accuracy.

Pain may cause the patient to assume an unnatural or cramped attitude
simulating curvature, especially of the Cervicals. More errors occur
from this cause in judging the laterality of C 2 than with any other
vertebra.

The occasional bent spinous process in Cervical or Dorsal regions may
deceive the palpater unless transverse palpation is employed. But the
frequency of slightly bent processes in dry spines and a superficiality
of reasoning upon the subject have led to great overestimation of their
importance. As a matter of fact only a very few maladjustments arise
from deception of the palpater in this way, though the profession
contains few practitioners who make a routine method of verifying by
the transverses. The reason is simple. Bent processes are caused by
direct violence applied before the union of shaft and epiphysis is
complete. Sufficient force to produce a change of direction usually
produces subluxation _in the same direction_. Adjustment continued
until the offending process was quite aligned with its fellows would
constitute overadjustment, but adjustment is not usually continued
after all symptoms have subsided, so that actually small harm occurs
through failure to detect bending.

An epiphyseal plate may be absent, having been broken off by trauma and
absorbed. This can be discovered by noting the too-wide space between
apparently adjacent vertebrae, and careful palpation will disclose the
apparently much anterior vertebra, an appearance not borne out by the
position of the transverses. When an epiphysis is absent a patient has
a somewhat weak back from lack of muscular attachment.

Lipoma, or the heavy cicatrix following a burn or carbuncle, may render
palpation of two or three vertebrae impossible. In such a case only
the palpater’s experience and his knowledge of the characteristics of
various vertebrae will enable him accurately to number the remainder.

Patients with much adipose tissue may require palpating in several
positions in order to permit certainty.

A deep third Cervical which is absolutely impalpable may mislead one,
but a careful count which shows one vertebra overlooked indicates the
necessity for a careful re-examination of the Cervicals, by which the
gap at the third at least may be appreciated. If the Axis is very much
inferior the third is especially likely to be overlooked.

Anomalous cases have been found in which there were more or less than
the usual number of movable vertebrae, the usual deviation being the
presence of twenty-five, and the extra one being most commonly a
Lumbar. In one case under my observation there were twenty-five movable
vertebrae, apparently thirteen Dorsals according to shape, and only
eleven pairs of ribs posteriorly, two pairs being dichotomous so that
there appeared thirteen pairs anteriorly. Deviations in number occur,
in my experience, about once in five hundred cases.

LANDMARKS

The regional location of vertebrae by means of certain landmarks (so
called) in or near the spine, is a much discussed question in the
profession. Without discussing the various arguments in favor of this
method, chief of which is the _inability of the untrained to count
vertebrae_, let us set forth the principal landmarks used and the facts
in regard to them.

The seventh Cervical, called Vertebra Prominens, is usually considered
a guide to the count. In over three hundred cases examined for that
purpose the seventh Cervical was found to be Vertebra Prominens in
about 65%, the other 35% showing the sixth Cervical or first Dorsal to
be the prominent one. This method is two-thirds as accurate as counting.

The tubercle (Chassaignac’s) of the sixth Cervical transverse is said
to be directly opposite the lower border of the cricoid cartilage and
this is a better guide than the above.

The third Dorsal spinous process is said to be on a level with the root
of the spine of the scapula, and with arms hanging at sides, the upper
angle of the scapula to be on a line between first and second Dorsal
spinous process. This is not at all constant.

The inferior angle of the scapula is said by some writers to be
on a line with the tip of the seventh Dorsal spine. Others locate
it opposite the interspace between seventh and eighth Dorsals.
Still others give it as opposite the eighth Dorsal spine. All are
correct--_sometimes_. In truth, the inferior angle may be opposite any
part of the spine between the sixth and ninth Dorsals. There is nothing
constant about it.

The twelfth rib may be followed to its articulation with the twelfth
Dorsal vertebra. This is a good guide, providing that the rib can be
palpated. The lower margin of the last rib is usually even with the
spinous process of D 12 about one inch and a half from the mid-spinal
line. The humor lies in the fact that the patient upon whom the count
is so difficult as to require this verification is usually obese and
obesity renders the rib impalpable.

The line drawn between the iliac crests falls between the third and
fourth Lumbar spinous processes in about 98% of all cases. _This is our
most reliable landmark._ It is used as described under the Count.

All landmarks except the last two show such variance in different
individuals as to be quite unreliable. The correct method of numbering
spinous processes is the obvious and logical method--_count them_.
The skill and accuracy of touch required for successful counting is
invaluable in determining direction of subluxations.

MENTAL ATTITUDE

In order to secure that absolute concentration without which it is
impossible to appreciate properly those tactile impressions for the
very _reception_ of which such continued practice is necessary, the
hands should leave the spine as little as possible during palpation;
a second person should record subluxations found so that the palpater
need only state, and not write, his conclusions; light pressure on
the spine should always be used, as a heavy pressure desensitizes
nerve-endings in the fingers; and silence should be maintained except
for the necessary statement of points to be recorded.

Palpate as rapidly as is consistent with good work. The more rapid
the palpation, _if concentration is absolute_, the more accurate the
impressions received.

The _end_ and _aim_ of palpation is to determine the means by which
impingement of nerves may be removed with the greatest rapidity and
success. Palpation includes such a study of the vertebral column as
will fix in your mind a clear thought-picture of the impinged nerves
throughout its length.

FINALLY

If you would achieve success in Vertebral Palpation, be persistent.
Spare no labor to acquire that accuracy of detail which distinguishes
the expert from the amateur. You can make of yourself what you will.
There is no limit to the ability which may be acquired. Another may
guide your hands but with _you_ lies your success.

NERVE-TRACING

Definition

Nerve-tracing is that branch of palpation by which the tenderness of
irritated spinal nerves is discovered and their paths demonstrated.

Organ-Tracing

Organ-tracing is that branch of palpation which deals with the
outlining of the boundaries and surface markings of a tender organ or
part.

Palpaters frequently confuse tenderness of one of the parenchymatous
viscera for the tenderness of interlaced and branching nerve filaments,
especially in the abdominal region. The fact that the tender area
takes on the characteristic shape of one of the viscera is conclusive
evidence that an organ, and not nerves, have been traced.

What Nerves Traceable

Any spinal nerve may be traceable for at least a part of its course.
The cranial nerves are made inaccessible to palpation by their
location, except the spinal portion of the spinal accessory and the
terminal portions of the nerves to the face. Likewise the sympathetic
trunks, except perhaps in the neck, are untraceable.

Nerve-tracing is comparatively easy in the upper and lower extremities,
neck and back. The superficial nerves of the scalp are hard to follow
on account of the hair. The superficial nerves of thorax, abdomen, and
pelvis are accessible under the conditions mentioned below; the deep or
visceral branches, never.

Of those nerves mentioned as traceable, only such as are _irritated_
and consequently swollen and tender, can be followed. If a nerve is
very heavily impinged, especially if the impingement be chronic, it
is partially or wholly paralyzed and not traceable. If the heavy
impingement be acute, or if there be a light impingement serving as a
mechanical irritant, nerve-tracing is a real aid to diagnosis.

Proportion of Cases with Traceable Nerves

About one-half of all the cases which visit Chiropractors for
adjustment are susceptible of nerve-tracing. In the remaining half it
is absolutely impossible to acquire any information in this way. Of the
half who are at all susceptible, it is possible in perhaps four-fifths
of all cases to secure _some_ accurate or reliable information.

The patient in whom all accessible nerves seem tender to light
palpation is hyperesthetic and unavailable for tracing.

In the usual case one or two nerves will be found easily traceable,
while the rest exhibit no tenderness on pressure. Such a case furnishes
the most reliable information securable by this method and the tender
nerves may be considered as lightly or acutely impinged.

Preconception of Nerves Essential

Knowledge of the anatomy of the nervous system is a part of the
necessary equipment of the Chiropractor who would trace nerves and this
knowledge should be so thorough as to enable the palpater to recognize
each tender line found as an anatomically described nerve-path or an
error on his part. The examiner must know the paths of all nerves and
be able to predict from the first tender points discovered the probable
course which the tenderness will follow, so as to direct his search
along that probable path.

He must be able to detect unconscious deception on the part of the
patient through his knowledge of the anatomical impossibility of the
apparent tracing. For instance, if for any reason he may appear to have
traced a nerve upward beside the spinal column from D 10 to the eye by
way of the vertex, he must know that this is an illusion--because such
nerves do not exist and cannot be anatomically demonstrated--or accept
the well merited ridicule of any educated person who discovers his
absurdity.

Because of the difficulty of determining whether the tender structure
found be muscle, nerve, or viscus, and because of the natural
suggestibility of both palpater and patient, nerve-tracing cannot be
so reliable a guide to nerve-paths as is dissection. It should not be
necessary to state this obvious truth but the calm acceptance, by many,
of the weird conclusions based upon a belief in the infallibility of
nerve-tracing testifies that it is necessary.

Nerve-tracing is valuable only where the nerve-path outlined as being
tender corresponds to the known path of some nerve.

Suggestion

Paradoxically, knowledge of nerve-paths may lead to error. By the law
of expectancy, we are prone to find what we look for and if we hold too
strongly to the belief that because we have found one or two points of
tenderness we must find a series of points extending along a mentally
pictured nerve-path, we may search until we falsely believe that we
have found this series.

Likewise the patient, having been carefully informed as to the manner
of procedure and knowing what we expect to discover, may unconsciously
deceive us by feeling tenderness in response to suggestion, where no
real impingement exists.

Place in Diagnosis

The value of nerve-tracing in diagnosis has been much overestimated
by many, though the tendency of the profession seems to be toward
rationalism along that line.

Whereas, in palpation of the spine every real subluxation gives
evidence of disease, or tendency to disease, while every normally
aligned pair of vertebrae furnish proof that no disease can exist
in the area of distribution of the nerve emerging between them,
nerve-tracing is much less reliable. If the tender nerve be traceable
to a vertebral subluxation it may be taken as additional evidence that
the effect of that subluxation is _disease_, rather than _tendency_ to
disease, truly an important distinction, but scarcely broad enough to
support a diagnosis without aid.

The absence of tenderness from nerves does not negative a disease in
any instance, whereas the absence of subluxation _does_. Like all
other expedients for the selection of vertebrae for adjustment without
admitting the necessity for first acquiring much skill by much labor,
nerve-tracing has a great weakness. Only irritated nerves are tender
and the effects of subluxation may be either irritation or paralysis.

If accurately done, sources of error carefully eliminated, and the
results of nerve-tracing found to correspond with the condition of
the spine and the other symptoms, this method of demonstrating to the
patient the connection between the vertebrae and the diseased region of
his body is valuable. It aids in convincing him of the validity of the
Chiropractic theory.

TECHNIC OF NERVE TRACING

Where to Begin

The palpater, having made his vertebral palpation, may begin at some
point in the body indicated by the symptoms as diseased and, finding
tenderness, follow the path of a nerve back to the spinal column where
the nerve may be fairly presumed to enter the intervertebral foramen.

Or he may use his palpation record as a guide and follow the tender
nerves outward to their periphery. This is the better method.

[Illustration: Fig. 5. Technic of nerve tracing, showing position of
fingers and marking of tender points.]

Palpation as Guide

When palpation has been made, remember that the impinged nerve is
usually found on the side opposite to the direction of the spinous
process in its departure from the median line. With a left subluxation
the tenderness is usually, though not always, on the right side. If in
the Lumbar, and the subluxation a rotation, the impinged nerve will be
found _below_ the transverse process of the subluxated vertebra. In the
Cervical and Dorsal regions the tender nerve is usually below, but may
be either above or below, the transverse of the subluxated one.

Examine the nerves having exit from the foramina of each subluxated
vertebra in turn from above downward. When a tender point is found
about an inch from the mid-spinal line, attempt to follow the nerve and
palpate until it has been traced as completely as possible.

Where to Expect Tenderness

The region immediately surrounding the spinous process of the
subluxated vertebra may be tender because of impingement of the axons
of the posterior primary division of that spinal nerve which emerges
below the vertebra. Such tenderness is more common with anterior
subluxations than with others. It is not to be confused with the
_soreness_ which often appears after adjustment and is due to bruising
or straining of the tissues.

Nerve tenderness may be discovered at a little distance from the
mid-spinal line and at a level slightly lower than the emergence of
the nerve. If a nerve is irritated, the finger inserted between the
ribs near their articulation with the transverse processes will elicit
tenderness. The discovery of tender points along the spine is the most
important part of nerve-tracing.

Nerve-Paths

Detailed description of the paths of all the spinal nerves may be
studied from any standard work on anatomy and will not be included
here, but it may be well to remind the reader of certain general
tendencies.

The spinal nerves do not cross the median line in front except perhaps
fine interlacing fibres.

In the Dorsal region the nerves are usually found following the
interspaces until the lower ones debauch upon the abdominal wall
anteriorly. There are, however, some Dorsal and lower Cervical nerve
bundles which pass obliquely downward and outward to innervate back
muscles.

Reference to the section on Spino-Organic Connection will make clear
the tissues supplied by each nerve.

_Slight_ deviations from the usual course of nerves are common;
_marked_ deviations very infrequent.

Use of Fingers

Use second finger of either hand for the palpating finger, choosing the
hand which can be most conveniently used as determined by the position
of patient and the part of the body to be examined. There is no set
rule. Reinforce this second finger by the pressure upon it of the first
and third and, if desired, by pressing thumb against it. (See Fig. 5.)

Apply the tip of the palpating finger to the nerve with a motion such
that it crosses the path of the nerve at right angles back and forth.
Meanwhile the probable path of the nerve must be kept in mind. As the
finger crosses the nerve-path it makes steady and even pressure upon
any structures passing beneath it. The motion of the hand is almost a
rolling motion, the finger tip probing, as it were, for a tender spot.

Tenderness--How Recognized

The irritated condition of the nerve which has thus been rolled beneath
the finger may be recognized in one of three ways; the patient may
involuntarily flinch, betraying the hurt; or he may inform the palpater
of the hurt; or the swollen, cord-like nerve may be felt.

The two former are the reliable guides, while the latter is only
occasionally possible. In children and in feeble-minded, insane, or
mute adults, the first mentioned method must be relied upon entirely.
Muscular contraction is the unconscious or reflex response to pain and
often occurs independently of the intelligence or state of mind of the
subject.

Of all the three methods the one most commonly relied upon is the
second--the statements of the patient.

Instruction to Patient

The patient should be informed of your intentions when palpation is
begun and should be asked to answer every time you apply your finger,
saying, “Yes,” if the spot is tender and, “No,” if not. He should
speak promptly each time so as to avoid self-deception which might come
with reasoning upon his sensations. Occasionally vary the steady rhythm
of your movements by omitting one and note if the patient responds
mechanically when you do not press.

At times during the tracing, it is well to depart from the probable
nerve-path and to touch again a point marked as tender, to see if
the patient’s information may be relied upon. Whenever you leave the
nerve-path his answer should be, “No,” immediately changing to, “Yes,”
when you re-cross the tender line.

Marking Tender Points

At each tender point noted a small mark should be made with an eye-brow
pencil or other grease-paint, which leaves a distinct but easily
removable mark. These tender points should be noted and marked at
intervals of about an inch.

Connecting Line

When the entire nerve-path has been traversed in this way, draw a line
with the eye-brow pencil, passing through all the marks indicating
points of tenderness. This line should be a sufficiently accurate
rough outline of the nerve-path to make clear the spinal connection
with the diseased area. The significance of this connection will be
better understood when the section on Spino-Organic Connection has been
studied.

[Illustration: Fig. 6. Anterior half of completed nerve tracing.]

Common Findings

In muscular rheumatism, neuralgia, neuritis, or in case of a local boil
or abscess indicating local disturbance of the trophic influence of
nerves, clear and definite tracings are common. Muscular spasm, such
as wry-neck, usually has a very tender nerve associated. Localized
painful disease of any kind is likely to be associated with a very
definite nerve tenderness, as is the case frequently with appendicitis,
ovaritis, hepatic colic, etc.

The painless disorders, or various disorders of spleen, diaphragm,
heart, lungs, etc., though they be of a very serious nature, seldom
are discoverable by nerve-tracing unless their serous membranes are
involved. Tracings _may_ be made from D 2 or 3 to anterior thoracic
walls in heart or lung disease but are not common.

Any spinal nerve may be traceable at times through at least a part of
its course.

Sources of Error

Several of these have been mentioned, such as the natural
suggestibility of both examiner and patient. Among others are: failure
in the back, thigh, or leg to reach the really tender nerve because of
the interposition of several muscle layers between it and the finger,
ignorance of nerve-paths, failure to apply equal pressure to all parts
of a nerve, application of such heavy pressure that muscle tissue is
bruised and hurt, and failure of full co-operation on the part of the
patient. Let us consider these in turn.

If several muscle layers interpose themselves between the searching
finger and the nerve, it is proper to push aside the intervening
layers, using a twisting and rolling movement until the finger
feels _underneath_ the muscles. This done, and a tender nerve found
underneath several muscle layers, the same amount of overlying tissue
must be pushed aside each time the finger searches for the nerve. Only
exhaustive study of the anatomy of the typical nervous system will
enable the examiner to know exactly at what point a nerve will become
more or less superficial. Unless he does know this it is best to follow
the neutral rule that nerves tend to follow the long axes of ribs and
limbs and to maintain their depth beneath the surface throughout their
course. This statement is too general for accuracy.

Care should be taken that equal pressure be made on all points palpated
on one nerve. If the nerve pass over a bone, _less force_ is needed
to exert the same pressure than if it overlie muscle or other soft
structure. The force used varies constantly as the hand moves from
place to place, according to the density and hardness of the structures
overlying and underlying a nerve.

Sufficiently heavy pressure will elicit tenderness in all except
anaesthetic patients. But if a nerve be irritated it will be tender
without heavy pressure, when the finger really makes a close contact
with it.

If the patient willfully attempts to deceive the palpater,
nerve-tracing might as well be abandoned except in those extreme cases
where the patient will flinch against his will on account of extreme
sensitiveness.

Use of Second Hand

As far as possible, the second hand is placed opposite the tracing hand
and steadily supports the body; its position changes with changes in
the position of the first. If the arm is to be examined it had best be
held away from the body, and the part to be examined held between the
two hands.

Position of Patient

For tracing nerves in the neck, back, and upper extremities, the
patient should sit easily. For lumbar, abdominal, or pelvic tracing,
or for tracing in the lower extremities, have patient lie on side or
back. Do not hesitate to change the position of the patient as often
as is necessary to secure easy access to the part to be examined and
relaxation of the patient’s muscles. Never allow the assumption of a
strained position during tracing; the sensation of cramped muscles may
be confused with sensations of nerve tenderness.

SUBLUXATIONS

Definition

A vertebral subluxation is a displacement, less than a dislocation,
in which the chief element is the partial loss of normal apposition
of the articular surfaces of the subluxated vertebra with those of
the vertebra above or below, or both. Or, Vertebral subluxation is a
permanent partial dislocation.

How Produced

Subluxations are primarily caused by trauma--falls, blows, strains,
etc., being the chief factors. Hereditary weakness in structure of some
part predisposes by rendering that portion more easily displaced.

Subluxations are never hereditary but may be congenital through violent
or instrumental delivery into the world or may _appear_ hereditary
because they occur shortly after birth through the effect of light jars
upon the hereditarily weakened segments of the spinal column.

They are always the result of concussions of forces; never of forces
acting entirely _within_ the organism. They result from the contact of
the body with its environment.

It has been said that muscular action in response to peripheral
irritation may produce subluxation. The laws of reflex action render
this impossible. Given a normally aligned vertebra, and consequently
normal nerves and a normal reflex arc in that segment, the ventral
horn cells respond to a _slight_ peripheral stimulus by exciting
muscular contraction on the _same_ side with the irritation. If the
irritation be sufficiently increased, the response occurs on _both_
sides but most strongly on the side from which the irritation comes.
Greater irritation merely serves to cause greater distribution of the
responsive action. (See any standard physiology on reflex action.) In
no case will the difference between the contractions of muscles on the
two sides be sufficient to displace a normally aligned vertebra. Nature
has provided against that contingency.

Given a subluxated vertebra causing nerve impingement and thus
interruption of the normal action of the reflex arc, irritation may
result in greater contraction upon the _opposite_ side than upon the
side of the irritation. This is an abnormal condition and accounts
for the _increase_ of previously existing subluxations under pain or
peripheral irritation. But in every instance trauma must and does
precede and cause subluxation.

Reaction of Secondary Causes

Once produced, however, a subluxation may not cause noticeable effect
until it has been _increased_ in degree by the reaction of forces
within the body such as poisons, general fever, etc. Thus germs,
dietetic errors, exposure to sudden temperature changes, waste of
energy through abnormal mental activities, as hate, fear, worry, etc.,
or through physical excess--in fact, all the _secondary_ causes of
disease may _appear_ to have produced a subluxation. In fact, they have
merely accentuated that which already existed and have done so through
the muscular contractions which they induced.

General thinning of intervertebral substance through a condition
of disturbed metabolism itself produced through the agency of some
_one_ serious subluxation, may narrow all the foramina and increase
impingement of nerves at any point where a slight subluxation
previously existed. An irritated nerve may become swollen and the nerve
impinged at the foramen.

Law Governing Location

So definite is the law governing the effect of force applied to a given
portion of the body upon an associated vertebral segment that the
skilled Chiropractor who has studied vertebrate segmentation thoroughly
may determine, from the history of a fall or injury, the vertebra which
would tend to be subluxated by that injury and the tissues controlled
from that part. The rule is this:

_Force applied to any body segment tends to subluxate the segmentally
associated vertebra. This subluxation tends to produce disease
throughout the area of distribution of the subjacent pair of spinal
nerves._

The task of explaining this law seems hopeless unless the student is
familiar with human embryology and the life history of the vertebrata,
as well all the details of human anatomy. To such a student the
law will be self-evident, so interwoven with the threads of higher
organization as practically to form its pattern.

In simple terms we might offer this general statement. Any force
applied to the body with sufficient violence will produce subluxation
of the vertebra above the spinal nerves supplying the injured area.
Thus, the brachial plexus controls the arm and shoulder and connects
with the spine by way of the 5, 6, 7, 8, Cervical and 1 Dorsal nerves.
Any force striking the arm or shoulder tends to produce subluxation
of the sixth or seventh Cervical or first Dorsal vertebra so that all
permanent disease conditions resulting will be found in the arm or
shoulder or nearby tissues of the neck.

This theme presents a magnificent field for individual study and
research but is, per se, beyond the limitations set for this work.

Effect of Subluxations

Slight subluxations may exist, because of the adaptation of surrounding
parts and the slight play within the intervertebral foramen, without
producing noticeable effect. They always, however, evidence a
_tendency_ to disease.

The majority of subluxations do produce disease, to some degree, and
do so by _impinging nerves_. Impingement may be either by pressure
_against_ a nerve or ganglion or by _constriction_ of a nerve where it
passes through an intervertebral foramen; the former occurs in the case
of the Cervical sympathetic, the sub-occipital nerves, and the sacral
nerves; the latter is the commoner form in Dorsal and Lumbar regions of
the spine. Probably the most positive constriction of a nerve which can
occur within the body is to be found in rotation of Lumbar vertebrae;
the body of the rotated vertebra encroaches upon the inferior nerve on
the side opposite to the direction taken by the spinous process.

Either variety of impingement produces disease, morbid structure or
function, by irritation of the nerve: light impingement irritates,
heavy impingement partially or completely paralyzes, the nerve.

VARIETIES OF SUBLUXATION

According to the abnormal relations between vertebrae subluxations may
be variously described as rotated, tipped, anteriorly, posteriorly,
or laterally displaced. They commonly combine two or more of these
forms, so that the purely rotary or the entirely lateral subluxation is
uncommon.

Rotation

Every vertebra has a vertical axis around which it tends to rotate.
This axis is not always the center of mass but depends upon the
arrangement of mass, the fixity of cartilages, ligaments, and muscles,
which tend to hold some parts of the vertebra more fixed than others,
and the apposition of articular processes, which tends to prevent
movement in certain directions.

The axis of rotation of the first Cervical is the center of the
odontoid process of the second Cervical, which articulates with
the transverse ligament and anterior arch of the first. A frequent
subluxation of the Atlas is a rotation around this process so that the
one transverse is permanently posterior to its normal position and the
other correspondingly anterior.

The axis of rotation of the Cervicals below the Atlas is in the extreme
anterior portion of their bodies. This part remains relatively fixed in
rotatory subluxation while the tip of the spinous process describes the
greatest arc.

In the Dorsals the axis of rotation lies in the posterior portion of
the centrum near the neural canal. When the spinous process appears
laterally displaced in rotation the anterior portion of the body is
slightly displaced in the opposite direction, twisting and straining
the fibres of the intervertebral disk.

In the Lumbar region rotation is the commonest form of subluxation,
the axis of rotation being laterally movable upon a transverse line
between the articular processes in the beginning and shifting, as
soon as the vertebra leaves its normal relations, to the junction of
the articular process with that of the adjacent vertebra on the side
toward which the spinous process is moving. Thus, in rotation of the
vertebra so that the spinous is to the right, the axis will be found
on the right side, the superior articular process of the next vertebra
serving as a support on which the inferior articular process of the
rotating vertebra may turn. The processes are so firmly locked that
unless the whole vertebra be quite posterior little lateral movement
of the spinous process is possible without marked rotation. The body
describes the greatest arc because it is further removed from the
center of rotation than is the tip of the spinous.

Tipping

This is a subluxation in which the one transverse process is, or
appears to be, superior or inferior to the other. It occurs frequently
to the Atlas in combination with lateral subluxation. In fact, the
shape of the occipito-atlantal articulations is such that, if the
remaining Cervicals maintain their proper relation to each other,
the Atlas cannot be laterally displaced without a certain amount of
tipping. It will be relatively superior on the prominent side and the
head will be tipped toward that side; that is toward the side of the
lateral displacement. Thus, on account of the wedge-shaped lateral
masses, if the whole Atlas be to the right of its normal position the
right side will be superior and the head tipped toward the right. This
is only true when the vertebrae below maintain a normal interrelation.

Approximation

This is a name applied to that condition in which, on account of
changes in the intervertebral disks due to subluxation interfering with
metabolic processes, the bodies or spinous processes of vertebrae are
crowded too closely together.

Occasionally a spine is found in which, on palpation, the spinous
processes are found to be crowded together in groups, sometimes of
two or three, sometimes of five or six; no two interspaces appear
equal, a very wide one being succeeded by one or two which are almost
inappreciable; the variation in width of the interspaces does not
correspond to the known normal variation in those regions where the
changing obliquity of spinous processes should modify the relative
width of successive spaces. We expect, for instance, to find a wider
space between third and fourth Dorsals than between second and third;
if we do not find this difference it is doubtless due to cartilage
change and the vertebrae are approximated.

In case of general thinning of intervertebral substance unequally
divided between different sections of the spine the record will show
that almost every vertebra is listed either S or I, and if a system of
underscoring is used that these two directions are frequently indicated
as most noticeable.

A study of the spine will make clear the fact that if the cartilage
between any two Dorsal vertebrae be thinned in front the bodies of the
vertebrae will be closer together and the spinous processes more widely
separated; the spinous process of the upper vertebra will be crowded
against the one superior to it and that of the lower against the one
inferior to it. These spinous processes are said to be _approximated_.

The correction of S or I subluxations, then, depends upon correction of
disturbed nutritive processes.

Lateral Displacements

According to the usage of earlier writers on subluxations this
term (lateral displacement) included rotation of the vertebra as
well as those changes in position in which the whole or nearly all
of the vertebra deviates sidewise from its normal position. Since
the introduction of the term “rotation” into the description of
subluxations, the meaning of the term “lateral displacement” is much
more restricted. It refers now to a condition which probably occurs in
the strictest sense only in the Cervical region, most frequently with
the first and second Cervical, the two being subluxated together.

We have already stated that the most important fact to be determined
regarding the Atlas is its lateral displacement, since this produces
the greatest impingement of nerves. Lateral displacement of any other
Cervical can best be judged by examination of the transverse processes,
since by palpation of the spinous process alone it is quite impossible
to distinguish between lateral and rotary subluxation.

In the Dorsal and Lumbar regions the R or L used to describe the
position of the spinous process most often indicates rotation of the
vertebra. While it is perfectly proper thus to describe the subluxation
on a record, in the determining of the form of adjustment to be used
the position of the _whole_ vertebra must be considered.

Anterior Subluxations

Forward displacements may occur anywhere in the spine. In the case
of the first Cervical they are usually, though not always, forward
displacements of only one side--rotation--though the whole Atlas may be
anterior if the Axis has moved with it or is tipped so that the spinous
process is much superior. This is rare.

Any Cervical may be anterior; usually a series are anterior (if any)
amounting to an increase in the Cervical curve--a lordosis. This
condition may be corrected by transverse adjustments given from the
front and side.

A Dorsal vertebra is only _relatively_ anterior, the adjacent ones
being relatively posterior, and the only possible correction at present
is the adjustment of the posterior ones. A Lumbar cannot be anterior
unless those below it are also anterior, on account of the locking of
articulations. Discovery of anterior Lumbars is quite common. The fifth
Lumbar may be subluxated anteriorly by slipping forward on the Sacrum;
it must be _superior_ at the same time, on account of the shape of the
articulating surfaces which face downward and forward. The spinous
process is crowded closely against the fourth while the body of the
fifth is too widely separated from that of the fourth.

Posterior Subluxations

There are many Chiropractors who have always considered the posterior
subluxation more than any other, not because it produces greater
nerve impingement than others but because it is easiest to detect;
it intrudes itself upon the attention of the unskilled examiner most
persistently. Nor should its importance be underestimated, though we
now realize that in some instances a rotated or anterior vertebra may
cause more nerve impingement than a posterior one.

The posterior subluxation in the lower Dorsals and Lumbars is the
easiest variety to adjust; in this region a posterior displacement of
one vertebra tends to bring with that one the next adjacent superior
one, the sharpest deviation occurring between the posterior one and the
one below it.

Any vertebra may be posterior: the Atlas is rarely so as a whole,
and never unless the Axis is also displaced backward; the Cervical
and Dorsal regions present frequent variations of this sort, which
must not, however, be confused with long, prominent, or overdeveloped
spinous processes; the Sacrum may be posterior to the ilium on one
side, or to both ilia.

Occipital Subluxations

Mention should be made here of a form of subluxation not strictly
vertebral--displacement between the condyles of the occipital bone and
the lateral masses of the Atlas. This occurs when the head has been
moved too violently upon the Atlas so as to cause an immediate nerve
irritation and muscle tension sufficient to hold it in its abnormal
position. The Cervicals may be quite normal below the Atlas though
this, of course, is not the rule. Correction of occipital subluxations
is made by applying force to the Atlas and to the skull, sometimes by
holding Atlas and rotating the skull.

Age of Subluxations

The relative age of subluxations may be determined, within rather wide
limits, it is true, by a study of the form of the spinous process.
Newly acquired subluxations are sharply defined, having noticeable
_edges_ on the spinous process. In time they tend to become rounded
and blunt and appear to cover more surface, just as the mountain range
which, when first upheaved, is sharp and rugged, gradually rounds into
regular curves through the work of the elements.

In this way Nature protects the subluxated vertebra from further
contact with the environment surrounding man, the rounded process
offering less opportunity for a blow or shock to affect it.

Changes in Shape

Bone diseases such as rachitis osteomalacia, etc., and especially
Potts’ Disease, or spinal caries, make marked changes in the shape of
vertebrae. Also a subluxated vertebra may gradually assume a shape
suited to the abnormal position it occupies, the commonest change
being the assumption of a wedge shape by the centrum. This is a great
obstacle to adjustment, as the abnormal shape of the vertebra makes it
tend to settle after each movement into the old abnormal position.

There are few spines without some more or less misshapen vertebrae.

Ankylosis also makes great changes in the shape of vertebrae. There
are two kinds of ankylosis--true and false. The first is a deposit of
bone cells upon bone, often the formation of a bridgelike structure
to hold contiguous vertebrae together. This may bind any portions of
the vertebrae but most commonly holds the bodies, in which case it can
only be appreciated by detecting the lack of movement between normally
separable vertebrae. False ankylosis occurs with fever in bone and
consists in an exudation of bone substance which sometimes produces
remarkable distortions of shape.

TECHNIC OF ADJUSTING

Definitions

Vertebral Adjusting is the art of correcting by hand the malpositions
of subluxated vertebrae.

A Vertebral Adjustment, strictly speaking, should mean the complete
restoration of normal relation between previously subluxated vertebrae.
As used in Chiropractic, it means either a partial or complete
restoration of such normal relation.

Maladjustment, as used in the profession, designates any movement of
vertebrae by hand which produces or increases subluxation.

GENERAL PRINCIPLES OF ADJUSTING

It will be well for the student to master first the general rules and
principles which govern vertebral adjustment and then to proceed to a
detailed investigation of each movement, in turn, before practicing
it. The art of adjusting can only be acquired by practice, and a high
degree of excellence in it only by _long-continued_ practice. However,
the rapidity with which it can be mastered depends largely upon the
formation of a clear pre-conception of the work to be done and the
manner of its doing.

As the student progresses in the art he finds himself occasionally
guilty of errors which mar, in some degree, the efficiency of his
work. These may arise from unconscious modification of the technic
first learned or from unconscious repetition of some necessary
modification demanded by a special peculiarity in one or more cases.

This section is intended to furnish the proper pre-conception and also
to serve as a monitor to adjusters who, by reference to the precepts
herein set down, may discover and remedy their own errors. It is not
intended to furnish sufficient education to warrant practice without
clinical instruction, which is unwarrantable, but rather to accelerate
the education which practice alone can furnish.

Object of Adjustment

The vertebral subluxation being an abnormality of _relation_ between
vertebrae, it is obvious that its correction must be a return of normal
relation. This can only be accomplished by bringing about a change of
_relative_ position. Movement of a section of the spine composed of
several vertebrae is not, in the true sense, an Adjustment. It is the
_single_ vertebra which must be moved.

The movement should be one calculated to bring the vertebra to its
normal position _in the most direct manner possible_. Such a movement
should be used as will reverse the direction of the forces which
subluxated the vertebra. It should be applied to the transverse or
spinous processes, or to the lamina, as is sometimes done in the
case of the Atlas, according to the _kind_ of subluxation. Different
subluxations require different handling. Cases vary. Select the move
_best suited to the case_. This can be determined most properly by
correct palpation which fixes in the mind of the adjuster the position
of every part of the vertebra, its relation to its fellows, the points
of greatest nerve impingement, etc., all of which should suggest the
best method for correction.

The prime object of adjustment is the removal of impingement from
nerves.

Transmitted Shock vs. Thrust

The movement used in adjusting has been variously described. Many
writers and teachers have used the term “thrust” to describe the
movement of the hands, and the term is correctly applied to the
movement used by many Chiropractors. But a careful study of the methods
of applying force in use among the most successful adjusters, those who
have attained the greatest results with the slightest percentage of
failures and a minimum of pain to the patient, discloses the fact that
the chief element of their adjustment is _transmitted shock_.

The hand is held in close contact with the vertebra to be adjusted
and the arms and shoulders describe such movements as to deliver the
required amount of force with the slightest possible change in the
position of the hands. The vertebra bounds away from the contact hand.
In the delivery of a _thrust_ the hand would follow the vertebra,
forcing each portion of the movement. The real effect of a thrusting
motion, since the hand cannot enter the body as a sharp instrument
would, is that of _pushing_. Pushing neither subluxates nor adjusts
vertebrae so readily as does a rapidly applied shock.

Let us illustrate with a common experiment in physics. Suspend a number
of ivory balls by cords of equal length in such a manner that each
is in contact with its fellow and all are in a straight line. When
the balls are properly adjusted a straight line should connect their
centers. Hold one end ball firmly in the hand or with an instrument
which renders it absolutely fixed. Then strike sharply with a light
hammer. The balls will all remain stationary except the one on the
opposite end which will fly off to a distance exactly measurable
according to the force of the blow. How does this occur?

A shock is transmitted through the molecules of the ivory until it
reaches the end ball, which is not held back by another. Here the
transmitted force is expended in molar motion, the ball leaping away
from its fellows as if it had been hung alone and had been struck with
the same force.

It is well known that by placing an elbow firmly against a man’s jaw
and then sharply striking the closed fist with the other hand, open, a
very heavy blow can be given; yet the forearm, through which the shock
is transmitted, does not move.

Now ivory is very like human bone. Further, it has been demonstrated
that the law illustrated by the above experiment is equally applicable
to the movement of vertebrae. The pushing or thrusting movement _may_
move a specific vertebra, but it is probable that the chief factor in
so doing is the element of transmitted shock contained in the movement
and delivered at the instant of release of the hand from the spine at
the end of the movement.

On the other hand it is obvious that a pushing or thrusting movement
may move several vertebrae in addition to the one directly in contact
with the adjusting hand, in consequence of the way in which the spinal
segments are closely bound together. If a steady strain is used, in
which muscles and ligaments have time to act, one of three results
may occur: (a) the specific adjustment; (b) the movement of several
vertebrae at one time, which does not constitute an adjustment; (c)
the giving way of the spine at its weakest point, which may be some
distance from the point of contact with the adjusting hand, the
ligaments and muscles having communicated and diffused the strain
throughout a large area. In the latter contingency the result is
usually a new subluxation or the increase of an old one, instead of an
adjustment.

The Rapid Movement

Thus _Speed_ becomes an important factor in correct adjustment.

A good illustration of the value of speed may be taken from a pile
of stakes bound together by a cord. If a man with a hammer desires
to remove the center stake of the group, and attempts to do so with
a slow pushing movement, the result is a change of position of many
stakes, which adhere to the center stake and to each other. If, on
the contrary, he strikes a sharp, quick blow with his hammer, meeting
squarely the center of balance of the one stake, it will fly straight
from its position leaving the others unmoved. This is exactly what we
desire to accomplish with an adjustment. By the speed of the movement
we expect to move _one_ vertebra before adhesion or the contraction of
muscles or inelasticity of ligaments can diffuse the force.

Close Contact

In order to accomplish the transmitted shock it would seem wisest,
at first thought, to draw back the hand and strike the vertebra
sharply. On the contrary, it has been found advisable to place the
hand carefully in _close_ and _immediate contact_ with the vertebra
to be adjusted. Nature herself shows us the way in the delicate
shock-transmitting mechanism of the tympanum.

Also the hand of the adjuster will cover much more than merely the
spinous or transverse process which is used as a lever and to which
it is desired to transmit the shock, unless carefully placed so that
only a _small portion_ is in contact; by such a contact diffusion of
the shock is prevented and its efficiency within a limited area is
increased. A carpenter wishing to countersink a nail places in contact
with the nail head a small instrument called a countersink, which he
then strikes sharply with a hammer. The contact hand of the adjuster
represents the countersink and is used by the two arms as a passive
instrument for transmitting shock.

The close contact of the hand, which remains passive, renders the
adjustment much less painful to the patient than it would otherwise
be, and one of the prime objects in the mind of the adjuster should be
the minimizing of pain inflicted, by any means which does not lessen
the resulting benefit. Also any drawing back of the hand before the
movement warns the patient and tends to induce involuntary muscular
contraction which interferes with adjustment.

Relaxation

In an adjustment it is necessary to overcome two kinds of
resistance--the passive resistance of inertia, of ligaments, or
of superincumbent weight, and the active resistance of muscular
contraction. It is important that both forms be minimized.

The first may be lessened through the position of the patient’s
body; he is placed so that the vertebra to be adjusted is in the
freest possible position. The second is reduced to the least possible
quantity, amounting to no more than muscle tonus, by using two methods:
(a) Oral Suggestion, and (b) Muscular Suggestion.

Oral Suggestion

Explain to the patient the need for relaxation. Make it clear to him
that less force will be required if his muscles are passive. Remind
him frequently of this and assume that he desires to relax. A word
immediately before the adjustment often induces a temporary relaxation
during which the adjustment is given. Anything which detracts the
attention from the coming shock is an aid. Sometimes asking the
patient to inhale and exhale slowly and deeply will sufficiently take
his attention from the adjustment. Experience will teach him that he
suffers less pain when relaxed and presently relaxation becomes a
habit. Instructing patients to think of sleep, turning the eyeballs
upward, has been effective with some.

Muscular Suggestion

This can only be given by maintaining a state of relaxation in one’s
own muscles, which in itself is desirable in most cases, for reasons
to be presently explained. In handling Cervical vertebrae move the
head gently from side to side with your own hands relaxed as much as
possible. The lazy motion suggests relaxation. Then when it is felt
that the neck is thoroughly relaxed, vary the motion with a quick
adjusting movement.

In Dorsal and Lumbar regions after the hands are in correct position
the adjuster should pause a moment both to be sure that the direction
of movement and his purpose to move are clearly fixed in his mind
and to be certain that both himself and the patient are relaxed. The
adjustment is given instantly and from a perfectly lax muscle, as a
boxer strikes.

An added advantage is the greater amount of speed and control which
may be commanded in this way. The lax arm, being in a neutral state as
regards motion, can be contracted in any desired direction without
loss of force or of time, whereas a taut muscle cannot further effect
motion of the arm without relaxation of its antagonistic muscles, which
takes time.

Muscular Control

Considerable contral over one’s own muscles is necessary in order
perfectly to relax arm and shoulder muscles just before the adjustment
and then to utilize a measured and determined quantity of force in a
desired direction. To acquire this much practice is necessary--practice
on the living subject. The desired end may be hastened, however, by
acquiring the abstract property of muscular control or by developing
control already gained.

Many different forms of exercise will aid in the acquisition of
muscular control and the ability to relax and then to follow the
relaxation with an instantaneous whiplike contraction in a given
direction. The best of these is without doubt _bag-punching_. The
movements employed with a punching-bag, especially the lateral
quadruple movement with both elbows and both hands, tend to develop
precisely the sort of control needed for correct adjusting. The
beginner can do no better than to practice in this way, by which, it
must be remembered, only a necessary _property_, and not by any means
the exact movement, may be acquired.

Amount of Force

The amount of force used in an adjustment varies so much in different
spines and in different parts of the same spine that it is quite
impossible to state any correct estimate of it in terms of physical
units. In general the Cervicals move with least resistance, then the
Dorsals, then the Lumbars, and finally the Sacrum and Ilia as hardest
of all to displace or replace.

In developing additional force when it is found that the force first
used on any vertebra has been insufficient to move it, remember this
law: _Work equals one-half Mass times the square of the Velocity_.
In other words, doubling the speed of the movement increases its
effectiveness four-fold; tripling it, nine-fold.

The increase in force should never be effected by increasing the
_weight_ or _pressure_ upon the patient’s body, for reasons which
should be clear from a study of previous pages, but always by
increasing the _speed_ of the movement.

Names Used to Describe Movements

The names herein employed to indicate certain movements, each a
well-defined method of procedure for the accomplishment of some special
end, are the names or descriptive terms which seem to be in the most
general use at this time. Few of these movements have arrived suddenly;
most of them are the result of gradual growth and evolution: so with
the terms by which they are known; they have gradually become a part
of the common language of the profession. Usage sanctions them, though
some of them are cumbersome, unwieldy, or entirely inappropriate.

[Illustration:

Fig. 7. Morikubo Move. For correction of a lateral and rotated
Atlas (L. A.). Pisiform contact with anterior transverse.
]

SPECIAL TECHNIC

MORIKUBO MOVE

A movement for the correction of a lateral and rotated Atlas, indicated
for use only when the Atlas is recorded as R. A. or L. A. The position
of the patient’s head renders the transverse process inaccessible
unless it be anterior on the side from which adjustment is to be given.

Position of Patient

Place two sections of the bifid bench together so as to secure the
effect of a solid bench with an upward sloping front. Have patient
lying on back with back of head resting firmly on bench, chin slightly
uptilted. Then turn patient’s head so that it faces sidewise and rests
flatly on the side of the least prominent transverse. This exposes
the anterior transverse in front of the tendons of the sterno-mastoid
muscle.

Use of Hands

Stand leaning over head of bench and carefully place the pisiform bone
of adjusting hand upon the tip of the transverse process, being careful
to push aside the sterno-mastoid tendons if they interpose themselves
between the pisiform and the process. The fingers of the adjusting hand
extend downward toward the clavicle and rest lightly, very lightly,
upon the patient’s neck. With the other hand firmly grip the wrist of
the adjusting hand, fitting the pisiform of the upper hand into the
hollow below the styloid process of the radius.

Movement

This is delivered straight downward toward the bench. It should be
light and quick and the hand should not follow the process in its
movement.

This movement is painful and should not be used if avoidable. When
used it requires the utmost care and a careful measuring of force.
Err, if at all, on the side of overcaution. The technic will be better
understood after study of the more detailed description of “The
Recoil”, since the position and use of hands, arms, and shoulders is
much the same for both.

PISIFORM ANTERIOR CERVICAL MOVE

Indicated for rotation of a Cervical vertebra in which one transverse
process is anterior to its normal position or more anterior than its
fellow which may also be somewhat, though less, anterior.

Placing Patient

As for the Morikubo Move place the patient in the dorsal recumbent
posture with head resting on bench and chin uptilted. Turn patient’s
face slightly away from the side of the selected anterior transverse
and steady the head with the free hand while palpating.

[Illustration: Fig. 8. Pisiform anterior Cervical move.]

Making Contact

Palpate downward from the Atlas transverse along the posterior margin
of the sterno-mastoid, dipping deeply into the neck and exploring with
the tips of the first three fingers until the offending process is felt
as a nodule of bone plainer to the touch than those above and below.
Always reach _across_ the neck to the selected transverse; if it be the
right, stand on the patient’s left and use left hand for palpating and
for contact hand as well.

Having found the process, gently move aside any tissues which tend to
interpose between the finger and the bone, change hands so that the
palpating hand is free and the other holds the contact spot clear of
interposed tissue and plainly points it out, then place pisiform bone
of contact hand gently but firmly against the _front_ of the process
so that a mass of bone is felt between the pisiform and the bench when
downward pressure is made.

Completing Position

It will be noted here that the head is unstable and tends to rock
with slight pressure or movement of the contact hand. Steady the head
by placing the knee upon head of bench and against side of patient’s
head, not roughly but so that the head cannot move further toward the
adjuster.

Now reinforce the contact hand by gripping the wrist with the other,
press slightly downward to tighten the contact and avoid slipping, and
you are ready for

The Movement

which is directed sharply _downward_ toward the bench. This move
rotates the vertebra around its vertical axis and puts a strain in a
backward direction on the whole column at this point.

Care must be used, because the move at best is painful. It is easy to
slip across the end of the transverse. Take every precaution to avoid
imprisoning a muscle, nerve, or blood-vessel between the contact hand
and the vertebra. Rightly used this move is valuable, perhaps most
valuable of all anterior Cervical moves, but it requires nice judgment.

LAST FINGER CONTACT

This movement differs from the preceding one in two important
particulars; the contact hand must be so selected with relation to the
side of vertebra adjusted that the fingers will extend upward toward
the patient’s head, and the opposing hand supports the head instead of
reinforcing the contact hand.

Placing Patient

As for preceding move. The head will remain in this position only until
the contact is made, after which it will be raised by the supporting
hand until a tight contact is felt and the neck muscles drawn fairly
taut.

[Illustration: Fig. 9. Last finger contact for anterior Cervical.]

Making Contact

Palpate with left hand if standing on patient’s left to adjust a right,
anterior subluxation. Find the offending anterior transverse, draw
tissues away with middle finger of palpating hand, change to middle
finger of free hand which marks and holds the point of contact. Now
place (with care) the base of the little finger of the hand which was
used for palpating, at a point just below the condyle of the last
metacarpal and a little to the palmar side, in direct contact with the
front of the transverse. The last finger will be flexed toward the
radial side and a shallow depression thus left for the contact.

Completing Position

Hold contact lightly and slip the free hand under the patient’s head,
which faces slightly toward the adjuster. Raise the head, bending the
neck away from the adjusting hand and toward patient’s chest until it
is felt that the contact is secure and that further movement would put
the neck upon a strain. You are ready for

The Movement

which is delivered entirely with contact hand, downward and toward the
back of the neck. The delivery is difficult because the force arm is
flexed at the elbow and the position awkward. Practice, however, will
soon render one adept.

Uses

For rotated vertebrae which have one transverse anterior to the other,
Cervicals only. This move gives a slightly less advantageous force
angle than the preceding, but is less likely to be painful.

SECOND METACARPAL CONTACT

Position of Patient

Place patient supine on bench so that his head extends beyond the end
of bench and is supported by the upraised knee of the palpater. Stand
at head of bench so as to face patient’s feet.

Use of Hands

Differing from their use in the preceding moves the hands are so placed
that the adjusting hand for a right, anterior subluxation will be right
hand, for a left anterior the left hand. The opposite hand supports the
head after contact is made.

Making Contact

Contact point on hand is second metacarpal at the end of the condyle,
or second metacarpo-phalangeal joint. This is placed in front of the
offending transverse, the head having been rotated away from that side
and other tissues drawn carefully aside from the bone. The back of the
hand is downward toward the clavicle, fingers semi-flexed on palm,
thumb resting on jaw.

Supporting Head

The following position is the correct one for supporting the head in
all Cervical adjustments delivered in the above position of patient and
adjuster.

Cup the supporting hand slightly and fit the patient’s ear into the
cupped palm. Let fingers extend toward the base and back of the neck,
the finger position varying according to the amount of rotation of the
head so that the fingers are in all cases directly _under_ the head
weight. The wrist then flexes on the hand, and wrist and forearm are
brought up across the patient’s forehead so that a force delivered
from the opposite side cannot cause the head to roll or move upon the
supporting hand. After placing both hands draw the head so that the
chin is tilted upward until it is felt that contact is snug and tight.
This supporting position is invaluable and much neglected by adjusters,
who might save themselves much annoyance and many failures by its
constant use. In the study of succeeding Cervical moves refer to this
description frequently. We shall call it the Hook Support, because the
arm and hand resemble a hook which grasps the under side of the head
and curves over the upper.

Movement

This is delivered entirely with contact hand and in a direction as
much posterior as can be achieved without slipping past the end of the
process. If the head is sufficiently rotated away from the contact side
the angle of force is better than with a straight lateral adjustment,
which it somewhat resembles, but not so good for anteriors as either of
the two preceding moves. It is chiefly useful when the other two fail.

OCCIPITO--ATLANTAL MOVE

To move an Atlas so disposed that its one side is posterior while the
whole vertebra is laterally displaced in the same direction; to move,
for instance, an Atlas R. P.

Have patient lying on back in position C with head projecting beyond
bench and supported by adjuster’s knee.

Placing of Hands

Place the first three fingers of one hand under the most laterally
prominent transverse so as to hold it firm, first placing the first
finger carefully just behind and against the end of that transverse and
then reinforcing it with the second and third fingers, slightly tensed,
and resting their tips on the lamina close underneath the occipital
bone.

Next place the other hand so that the thumb rests firmly upon the
patient’s jaw and the first finger extends backward along the lower
margin of the occipital bone.

To complete the position rotate the head gently toward the side of the
laterally prominent Atlas, until it rests, face toward the side, and is
supported by the three fingers of the one hand and the heel and wrist
of the same hand. It will be noted that when the head is rotated the
first finger of supporting hand slips to a position directly upon the
tip of the transverse process and the other two take its place against
the posterior aspect of the tip of the transverse. The Atlas now rests
with its intertransverse line almost vertically upward from supporting
fingers, which hold it against further rotation.

Movement

When the neck muscles have been thoroughly relaxed by slight and gentle
movement, throw the upper elbow sharply away from your body, which
has the effect of transmitting force through the thumb to the jaw and
sharply rotating the head still further, loosening its articulation
with the now firmly held Atlas. The condyloid joints thus loosened tend
to settle into their proper relations, the weight of the head causing
it to slip downward--laterally upon the Atlas.

Uses

This is really a movement of the head rather than of the Atlas and is
an easy movement when practicable. It requires complete relaxation and
will often fail. It is probable that many apparent Atlas subluxations
are really subluxations of the head upon that bone which leave Atlas
and Axis in normal relation. This move is most used to loosen the Atlas
when it resists ordinary adjustments.

“THE BREAK” No. 1

(Lateral Cervical Move)

The principle involved in this and the three succeeding moves is the
same. The contact is made with the end of the laterally prominent
transverse process of a Cervical vertebra other than the Atlas, and the
movement is directed entirely from side to side. It is to be used only
for lateral and not for rotary or anterior or posterior subluxations, a
point to be remembered as it is just as easy to produce as to correct
subluxation with this move.

Position

Have patient lying on back in position C, with head projecting beyond
bench and supported by adjuster’s knee. Following a record previously
made count downward to a subluxated vertebra and palpate both
transverses with the two hands at once to find if one is prominent
laterally, remembering that the record indicates merely the position of
the spinous process.

Having found the laterally prominent transverse, place the tip of the
finger of the corresponding hand on the spinous of the subluxated
vertebra; that is, if a right subluxation, use right hand and if a
left, use left hand. Then draw the hand around until the middle of
the proximal phalanx of the first finger rests against the end of the
transverse. The tip of the finger will be freed from the spinous by
this movement.

Hold the adjusting hand tense, edgewise to the neck, fingers together
and pointing downward. The thumb may rest against the patient’s jaw
or may be free; the essential thing is the snug contact of the first
finger against the transverse.

[Illustration: Fig. 10. “The Break,” No. 1, from right. Contact; first
phalanx with end of right transverse.]

Movement

With the hand in position and the head supported by the Hook Support,
bend the head laterally, keeping the face upward, until it is felt
that further movement would strain the muscles.

Deliver the movement in a straight lateral direction, quickly and
entirely with the contact hand.

“THE BREAK” No. 2

For the Atlas only, and for straight lateral displacement of that
vertebra.

Position and Contact

Position of patient’s head and of supporting hand exactly as in using
Break No. 1. Contact is made with the end of the Atlas transverse
on the laterally prominent side. Contact point on hand is second
metacarpo-phalangeal joint, or rather, the condyle of the second
metacarpal.

Movement

As for Break No. 1.

“THE BREAK” No. 3

Position

Have patient sitting erect on bench or stool and stand before him. For
a right subluxation use left hand and for a left, right hand. Contact
point is the middle of the proximal phalanx of the first finger and the
fingers reach backward and downward, thumb upward so as to be out of
the way.

Movement

Force _should_ be applied entirely with the contact hand to avoid the
possibility that movement of the head may bring about movement of some
other vertebra than the desired one. But in practice the force is
usually divided between the head and the vertebra. The Hook Support
cannot be used in this position.

Uses

The use of this position for the Break avoids the necessity for the
patient to lie down again in a new position after having Dorsals and
Lumbars adjusted. It is extremely convenient. But on the other hand it
is undeniably harder for the patient to relax his muscles when sitting
up with head flexed sidewise and a sense of lost equilibrium than when
lying down. The Break No. 1 will be found the better for the average
case.

“THE BREAK” No. 4

Position

Same as Break No. 3 except that adjuster stands behind patient and
rests the thumb upon the base of the neck posteriorly while the fingers
extend downward and forward toward the clavicle. As with No. 3, the
supporting hand rests against the opposite side of the head and forces
it sidewise to tighten the contact.

[Illustration: Fig. 11. “The Break,” No. 3.]

Movement

Properly, a quick lateral movement of contact hand while the head is
firmly held by the opposing hand.

NOTE: “The Break” is unfortunately named and it would be well if some
less suggestive term were generally substituted.

THE ROTARY No. 1

For the correction of rotation only, and usable in the Cervicals from 2
to 7 inclusive.

Philosophy of the Rotary

A study of the Cervical articulations will make it clear that if a
force be applied laterally to the spinous process the probable result
will be a _rotation_ of the vertebra, which swings one articular
process back from its fellow but leaves the other in close, but
modified, contact. Thus the spinous process may appear to the left
while the left articular process is fitted firmly against that of the
adjacent vertebra, while those on the right are separated. Similar
rotation, modified only by the difference in shape of the vertebrae,
occurs in the Lumbar region.

A movement applied to the spinous process might correct this condition
or might complicate it according to the manner of application. But the
_most direct line_ of force for correction is along a line which would
pierce the separated articular processes almost in an antero-posterior
direction. The Rotary approaches this very closely. It is a setting
forward of the articular process against its fellow by applying a
movement directly to the transverse process, which lies very close to
the articular process.

The great safety of the movement lies in the fact that it is impossible
with any reasonable amount of force to move the transverse process too
far. If the vertebra is not subluxated so as to indicate this movement,
gentle attempts to use it will fail. The deceptive bent spinous process
may sometimes be detected in this way.

The chief objection to Rotary Nos. 1 and 2 is that the Dorsals and
Lumbars cannot be adjusted in this position and the patient must rise
from the bench and lie down again to have his Cervicals adjusted. This
is obviated if No. 3 is used but the latter position fails to secure
the perfect relaxation of muscles of Nos. 1 and 2, and is therefore
recommended as an alternative only.

The commonest obstacle to the use of this move is the voluntary or
involuntary contraction of the neck muscles. The Hook Support, q. v.,
will limit this resistance by affording a sense of perfect security to
the patient. If muscles are _contractured_ a slight “check” will be
felt as the head reaches a certain degree of rotation, and beyond this
point it will refuse to move though easily movable within the radius
limited by the “check.” It is as if the head were held by an inelastic
cord. It is best when contracture is present not to attempt moving
the head too far but to deliver the movement with the muscles as much
relaxed as possible.

[Illustration: Fig. 12. The Rotary, No. 1. Ready for the movement.]

Position and Palpation

Place patient in position C as described under Technic of Palpation.
Stand at head of bench with patient’s head supported by one knee and
perhaps also by one hand. Palpate chiefly to discover the numbers of
vertebrae, following a record previously made. Finish palpation with
the tip of the first finger of either hand resting upon the spinous
process of the vertebra to be adjusted.

Placing Contact

Consider here which way the vertebra is to be moved; if toward
the right use right hand and if toward the left use left hand for
adjusting. Draw the adjusting hand straight around until the first
finger, about the middle of the proximal phalanx, rests against and
_behind_ the transverse process.

It is important that the finger be drawn _straight_ around, and not
upward or downward, except with the second Cervical with which the
finger may pass slightly upward to the transverse. To insure correct
placing of finger let patient’s head be absolutely at rest, supported
by the Hook Support with face turned slightly away from the adjusting
hand. Reinforce contact finger with the other three fingers held
close together behind it. The thumb may or may not be placed against
patient’s jaw as desired, but one must be careful not to lose exact
contact by drawing adjusting hand upward from a lower Cervical in an
attempt to reach the jaw.

Use of Second Hand

Meanwhile the other hand supports the head and holds its weight as
described under the Hook Support, q. v.

Turning Head

Next, holding the first finger gently but firmly pressed against the
transverse process, turn the head in the direction of the subluxation
and away from the adjusting hand. That is, if the vertebra be
subluxated to the right turn the face toward the right, the use of the
terms “right” or “left” referring to the spinous process.

Movement

When the head is drawn around so that the vertebrae are thoroughly
separated on the side toward which movement is to be directed, and the
patient’s muscles are thoroughly relaxed though it is felt that further
rotation of the head would put them upon a tension, give the movement.
It consists in a quick throw of the adjusting hand, force transmitted
from shoulder through an outward fling of the elbow, directed upward
and inward against the transverse process. It replaces the articular
process against its fellow, moving one vertebra, smoothly and easily.

_All_ force should be delivered with contact hand. The hand moves
through very little space. The principle of the movement is transmitted
shock.

[Illustration: Fig. 13. The Rotary, No. 2.]

THE ROTARY No. 2

A transition in technic between No. 1 and No. 3.

Position

Patient lies face upward on closed table, head resting upon forward
section. Adjuster stands at side of patient, choosing the side
according to the subluxation so as to face across the table in the
direction toward which spinous process is to move. Palpation is
difficult in this position on account of the increase in the curve of
the Cervicals, so that it is best to follow a record previously made.

Having found the subluxation make contact as follows.

Contact

Reach across patient’s neck with right hand for a right subluxation or
left hand for a left, and find spinous process. Then draw the middle
finger straight around until the palmar surface of the middle finger
just below the second joint fits snugly behind the transverse process.
Place the other hand under the head and with both hands working
together turn the head toward you, chin upraised, and draw the neck
into a greater flexion until it is felt that contact is firm and close.

Movement

The movement is a quick drawing toward the adjuster of the second,
or contact, finger, which has been, as it were, hooked over the
transverse. The transverse is thus drawn sharply forward and the
vertebra rotates around its vertical axis so that the spinous follows,
or tends to follow, the transverse in the same arc of movement.

ROTARY No. 3

Position

Patient sitting erect, both feet evenly on floor and hands not braced.
Stand in front of the patient but to one side or the other as for
Rotary No. 2. Use right hand for adjusting right subluxations and left
hand for lefts.

Contact

As for No. 2, contact is with palmar surface of second finger but
may be shifted to third finger for the lower vertebrae if desired.
The thumb is usually placed on the mandible and aids the opposite
hand, placed on the other side of the head, in turning and otherwise
controlling the head.

Movement

Turn the head away from the adjusting hand until the neck muscles feel
taut as a result of position and not of contraction. The movement then
is given as a sharp jerk of the contact hand forward.

[Illustration: Fig. 14. The Rotary, No. 3.]

ANCHOR MOVE No. 1

Theory

It is held that a vertebra often loses its proper relation with the
vertebra below, and consequently with _all_ the vertebrae, or the
entire column of the spine below, without being disturbed in its
relation to the one, or ones, above; that, in other words, the column
may be divided into two sections by subluxation, the upper section set
askew upon the lower. With this reasoning it would clearly be desirable
to so adjust the spine as to move a given vertebra, and with it all
vertebra above, so to speak, upon the vertebra below. To do this all
vertebrae above the one to which force is applied must needs be firmly
_anchored_ to prevent strain between them.

Such a move has been devised by Bunn for Cervical use and is here
described from the author’s few observations only. Further study may
modify the technic somewhat.

[Illustration: Fig. 15. “Anchor Move,” No. 1. For a P. L. subluxation.]

Position

Patient is placed as for Dorsal and Lumbar adjustments in position
B. Move is applied to rotated, postero-rotary, and antero-rotary
subluxations and face turned toward side from which move is to be made.
Adjuster, after palpation which discovers the vertebra to be moved and
the direction of movement, stands at the head of table facing patient’s
feet.

Contact

With the palms of both hands resting against the side of the neck and
thumbs extended at right angles to hands, make contact with both thumbs
on one vertebra as follows:

If vertebra is to be rotated toward patient’s left, place right thumb
against spinous process on its left side and left thumb upon right
transverse process from behind it. Press firmly with the palm and
fingers of each hand against the vertebrae above, gripping around neck
and base of skull so as to hold all parts together.

Movement

The move is delivered simultaneously with the two hands, forcing
spinous process toward the right and transverse in an anterior
direction. The head must be raised from the bench and wholly supported
by the hands and the head turns with the vertebra.

Uses

A powerful comparatively easy move which has the advantage of wide
applicability and of avoiding the change of posture of the patient
which mars many Cervical moves.

[Illustration: Fig. 16. Posterior Cervical move.]

ANCHOR MOVE No. 2

Position

Same as for No. 1.

Contact

For a left subluxation to be moved toward the right, place the left
thumb upon the right side of the spinous process so that it hooks over
the spinous in position to draw or pull the spinous. Place right thumb
against the end of the left transverse as much on the anterior
side as possible so that it may exert a _prying_ force in a posterior
direction.

Movement

Simultaneous application of force with the thumbs tends to rotate the
vertebra as does No. 1, but unlike No. 1 the tendency is to bring
the vertebra out in a posterior direction instead of driving it more
anteriorly.

Uses

This move is applied to rotated Cervicals which are anterior, more on
one side than on the other.

POSTERIOR CERVICAL MOVE

Uses

For a posterior Cervical below the Atlas. The common and careless
practice of moving such a vertebra with the Rotary, or the dangerous
practice of using the Recoil may be avoided by this move and much
better results obtained.

Position

Patient in position C, head projecting well beyond bench so as to allow
for a dropping backward of the head. Palpate as for the Rotary and hold
palpating finger on tip of spinous process of posterior vertebra while
contact is made.

Contact

Contact point is middle of radial surface of first phalanx of first
finger and is placed against the tip of the spinous process, directly
between it and the floor, as the patient lies. Hand is held rigid and
edgewise, fingers together so that the contact finger is well supported.

Completing Position

Use the free hand to hold the head with the Hook Support, q. v. Turn
the patient’s chin slightly away from the adjusting hand and drop the
elbow of adjusting arm down until a straight line could pass through
elbow, spinous process, and patient’s chin. It may be well to crouch
and rest the elbow against one knee for solidity. Then allow the head
to drop backward until chin is elevated and further backward flexion
would strain the muscles. You are ready for the movement.

Movement

A quick throwing movement upward and inward, or toward patient’s chin.
As nearly as may be the force should tend to pass along the spinous
process in a direction exactly anterior to the (then) plane of the
vertebra.

NOTE: Either hand may be used with this movement.

[Illustration: Fig. 17. Movement for correction of a lateral Atlas
whose prominent transverse is posterior.]

DOUBLE CONTACT MOVE

Uses

This is indicated for postero-rotary or postero-lateral subluxations.
Its line of force is a bisector of the angle between the straight
anterior and the straight lateral movement.

[Illustration:

Fig. 18. A movement for Atlas when laterally displaced. Contact:
metacarpo-phalangeal joint with end of prominent transverse.
]

Contact

There are two points of contact, both on the first finger, one (first
secured) on the radial side of the second phalanx and the other on the
radial side of the proximal phalanx. The first contact point is placed
against the tip of the spinous, the other behind the transverse process.

Press slightly against the two processes with the finger so as to feel
them plainly.

Completing Position

Hold the head with the Hook Support and turn the face away from the
adjusting hand (right hand for a P. R., left hand for a P. L.). Drop
elbow low and hold it well away from your body so that there appears
an obtuse angle between wrist and forearm with the point of the angle
toward you. Be careful of this point as the tendency is to make an
angle with the point away from you--a weak position.

Drop head backward until firm resistance is felt.

Movement

Force is delivered in an antero-lateral direction as above described,
_entirely_ with adjusting hand.

THE “T. M.” No. 1

Uses

For subluxations listed R or L but not Posterior and upon C 6, C 7, D
1, and D 2 only. This movement applies a lateral force to the spinous
process so as to correct _rotation_ of the vertebra, but I repeat that
it is inappropriate for posterior or postero-lateral subluxations.

Position

Patient lying in position B as for Dorsal adjustment. Find the
subluxation by following the record and perceiving that the count
assumed to be correct permits the subluxations to correspond to those
recorded and that a vertebra in this region is R or L, R. A. or L. A.,
R. S. or L. S., R. I. or L. I. The laterality of the spinous process
determines the next step.

For a right subluxation turn the face toward the _left_ and use _right_
hand for contact hand. For a left subluxation turn the face to the
right and use left hand for contact hand.

Contact

Thumb of contact hand is placed upon and against the side of the
spinous process so that it presses firmly. The thumb is extended almost
at right angles to the hand which rests upon the patient’s shoulder
with fingers extending, and gripping, over the clavicle. Be sure of the
solidity of the position.

Next place the other hand upon the patient’s forehead and press the
head backward, or toward the side of the contact hand, until the neck
is well flexed and the tissues tightened between the now opposing
hands.

[Illustration: Fig. 19. The “T. M.,” No. 1.]

Movement

When this tightened condition is reached a quick decisive movement of
_both_ hands in opposite directions, but chiefly of the hand applied to
the head, will secure an easy movement of the vertebra.

This move is a very valuable adaptation of the old crude and other
dangerous “T. M.,” of which No. 2, below, is another, more like the
original move but possessing several “safety” features.

“T. M.” No. 2

Position of Patient

The patient sits erect on a flat seat with both feet resting upon the
floor as during palpation.

Placing Hands

After careful palpation and selection of a vertebra to be adjusted
in this way, stand directly behind the patient. If the vertebra is
subluxated to the right use right hand for adjusting (or contact) hand,
if to the left use left hand. Hold the hand so that the thumb is at
right angles to the hand and tense and firm. Place the palmar surface
of the end of the thumb against and upon the tip of the spinous process
and grasp the neck firmly with the fingers, which extend over the base
of the neck and toward the clavicle. The other hand is placed easily on
the top of the head.

Position of Head

The completing of position after contact has been made is governed by
two considerations; the need for relaxing the neck muscles and for
so supporting the vertebrae above the contact that movement will take
place only at the point of contact. If the neck muscles are contracted
the movement is almost always defeated and should always be abandoned
to avoid strain.

To secure the desired position ask the patient to relax his muscles
and allow you to place his head as desired. If he seeks to place it
himself the necessary muscular contraction on his part will defeat the
movement. The movements of the head must be passive.

With thumb and remainder of adjusting hand properly placed, use the
other hand upon the head as follows: First flex the head forward on
the chest as far as possible, then rotate it slightly so that the face
is turned a little toward adjusting hand. Then flex the head sidewise
until a resisting pull of muscles indicates that they have been
stretched taut. It is well during the third movement described to let
the forearm swing down at right angles to the hand so that it presses
firmly against the ends of all the Cervical transverses, distributing
the force among them.

Or, after placing contact hand rest the elbow in the angle at the base
of the neck and let the forearm extend upward along the side of the
neck. Then flex the wrist until the hand will rest upon the patient’s
head and perform the movements of the head as described above.

[Illustration: Fig. 20. The “T. M.,” No. 2. Note position of right arm
and hand of adjuster.]

Movement

A quick, simultaneous movement of both hands in opposite directions,
_two-thirds_ of which is given with the hand which holds the head.
The thumb in contact with the spinous process moves slightly inward
toward the median line but its chief use is to hold the vertebra very
firmly. To this end part of its force is directed forward against the
shoulder and through the ball of the thumb.

Failure to place the head properly or in securing sufficient flexion
of the neck before move is attempted are the chief causes of failure.
Force must be delivered quickly and sharply and the best adjustment of
this kind is usually the one in which the head and hands move through
the least space.

Uses

This movement is obviously useful only for the correction of
_rotation_, since the force is directed sidewise against the spinous
process.

The “T. M.” was originally intended as a Cervical adjustment, but its
greatest use is now from C 6 to D 2 inclusive. Above the sixth its use
is questionable because of the possibility of moving more than one
vertebra or some other than the one desired.

“THE RECOIL”

(Pisiform Contact)

Position of Patient

This movement is best given on bifid bench of the type commonly known
to the profession. Place patient on forward section so that its rear
edge rests just below the axilla; this may be ascertained by passing a
hand under patient’s arm after he is in position, when the edge of the
bench should be felt about an inch below the hanging arm. The thighs
should rest on rear section so that the pubic symphysis is free of the
bench. The semicircular pubic cut is an advantage in that it avoids
injury without making necessary too great a suspension between sections.

Thus the abdomen and the lower part of the thorax are suspended between
sections. Under them an abdominal support may be used but it must have
the quality of elasticity in a high degree and must lie always below
the plane of the other two sections or it will interfere with a perfect
adjustment.

For adjustment of the last two Cervicals or any Dorsal down to the
sixth, it is best to turn patient’s head toward the direction of the
subluxation. This curves that section of the spine into an arc toward
the convex side of which movement may be made more easily than toward
the concave.

The patient’s hands may lie under the table, loosely, or may reach back
and rest upon the buttocks, palm upward. Whichever position secures
best relaxation is to be used in any case.

This movement may be used with the roll. (See Fig. 30 and p. 285.)

[Illustration: Fig. 21. After palpation. Finger ready to guide contact
hand to a spinous process.]

Position of Adjuster

Stand on either side of patient, feet apart for base and poise. The
direction of the feet and position of body will vary according to
the direction of the adjustment, by the following two rules:

Rule 1. For movement of a vertebra _away_ from the side on which
you stand, place your arms and hands in such a position that the
pisiform bone of adjusting hand, both elbows, and both shoulder joints
(shoulders being dropped loosely forward) will fall in the same plane
and that the plane of direction in which the vertebra is to be moved.
In other words, let the force be applied in a line straight from
your body _through_ the vertebra. Always shift your feet to a proper
position from which to direct the movement.

Rule 2. To move a vertebra _toward_ the side on which you stand, step
close to patient’s body and support yourself with one knee against
the adjusting table at the most convenient point. Then place arms so
that contact point, elbows, shoulders, and the mid-point of the body’s
base, between the feet, are all in the same plane. This insures balance
during and after the movement and is the attitude from which the
greatest and most carefully measured force can be delivered.

It will be seen that the desire is always to deliver all force in one
plane and thus avoid conflict of forces and waste or misdirection
through the predominance of one force over the other, and to use both
arms with equal facility in the move. There are at least a hundred
ways to hinder this movement by varying the preliminary positions. And
no one can know the real efficiency of the move who has not become
instinctively adept at taking position.

Use of Hands and Arms

Use of hands for palpation has been described. (P. 46.)

The palpating hand comes to rest with the middle finger on the spinous
process of the vertebra to be adjusted. The heel of the hand is raised,
the first and third fingers doubled back, and the heel lowered again.
Now the middle finger alone is a slender pointer guiding to the contact
point.

Place pisiform bone of other hand snugly _against_ the process to
be moved. The hand should rest in a slight arch, pisiform against
spinous, fingers rigid and flexed on hand, last finger firmly anchored,
or pressed into the flesh, to prevent slipping. (Fig. 22 shows the
position.)

The anchoring fingers must always extend away from the adjuster. To
turn the fingers back across the spine, in moving a vertebra toward
you, is always an error, and the price is partial loss of use of one
arm.

With the adjusting hand satisfactorily placed, grasp its wrist firmly
with the other hand so that the pisiform of the supporting hand rests
in the hollow between the wrist and the metacarpal bone of the extended
thumb. By this contact force is driven directly through the chain of
bones across the wrist and to the pisiform bone without spreading.
In grasping the wrist let the thumb extend around the forearm in one
direction and the four fingers in the other. Beware of gripping only
with thumb and first finger in which case the edge of the supporting
hand will rest on the back of the contact hand and spread the delivered
force too widely.

[Illustration: Fig. 22. “The Recoil.” Ready for the movement.]

Movement

I have said, but have not sufficiently emphasized the command, that the
shoulders must be dropped loosely forward. Let me add that just before
the movement is given the head should be allowed to sag downward and
the muscles to become relaxed. This movement given with stiff shoulders
and upraised head becomes a _push_.

The desired movement is a _throwing_ movement.

Force is released from both shoulders at once, concentrated at the
same instant by a slight shifting forward of the elbows, and strikes
the spinous process as _one_ force, which is the resultant of the two
meeting at the wrist of contact hand and being united there. The two
arms use the contact hand as a passive instrument for driving the
vertebra.

The objective point, the distance to which the movement is mentally
thrown at the instant of delivery, should be the center of mass of the
vertebra, varying according to the section of the spine.

Contact Point

The exact contact point of hand with vertebra varies. If the vertebra
is to be moved toward the right the pisiform rests _against_ (not
_upon_) the left side of the spinous; if toward the left and inferior,
against the right side and just above, in the notch between it and the
next superior process. The rule is to so place hand that the spinous
process is between the pisiform and the direction to which movement is
given.

On the hand the contact may be said to vary, according to the direction
of subluxation and position of adjuster, so as to describe a circle
around the pisiform in the course of the various changes of position
necessary to the use of this movement. No error could be greater than
to attempt to use always the same face of the pisiform and to adapt the
position of hands and arms to this end, when any face or aspect of the
little bone is equally good with any other.

Which Hand Used

When standing on patient’s right use left hand for palpating hand
and right hand for contact with the vertebra, using left hand again
to grip and reinforce the contact hand. Exception to this is made by
introducing an extra change of hands with C 6, or 7, D 1, L 4 or 5,
and Sacrum. The change is necessitated by the insecurity of the usual
position or the fact that it cramps the wrist of contact hand. To make
the change: palpate as usual, hold subluxation with second finger of
palpating hand, substitute second finger of other hand and withdraw
palpating hand, which is then free to make the contact.

When standing on left side exactly reverse the use of hands. Palpate
with the same hand which would be used if patient were sitting.
Introduce no unnecessary move into the placing of the hands. This will
be found to produce better results than any other technic for this
portion of the move.

Delivery of Force

In using this movement it is perhaps best to deliver nearly equal force
with both hands; certainly whatever forces are released by the arms
should be simultaneous. It is possible, however, to allow one arm to
preponderate in the movement without marring its efficiency, but the
amateur adjuster will do well to balance his forces at first.

Speed and Concentration

Speed is a prime essential. By its employment a very ordinary amount of
muscular strength can be made to accomplish a large amount of work and
very difficult adjustments may be accomplished.

Concentration of mind at the instant of adjustment, so as to secure
muscular control and perfect co-ordination of the two arms as well
as to direct and concentrate the forces used at a given and strictly
limited area, is also essential.

Uses

For ordinary adjustments of Dorsal or Lumbar subluxations, excepting
the middle four Dorsals, for breaking ankyloses by repeated
applications of force, and for overcoming muscular resistance in
patients who are unable to relax at all, this form or style of
adjusting is probably the best. It is most useful in the Dorsals. In
many instances Lumbar vertebrae will move better by application of a
slightly slower force, especially if a roll is used. The Recoil may be
used with the roll.

While it is easily possible to move any Cervical in this way, making
no change in the technic except to use the ulnar side of the fifth
metacarpal bone for the contact instead of the pisiform, it is
inadvisable in most cases above the sixth, and in some instances
absolutely unpardonable. The shock to the nervous system and the danger
of moving two or more vertebrae or of subluxating a normal one are
too great. In at least one instance hemiplegia instantly followed the
use of this move on the Axis, and headaches and nerve exhaustion are
frequent sequelae.

For these reasons it is probably best never to use “The Recoil” above
the sixth Cervical. For every form of subluxation there is an easier
and safer mode of correction.

Name

This has been called “The Recoil” because of a belief that if force
be applied to a vertebra in the form of a very rapidly transmitted
shock the vertebra will rebound to the shock and settle in its normal
position, the intelligence within the body utilizing the force thus
blindly applied to bring about this result.

This belief is erroneous. First the vertebra and all surrounding
tissues are misshapen to fit their _abnormal_ position and relation
and this shape gives them a tendency, if rapidly loosened, to settle
into the old abnormal position. Second, there is no such conscious
intelligence which has power to replace a subluxated vertebra. If this
supposition were correct, then the Innate Intelligence would do well to
utilize those jars and shocks which ordinarily _produce_ subluxation
to bring about normality and keep the spine perfectly aligned.

There is no such internal rebound or recoil as stated above. The chief
value of the movement lies in its speed, according to principles
equally applicable to other moves, and in accord with the Law of
Momentum.

Sources of Information

This movement as described above contains many essential principles
which follow Parker and Palmer, developers of “The Recoil,” but the
technic is considerably modified to suit the author’s own views. It
cannot be claimed, therefore, that this is “The Recoil” as now taught
by Palmer, since the chief stress is here laid upon the movement of
the vertebra in a predetermined direction and not upon the withdrawal
of the hands to let “Innate” do the work. The name “Recoil” is really
inappropriate for the move as described.

THE HEEL CONTACT

A movement for the adjustment of posterior, postero-superior, or
postero-inferior subluxations in the Dorsal region (except middle
four) and in the Lumbar. May also be used for postero-laterals when
laterality is very slight. Given with patient in position B. Contact
point, heel of hand with spinous process.

Heel Contact

By the “heel of the hand” is here meant the depression between the
scaphoid and pisiform bones. This hollow forms a natural receiver for a
spinous process and thus avoids lateral slipping.

The four fingers of adjusting hand are spread out and anchored upon
the patient’s body. The wrist is held at a right angle to hand and the
arm straightened, the elbow being outrotated until it “locks,” that is
until it will move no farther. The other hand grasps the wrist of the
adjusting hand.

Adjusting Hand

The rule is to use the right hand for adjusting hand if standing on
patient’s right and palpating with left, or to use left hand if on left
side and palpating with right. The fingers are to be directed toward
the patient’s feet. Exception to this rule is made with the last two
Lumbars, where it is more convenient to change hands and direct the
fingers toward the head.

[Illustration: Fig. 23. “Heel contact.”]

Movement

This is given almost entirely with adjusting arm; that is, with the arm
whose hand is in contact with the vertebra. The supporting hand serves
merely to guide the force to a definite point as if a straight rod were
working through a fixed circlet. Indeed, the force in this movement is
delivered almost straight down from the shoulder. Shoulder should
be dropped well out of its socket so as to secure play for a sudden
downward movement without raising the hand from its contact. If the
shoulder is stiff or the head of the humerus remains in the glenoid
cavity the movement cannot be properly given without raising the hand.
Movement is quick, sharp, and _deep_, i. e., directed to the center of
mass of the vertebra.

It may be directed straight toward floor to correct a posterior,
inclined slightly toward the head or feet to correct approximation,
or--as some aver--slightly sidewise to correct a mild degree of
rotation.

PISIFORM DOUBLE TRANSVERSE No. 1

An adjustment to be used only in the Dorsals from fourth to ninth
inclusive, for posterior or postero-rotary subluxations. It is probably
best to use this movement only for straight posterior subluxations and
to apply either the Pisiform Single Transverse or the Two Finger Double
Transverse to the rotary displacements in this region.

Contact

Both pisiform bones, each _upon_ a transverse process and both upon the
_same_ vertebra.

With patient in position B and the adjuster standing upon his left
the contact should be made by the following exact method. Palpate
with right hand, which comes to rest upon the spinous process of the
subluxated vertebra. Note if it be P. R. or P. L., because this fact
will govern the next movement. Let the first finger of palpating hand
reach outward about one inch and upward to a point opposite the tip of
the next superior spinous process, which point will approximate the
position of the transverse. This first upon the side of the _posterior_
transverse, which will be the right with a left subluxation or the left
with a right one. Let second and third fingers, now abandoning the
spinous, follow the first and rest over the assumed position of the
transverse.

Now palpate with a deep, limited, massage movement until the
club-shaped extremity of the transverse is felt under the middle
finger. Hold this point with the middle finger, drawing away the other
two, and guide the free hand to an exact contact _upon_ the transverse.
Thus if standing on the left, as predicated, the _left_ hand will be
first to make contact and with the most posterior transverse, with
which most _exact_ contact is necessary.

With pisiform placed, let the fingers extend away from your body; if on
the side of the spine opposite you, let them extend downward so as to
follow the curve of the rib and to be anchored upon the rib connected
with the transverse of contact; if on the same side, let fingers extend
downward parallel with the column.

[Illustration: Fig. 24. Pisiform double transverse adjustment as it
should be given, elbows locked.]

Now--still using the original palpating hand--palpate on the other
side from the first contact until the other transverse is discovered.
Mark its tip with a quick, deep pressure and a sharp withdrawal of the
fingers, so that a spot of anaemia appears momentarily. Carefully
place the pisiform of the palpating hand in contact, guided by the
anaemic spot. If this second contact is on the side on which you stand
the fingers will be toward the head; if on the opposite side, they will
follow the rib curve outward and downward.

Re-read the above directions carefully. It will be seen that the
technic is quite free from unnecessary movements.

The two hands are now placed almost exactly at right angles to each
other, arched fingers anchored to prevent slipping.

If you stand on the patient’s right the use of hands is, of course,
exactly reversed, the left hand being palpating hand, and making the
first contact.

Completing Position

When hands are in position and adjuster standing so as to face directly
across the spine, the arms are rotated outward until the elbows
“lock.” The adjuster leans over so as to have shoulders directly over
the spine, draws the body back from the shoulder girdle to secure
freest play in the shoulder joints, and drops head loosely between the
shoulders so as to relax the trapezius and prevent any checking of the
force.

Movement

Directly downward from the shoulders through straight, stiff arms. The
force is delivered separately with the two arms and yet simultaneously.
If the vertebra is straight posterior, equal force must be applied
on the two sides; if it is posterior and slightly rotated (P. R. or
P. L.), most force must be applied to the more posterior transverse.

Considerable practice and looseness of shoulder are required to use
this movement properly. It is a regrettable fact that few adjusters
_do_ use it correctly, most of them giving a _thrust_ instead of a
transmitted shock.

PISIFORM DOUBLE TRANSVERSE No. 2

This modification of the pisiform double transverse move is here
described because of its popularity rather than because the author
wishes to recommend it. The position is the same as for No. 1, and
the uses also, except that it tends to correct postero-inferior
subluxations and is not at all adapted for use with superiors.

Contact

Both pisiforms below the two transverses (caudad). After palpation
which discloses the posterior transverse the hands are placed as
follows: Palpating hand rests always on the side of the spine next the
operator; opposite hand crosses the spine. Both are slanted upward
so that the fingers point toward the head with the axes of the hand
slightly diverging above. The wrists are thus crossed in such a way as
to force the forearms to be somewhat flexed on the arms and to slant
away from the wrists at an obtuse angle. This with the contact _below_
the transverses, renders it impossible not to force the vertebra in an
upward (superior) direction when movement is given.

[Illustration: Fig. 25. Two-finger double transverse.]

Movement

A comparatively slow thrusting movement, which tends to spring the
spine. The merit of this method lies in its comparative painlessness.
Its technic is not attractive.

TWO FINGER DOUBLE TRANSVERSE

A movement for posterior or postero-rotary displacements from fourth
to ninth Dorsal inclusive. It serves the same purpose as the Pisiform
Double Transverse but is less painful and often easier of delivery. The
palmar surface of the fingers, with the flesh of the patient’s back,
make a compound cushion which acts as a shock-absorber.

Palpation--Contact

The usual downward gliding movement of left hand if standing on right
or of right hand if standing on left will serve for the discovery of
the vertebra listed for adjustment. The gliding hand stops with the
second finger indicating the spinous process. The first finger reaches
upward and outward to the assumed location of the transverse on the
side nearest the adjuster; then the second finger reaches to a similar
point on the other side, both fingers pointing toward patient’s head.
Now the fingers are rolled a little to make sure that they are in
contact with the ends of the transverse, the palmar surface of the tip
of each finger being the proper contact point. The heel of the contact
hand rests near, but not on, the surface of the body over the midspinal
line.

Supporting Hand

The ulnar edge of the free hand is now placed across the tips of the
two contact fingers so that it rests directly above the ends of the
transverses but separated from them by the finger tips. The upper arm
is then straightened and the elbow outrotated until it locks firmly so
that the arm makes a straight line directly above the transverses. The
body is drawn away from the shoulder girdle, pulling the head of the
humerus out of its socket as far as possible to allow free play, for
all force is to be given by this straight arm.

Movement

If the subluxation is a straight posterior the force is driven directly
downward so as to be distributed equally to the two contact points. If
it be a postero-rotary, most force is directed to the more prominent
(posterior) transverse. Force should be delivered quickly, keeping in
mind the principle of transmitted shock.

Contrary to the general belief, as much force can be developed with
this move as is needful for any ordinary adjustment. The fact that it
is often recommended for use with children or with sensitive or frail
patients has led to the belief that it is a relatively ineffective
move, whereas its value in such cases lies only in the fact that it
inflicts less pain than some others.

[Illustration: Fig. 26. Pisiform single transverse move, No. 1.]

PISIFORM SINGLE TRANSVERSE MOVE No. 1

Like the movement just described, this adjustment may be used in
the Dorsals from fourth to ninth inclusive. It should be limited to
those subluxations which are rotated without being posterior. In such
an instance the spinous process _appears_ to be laterally displaced
without being posterior, or may appear slightly _anterior_ because it
is describing an arc about a fixed center of rotation in the body of
the vertebra. One transverse process appears anterior and the other
posterior to the line of their fellows.

Palpation

Palpate as for the Recoil and use the same adjusting hand as in that
movement, i. e., right hand if standing on right side and palpating
with left, or left hand if standing on left and palpating with right.
When the palpating fingers have discovered the subluxated spinous
process, the first finger seeks a point even with the tip of the next
superior spinous process and about an inch to the side on which is the
_posterior_ (prominent) transverse. The second and third fingers follow
and, dipping inward with a rolling or massage motion, discover the end
of the transverse.

Contact

Now the adjusting hand is placed with its pisiform resting directly
_upon_ the blunt end of the transverse. If the contact is on the same
side of the spine with the adjuster the fingers of adjusting hand
extend across the spine and are anchored on the other side, the hand
arching sharply and fingers extending somewhat downward. If contact is
on opposite side of spine the fingers follow the rib curve downward and
outward and are similarly anchored. In every case the fingers should
extend away from, and never toward, the adjuster’s body. To violate
this rule renders one arm almost useless through its position.

At this juncture the palpating hand becomes a reinforcing hand, to grip
the wrist of the other and to aid in the movement.

Movement

The force is directed in a straight anterior direction, quickly and
decisively, as if a spinous process were the lever used. Remember that
contact must always be made with the _posterior_ transverse. To drive
this anterior is to rotate the vertebra around its vertical axis and to
bring the spinous process toward the median line, while the opposite,
and more anterior, transverse becomes more posterior, as it should be.

PISIFORM SINGLE TRANSVERSE No. 2

Uses

For rotated first or second Dorsals with which, for any reason, the
“T. M.” fails. This move involves a use of the head as a lever, as does
the “T. M.” No. 2. Inadvisable unless the posterior transverse of the
rotated vertebra can be palpated--but often used in cheerful disregard
of this detail by those sublimely capable adjusters who do not need to
find a vertebra before moving it.

Palpation--Contact

Palpate as for No. 1 above. Very deep palpation will be necessary
because the spinous process here is nearly horizontal to the body and
the transverse is very deeply placed, overlaid with heavy muscles.

When process is found place pisiform bone of free hand upon it,
pressing the muscles aside as much as possible to avoid bruising and
resting a considerable amount of weight upon the contact hand. Fingers
of contact hand may extend across the spine or downward and parallel
with the spine. Or, the hands may be changed so that the palpating hand
becomes the contact hand and is placed with the fingers gripped over
the base of the neck toward the clavicle.

Head Leverage

The free hand is now placed upon the forehead and the head, which faces
toward the contact hand, is flexed backward until the muscles seem taut.

Movement

Is a quick, but fairly gentle, movement of both hands together, so that
the head is rocked still further backward at the instant an anteriorly
directed force is applied to the prominent transverse. The result is
rotation of the vertebra--unless there be a loose articulation in the
Cervicals which gives way under the force applied to the head.

THE EDGE CONTACT

(“Point 2 Contact”--“Knife Move.”)

Name

This movement has various names. The name “Point 2 Contact” is
handed down from the days when Palmer used three contact points and
three moves and designated the middle of the ulnar side of the fifth
metacarpal bone as “Point 2.” The name “Edge Contact” was applied
later, during the improvements in its technic when the hooking of the
thumbs stiffened its efficiency and made it very valuable. It has since
been rediscovered (though in constant use) and re-named “Knife Move.”

Uses

A movement which uses the spinous process as a lever and is applicable
to D 2, 3, or 4, and to any Dorsal or Lumbar from D 8 down, when
posterior, postero-superior, or postero-inferior. It does not correct
rotation except insofar as the shape of articular processes may aid an
anteriorly directed move in rotating the vertebra.

Some Chiropractors have used the Edge Contact in the Cervicals but this
is always improper, as it is practically

impossible in some, and difficult in all, cases to cover only one
spinous process when the head is resting on its side.

[Illustration: Fig. 27. The edge contact in Lumbar region.]

Palpation

Same as for Recoil or Heel Contact, q. v.

Contact

Using the same adjusting hand as for the Heel Contact, place the
middle of the ulnar edge of the fifth metacarpal bone in contact with
the spinous process. If the vertebra be superior, place the edge of
hand _above_, if inferior, place the hand _below_. This contact is
especially good for S or I vertebrae.

Position of Hands and Arms

The fingers of adjusting hand cross the spine at a right angle to its
long axis. The back of hand will be toward patient’s head except in
adjusting the last two Lumbars, with which a change of hands is made
necessary by the upward slant of the lower half of the Lumbar curve.

The palpating hand now grips the adjusting hand so that the fingers of
the upper hand, held close together, press against and reinforce the
lower on its dorsum and just above the contact point. The thumbs are
hooked together as shown in Fig. 27, so that the hands may be stiffened
and their tendency to roll avoided.

The elbows are outrotated and locked as in the Pisiform Double
Transverse Move and both shoulders are loosened.

Movement

This is chiefly delivered with the upper arm, using upper hand to
drive the lower. Force should be quickly delivered when patient is
relaxed. The direction of force should be determined by the direction
of subluxation and by the slant of the spinous process. Thus, when
patient lies prone upon a bifid bench and sways downward against a lax
abdominal support, the spinous processes of the lower dorsal make an
acute angle with the plane of the floor. If one be superior, contact
above it and force driven straight toward the floor will tend to
correct the subluxation. There is a slightly different force angle for
every subluxation correctable by this move.

This move is less painful than the pisiform contact and may often be
used to advantage, especially in the Lumbar region.

LUMBAR SINGLE TRANSVERSE

For the correction of a rotated Lumbar. Best used on second and third.
This movement should never be attempted unless the transverse process
can be palpated. Lumbar transverses are sometimes short or fragile, and
unless they can be distinctly felt no force should be applied where
they are _believed_ to lie.

Contact

Pisiform bone with posterior transverse.

[Illustration: Fig. 28. Lumbar single transverse move.]

Palpation and Placing of Hands

Palpating as if for other movements, pause with the second finger of
palpating hand indicating the spinous process of the vertebra to be
moved. Note that if the spinous process be to the right of the median
line the left transverse will be posterior, if to the left, the right
transverse.

The transverse may then be found as in the Dorsals; it should lie even
with the interspace above the spinous process, deeply overlaid with
strong muscles. When the transverse has been located by a deep, probing
movement of the fingers, place adjusting hand, pisiform on transverse,
close to the spinous process for greater solidity and fingers extending
downward and outward from the midspinal line parallel with the lower
rib curve.

If the adjuster stands on the side of the patient opposite to the
transverse to be moved the hand opposite the palpating hand becomes the
contact hand, as in other moves. But if the posterior transverse is
on the same side with the adjuster, a change of hands is made and the
palpating hand becomes contact hand. To accomplish this the adjuster
must turn and face away from the patient with arm extended straight
downward to the contact. After contact is made the remaining hand
reinforces the adjusting hand by gripping the wrist.

Movement

In making the contact press downward, deeply and firmly, so as to
crowd the muscles aside and place the pisiform directly _upon_ the
transverse. Movement is given after the patient’s body has been swung
downward for a considerable distance, and is sharp and decisive,
directed straight toward the floor.

LUMBAR DOUBLE TRANSVERSE MOVE

A movement sometimes applied to posterior or postero-rotary Lumbars.

Palpation and Contact

From the spinous, find first the more posterior transverse and make
contact with it, since most force must be directed there. Stand facing
patient’s head and place right hand on right transverse and left hand
on left.

Contact point in this move is the tuberosity of the scaphoid with the
posterior surface of the transverse. Fingers curve away from median
line so as to avoid the rib curve.

Movement

After heavy, steady pressure downward, force is delivered with a quick,
throwing movement, most force on the posterior side.

THE “SPREAD” MOVE

Upon the theory that when two forces are simultaneously applied, the
one to drive some vertebra cephalad (by its spinous process) and the
other to drive some lower vertebra caudad, the intervening vertebrae
tend, if anterior, to be drawn outward or toward a more posterior
position, this move is predicated.

The author does not believe that it accomplishes its purpose, but will
briefly describe it for the benefit of those who do.

Position

Patient is placed over a roll which rests under the thighs so as to
flex thighs and pelvis on the Lumbar spine, or an adjustable table
is so tilted, both sections sloping downward from the middle, as to
accomplish the same result.

Contact

The usual method, if only a single vertebra is anterior, is to make
contact with the vertebrae immediately adjacent, crossing the hands and
having fingers of upper hand pointing toward head and of lower hand
toward Sacrum. But some adjusters use this move differently, making
contact with Sacrum and with the mid-dorsal region in general and
applying a slow force with both hands. Contact is with heel of hand
upon spinous process.

SACRAL ADJUSTMENTS

The adjustment of the comparatively fixed sacrum is difficult at
best and requires a very considerable force, violently applied. It
is probable that nine-tenths of all attempts to move sacra fail. In
children, when sacrum does not articulate properly with the ilia, and
in adults in whom the sacrum has been loosened by trauma and remains
in an abnormal relation to surrounding structures, it can be moved.

The sacrum is described as being posterior at the base or at the apex,
and its axis for rotation is believed to be a transverse line through
the sacroiliac articulations. Force for its adjustment is applied at
right angles to the curve of the sacrum at the point of contact. The
best contact is with the heel of the hand against a part of the sacrum,
the wrist of the adjusting hand being gripped and reinforced by the
other hand. If standing on patient’s left, the right hand becomes
adjusting hand for sacrum as for the last two Lumbars, if on the right,
the left hand.

Another contact is with the pisiform and adjacent soft part of hand
upon the sacral base, the pisiform hooking against the first sacral
spinous process.

Do not mistake an anterior fifth Lumbar for a posterior sacral base.
Discriminate between iliac and sacral subluxations by noting that with
the latter both sacroiliac articulations, and with the former only one
seems abnormal.

[Illustration: Fig. 29. “Bohemian Move” for correction of anterior
fifth Lumbar by transmitting shock through spine.]

ILIAC ADJUSTMENTS

Palpation

With patient sitting erect on flat surface, feet on floor, stand behind
and examine both sacroiliac articulations at once with the palmar
surfaces of the fingers of both hands. If the two articulations are
similar in every line neither ilium is subluxated, though the _sacrum_
may be rotated on its transverse axis between the ilia, so as to be
posterior or anterior at base or apex.

But no examination of the ilia is complete without investigating also
the lumbosacral articulation. It sometimes happens that though the
first sacral spinous process naturally completes the lumbar curve and
there is no lumbosacral subluxation the crests of both ilia appear much
posterior to their normal relation to the upper part of sacrum: this is
a double iliac displacement.

Usually the ilia are both normally articulated; this is one of the most
difficult joints to weaken and is seldom affected except by the most
extreme force. When iliac subluxation exists one side is affected alone
nine times out of ten. The tenth case may show double subluxation.

Movement

Nine-tenths of the so-called “iliac adjustments” are quite amusingly
ineffective. The force required really to _move_ an ileum (save in
joint disease or in children) is tremendous and not to be commanded by
the ordinary adjuster. The light jars applied as a routine procedure
by so many Chiropractors are in reality nothing more than single
percussion strokes which stimulate the sacral nerves.

Place patient in position B and apply the hands to a posterior ilium
as to a posterior sacrum, making contact with the most prominent
portion of crest or posterior border and driving in a direction which
would represent a part of the circumference of a circle of which the
transverse sacral axis of rotation touches the center, or the center
of fixation in the sacroiliac joint.

COCCYGEAL ADJUSTMENTS

Examination

Place patient on an angle table, i. e., one which rises in the center
and slopes away toward either end. Separate the thighs slightly,
patient lying face down, and insert the rubber-covered second finger,
palmar surface upward, very carefully into the rectum. The tip of the
coccyx may then be felt and its movability and position determined.
Unless it is immovably fixed in an abnormal position it should not be
molested; the movable coccyx responds to mere muscle tension by changes
of position and cannot act as a primary cause of nerve impingement.

Usually this examination will be rendered unnecessary by the external
palpation which may disclose the movability of the coccyx and at once
render further exploration superfluous.

When the coccyx is anteriorly subluxated and ankylosed in that position
it may be a factor in producing constipation, hemorrhoids, etc., but
its influence in other diseases, especially of the nervous system, has
been greatly overrated by those who have not yet fully accepted the
doctrine that nerve impingement is the primary cause of all disease.

[Illustration: Fig. 30. Edge contact with “Roll,” q. v. Attitude of
patient for coccygeal adjustment.]

Movement

When it has been decided that the coccyx must be moved, the position
and use of hand is the same as for the palpation. The finger hooks
under the tip of the coccyx, draws upon it until a tight contact is
secured and then jerks sharply backward upon it with a view to its
abrupt fracture. No mitigation of the jerk in the hope of previously
loosening or gradually replacing the bone is of value for _osseous
tissue_ must be broken before any movement may take place.

This movement is painful and the region of the newly fractured coccyx
may remain sore for a period ranging from a few days to several weeks.
It is wise to warn the patient of the facts before proceeding.

The fractured coccyx may be absorbed, or may be reankylosed in a proper
position or in a new abnormal position, or may remain loose and movable.

ADJUSTMENT OF CURVATURES

We have previously discussed in detail the nature and discovery of
curvatures. A few words should be said here about their correction.

If the sole object of the adjustment is to correct the curvature it is
best to select for adjustment those vertebrae which are most subluxated
in the direction of the curvature. According to the length of the
curvature a series of from two to six, separated by some distance, are
chosen. These are adjusted until they cease to be the most prominent
ones in the curvature and then others, then most prominent, are chosen
and adjusted until they in turn cease to be most prominent. In this
way the curvature may eventually be straightened, or nearly so. It is
doubtful if any curvature can be absolutely eradicated, although it may
be straightened until unnoticeable except by the expert.

To overcome a curvature it may be necessary to break every rule which
governs ordinary adjusting and to invent new ways of placing the hands
or of delivering force. No two require exactly the same measures and he
is most successful with curvatures who is most adaptable to changing
conditions.

One rule may be safely laid down. Do not alternate from day to day,
loosening at the same time many vertebrae, but choose the ones most in
need of adjustment and _follow your choice_ as long as it is indicated.
The chief vertebra is nearly always the one at the _angle_ or _point_
of the curvature.

The sharp, angular curve of Potts’ Disease, involving two or three
vertebrae, should warn against adjustment, usually, since in this
disease the vertebrae are fragile and easily fractured. If a case has
not progressed too far a cure may be effected, but great caution in
taking such cases must be exercised. Every Chiropractor should be well
informed on the diagnosis of Potts’ Disease, or spinal caries.

Many months are usually required for the straightening of a
curvature--how many can scarcely be estimated in advance of the
experiment with any case. Often the case which seems simplest requires
the longer time, while a very pronounced curvature, as in some cases of
rachitis, may yield in a few months.

PREFERABLE ADJUSTMENTS

The selection of the move with which to correct each subluxation
depends upon the adjuster’s concept of the _kind_ and _direction_ of
the subluxation and of the mechanics of the different corrective moves
in his repertoire. The move used should be one in which the application
of force is exactly along opposite lines to the lines of force which
originally produced the subluxation.

Omitting involved explanations as to the elements of each displacement
and the manner of change in bone, muscle, ligament, cartilage, etc.,
and presupposing a comprehension of the principles of each adjustment
named, there follows here a list of possible subluxations of each
vertebra in turn, from Atlas down, with a simple statement of the RIGHT
MOVE for that subluxation.

In each instance there are other moves than the one listed which would
_move_ the vertebra and some which would partially correct it, but none
which would quite so definitely tend to _correct the displacement_.
Unfortunately it is not a fact that every movement of a vertebra is an
adjustment. If this were true subluxations would not exist, because
they could never have been produced. Too often the adjuster uses a
move because it is easy, because its use has become habitual with him,
rather than because it is indicated by the conditions of the case--then
blames Chiropractic because his results are negative or bad.

The move which is suited to a certain kind of subluxation of one
vertebra may be quite out of place with another, in a different part of
the spine. Thus the Recoil is quite proper for a posterior Lumbar and
is contraindicated with a posterior middle Dorsal.

If all vertebrae were shaped exactly alike, if all were equal in size,
if subluxation were possible only in one direction, then one method of
adjustment would be quite sufficient. Diversity of technic is demanded,
but a discriminating diversity, with a good reason for every move used.

First Cervical

_Subluxation._ _Adjustment._

Right--R. Break, or straight lateral.
Right, posterior--R. P. Rotary lateral.
Right, anterior--R. A. Morikubo.
Right, superior--R. S. Break.
Right, inferior--R. I. Break.
Right, posterior, superior--R. P. S. Rotary lateral.
Right, posterior, inferior--R. P. I. Rotary lateral.
Right, anterior, superior--R. A. S. Morikubo.
Right, anterior, inferior--R. A. I. Morikubo.
Left--L. Break.
Left, posterior--L. P. Rotary lateral.
Left, anterior--L. A. Morikubo.
Left, superior--L. S. Break.
Left, inferior--L. I. Break.
Left, posterior, superior--L. P. S. Rotary lateral.
Left, posterior, inferior--L. P. I. Rotary lateral.
Left, anterior, superior--L. A. S. Morikubo.
Left, anterior, inferior--L. A. I. Morikubo.
Anterior (entire Atlas)--A. Morikubo (both sides).
Posterior (entire Atlas)--P. Rotary lateral (both sides).

NOTE.--All right subluxations adjusted from right side, all left
from left side.

Second Cervical

Posterior--P. Posterior Cervical move.
Posterior, right--P. R. Double contact on right side.
Posterior, left--P. L. Double contact on left side.
Posterior, right, inferior--P. R. L. Double contact on right.
Posterior, right, superior--P. R. S. Double contact on right.
Posterior, left, inferior--P. L. I. Double contact on left side.
Posterior, left, superior--P. L. S. Double contact on left side.
Right (lateral)--R. Break (Same if R. I. or R. S.)
Right (rotary)--R. Rotary (Same if R. I. or
R. S.)
Left (lateral)--L. Break (Same if L. I. or L. S.)
Left (rotary)--L. Rotary (Same if L. I. or
L. S.)
Superior--S. Posterior Cervical move.
Inferior--I. Posterior Cervical move.
Anterior (entire Vertebra)--A. Ventral transverse contact on
most anterior side.
Anterior, right (lateral)--A. R. Second metacarpal contact from
right.
Anterior, right (rotary)--A. R. Pisiform Ant. Cerv. contact on
right.
Anterior, left (lateral)--A. L. Second metacarpal contact from
left.
Anterior, left (rotary)--A. L. Pisiform Ant. Cerv. contact
on left.

Third Cervical

Same as second.

Fourth Cervical

Same as second.

Fifth Cervical

Same as second.

Sixth Cervical

Posterior--P. The Recoil, hands reversed.
Posterior, right--P. R. Recoil, hands reversed.
Posterior, left--P. L. Recoil, hands reversed.
Posterior, right, superior--P. R. S. Recoil, hands reversed.
Posterior, right, inferior--P. R. I. Recoil, hands reversed.
Posterior, left, superior--P. L. S. Recoil, hands reversed.
Posterior, left, inferior--P. L. I. Recoil, hands reversed.
Right (lateral)--R. Break (Same if R. I. or R. S.)
Right (rotary)--R. Rotary (Same if R. I. or
R. S.)
Left (lateral)--L. Break, from left (Same if
L. I. or L. S.)
Left (rotary)--L. Rotary (Same if L. I. or
L. S.)
Superior--S. Edge contact move.
Inferior--I. Edge contact move.
Anterior (entire vertebra)--A. Pisiform Ant. Cerv. contact on
most anterior side.
Anterior, right (lateral)--A. R. Second metacarpal contact from
right.
Anterior, right (rotary)--A. R. Pisiform Ant. Cerv. contact on
right.
Anterior, left (lateral)--A. L. Second metacarpal contact from
left.
Anterior, left (rotary)--A. L. Pisiform Ant. Cerv. contact on
left.

Seventh Cervical

Same as sixth Cervical, except that T. M. may be used on right or
left rotary subluxations.

First Dorsal

Posterior--P. Recoil, hands reversed.
Posterior, right--P. R. Recoil, hands reversed.
Posterior, right, superior--P. R. S. Recoil, hands reversed.
Posterior, right, inferior--P. R. I. Recoil, hands reversed.
Posterior, left--P. L. Recoil, hands reversed.
Posterior, left, superior--P. L. S. Recoil, hands reversed.
Posterior, left, inferior--P. L. I. Recoil, hands reversed.
Posterior, superior--P. S. Heel contact.
Posterior, inferior--P. I. Edge contact.
Superior--S. Heel contact.
Inferior--I. Edge contact.
Right--R. T. M. (Same if R. S. or R. I.)
Left--L. T. M. (Same if L. S. or L. I.)
Anterior--A. No correction.

Second Dorsal

Posterior--P. Heel contact.
Posterior, superior--P. S. Heel contact.
Posterior, inferior--P. I. Edge contact.
Posterior, right--P. R. Recoil.
Posterior, right, superior--P. R. S. Recoil.
Posterior, right, inferior--P. R. I. Recoil.
Posterior, left--P. L. Recoil.
Posterior, left, superior--P. L. S. Recoil.
Posterior, left, inferior--P. L. I. Recoil.
Left--L. T. M. (Same if L. S. or L. I.)
Right--R. T. M. (Same if R. S. or R. I.)
Anterior--A. No correction.

Third Dorsal

Posterior--P. Heel contact.
Posterior, superior--P. S. Heel contact.
Posterior, inferior--P. I. Edge contact.
Posterior, right--P. R. Recoil.
Posterior, right, superior--P. R. S. Recoil.
Posterior, right, inferior--P. R. I. Recoil.
Posterior, left--P. L. Recoil.
Posterior, left, superior--P. L. S. Recoil.
Posterior, left, inferior--P. L. I. Recoil.
Right--R. Pisiform single transverse (on
left) (Same if R. S. or
R. I.)
Left--L. Pisiform single transverse (on
right) (Same if L. S. or
L. I.)
Anterior--A. No correction.

Fourth Dorsal

Same as third Dorsal.

NOTE.--While the Recoil is here, the preferred move for posterior
and postero-lateral subluxations, the pisiform double transverse or
the two finger double transverse may be used if both transverses
are palpable.

Fifth Dorsal

Posterior--P. Double transverse move.
Posterior, superior--P. S. Heel contact.
Posterior, inferior--P. I. Double transverse.
Posterior, right--P. R. Double transverse.
Posterior, right, superior--P. R. S. Double transverse.
Posterior, right, inferior--P. R. I. Double transverse.
Posterior, left--P. L. Double transverse.

NOTE.--The pisiform double transverse and the two-finger double
transverse, apply force in exactly similar directions and may
therefore be used interchangeably. The latter is preferable for
children.

Posterior, left, superior--P. L. S. Double transverse.
Posterior, left, inferior--P. L. I. Double transverse.
Right--R. Pisiform single transverse
(Same if R. S. or R. I.)
Left--L. Pisiform single transverse.
(Same if L. S. or L. I.)
Anterior--A. No correction.

Sixth Dorsal

Same as Fifth Dorsal.

Seventh Dorsal

Same as Fifth Dorsal.

Eighth Dorsal

Same as Fifth Dorsal.

Ninth Dorsal

Same as Fifth Dorsal.

Tenth Dorsal

Posterior--P. Heel contact.
Posterior, superior--P. S. Edge contact.
Posterior, inferior--P. I. Edge contact.
Posterior, right--P. R. Recoil.
Posterior, right, superior--P. R. S. Recoil.
Posterior, right, inferior--P. R. I. Recoil.
Posterior, left--P. L. Recoil.
Posterior, left, superior--P. L. S. Recoil.
Posterior, left, inferior--P. L. I. Recoil.
Right--R. Recoil (Same if R. S. or
R. I.)[A]
Left--L. Recoil (Same if L. S. or
L. I.)[A]
Anterior--A. No correction.

[A] Note.--The use of this move is not quite mechanically correct,
but it is advised because of the possible danger of using the
transverse processes as levers.

Eleventh Dorsal

Same as Tenth Dorsal.

Twelfth Dorsal

Same as Tenth Dorsal.

First Lumbar

Posterior--P. Heel contact.
Posterior, superior--P. S. Heel contact.
Posterior, inferior--P. I. Heel contact.
Posterior, right, superior--P. R. S. Recoil.
Posterior, right, inferior--P. R. I. Recoil.
Posterior, left--P. L. Recoil.
Posterior, left, superior--P. L. S. Recoil.
Posterior, left, inferior--P. L. I. Recoil.
Right--R. Lumbar single transverse move,
if transverse is palpable,
otherwise Recoil. (Same if
R. S. or R. I.)
Left--L. Lumbar single transverse move,
if transverse is palpable,
otherwise Recoil. (Same if
L. S. or L. I.)
Anterior--A. No correction.

Second Lumbar

Same as First Lumbar.

Third Lumbar

Same as First Lumbar.

Fourth Lumbar

Posterior--P. Heel contact.
Posterior, superior--P. S. Heel contact.
Posterior, inferior--P. I. Heel contact.
Posterior, right--P. R. Recoil, hands reversed.
Posterior, right, superior--P. R. S. Recoil, hands reversed.

NOTE.--The Heel contact may be substituted for the Recoil above if
force be carefully directed in the proper direction in delivery.

Posterior, right, inferior--P. R. I. Recoil, hands reversed.
Posterior, left--P. L. Recoil, hands reversed.
Posterior, left, superior--P. L. S. Recoil, hands reversed.
Posterior, left, inferior--P. L. I. Recoil, hands reversed.
Right--R. Lumbar single transverse move,
if transverse is palpable,
otherwise Recoil. (Same if
R. S. or R. I.)
Left--L. Lumbar single transverse, if
transverse is palpable,
otherwise Recoil. (Same
if L. S. or L. I.)
Anterior--A. No correction.

Fifth Lumbar

Posterior--P. Heel contact.
Posterior, superior--P. S. Edge contact.
Posterior, inferior--P. I. Edge contact.
Posterior, right--P. R. Recoil.
Posterior, right, superior--P. R. S. Recoil.
Posterior, right, inferior--P. R. I. Recoil.
Posterior, left--P. L. Recoil.
Posterior, left, superior--P. L. S. Recoil.
Posterior, left, inferior--P. L. I. Recoil.
Right--R. Recoil (Same if R. S. or
R. I.)
Left--L. Recoil (Same if L. S. or
L. I.)
Anterior--A. “Bohemian” anterior fifth
Lumbar move. (Not always
advisable.)

Sacrum

Posterior base--B. of S.--P. Heel contact on base.
Posterior apex--A. of S.--P. Heel contact on apex.
Entire Sacrum posterior Sac. P. Heel contact between
sacroiliac articulations.

Coccyx

To be adjusted only when ankylosed in an abnormal position and then
by leverage of finger through rectum.

A FINAL WORD

Some useful information pertaining to adjustment will be found in
section entitled, “Practice,” q. v.

After a careful and painstaking study of the foregoing pages it will
still be found that the student is not by any means equipped for the
work. He must _practice_ these things to learn them. We learn to do by
_doing_. The chief use of this section will be as a reference and guide
during the practice of adjusting.

THE CAUSE OF DISEASE

Disease a Morbid Process

Disease has been variously regarded as an entity, a process, a
condition. It has been mentioned in terms which would almost
personalize it, such as, “attacked by pneumonia,” “seized with cramps,”
“in the clutches of tuberculosis.” Men have endeavored constantly
to discriminate between diseases and to learn the appearance and
peculiarity of each, and have resolved each into its peculiar elements
only to learn that the merging lines between two diseases or between
cases of the same disease are imperceptible. It is no more possible to
define any one disease within exact limits and to distinguish it from
all others than to consider one function of the human body without
studying its interdependence with others.

Disease is a _process_. It is a natural process. It follows certain
well-defined laws and consists in the abnormal performance of function
in some bodily organ or organs, or in the untimely performance of some
function which would be normal in its proper chronological relation
with other functions or at another period of the body’s development.
The balance of function of the body is destroyed--some function
intensified or diminished--that is all. Every disease, properly
studied, reveals its functional base.

Disturbances of the functions of _growth_, _nutrition_, and _repair_
produce changes in structure, physical evidences of disease. It is
probable that every disease has a certain amount of structural change
connected with it; it is hard to conceive of functional derangement
without structural change, in a universe in which Nature is eternally
building, destroying, or modifying organic peculiarities to meet
changing functional demands. But in many instances this structural
change is so slight as to be undiscoverable; such diseases are called
“functional” to distinguish them from those in which structural
pathologic changes are directly discernible, called “organic.”

Beginning of the Process

Recognizing the fact that disease consists in a succession of steps
or a series of events, each depending upon the next preceding one and
making possible its successor, and desiring to arrest or check this
process and correct the damage done, in other words, “to cure disease,”
the question arises, “Where does this process begin?”

If we wish merely to check the process or to modify it, as does
medicine, the etiology of the disease is less important than the
present state. It is then more important that we understand the changes
which are taking place in the body at the time of our attempt, the
condition of each organ at that time, and the general recuperative or
resisting power of the individual.

But if we would correct all the damage done instead of merely
preventing further damage or building up internal resistance against a
still active destructive process; if we would so eliminate the effects
of the earlier steps as to make the resumption of the disease process
most improbable, we must know each step from the beginning to the
present, understand their sequence and relation, and go back to the
beginning with our correction, _removing the cause_.

The Cause of Disease

Since each event in the morbid process depends upon the preceding
one and makes possible those which follow, it is possible to stop at
any point in the chain of events and declare, “Here lies the Cause
of Disease.” This explains the various etiologies adhered to each
by a school of intelligent and scientific men, yet each apparently
disagreeing most flatly with the others. No matter which step we select
as our “ultimate cause” it truly is the cause, or one of the causes,
of succeeding steps, which succeeding steps may well stand in our
minds as the whole of the disease. Thus the physician, having found a
germ, is quite content to look forward from the invasion of the germ
and consider that as the primarily necessary requisite for disease
production. In retrospect he follows disease back within the body to
the time of entrance of the germ and then leaves the body to study
the life habits of the germ and its favorite mode of conveyance. He
has unwittingly left the direct line of investigation and followed a
spur-track.

So with the osteopath who discovers contractured muscles drawing a
member, or a bone, from its normal position. He proceeds to a study
of the effect of such contracture upon other tissues and strives to
relieve it by treatment--of the muscle.

The dietist discovers that certain food combinations cannot be properly
cared for by an individual and that if taken they tend to develop
toxins deleterious to the system. Whereupon he undertakes to discover
food combinations which the body _can_ care for and believes that he
has solved the question of etiology.

Now it is _most_ important that we find the _primary_ cause, the one
which makes possible the operation of all the rest and without which
all would be powerless to harm man. This we shall expect to find at
the point of entrance of disease into the human organism. The primary
cause must be the first step _which concerns man_, the first change
from normal to abnormal, on which all subsequent changes depend. It is
useless to pass outside of the consideration of man and those forces
which directly affect man, in our search for the cause of disease. We
are powerless to affect outside forces or to control or amend the laws
of nature through which disease exists.

Let us attempt then to resolve disease into its successive steps and
to find the first which concerns man. Correcting that, we shall have
corrected, fully and completely, the process which constitutes disease.
By striking at the root we may destroy the entire growth.

Vital Energy

_Irritability_ is the property of being susceptible to excitement
or stimulation. Stimulation is the process of increasing the
functional activity of any organ. Inhibition is the act of checking,
restraining, or holding back the functional activity of any organ.
These definitions, taken from Gould, are here introduced as a necessary
preface to an attempt to set forth, without unnecessary reference to,
or discussion of, any other theory as to the etiology of disease, the
Chiropractic explanation of its presence.

Chiropractic maintains that all the chemical and physical activities of
the human organism are controlled, directly or indirectly, through a
third form of energy transmitted through the Nerve System; that while
all three forms of energy are interdependent and closely related in
their ultimate expression, one of the three is the _primary_ and most
essential form, and especially indicative of life. We may call this
third form _Vital Energy_.

There are several good reasons for believing that this nerve force is
the primary form in which energy is expressed in man and for believing
that it controls and directs the others in greater degree than it is
controlled and directed by them.

Of the four forms of tissue of which the body is composed--connective,
epithelial, muscular, and nervous--the latter is the one damage to
which is followed by the greatest and most permanent consequences.

It is a fact that there are several organs whose removal leads to
certain death because of their importance in the general economy of
the body, but it is also true that section of the nerves leading
to these organs just as certainly causes death by the cessation of
their functions. There is no organ in the body aside from the nerves
themselves which does not immediately cease to act upon withdrawal of
its nerve force and at once begin a process of degeneration or atrophy.

Pathologic changes in the Nerve System invariably are followed by
pathologic changes in the organs controlled by the diseased segment but
the converse is not true. Excitation or inhibition of nerve activity
produces corresponding and responsive change in the activity of the
organs innervated, but excitation of an organ does not necessarily
produce similar changes in the Nerve System. That system possesses the
power of inhibiting or permitting responsive action, in other words,
the power of _choice_.

Research in Comparative Anatomy develops the fact that the differences
in power of complex action possessed by different organisms are
entirely measurable by differences in the structure and complexity of
their nerve mechanisms.

Further, by studying the effects of removal or extirpation, or of
pathologic changes in various parts of the nerve system it has been
demonstrated that the Brain is the center for those higher forms of
activity known as psychic, for the power of accelerating or inhibiting
the responses of the lower centers of the nerve system to stimulation
from without, and for the conveyance of authority to act to all the
lower centers. The Nerve System is the morphologic, physiologic, and
dynamic center of the organism and the Brain the center of the Nerve
System. We may, then, logically expect to find in the Brain, or in the
channels by which power is distributed from the Brain to lower centers
or organs, the initial step in the disease process, which is our
present quest.

One Nerve System

All nerve tissue in the body is organized and linked together in
a complicated aggregation of individual units, communicating by
_contact_, and forming one great Nerve System having its directing
center in the Brain. It is said by some writers to consist of two
distinct systems--cerebro-spinal and sympathetic--but would better be
described as consisting of central organs--brain and spinal cord--and
peripheral organs--cranial, spinal, and sympathetic peripheral axons
connecting with cells in the central axis and linked together in a
net-work improperly separable into separate or distinct divisions,
the fibres of different parts being bound together in such a way as
to establish an intricate intercommunication, closest on the one hand
between the cranial and sympathetic and on the other between the spinal
and sympathetic. The sympathetic system may be regarded as nothing more
than a medium for proper distribution of impulses originating in the
cerebro-spinal system, and a series of reflex centers deriving their
power to act from the central axis. The proper action of sympathetic
ganglia has been demonstrated to depend upon the integrity of the
spinal nerve fibres, or rami communicantes, which pass to and terminate
in the ganglia with their telodendria (terminal arborizations) in
contact with the dendrites (cellulipetal processes) of the ganglion
cells.

It will appear that interference with one division or part of the
nerve system may be followed by effects partly manifested through a
distant part; that excitation or inhibition of a spinal nerve may
correspondingly excite or inhibit sympathetic fibres.

Chiropractic Hypothesis

Chiropractic has accepted, as a convenient working hypothesis
amply justified by years of clinical experiment and anatomical and
physiological research, the proposition that all disease in the human
body is primarily made possible by injury to (stimulation or inhibition
of) some part of the nervous mechanism.

Injury to other tissues, unless the injury also involves nerve tissue,
is quickly repaired and the body goes on without disease. Or the injury
is sufficient at once to render the body untenable and death ensues.
Few pathological changes follow trauma unless nerve tissue be injured.

This theory to be logical must and does include the entire nerve
system. Also, since it is noted that each nerve cell presides over the
nutrition of its own processes and possesses its own power of repair,
it follows that unless an injury be of fatal nature or of permanent
duration, even injuries to nerves tend toward automatic cure. We must
seek a permanently operating interference with nerve tissue.

The brain, enclosed within the comparatively solid cranium, is so
well protected that nothing except fracture of the skull, violent
concussion, or shutting off of its blood supply from without, will
produce permanent change there. Also, unless there be pressure by
foreign substance against the brain, an injury will be repaired in
time and the body resume its normal functional activity. It has been
demonstrated that comparatively few diseases occur in this way. Such as
do are called traumatic; i. e., caused by wound or injury.

In the broadest sense all disease is caused by trauma, as we shall
presently show.

The upper or cephalic peripheral nerves, called cranial, leave
the skull by foramina in its base (except the auditory) and are
so protected by the immobility of the bones of the skull as to be
comparatively free from direct injury. Peripheral injuries occur to
cranial nerves but are repairable; even section of the trigeminal for
neuralgia is usually followed after an interval by a reunion of the
severed parts. As will be shown later, the special end organs of the
cranial nerves are not free from the effects of spinal subluxation and
their nuclei (deep origins) often share in morbid changes in the brain
tissue due to nutritional disturbances.

The sympathetic portion of the nervous system might be classed with
the cranial as regards infrequency of permanent interference were it
not for the proximity of the great gangliated cord to the transverse
processes and bodies of the vertebrae. This proximity renders it liable
to sustain permanent impingement in vertebral subluxation.

Trauma Affects Spinal Nerves

With the exception of the first pair of Cervical nerves and the Sacral
and Coccygeal, all spinal nerves pass through foramina of exit which
are composed each of two movable vertebrae. The Chiropractic hypothesis
is based upon the discovery that in addition to the part these
vertebrae may take in general movements of the spine it is possible
that their relation to each other may be changed by the application of
force from without, and that this change once produced tends to remain
permanently. These permanent vertebral subluxations occur with great
frequency, a fact clinically demonstrable by palpation and by the X-Ray.

The discovery of this fact led to the ascertaining of two more, namely,

_No disease is ever found without accompanying subluxation._

Since each organ or tissue is connected with some definite and special
vertebra, subluxations accompanying disease bear a relation to disease
which is controlled by a general law, operative alike on all human
organisms.

The latter fact required one other for its complete demonstration;
namely, that the removal of the subluxation is always followed by the
complete disappearance of the disease. Given more perfect methods of
correcting subluxations it would follow that proof of the Chiropractic
theory would be so complete and overwhelming as to meet at once with
general acceptance. The difficulty lies in the fact that with our
present methods much time is often required for complete correction of
the vertebral displacement and much skill is needed even for successful
investigation of the results obtainable. The theory is too often judged
by unskilled or imperfect applications of it.

Every school of Chiropractic accepts the presence of the subluxation
and has spent much thought and time in the effort to deduce the law
governing its connection with disease. Diverse conclusions have been
reached owing to the difficulty experienced in completely eradicating
the subluxation. When it _is_ accomplished the results are absolutely
conclusive. When it is partially or relatively accomplished the results
are so good in a great per cent of cases as to lead sometimes to the
erroneous belief that the subluxation did not cause the disease since
mere partial correction of the subluxation suffices to bring about
the apparent total removal of the disease. In every case of thorough
experiment the results warrant the recommendation of the subluxation
theory as at least a proper working hypothesis.

Without attempting here to review all the various conclusions reached
or the methods by which they have been attained, we would simply state
our own conclusion, which we believe is the only one compatible with
demonstrable facts. It is briefly this: Since every portion of the body
is connected through the nervous system with the spinal nerves and
since it has been proven that this connection is reasonably constant
and anatomically demonstrable; since the removal or correction of a
subluxation leads in all cases to the complete disappearance of disease
from the organs or tissues innervated from the subluxated portion of
the spinal column, we conclude that the subluxation is the _primary
cause_ of disease.

The final test of the correctness of any theory is the result of its
application. Since Chiropractic secures a larger percentage of results
than any other known system of healing it is safe to assume, at least,
that it has discovered the way to remove the primary cause of disease.

That the Chiropractic theory, or more properly the subluxation theory,
does not include all of the etiology of disease is evidenced by the
facts of contagion and infection, by the effect upon the organism of
the introduction of poison, by the consequences of worry, anger, and
other abnormal mental states and conditions. These facts do not in the
least invalidate the theory. They merely require explanation which will
make clear their relation to the subluxation. That such explanation is
abundantly at hand strengthens the position of Chiropractic more than
would negation of all other causes save the one we concentrate upon.

The Mentalist who holds that all diseases exist in and are but figments
of the mind is as far afield as the Physicist who holds that special
nerve energy is nonexistent. The Chiropractor views Man as a complex
psycho-physical unit, self-operating and internally self-healing until
environmental forces disturb the nice adjustment of the machinery.

Disease is produced by, and is, a series of events, chief and most
permanent of which is the subluxation. We may consider its etiology
according to the order in which the events take place thus:

Direct Chain

Concussion of Forces.

Subluxation of Vertebra.

Impingement of Nerve.

Excitation or Inhibition.

Disease--Abnormal Function.

Accessory Chains

Between the last two steps above, or following the last, are often
introduced one or more of the following accessory chains which modify
or increase the final effect and are themselves made possible by the
first four steps in the direct chain.

Pathogenic germ.

Poisonous excretions from germs.

Tissue destruction by chemical action of such toxins.

Reflex muscular tension tending to increase subluxation and thus
augment nerve impingement and its effects.

Dietetic error.

Abnormal chemical action.

Tissue destruction or nerve irritation by chemical poisons.

Reflex motor disturbances which further limit digestive power.

Abnormal mental condition.

Waste of nerve energy with production of toxins.

General metabolic disturbance.

Increased disease wherever disease previously existed.

These are offered merely as illustrations. There are many accessory
chains which aid in the production or development of disease and act as
_secondary causes_.

Concussion of Forces

Man was so created, so provided with means for repair, growth, etc.,
that the body tends to maintain its own functional balance--perfect
harmony among all its parts--unless interfered with by some outside
agency. There are certain natural laws such as the law of gravitation
and the law of momentum and inertia which operate without regard for
man or man’s welfare. If man, wittingly or unwittingly, allows himself
to come into violent conflict with one of these laws by falling to the
ground or in meeting sudden and unexpected opposing force or mass while
in motion, that which may be termed a concussion is produced by the
meeting of the outside force and the internal bodily resistance.

Many such concussions may occur without serious damage. Some produce
wounds or injuries which it is possible for the body to heal without
causing serious disturbance of function. Other concussions are so
violent as to produce displacement of structure which tends to
remain permanently. Under Spino-Organic Connection will be found an
explanation of the manner in which force applied to various parts of
the body tends to affect the spine.

Now the displacement of a bone cannot be corrected by the body without
outside aid. No method is provided for such correction. Produced by
outside force affecting the body, it can only be reduced by outside
force. It is this failure of Nature to make man adaptable to _every
untoward circumstance_ which renders him susceptible to disease.

Subluxation

As has been previously stated by no means all concussions of forces
produce subluxation. (All subluxations, however, are produced by
concussion of forces.) It may be added that not all subluxations
impinge nerves and that when they do not so encroach upon nerve tissue
they produce no noticeable effect after the first temporary soreness
has disappeared.

Every subluxation, however, evidences a _tendency_ to disease. Once
moved from its normal position and the poise and symmetry of the body
disturbed, there are influences which tend more readily to affect the
same vertebra. The subluxated vertebra is more easily disturbed by
jars, strains, etc., than the normal one because such jars are less
regularly distributed to all its parts. A reflex muscular tension due
to other and more pronounced subluxations and their disease effects
may in turn increase the slight deviations throughout the spine,
rendering them in their turn capable of producing disease. When the
spine or any part of it has lost its perfect regularity disease is made
_possible_, if not a fact at once. The average number of subluxations
in each individual is about nine and one-third. Of this number probably
not more than one-third (though no accurate figures are available)
are actually productive of conditions nameable as disease at any
given time. Discrimination between those which do, and those which do
not, produce discoverable symptoms in a given case is a matter which
requires a nice technical skill and perfect judgment.

Impingement of Nerves

When a vertebra has lost its normal articular relations with its
fellows and occupies an abnormal position as a consequence in regard
to _all_ surrounding or adjacent tissues it may impinge nerve tissue
in two ways, by _tension_ or by _constriction_. By the displacement of
one vertebra of a pair the size and shape of the intervertebral foramen
may be altered (occlusion) constricting the nerve which passes through
the opening. That this change in the size and shape of the foramina
does frequently occur is shown by the frequency with which alterations
in the shape of vertebrae appear in dry spines, by post-mortems which
have demonstrated the altered foramina in the cadaver and by permanent
occlusion of the foramina in ankylosed spines so that the occlusion may
be preserved. Adding cartilage changes in the intervertebral disks to
alterations in bone shape and position, especially the latter, we find
full and sufficient reason for all the pathological phenomena which
follow the subluxation. Explain it as you will, these morbid results
_do_ follow subluxation and can be experimentally produced in animals.
Moreover, the disease may be directed to a desired organ or region by
selection of the particular vertebra to be displaced.

The suboccipital, sacral, and coccygeal nerves cannot be constricted
as they pass through the foramina because they do not emerge through
complete rings formed of separate and movable bones. But these
nerves may be _pressed upon_ or stretched by displaced bone, as may
also the great gangliated cord of the sympathetic, especially the
Cervical portion of it. _Tension_ of the Cervical sympathetic cord by
subluxation of vertebrae is a very common occurrence.

Whether the impingement be by constriction or by tension the effect
is much the same depending upon the degree to which the molecular
continuity of the nerve substance is impaired--interference with the
function of the organ connected with the nerve and sometimes swelling
and pain in the nerve itself followed by degeneration. The effects are
chiefly noticeable in peripheral tissues. S. Weir Mitchell says (1872),
“A continuous pressure upon a nerve results in the degeneration of the
nerve and a disturbance of function of the parts innervated by that
nerve.” No clearer statement can be made.

It must not be understood that all nerve impingement is due directly
to subluxation of a vertebra. A dislocated shoulder would produce a
similar effect of nerve tension. But dislocated shoulders are seldom
met with as permanent conditions. Likewise there may be secondary
impingement from new growths, themselves due to some primary
subluxation. Aneurism of the thoracic aorta often produces hoarseness
by impingement of the recurrent laryngeal.

Not all impingement is sufficient to produce noticeable disease.
To a certain extent the power of adaptation inherent in the body
can overcome its deleterious effects and suppress all signs of its
existence until an overtax upon bodily energy lessens this adaptative
power. Then disease appears and we say that the overtax caused it.

Excitation or Inhibition

A slight impingement serves as a mechanical irritant to increase the
action of the nerve and the functions of the attached peripheral
organs. Such stimulation beyond the normal is always followed by a
reaction, or fall to subnormal action.

Heavy impingement, especially the impingement due to marked occlusion
of foramina, partly or wholly paralyzes the affected nerves. Often the
impingement produces only a latent weakness in some organ, a weakness
which may be brought to light only through the introduction of some
secondary cause which takes advantage of the susceptibility of the
organ to produce some definite disease. As an instance of this we may
mention typhoid fever. No typhoid case is found without subluxation
in the region of the second Lumbar; yet the latent weakness produced
by that subluxation may not have been observed until the typhoid germ
found a fertile feeding and breeding ground in the weakened tissue and
proceeded to multiply there and develop its toxins.

Effect Upon Single Cell

Each nerve cell is trophic to its processes and to the tissue cells to
which these processes are distributed. The growth, nutrition and repair
of each cell of the body is dependent upon the integrity of the axon
which supplies it. The effect of nerve impingement upon the single cell
is a weakening of cell structure and a disturbance, slight or great,
of the special function possessed by that cell. Dunglisson says of
diseases, “All ... are dependent upon modified cell-action.”

Effect Upon Organs

Each organ is but an aggregation of cells of some special type or kind.
Nerve Impingement usually involves either a whole nerve trunk or many
of its fibres and thus weakens either the entire organ or many of its
cells and increases or diminishes its special function. Some organs are
innervated by more than one nerve and may be injured only in part by a
localized impingement.

Alteration of the action of one organ often tends to affect the entire
body, as in subluxation of the fourth Dorsal interfering with the nerve
supply to the liver the secretion of bile becomes altered in character
or quantity and the entire system suffers, through deranged digestion,
from this alteration in a necessary secretion. Every disease presents
symptoms only indirectly referable to the organ which is primarily
affected and the problem of the diagnostician is to so discriminate
between direct and indirect symptoms as to be able to _locate_ disease.

Simple Subluxation Disease

We have considered a chain of events by which disease is produced
without the intervention of any secondary cause. Such a condition may
be called, for convenience, a simple subluxation disease. Its existence
depends directly upon the subluxation which is the first change
manifest in the individual and upon which all the other changes depend.

The two facts that not all subluxations impinge nerves and not all
nerve impingements cause demonstrable disease explain why we do not, in
practice, find a disease to correspond with each subluxation discovered
by palpation. It must be remembered that there may be latent weakness
following a subluxation and of importance because it renders the
patient susceptible to infection or to the action of other secondary
causes.

SECONDARY CAUSES

Among the secondary causes of disease may be mentioned the pathogenic
germ, poisons, dietetic errors, abnormal mental states, bodily
excesses, exposure to sudden temperature changes, and inhalation of
non-poisonous but irritating substances as the most common. Many others
might be included but these will suffice for complete illustration
of the principle. It will be our endeavor to show how each of these
secondary causes operates by virtue of a previous susceptibility, or
breaking down of the normal resisting power of the organism caused
by subluxation, and how each in turn _may_ bring about increase in
subluxation and thus, both directly and indirectly, increase disease.

Bear in mind these two all-important facts. _None of these secondary
causes can operate without previous subluxation. A subluxation may
produce disease without the aid of any secondary cause._

GERM DISEASES

These comprise a large portion of the febrile affections. Most germ
diseases are characterized by fever and the presence of circulating
toxins with resulting disturbance of the metabolic processes of the
body.

It is generally agreed among pathologists that the greater number of
varieties of micro-organisms found at times in man are not pathogenic.
Some aid in the decomposition of food in the alimentary canal; others
have various beneficial functions to perform. But some, under proper
conditions, feed upon and destroy living tissue. These are the
so-called pathogenic germs.

The pathogenic germs are many. They enter the body by various routes,
in the air we breathe, the food we eat, the water we drink; sometimes
they are communicated by direct contact with other persons or with
objects infected with them. The term “contagious” is applied to those
diseases whose germs may be carried through the air from one to
another; “infectious” refers to those communicable only by contact.

In every healthy individual are found multitudes of germs of both
the pathogenic and harmless varieties. We are constantly exposed to
the influence of the former yet by no means all bodies into which
pathogenic germs find entrance contract disease. This fact has caused
much study and among pathologists and bacteriologists generally the
conclusion has been reached that the development of colonies of
micro-organisms sufficiently to produce disease depends upon what is
known as “susceptibility” of the organism. There must be a latent
weakness of which the micro-organisms take advantage.

This amounts to the admission that the body contains the inherent
property of successfully resisting all germ action. Indeed, the
fundamental proposition of Serum-Therapy is that under stress of the
presence of dilute germ infusions the body _does_ develop special
chemicals which neutralize the germ poisons and kill the germs and
which remain after the inoculation to guard against any further
entrance of germs of the same kind and vulnerable to the same
protective chemicals.

This theory is sufficiently correct to have served as an unassailable
basis for a most illogical procedure. The truth is that the
auto-protective power of the body must be lower than normal and the
germs must find a weakened area for development and multiplication
before they can develop sufficiently to produce disease. Once they gain
a foothold they tend to multiply with great rapidity and to develop
alarming symptoms often leading to death.

Only in a few instances does modern science believe that a pathogenic
germ can successfully attack a healthy body, but is claimed that there
are a few germs, such as the Klebs-Loeffler bacillus (diphtheria
producer) and the bacillus of anthrax, which may find lodgment in any
organism, healthy or unhealthy, to produce disease.

Now, the susceptibility of the body to germ invasion requires
explanation. Merely to say that one is susceptible and another is not
leaves too wide a field of possibility for error. It is easy to reason
from the fact that all persons are at some time exposed to contagious
or infectious diseases while comparatively few contract them that
some persons are vulnerable to certain diseases while others are not.
It is plain that while a person may be susceptible to typhoid fever
because he has a weakness in the intestines, he may be quite immune
from pneumonia or tuberculosis or any other infectious or contagious
disease. But why this difference? Let us look at the problem from
another angle.

Chiropractors find with every contagious or infectious disease certain
subluxations whose location with relation to the disease is constant
and demonstrable. Thus all cases of pulmonary tuberculosis show a third
Dorsal subluxation with only enough exceptions to prove the rule;
tonsilitis is invariably accompanied by subluxation of the second,
third or fourth Cervical. Correction of the subluxation is, in all
except the most fully and virulently developed cases, followed by a
radical cure. Indeed, in many of the germ diseases it is possible to
abort the fever with improvement of all symptoms in from five minutes
to twelve hours. We are so accustomed to checking germ diseases at
once that failure to do so leads us to immediate investigation of
our palpation and adjustment to discover some technical error in the
application of the principles of Chiropractic to the case in question.

It is manifestly impossible by vertebral adjustment to raise the body
beyond _normal power_. Nothing is added to the body; no energy is
utilized other than the energy of the body itself which is provided
by Nature and released through restoration of the normal carrying
capacity of nerves. The highest goal attainable is normality, and it
is observed that no matter whether the impingement be in the nature of
an excitation or an inhibition of nerve action the effect of a correct
adjustment is always in that direction--toward normality. It may be
as well to digress here long enough to remark that abnormal change is
never the result of _adjustment_ but always of _maladjustment_, and
those who claim to be able to produce stimulation by moving a given
vertebra one way and inhibition by moving it another are entirely wrong.

It is evident from the results of adjustment in germ disease that
the normal body is entirely capable of throwing off the poisons and
exterminating the germs, which conclusion quite agrees with science.
The fact, not known by other branches of science, and asserted by
Chiropractic is simply that _the subluxation is the factor which
determines susceptibility_.

Upon ascertaining that a certain vertebra is in normal alignment we may
say with absolute certainty that the organs innervated by the nerves
passing through its foramina are not and cannot be the site of any
pernicious germ activities. To go further, it has been demonstrated in
a number of cases that the subluxation existed before the contagion
or infection developed. A man has been known to have a second Lumbar
subluxation for many years without effects other than a tendency to
constipation and on the appearance of a typhoid epidemic to contract
the disease. Correction of the subluxation afforded a cure. Such
instances might be cited in great numbers. No person without the
necessary subluxation ever contracts a germ disease and the necessary
subluxation can be exactly located for the vast majority of such
diseases. Unfortunately it is impossible to find a person who has not
_some_ subluxations and is not, therefore, subject to _some_ form of
contagion or infection.

So far Chiropractic agrees with general knowledge of germ disease and
its etiology, simply adding the explanation of susceptibility which all
other modes of investigation have failed to afford. In one particular
we find apparent disagreement.

We have said that several bacilli are supposed to have power to cause
disease in healthy bodies. Diphtheria is a disease caused by one of
these. Yet Chiropractic adjustments have rapidly aborted diphtheria,
apparently proving that the body has power to react strongly enough to
conquer even this germ, providing the nerve channels be opened to allow
of exertion of its full activity. It is probable that all diseases fall
under the same law and that _no_ germ can find lodgment in healthy
tissue. Chiropractic affirms this as a truth and as yet no experience
has tended to disprove it; the belief is strengthened by the years.

The experiments which are said to have proven that certain
micro-organisms can attack healthy tissue are based upon the
supposition that careful examination demonstrated the absence of
disease in the animals experimented upon by inoculation. Since these
experiments and these examinations were made without any knowledge of
vertebral subluxations, and consequently without discovering whether
or not there existed latent weaknesses of various organs, we doubt the
validity of the experiments. Our own examination of human and animal
spines has thus far failed to discover any perfectly normal specimens.

Our clinical experience with diphtheria at least absolutely disproves
the conclusions of Pasteur and others in regard to its origin.

Increase of Subluxations

It has been observed that in many instances the subluxation which
existed previous to infection or contagion is greater and more
noticeable during the febrile and active stage of the disease than
before, and this fact has led some careless or insufficiently skilled
palpaters to assume that the disease caused the subluxation.

The development of germ life is accompanied by the excretion of
toxins of greater or less virulence which circulate through the blood
and affect the entire body. This poison, irritating sensor nerves,
brings about motor reactions in the segments irritated and, since
the normal operation of the laws of reflex action is interrupted
somewhat by subluxation, and since the muscles immediately around a
subluxated vertebra tend to pull upon it with unequal leverage, this
motor reaction is likely to _increase_ already existing malalignments,
especially in the same body segment in which the poison is generated
and in which the irritation is consequently greatest. Thus subluxation
is most pronounced during the activity of the disease caused by it
and reacting upon it and thus a disease which began as a localized
destructive process may manifest systemic effects through its action
upon other abnormal spinal segments.

DIET

The internal chemistry of the body varies so greatly under changing
conditions, the operation of any two different organisms is so hard
to compare accurately, that it is impossible to set down any rule for
diet which will apply properly to all patients or to all with the same
disease or habit of body. In fact, only experiment with an individual
can determine the exactly proper diet for him.

Through lack of judgment or of observation of the effects of certain
foods upon us we often eat that which our bodies cannot properly digest
and assimilate. Sometimes through accident or negligence we partake of
food which is proper in kind for us but improper in quality, perhaps
partially decomposed. Improper food, when taken into the body, tends to
exert a deleterious effect upon health. This fact should not lead us to
confine ourselves to reasoning superficially that improper foods _cause
disease_ or that dietary measures will _cure_ disease.

Some Chiropractors have held that the hunger of individuals for certain
foods is a safe guide to a proper diet. This is manifestly untrue
in some cases; the voracious appetite of the convalescent typhoid
patient is an example. But it would probably be true _if all men were
normal_. Close observation of a few exceptionally well-developed and
normal individuals has disclosed an interesting fact. If a man has no
subluxation in that portion of the spine which controls the stomach,
the ingestion of decomposing food, even though the alteration be so
slight as to escape notice on casual examination, induces immediate
vomiting followed by no untoward consequences. Only occasionally
does one find persons without subluxations in some way affecting the
stomach; in such cases the body promptly rejects and expels injurious
material.

This carries us to the rather surprising conclusion that _the normal
person is not susceptible to the influence of bad food_. In the
majority of individuals, some degree of abnormality existing, improper
food has a decidedly bad effect. Passing through the alimentary canal
it is improperly digested; toxins are developed; these chemically
affect the entire body, perhaps leading only to a congestion and
inflammation of some part of the lining of the alimentary tract,
perhaps producing a general fever, malaise, diarrhea, and the other
effects of a general poisoning.

It has been found that proper adjustment is followed by quick relief
in such cases, the commonest effect being the rapid expulsion of the
deleterious matter by vomiting and diarrhea with breaking of the fever
and lessening of all symptoms.

It has also been observed that during the suffering from dietetic
error the subluxation controlling the stomach or some part of the
small intestines is often found increased in degree with tension of
the adjacent muscles. With adjustment and relief of the other symptoms
the muscular tension tends to disappear. This motor reaction from the
irritation of food poison undoubtedly serves to _increase_ subluxation
already existing, thus intensifying effects. But for its primary effect
food poison requires a previous subluxation lowering the natural
protective power of the body. Food poisoning is often a secondary cause
of disease.

When it is found in any specific case that certain foods exert a
bad influence upon the progress of the case, that the symptoms are
aggravated by the taking of these foods, they must be abandoned. Yet no
rigid diet need be prescribed in any case. Every patient will require a
different diet, nor is it possible to understand the intimate chemical
relations within the body sufficiently to fix a proper diet except by
experiment.

A word here about fasting. If improper food were a primary cause of
disease, fasting would be an effective, though somewhat radical,
removal of the cause of disease and a logical procedure. Since improper
food is _not_ a primary cause of disease and since nature requires
food for the repair work made possible through adjustments, it would
seem unwise for Chiropractors to prescribe fasting. Also it is well to
remember that fasting and starvation are synonymous and their symptoms
identical.

POISONS

Any substance taken into the body and not usable as food may be
considered poison. Most drugs administered as medicine or used
habitually are either directly poisonous and commonly so considered
or are poisonous in the sense that they do not build but rather tend
to injure the body. Injurious substances accidentally taken into
the body; certain products included in the preparation of otherwise
nutritious foods, alcohol, tobacco, etc., affect the body in varying
degrees but in accordance with the same laws. Poisons may be internally
generated through the action of pathogenic germs or through the failure
of the body to digest food and to prevent injurious chemical changes in
it. It has even been said by some that abnormal mental states so affect
metabolism as to cause the formation of certain auto-toxins which
injuriously affect the entire body.

However poison may make its appearance in the body its presence
is associated with certain bad effects. Poison may be corrosive,
destroying tissue wherever it touches; it may be stimulating, affecting
the nerves so as to increase their activity, following which waste of
energy there is a weakening reaction; it may be narcotic, lowering some
physiologic process below normal.

If a man without subluxation--and therefore normal--have poison
introduced into his body one of two effects will follow. Either the
poison will be sufficient to produce death in a short time, and will do
so, or the poison will be ejected from the body and the patient recover
naturally and without treatment, and recover fully.

This is the statement of the ideal, not the real. The fact is that
no person has yet been found without subluxation in some part of
the spinal column. Occasional cases have been reported but always
by Chiropractors whose statements are open to question on account
of imperfect training in vertebral palpation or a known habit of
unconsidered statement. And in the weakened body, whose natural
protective power has been lowered, the effect is different.

The body fails to throw off all the poison normally and some of it
remains in the circulation and tends to cause progressively increasing
damage. In addition to the direct effect of the poison upon the
tissues, the irritation of sensory nerves gives rise to a motor
reaction which increases subluxation generally throughout the spine but
especially in the segment in which the sensory irritation is greatest.
If the poison be taken into the stomach the vertebrae affecting that
organ are most affected in the resulting motor disturbances. When
vaccine virus is introduced into the arm the greatest influence is upon
the last two Cervicals and first Dorsal, causing increased weakening of
the nerves to the arm. If the vaccination does not “take” it is because
the body is so normal as to be able to take up and rapidly excrete the
poison or to neutralize it with an internally generated antitoxin.

This tendency of poisons to increase subluxations already existing has
caused many to conclude that _new_ subluxations could be produced by
the motor reactions from poison. The laws governing reflex action make
this impossible. If a mild stimulus be applied in the segment occupied
by a given, and normally aligned, vertebra, the resulting contraction
will tend to appear on the same side as the irritation and would--if
sufficient to subluxate the vertebra--draw it _toward_ the irritated
side. If a stronger stimulus were applied the resulting reaction would
appear on _both_ sides and with sufficient intensity on the opposite
side to the irritation so that the difference between the contractions
on the two sides would never be sufficient to overcome the fixity and
inertia of the vertebra. If this bit of theorizing be doubted, let me
add that if poisons _could_ cause subluxation they would undoubtedly
cause drawing of the vertebra _toward_ the irritated side--which is
not the way we find them in poisoning cases. Almost without variation,
the subluxation is _away from_ the affected side. Such a subluxation
produces most impingement on the side of the irritation; the only kind
which could follow poisons would produce its effects on the opposite
side.

In acute poisoning cases which may possibly proceed to a rapidly fatal
termination, while immediate adjustment may be sufficient to cause the
expulsion of the poison and the recovery of the patient it is probably
wisest to administer an antidote or to call a physician with a stomach
pump. Just so, the pulmotor should be summoned for gas asphyxiation;
but at least one case was recently encountered in which an adjustment
started the heart and artificial respiration movements restored
consciousness before the pulmotor could arrive. There are few, if any,
acute poisoning cases in which an adjustment will not aid. Sometimes it
should be assisted by other measures not strictly within the province
of Chiropractic.

Chronic poisoning, such as lead poisoning from paint work, yields
well to adjustments providing the secondary cause, the persistent
inhalation of lead fumes, be discontinued.

Poisons may wound or injure the body whether or not it be normal; in
such case they might properly be classed with trauma. But no poison
causes disease except through the medium of vertebral subluxation
previously produced. Some subluxation which has never been sufficient
to produce active disease may be so increased by the action of poisons
as to be of serious effect even though the poison has long since been
eradicated from the body--for the subluxation is permanent until
affected by force outside itself. In considering the etiology of any
disease the possibility of its being augmented by medicines, drug
habits, or dietetic errors should be weighed with other evidence.

EXPOSURE

By this term is especially meant exposure to sudden temperature
changes. The body may sustain a very high or a very low outside
temperature providing the change is gradual enough so that the
heat-regulating mechanism may adapt itself properly to protect the
body and maintain an even temperature within. A sudden change from a
very warm room to a very cold atmosphere; a quick transportation from
cold air to a superheated apartment; or a sudden draft of air whose
temperature is sharply at variance with surrounding air and therefore
with the condition of the body surface may have a very bad effect.

The skin and mucous membranes of the body have become accustomed
to a certain temperature; the change irritates them. And the
immediate result is a motor reaction increasing subluxation in the
same body segment in which the irritation is greatest and probably
producing first an irritation of the nerves at the spine and then an
inflammation of the exposed surface. Thus a “cold” is produced. One
who has no subluxation affecting the respiratory tract--a rare degree
of normality--may escape coryza, bronchitis, or pneumonia, the most
common effects, but may suffer a congestion of the stomach walls or
of other parts of the body. It is said that the cold “settled on the
stomach.” The fact is that the motor reaction takes advantage of the
weak parts of the spine and affects them most, like the pernicious
habit of spine-stretching which used to prevail among Chiropractors.
This explains why “cold in the head” is so very frequent. The fourth
Cervical vertebra is situated at the middle point of the neck and is
very freely movable and easily subluxated and, in fact, more often
displaced than other Cervicals.

Noxious or poisonous vapors may have an effect identical with that of
sudden temperature change. Sleeping in an improperly ventilated room
often appears to cause “cold.” Careful study of the part of the body
exposed to draft, and of spino-organic connection, will show that in
most instances the effect of such exposure is first felt in the same
body segment.

It is a well-known fact that not all people are “subject to colds.” One
may be “subject to lung colds,” another to “cold in the head.” The
susceptibility is entirely governed by the condition of the spine, the
person having no middle Cervical subluxation being immune from coryza
even though subjected to the same exposure which will produce it in
others. The pollen of plants produces hay fever in the susceptible
in much the same manner that draft produces coryza, both acting as
secondary causes.

BODILY EXCESSES

In this division of secondary causes may be mentioned overwork,
continuous loss of sleep, overeating, venereal excesses, etc.

They act in this manner. Wasting and overusing the bodily resources
they lower the general vitality. Now, though there be subluxations at
various points in the spine there is still transmitted through each
impinged nerve a certain amount of Vital Force which to a certain
extent maintains the functions of the body and keeps it in a state
of activity sufficient for ordinary demands. When the entire stock
of vitality is lowered through excess the amount of energy passing
through each nerve in the body is lessened, but the effect of such
lessening is felt most where there is subluxation. At the high tide
of vitality the subluxations are not sufficient, perhaps, to produce
serious disease. At low ebb, every organ whose nerve is interfered with
suffers keenly. Under such conditions the body is much more subject to
adverse influences, to shocks and jars, to contagion or infection, to
the action of cold or exposure. Thus bodily excess acts as a secondary
cause of disease.

ABNORMAL MENTAL STATES

There are many who believe that fear, worry, hate, grief, etc., are
in themselves sufficient to produce disease in a normal organism.
Shock following the demise of a loved one or some deep disgrace is
occasionally alleged as a cause of death or of a rapid decline in
health which terminates fatally.

The failure of Suggestive Therapeutics to cure disease except when it
is largely imaginary rather argues against this theory. It is also
true that proper Chiropractic adjustments not only lead to the cure of
disease apparently caused by abnormal mental states but also, restoring
proper blood-supply and nutrition to the brain, induce a happier mental
state in the patient. Even insanity has been cured in a number of cases
by Chiropractic.

We hold that worry, fear, etc., are abnormal; that they arise from the
improper expression of Mind through disordered brain-cells. “Diseases
of the Mind,” in the strictest sense, cannot occur, but only diseases
of the physical medium through which mind is expressed and translated
to the physical plane of being--the brain.

A condition of abnormal mental expression or activity, especially
worry, fear or anger, probably has a two-fold effect: it rapidly wastes
the body energy and, like bodily excess, renders every subluxation more
effective; it is possible that it may also really produce auto-toxins,
generated by abnormal brain-action and affecting the body metabolism
adversely. In this way disease appears through the action of abnormal
mental states as secondary causes.

They themselves are the result of subluxation of the first or second,
sometimes third, Cervical, impinging the nerves which control the
blood-supply to the brain and hence its nutrition. Correction of the
subluxation causes them to disappear.

INFLAMMATION

Inflammation is a morbid process characterized by the presence of
increased temperature and one or more of the symptoms, pain, redness,
and swelling. It is distinguished from fever by being confined locally,
while fever is a general functional disturbance showing elevation of
temperature, increased katabolism, decreased secretion, etc.

Our clinical experience with fevers leads us to accept Metchnikoff’s
conclusion that the essential phenomenon of inflammation is hyperaemia.
Upon the hyperaemia depend the swelling, pain, and local increase in
heat-production. Hyperaemia in turn depends upon disturbance of the
vasomotor nerves either as a direct result of some local subluxation or
as an indirect consequence of local irritation.

A newly acquired subluxation produces an acute irritation of the
pre-ganglionic axons which connect the spinal nerves with the
sympathetic ganglia. If these ganglia send out post-ganglionic axons
which are vaso-motor in function, an inflammation may be produced
without the intervention of any secondary cause. On the other hand,
there may be a subluxation producing weakness of some part; through
injury to that part or the introduction of poisons or irritants such as
germ infection, sensory end-organs are affected and the motor reaction
which follows increases the subluxation; this slight increase produces
acute irritation of the nerve and hyperaemia, with its resultant
phenomena, follows. Stated briefly, irritants produce inflammation
only by acting through the medium of the spine. If the spine be normal
these irritants are insufficient to produce morbid process. Local
inflammation tends to develop toxins, especially if it be of bacterial
origin, which may in turn affect the entire organism--an effect which
will be discussed presently. Exception must be made in those traumatic
cases in which hyperaemia is essential to the reparatory process,
and which are attended by what may be termed a normally increased
heat-production. This beneficent and reparatory condition cannot be
termed disease or morbid process.

The normal temperature of the body depends upon the balance maintained
between heat-production and heat-expenditure. This balance is
maintained through a complicated nerve mechanism consisting of various
nidi in thalamus, medulla, spinal cord and sympathetic ganglia, and
a network of communicating axons of both the cerebro-spinal and
sympathetic systems, controlling the amount of blood passing through
any given body area at a given time, the secretion of the perspiratory
glands, the internal metabolic processes, etc. Most important are the
vaso-motor nerves, directly, but not originally, derived from the
sympathetic, and governing the size and caliber of all blood-vessels
so as to control the amount of blood flowing to and through the surface
capillaries on the one hand, or the deep-seated, heat-making organs on
the other. More than seventy per cent of the body’s heat expenditure
is through the skin by evaporation, radiation, and direct conduction.
The major portion of the heat production is in the muscles and the
parenchymatous viscera, such as liver, spleen, etc., where metabolism
is active.

This mechanism is so delicately adjusted that when the outside
temperature is lowered the amount of blood passing to the skin is
reflexly lessened while internal heat production is increased and the
bodily temperature retained at normal. Conversely, the body perspires
freely and the surface is flushed with blood in a high temperature, so
that heat production is lessened and its discharge accelerated, again
tending to maintain an even and normal temperature.

The nervous mechanism is responsive to many and various forms of
stimuli--thermic, emotional, mechanical, physiologic need, toxic.
Poisons in circulation may affect the bulbar center and produce general
fever. A number of centers in the spinal gray may be stimulated with
like result. Or there may be purely local irritation which results in
local hyperaemia and inflammation.

It will always be found that the primary cause of any permanent
derangement of the mechanism lies in vertebral subluxation impinging
some of the nerves and thus throwing the mechanism out of its natural
balance and poise. Other forms of disturbance are transient and the
very nature of the mechanism makes it normally capable of adjusting
itself to thermic, mechanic, or emotional stimuli in a short time.
Only the subluxation produces permanent elevation of temperature. When
such elevation does occur there are many associated changes, increased
katabolism, lessening of secretions, anorexia, sometimes mental
changes, such as delirium or coma. Fevers vary according to the part of
the nerve mechanism affected and the action of any secondary causes.

Fever due to vertebral subluxation alone without any secondary cause
operating is very rare. Ordinarily fevers come about in this way. A
subluxation occurs which weakens tissue and permits germ invasion;
toxins enter the circulation from the germ action and motor reaction
increases the original subluxation and causes local inflammation; germ
activity is favored by the increasing degree of abnormality and toxins
from rapid tissue destruction are added to those already present.
The poison-loaded blood then affects the general centers for heat
regulation, blood becomes internally engorged, and a chill (internal
fever) followed by general increase of temperature occurs. At this
juncture any subluxation previously existing is likely to be increased
and to add its quota of harm to the rapidly developing picture.

Our problem is to find the original subluxation which controls the
site of the original pathologic change and to correct that. In nearly
all cases where this is done, even partially, the body is enabled to
care for the remainder of the damage and to throw off the accumulated
toxins. It is not uncommon that the temperature falls two degrees in
five or ten minutes after a proper adjustment. We expect always to
abort or check a fever in twenty-four hours or less.

There are cases in which the temperature drops after adjustment
but presently rises again. This indicates the virulence of the
autointoxication or that some other area of poison production is
operating than the one our first adjustment would control. A correct
diagnosis will enable one to give specific adjustment and check
practically any fever except a chronic one with much tissue destruction
already accomplished; even some of these yield.

The commonest cause of fever is at the fifth or sixth Dorsal vertebra,
long known as Center Place, or Fever Center. Here emerge many
pre-ganglionic fibres which distribute their impulses through lower
neurons in the sympathetic system to the coeliac plexus and thence to
the blood-vessels supplying the major portion of the abdominal viscera.
Adjustment here causes a sudden contraction of these abdominal vessels
and a forcing of the blood to the surface with rapid cooling.

Often, however, this adjustment is followed by a recrudescence which
indicates that some other vertebra must be adjusted. Many fevers,
such as typhoid, pneumonia, tonsilitis, etc., yield to specific local
adjustment without any involvement of the so-called Center Place.

I have said that we expect to check or abort a fever with spinal
adjustments. The facts that we do so and that the more rapidly
we accomplish the result the more rapid the convalescence and the
less likely are complications and sequelae argue loudly against the
correctness of any theory which supposes fever to be a beneficial and
cleansing process. According to such theory it would be totally wrong
and dangerous to abort a fever but wiser to encourage it in taking its
course. The exact opposite proves true under Chiropractic. The very
fact that fevers _do_ diminish and disappear under proper adjustments
is a proof that they are abnormal, since adjustment does not in any
case tend to lessen normal processes, but only to restore normality no
matter in what way the functions of the body have departed from that
condition.

All the clinical evidence gathered by Chiropractors in regard to
inflammations and fevers tends to prove the correctness of the theories
herein set down. Fever plays a part in so many diseases that it has
been considered advisable to consider the subject under a special head.

IN CONCLUSION

The vertebral subluxation is the primary cause of all truly
pathological conditions. Through its existence the action of a large
number of secondary causes becomes possible. Upon no other hypothesis
can we explain the remarkable percentage of cures of all known classes
of disease through the specific vertebral adjustment.

THE PROCESS OF CURE

Nature is the only real _curative_ agent. Neither suggestion,
manipulation, adjustment, nor any other known method applied by Man
for the eradication of disease has in itself any power to heal. No man
possesses power to do more than so arouse the vital energies of the
patient that the body heals itself.

We contain within our own bodies the possibilities of perfect
normality. Unless interfered with by powerful outside force we should
continue normal from birth to death and death itself would only
occur through the simultaneous wearing out of all the parts of the
human mechanism. The Chiropractor, insofar as his work succeeds in
its purpose, assists the body by adjusting displaced structure and
affording the body a free and unhindered opportunity for the exercise
of its own self-healing powers. It may be interesting and instructive
to analyze the process of cure and to study the exact effects of
vertebral adjustment as we have studied the exact effects of vertebral
subluxation.

Cure of Simple Subluxation Disease

An acute subluxation--that is, one resulting entirely from concussion
of forces within twenty-four or forty-eight hours prior to the moment
of adjustment--rarely produces a condition which could be named as any
particular disease. The symptoms are those of “wrenched back,” if any.
A single adjustment usually suffices to correct such subluxation just
as a single movement might correct a dislocated humerus within the
same period, and any symptoms promptly disappear. This is probably the
maximum benefit to be derived from adjustment and the best time for
its administration, because it leaves the spinal column in an exactly
normal condition and no more susceptible to further jars or shocks than
before the injury. All disease which might have resulted from that
subluxation has been fully prevented.

Older subluxations must be dealt with differently because they present
a different condition. Adaptative changes have taken place in the shape
of the vertebra itself and of every surrounding tissue as they prepare
to make the best of their situation. But a vertebra once displaced
has lost its poise and broken or modified the reflex arcs through its
nerves so that it becomes more likely to respond to further forces
applied, or to muscular contractions within the body, by further change
of position. Such changes are always followed by further adaptation of
the surrounding parts.

The degree of nerve impingement must change to keep pace with the
developing malposition and thus, by gradually successive steps, disease
develops in the area of peripheral distribution of the nerves. The
nerve is under a thumbscrew gradually tightening.

To adjust such a vertebra many successive movements are required. An
apparently full and free movement of a subluxation meets the elastic
resistance of the solidly packed tissues and the pull of the modified
intervertebral disk--strains at these tissues--and rebounds so as to
settle almost, but not quite, in its old abnormal position. The amount
gained in a single adjustment can rarely be appreciated by palpation.
To the touch it would appear that no change had been made, except
occasionally in the Cervical region. But with repeated adjustments
the vertebra will be found to have approached its normal position.
Sometimes in a few weeks, sometimes in a few months, the gain becomes
palpable and then perhaps visible to the eye in thin subjects.

The relief of impingement then is not usually an instantaneous process,
but proceeds by gradual steps. Each movement of the vertebra is
accompanied by a shock to the nerve against some part of which the bone
is pressing, which may produce some disturbance in the diseased organs
and may even appear to have aggravated disease for a time. Some pain
and soreness around the vertebra may accompany the necessary adaptative
changes of shape which readapt the tissues to their proper shape and
relation.

As the impingement of the nerve is gradually relieved the disease is
gradually modified and finally disappears. As the course of adjustments
nears its conclusion and the impingement has been reduced to a
comparatively slight one there may appear a stage of irritation of the
nerve which is a reduplication of the first steps which appeared in
the development of the disease. As most subluxations appear not all at
once but by a series of changes, so disease develops synchronously,
passing from stage to stage with the changes in the impingement. Often
it passes through first an acute and active stage due to irritation
and then a chronic and comparatively passive stage due to heavier,
inhibiting impingement.

Under adjustment these successive stages tend to reappear in reverse
order, the most alarming sometimes appearing last and just before the
cure is completed. It must be remembered that from the moment one
practitioner administers medicine or other remedy and the other adjusts
a vertebra, the clinical courses differ widely. No text-book on medical
practice has as yet described the clinical course of the various
diseases under Chiropractic adjustment.

In chronic diseases where the nerves are paralyzed there may be a
period under adjustment during which no change is apparent. This is
followed by a period of rapid gain leading to complete recovery. This
may be accounted for by the fact that the nerves are degenerated
and must be repaired all along their course before communication is
reestablished between nerve centers and peripheral organs. When this
repair is sufficiently completed to allow communication, the cure is
really well advanced, although evidence of it then first appears. This
has been noted especially in locomotor ataxia.

Cure of a Germ Disease

First, under adjustment, the acute or acutely increased impingement is
relieved. The caliber of the blood-vessels is at once regulated and the
destructive action of fever checked. At the same time the vitality of
the local tissue in which the germs are active is suddenly increased
and there ensues a struggle between the body, as represented by its
phagocytes and auto-protective chemicals, and the germs, which if
adjustments be continued results in the rapid destruction of the germ
colony. Also the elimination of the toxins already in the body proceeds
so rapidly that if the fever can be held in check it takes only a short
time for the body completely to overcome and eradicate the germs.

Cure of Mental Disease

Mental diseases--so-called--usually depend upon disturbance of the
blood-supply to the brain, controlled by the Cervical sympathetic.
Adjustments, relieving the pressure on the sympathetic ganglia or
cord and perhaps the direct impingement from the vertebral arteries,
restore a normal circulation to the brain. The time required by Nature
to effect a cure depends upon the rapidity with which the impingement
is removed and the amount and character of the damage to brain tissue
which must be repaired. The cure often requires time for a change
of materials in brain cells or fibre tracts, by which they are
reconstructed and again become capable of expressing normal function.

Cure of Dietetic Disease

When the subluxation is corrected, or partially so, the appetite
changes and the craving for food becomes more normal. Adjustments may
lessen a voracious appetite, increase a too capricious one, or abolish
a perverted. At the same time the stomach is enabled to digest its
contents more properly, the intestines to take it up and continue it,
and the tissues to assimilate that which is brought to them. The body
eliminates its waste with less effort and in some extreme cases the
first effect of the adjustment may be to cause vomiting and diarrhea
and thus purge the alimentary tract of materials which have become
unusable.

If injurious diet be persisted in the effects of the adjustments will
be partly counteracted, the tendency of the poisons generated within
the body being to increase subluxation while the tendency of the
adjustments is to correct them.

Cure of Poisoning Cases

In acute poisoning by way of the alimentary canal and sometimes when
poison has been injected hypodermically, the body rids itself of the
menace to its integrity by means of vomiting, diarrhea, and increased
secretion of urine. Chronic cases tend rather toward the gradual
absorption and removal from the body of the poisons and their cure
depends upon the cessation of the poisoning; i. e., it is useless to
try to cure a morphine case while the patient is still using the drug.

In acute poisoning the muscular contraction often increases subluxation
and counteracts the effect of the adjustments, so that it becomes
necessary to give very frequent adjustments until relief is had.

Cure of Exposure Disease

After the acute irritation of nerves arising from the exposure and
causing irritation has been removed, perhaps by the first adjustment,
if the exposure is not repeated the body heals itself with great
rapidity, repairing with comparative ease the damage done.

Cure of Bodily Excess Disease

This depends upon the nature of the excess. If it be overeating,
perhaps a more moderate diet will of itself and without adjustments
enable the body to rid itself of the bad effects and restore general
equilibrium. Adjustments will aid and accelerate this process. Venereal
excess is most often engendered by an improper state of mind, perhaps
demanding attention as a mental disorder, or by an irritation of the
genital organs which demands local adjustment for its relief. Normality
of the reproductive tract leads to sane forgetfulness and libidinous
habits always suggest sexual weakness or disease. Often where a cure
would be possible with right habits, no cure can be effected without
their correction. A little good sound advice which will arouse the will
of the patient to co-operation may aid. Boys with the masturbation
habit offer small chance for favorable results in enuresis or nervous
disorders unless the secondary cause be understood and overcome.

ADJUNCTS

In this connection the author cannot forbear a reference to the use of
other methods to relieve disease in combination with the Chiropractic
adjustment. From the foregoing study of the laws governing the cause
and cure of disease it will be seen that therapeutical methods have
little direct bearing upon the removal of disease. The logical method
of effecting the cure is the removal of the cause. The subluxation
being always the primary cause, its correction is always the logical
method of effecting a cure. Not sometimes but _always_.

We know that when the subluxation is corrected the body naturally
heals itself. Can we accelerate and aid that healing with stimulant
or narcotic? Logic says no; experience says no: the use of any method
which strikes at the disease beyond its primary cause and operates upon
some of the effects of that cause without touching the cause itself is
inconsistent with belief in Chiropractic.

Administration of poisonous drugs to the well body is considered
poisoning; their administration to the sick body is also poisoning,
whose symptoms combine with the disease to produce different outward
signs. Fasting is starvation. Massage is stimulation or inhibition.
Spondylotherapy means exhaustion of the spinal nerve centers in riotous
expenditure of their stored-up energy.

It would require a wisdom beyond the human to improve upon the natural
healing processes with which the body has been provided. It should
be our entire business to remove the obstructions which hinder the
full exercise of that healing power--the subluxations--to remove them
dexterously and decisively and to interfere in no other way.

Other methods may and do serve to scatter or modify disease but not to
cure it--unless they affect subluxations, as they sometimes do without
intent. This accidental adjustment factor is valueless in the presence
of a scientific and intelligent adjustment.

Let Medicine, Osteopathy, Spondylotherapy, Christian Science, Massage,
and Electricity have their field. It is not ours. Nor can any of
these methods be rationally combined with Chiropractic. Their basic
principles contradict ours; their application interferes with the
results of adjustment. If you claim to remove the cause of disease, _do
so_, and do not mar your work by treatment of effects.

SPINO-ORGANIC CONNECTION

It has been said in a previous section that when subluxation and
disease are associated the subluxation always precedes the disease and
that the former is the cause, the latter the effect. So clearly do we
understand this law that we are able to say _what_ subluxation would
cause a certain disease and err by only so many cases per centum as
there are variations from the usual structure of the spinal column and
the nervous system.

But merely to state that a second Dorsal subluxation causes heart
disease is not enough. We must know why and how it causes heart disease
and whether, perchance, some other subluxation may sometimes have a
like effect. We must map out the sphere of malign influence of each
possible subluxation so that when our fingers encounter it it at once
and inevitably suggests its possible effects, from which, by diagnostic
methods, we may choose the one toward which most symptoms point. And we
must know the relation of every nerve in the body to peripheral organs
and their functions so that when we encounter indubitable evidence of
some functional or organic disease we may know exactly where, in the
spinal column, to seek for its cause.

We have learned how to discover a subluxation, how to adjust it, and
how that adjustment permits a natural cure of its abnormal effects. We
must now learn exactly _where_ to apply adjustment for any given organ
in the body or for any disease. It must be understood in interpreting
this statement and all those which follow in this section that it is
never proper to adjust a vertebra merely because it is stated to be the
cause of a disease believed to exist in a patient. No vertebra should
be moved unless palpation determines it to be subluxated. Rather let it
be known that _as a rule_ the statements of spino-organic connection
here made will prove to be verifiable by palpation. There is no rule in
Chiropractic without some exceptions, and mere diagnosis of disease is
too notoriously unreliable to serve as a guide to adjustment without
the verification of the trained touch.

The Field of Study

We wish to know the relation existing between each part of the Nerve
System and other parts and between each part and the other organs of
the body. Especially we wish to understand the relation between each
part of the Nerve System and the spinal column, by which permanent
subluxations of the latter interfere with the former’s action and
therefore with the peripheral organs.

This requires a general knowledge of anatomy, physiology, and pathology
which we shall presuppose the reader to possesses so that we may
present only facts to which his attention should be particularly
called. Let us begin with the relation of nerve tissue to other tissues
where this relation can be most clearly comprehended, namely, with the
development of the human embryo.

Segmentation

The complete human organism represents the snarled fusion of a series
of similar, yet specialized, somatic segments, each presenting most
of the attributes of a simple animal, though the association and
co-ordination of all are required for the production of higher animal
phenomena.

The embryo is composed of such segments placed with their centers in
the same axial line. Each segment contains in association which is
morphologic, physiologic, and anatomical, a segment of nerve matter and
a somatic (body) segment. The neural segments are arranged end to end
so as to form the rudimentary beginning of the complete central nerve
axis of the adult human body; the somatic segments blend together with
somewhat indefinite lines of cleavage which are to become much more
indefinite and obscure by changes in relative form due to differences
in the growth rate of different parts or to involuntionary changes
following functional inutility at various periods. Gray says, “The
intrinsically segmental nature of the spinal cord is expressed by the
association of each definite segment with the somatic segment supplied
by its nerve.”

Within each segment there may be observed at an early period cell
migrations from the walls of the primitive neural tube and amoeboid
projection of axonic and dendritic processes from these cells, which
serve to bring the other tissues of the segment under the control of
the nerve elements; there is an assumption of command, as it were, by
the nervous system, so that the epithelial, connective, and muscular
tissues of each segment are linked in sensomotor and vegetative
co-ordination by the contact association of the nerves which ramify
them--sensomotor because the nerves are presently to carry the only
force capable of inciting activity of any kind in other tissues,
vegetative because the functions of growth, nutrition, and repair, in
each somatic cell, depend upon the continuity of communication between
it and the lowest nerve cell in the nerve pathway which connects it
with the higher motor and sensor centers.

Development of the Nerve System

Already may be noted a hint and a prophecy of that future segmental
organization by which it becomes possible for some spinal vertebra to
become displaced and thus begin a morbid process which may diffuse
itself throughout an entire body segment, involving neural and somatic
elements together. Already the simple organization begins to become
rapidly complex and difficult to trace.

Cell masses begin to migrate from the walls of the primitive neural
tube to a position laterad to become the spinal ganglia; these send
out long dendritic processes which marvellously thread their way to a
predetermined peripheral connection which is to bring some cutaneous,
or muscular, or joint tissue into sensor relation with the dorsal,
or Sensor, portion of the cord and through it with the brain; at the
same time they send their axonic processes inward to mingle with and
communicate with the dendrites of other sensor cells remaining in the
central axis to form the gray matter of the cord, and thus, migrating,
keep up communication both with the central axis and the periphery.
Other cell masses migrate ventrolaterad to form the sympathetic ganglia
and they also send out afferent and efferent processes which make a
connection on the one hand with the periphery and on the other with the
source from which the cells developed, the situation to be occupied
by the cord. From this view it is seen that the sympathetic system
is merely an offshoot from the same source with all the rest of the
peripheral nerve system, merely a mechanism for the proper distribution
of nerve impulses from the central organs, and that it retains its
connection in all its parts with those organs. Its ganglia, like those
of the cord, are always and from the beginning under the domination of
the upper or cephalic end of the neural tube.

This cephalic end rapidly expands. Its growth is faster than the rest
of the neural tube and from its walls, by proliferation, develop the
structures of the cerebrum, mid-brain, and hind-brain. It also gives
off ganglionic masses from which grow sensor processes to form the
afferent elements of the cranial nerves and contains, like the cord,
motor nuclei, or nidi, from which motor axons grow toward the periphery
to come into relation with definitely predetermined organs.

The Spinal Column and Cranium

Now appear the primitive cartilaginous and membranous elements from
which a bony wall is to be built around the central nerve axis,
primitive vertebrae, the upper known as cranial and numbering four,
and the lower, or spinal, numbering usually thirty-three. These bone
structures develop around the brain and spinal cord. Later the cephalic
vertebrae fuse into a solid vault, the cranium, completely enclosed
except for various foramina for the passage of spinal cord, nerves, and
blood-vessels. The succeeding twenty-four vertebrae remain separate and
movable upon each other and leave between them the openings for the
emergence of the spinal nerves. The last nine segments fuse eventually
into two immovable or false vertebrae called Sacrum and Coccyx. These
latter also contain foramina from which nerves issue.

The Adult Nerve System

When this development and growth of new parts is completed the
Nerve System appears as a set of complex organs made of a central
axis, brain and spinal cord, and peripheral connections made up of
forty-three pairs of directly attached nerves (12 cranial and 31
spinal) with two great gangliated cords and numerous other sympathetic
ganglia and communicating cords situated outside the skeletal axis
but communicating with it intimately by means of interchange of fibre
bundles between the sympathetic and the cerebro-spinal nerves.

[Illustration: Schematic diagram of Spinal nerve and Rami.

A: Spinal nerve. B: Spinal ganglion. C: Posterior nerve root. D:
Anterior nerve root. E: White ramus communicans. F: Gray ramus
communicans. G: Sympathetic ganglion. H: Sympathetic cord.

After Gray
Parker

31. Interchange of fibre bundles between spinal and sympathetic
nerves.]

But we who have viewed the embryonic development even briefly and
sketchily, understand that all these complex organs are merely an
aggregation of neurons, each neuron made up of a cell body, one or more
axons, and dendrites; that the nerve cells are the controlling elements
and the axons the centrifugal carriers of nerve energy, while the
dendrites are the centripetal processes through which each nerve cell
receives communications.

The Body Axis

The skull and spinal column, taken together, constitute the bony axis
of the body, the center of organization of the skeleton; to these parts
are attached other skeletal structures, mandible, ribs and sternum,
extremities, classified as the appendicular portion of the skeleton.
Likewise are attached, directly or indirectly, the voluntary muscles
which move the skeleton, and the vessels and viscera. Any given
structure in the body can be traced to a supporting connection with
this bony axis.

The bony axis contains the neural axis. Its strength and solidity are
such as to preserve the integrity of the most vitally important tissue
of the body from every form of injury if such protection be possible.
Through openings in the bony axis--foramina--the central nerve
organs give off or receive the nerve bundles which bring them into
communication with every other structure of the body. And the body has
been so arranged that every single part of it is partly or wholly under
control of nerves emerging through these foramina. Even the brain
and spinal cord themselves respond to changes in the blood-vessels
which are controlled by nerve impulses which have emerged through the
intervertebral or cranial foramina and returned by other routes to
supply the muscular coats of the vessels.

Concussion of Forces Affects Spinal Column

Reverting for a moment to the primitive segmental arrangement which
is none the less persistent and important because in the completed
human the regularity of contour of the segments has been wholly lost
and aberrant organs have moved from their original positions carrying
their nerve supply with them, let us first state and then illustrate a
general law.

Any violence applied to the body tends to affect the spinal column.
Such violence does or does not produce permanent displacement of a
spinal segment according as it does or does not succeed in overcoming
the internal resistance. But whatever effect upon the spine is
accomplished will occur most noticeably in the same body segment
to which violence was applied. That is, force applied to any body
segment tends to subluxate the vertebra which would impinge the nerves
controlling that segment. Thus diseases are primarily segmental and
later general just as the body is primarily segmental and later
co-ordinated into complicated functional systems, all more or less
interdependent.

If a man falls so that he strikes first on the point of his shoulder
the force will be transmitted almost directly across the line of the
spine, at right angles, and may subluxate the sixth or seventh Cervical
or first Dorsal. If subluxation occurs it is because the law of gravity
causes the remainder of the body to keep moving downward after the
shoulder strikes and until it too comes to rest. The subluxation
which results is a right one if the left shoulder be struck and vice
versa. Now the brachial plexus is chiefly controlled by these three
vertebrae and a right subluxation tends to impinge most the nerves
on the left side, so that if any permanent effect of the fall follow
it will be a permanent weakness or disease of the left shoulder or
arm, with possible slight extensions along other branches of the same
plexus, as to the latissimus dorsi. Also by the internal sympathetic
communications from this same region the larynx, trachea, or large
bronchi may be affected, occasionally the heart, all structures
segmentally associated with the arm.

This law applies throughout the body and can be fully demonstrated
by any one having a complete knowledge of nerve connections and body
segmentation upon being furnished with a complete and accurate history
of any injury to the body. It goes further than this. Toxins or other
secondary causes operating within the body tend always to produce their
motor reactions and consequent effect upon any subluxated vertebrae in
the same body segment with the peripheral irritation, so that if the
stomach contain a poison which affects the spine the sixth or seventh
Dorsal vertebrae will be most affected and the stomach itself the organ
to suffer most.

The spinal column is peculiarly adapted, with its strong ligaments,
its cartilage cushions, its perfect flexibility and flexuousness,
to withstand jars and shocks. Yet the spine is the door by which
disease enters the organism. Concussion of forces, the energy from the
environment encountering the bodily resistance, is of no serious effect
upon the organism--of no permanent or irreparable effect--unless it
affects the spine and brings about vertebral subluxation, disturbance
of the normal alignment between vertebrae, and thereby interrupts the
perfect healing and controlling influence exerted by the vital part of
the segment, the central nerve portion.

When a concussion of forces _does_ produce subluxations, does disturb
the perfect poise and balance of that center of structure of the body,
its consequences affect an entire body segment, producing, or tending
to produce, disturbances through the entire segment.

Disease is the indirect consequence of the contact of man with his
environment and is _natural_ but not _normal_.

The spinal column is a _center_ or a series of centers for disease.
In this column will be found the primary cause--the introductory
element--by which disease first makes its appearance in a previously
healthy body.

Comparative Anatomy

The study of Comparative Anatomy is necessary to a complete
understanding of the human organism. We may trace in the simplest forms
of animal life the beginnings and foreshadowings of the same plan of
organization. We may follow it through the ascending scale and watch
its complexity develop, and by viewing each step in the process we
may come fully to realize that the original plan has been preserved
throughout, though often in such form that by study of the single
species we should fail to recognize it.

We lack space for complete consideration of this subject and shall
merely suggest certain facts and phases. No clear analogy can be drawn
until we reach the worm, with its rudimentary spinal column and nerves.
Roughly speaking, dissection of one spinal segment with its nerves and
their controlled area--if this were possible--would separate from the
rest a fairly regular _layer_ similar to all the other layers. This is
the primitive segmentation.

It is shown much more clearly in the fish but the segments have begun
to curve with their periphery directed slightly caudad and some have
already shown a preponderating growth over other segments and a change
of shape from the original symmetry.

The reptiles and birds show still more complicated segmentation. It
is notable that in these lower animals the purely reflex portion
of the nervous system is highly developed while the volitional and
sensory portions, the cerebral hemispheres, are yet rudimentary. In
birds, particularly, the cerebellum is very highly developed because
its function of co-ordination of muscles for the maintainence of
equilibrium is required in a high degree for flying.

Those land animals which walk on all fours approach still closer
but their arrangement is much more readily comprehensible than in
man. As the animal stands on all fours with head extended, a gigantic
cleaver slicing out each vertebra and pair of nerves and slicing
straight toward the base of support might be said to divide the body
_approximately_ according to the structural and functional arrangement
in segments. Yet no segment so separated would exactly correspond to
the nerve distribution; there would be enlargement of some organs
with extension into the zone previously occupied by their neighbors;
enlargement here and atrophy there; invagination of one organ by
another and overlapping and intermingling of parts. Even the relation
between the spinal cord segments and the vertebrae has departed much
from the primitive so that the growth of the vertebrae has exceeded
that of the cord and the cord terminates opposite the Lumbar region
instead of at the end of the Sacral canal. It may here be remarked
that in the human embryo the cord at first occupies the entire length
of the neural canal formed within the vertebrae; that in the adult it
terminates opposite the lower border of the body of the first Lumbar
vertebra and that the nerves, still retaining their original foramina
of exit and their relation to the somatic segments, pass downward
within the canal to their respective openings and collectively form a
brush like mass called “cauda equina.”

Causes of Segmental Changes

The causes of the change in the shape, form, and relation of the
different segments are functional: the body changes to meet the
changing needs of its environment and the steady progressive functional
development from one species to another.

When the animal at last assumes the erect position, doing more
intricately and intelligently the bidding of a developing and improving
central nervous system, the change of position and the force of gravity
bring about a gradual downward, or caudad, tendency of the parts of the
somatic segments most remote from the spine and of the nerves which
supply them.

The nerves, muscles, and bones of the lower extremities change from
almost a right angle to an extremely obtuse angle, less obtuse during
infancy and more so in the adult. The forelegs become arms and hang at
the sides, extending downward from the part of the spine which controls
them. The ribs tend more obliquely downward and outward from the spine
and the tendency of all the nerves is downward from their attachment to
the spinal cord to their emergence from the intervertebral foramina. In
the neck and head alone is this rule varied, the tendency of the nerves
and some other structures there being to run from the spine either at
right angles or upward.

It seems almost symbolic and indicative of the purpose of creation that
the body, which is less strong and vigorous in Man than in the lower
animals, should tend more and more obliquely downward from its central
axis, while the cranium, containing a highly specialized mass of cells
and fibres, the organ of Mind, which marks Man’s supremacy in the
animal kingdom and is his crowning glory, is reared _above_ the body it
dominates.

In all the form changes which mark the growth of the body the organs
are arranged to afford the greatest possible economy of space and
convenience for use. This perfect and matchless mechanism adapts itself
to the changing habits and environments and to the quality and needs of
the Mind which inhabits it.

Necessity for Table of Spino-Organic Connection

To the practitioner who is fully equipped with an instantly available
knowledge of all the nerve connections in the body and to whom
palpation of a subluxation at once suggests its somatic sphere of
influence as a weakened or diseased area, or to whom mention of a
disease immediately calls to mind the organ, or segment, which is
primarily affected and its nerve connection with the spine, any
tabulation of spino-organic connection or of diseases and adjustments,
for reference, is unnecessary. But the ordinary practitioner finds it
difficult to acquire and retain such an array of information and much
more convenient to refer to reliable and easily read tables which will
supply at once any such information desired.

No specific adjustment is possible without knowledge of the vertebra
which controls the part diseased and toward the healing of which the
nerve energy should be directed. Specific adjustment without correct
diagnosis is of course impossible. And whenever correct diagnosis has
been made it is essential that the mind of the Chiropractor should
revert to one certain vertebra which he expects to find subluxated as
the primary cause of the disease.

Diagnosis is essential in order to find out _what_ organ is the site
of the disease, for all disease is primarily segmental. The _location_
of the disease having been determined, a quick reference to a table
showing the spinal connection with that location makes specific
adjustment possible. The value of specific, as against general,
adjustments will be considered under “Practice.”

Method of Investigation

One who wishes to determine for himself the proper specific adjustment
for a certain disease must, in order to be able to attach any weight to
his conclusions or to announce them with any hope of credence by the
scientific world, proceed very much after the following method, which
sets down what may be termed “standard test conditions” for research
into the spino-organic connection.

He must make a correct diagnosis which serves to determine the nature
and location of the disease process. In this he may be greatly aided
by vertebral palpation and nerve-tracing, especially in differential
diagnosis. Any case which affords less than a quite positively correct
diagnosis should be excluded from the test list because any conclusion
based on a doubtful diagnosis must itself be doubtful and may be
seriously misleading.

He must then ascertain as far as possible the known anatomical nerve
connection between the spine and the diseased part. If several
connections are known he must decide according to nervous physiology,
by recognizing the morbid functions which constitute the disease and
learning which nerves control these functions and which must therefore
be deranged in order that the disease may exist. I may say right
here that to attempt to answer the problems of Chiropractic on the
assumption that standard anatomies are incorrect in their statement of
nerve connections is as hopeless as the wail of the schoolboy that the
answers in his arithmetic are wrong because his sums fail to come out
that way.

The investigator must next be accurate in Palpation, selecting the
subluxation which would, from his knowledge of the body segmentation,
seem most likely to influence the nerves involved, and positively
ascertaining the _number_ of the subluxated vertebra. No one who cannot
count vertebrae accurately can positively say which vertebra he has
adjusted. More than that, no one who _has not_ counted the vertebrae in
the special case in question can say which vertebra he has adjusted. No
mere regional localization will suffice for scientific investigation.

Correct and accurate adjustment must follow selection of the single
vertebra and the adjuster must know that he has used the one
special movement, or form of adjustment, which is mechanically right
for that kind of subluxation and has so moved the vertebra as to
release impingement. Mere movement of a vertebra is not necessarily
an adjustment or even a maladjustment; it may be movement without
permanent change of relation or release of impingement. (See
“Preferable Adjustments,” p. 155.)

There follows the observation of the progress of the case and this
must be so careful and accurate that the observer knows to a certainty
whether the disease is progressing unfavorably, or favorably, or
whether it has been entirely eradicated. He must know the value of
every changing symptom, the real meaning of each new development. Every
diagnostic method should be at his command for this work. Constant
vigilance and constant thought should mark each step of his work.

Finally he must be so cautious and careful in his statements that no
doubtful conclusion is allowed to escape from his own mind. We may
believe or suspect or hope for proof of our theories but we have no
right to state as a fact anything except that which has been proven
under the most rigidly guarded scientific test conditions.

Failure to observe any of the precautions mentioned renders worthless
the results of investigation. Nothing further than a mere presumption
can be based upon research which fails to observe all these rules.
It will be readily understood that there are few Chiropractors
whose training has been sufficient to enable them successfully to
accomplish such research. There are thus many things connected with the
spino-organic connections which are commonly held as facts but which
should be classed as presumptions. And the prevalence of the habit of
general adjustment rather than specific makes the future final solution
of all these problems remote.

Kinds of Evidence Acceptable

It will be seen that of the three kinds of evidence--Anatomical,
Physiological, and Clinical--which are admissible in reasoning upon
the connection between the spine and disease, only one form--clinical
evidence--has been adduced by Chiropractic. For anatomical and
physiological corroboration of our apparent clinical findings we are
obliged to turn to standard works on these subjects; fortunately we
find it in abundance.

Anatomy, fortified now by research in the morphologic relations of the
parts studied and by physiological and pathological experiment which
has thrown much light on the proper viewpoints from which to describe
structure, contains sufficient data on the nervous system to enable us
to explain practically every fact observable in a Chiropractic clinic.

It is true that there are a few statements in the ensuing outlines for
which we cannot as yet find the anatomical or physiological proof. But
it must be remembered that anatomists and physiologists have never
studied the body with a knowledge of the subluxation theory to aid them
in gaining perspective and that Chiropractors, as a class, have not
yet delved deeply enough into anatomy and physiology to extract all the
available and illuminating information from them. Ofttimes the facts we
value most are most obscure in the texts because to others they seem
least important. But they are there. Armed with information concerning
Chiropractic facts it is probable that the scientist of the future will
corroborate all of our clinical findings of today and emphasize the
rational explanations of them.

In the following tables it has been found best to insert in parentheses
the capital letter (P) to call attention to any statement in support of
which we have gathered less than all three forms of admissible evidence
and which is therefore as yet presumptive. It is well, however, for the
practitioner to be careful lest he regard too lightly such presumptive
statements. Unless there is very strong and reasonable ground for such
presumption or a general belief in its correctness all mention of it
is omitted. Those labelled presumptive are merely so indicated because
they have not yet been proven and not because they have failed to serve
as a convenient and useful guide to adjustment. For each presumption
offered there is either clinical or anatomical justification but not
both.

SPECIAL NERVE CONNECTIONS

This section does not purport to state with any degree of completeness
the various nerve-paths by which spinal vertebrae come into relation
with all, or nearly all, the peripheral organs of the body. It merely
points out some of the more interesting and important connections,
some of the paths which serve to explain the common effects of
vertebral adjustment. It is not expected that this resume of the
subject will be more than suggestive to the student; certainly it
cannot, in so brief a space, be a complete exposition.

Outline of Nerve System

Let us begin with the observation that almost every organ of the
body, including the central nerve organs themselves, may be adversely
affected by spinal subluxation impinging spinal nerve axons at their
exit from, or entrance through, intervertebral foramina, or by
spinal subluxation producing direct impingement upon some part of
the sympathetic system and similarly interfering with its power to
functionate.

The Nerve System may be divided into two great divisions, the central
axis and the peripheral system which distributes nerve energy from,
and brings stimuli to, the central axis. The central axis consists of
the brain and spinal cord; the peripheral system of 12 pairs of nerves
attached to the brain and having exit (except the eighth) through
foramina in the base of the cranium, 31 pairs of spinal nerves emerging
through intervertebral foramina whose parts are movable upon each other
(except the foramina for sacral and coccygeal nerves), and an intricate
system of sympathetic fibres and ganglia arranged in a double chain
of ganglia in front and at the sides of the vertebral column, three
great prevertebral plexuses, the cardiac, coeliac, and hypogastric,
and numerous scattered ganglia and communicating cords which bind the
ganglia together and connect them with spinal or cranial nerves and
with the periphery.

The peripheral system is somewhat complex and numerous
intercommunications are established by which nerve impulses originating
in the central axis and leaving by one part of the peripheral system
may exercise a controlling influence over another part. Plexuses, or
intertwinings of nerve axons, are so numerous and complicated that it
is difficult to follow each set of nerve stimuli from their origin to
their final destination and effect without considerable study.

Direct Distribution of Spinal Axons

The spinal nerve axons, taken as a whole, establish paths between
the motor gray of the ventral horn of the spinal cord and all
voluntary muscles of the body below the head except the trapezius
and sternomastoid, partially innervated by the eleventh cranial, and
between the sensor cells of the dorsal spinal gray and gracile and
cuneate nuclei of the medulla on the one hand and the sensor end
organs in skin and mucuous membrane, muscles, tendons, and joints on
the other. The ventral cornu receives impulses from the cortico-spinal
axons of the direct pyramidal, crossed pyramidal, rubrospinal, and
other smaller tracts which bring the spinal gray under the direct
voluntary domination of the volitional centers in the brain or of
the indirectly voluntary pathway through the cerebellum. The spinal
nerves are the direct media for motion of the body or its parts in
relation to its environment. The sensor gray of the cord is similarly
in communication with the conscious sensation area in the cerebrum
and with the cerebellum by way of the dorsal tracts of the cord, the
lemnisci, and the cerebellar peduncles.

In the main these nerves of motion and sensation are arranged as
follows:

The Cervical plexus is composed of the intertwining of axons from the
anterior primary divisions of the four upper Cervical nerves. Its
branches pass to and innervate many voluntary muscles of the neck
and side and back of head, and supply sensor fibres to the adjacent
cutaneous areas. Branches also communicate with the last three cranial
nerves and one long branch, the Phrenic, or Internal Respiratory Nerve
of Bell, passes through the neck and thorax to the diaphragm, as its
motor nerve.

The Brachial plexus is made up of the anterior primary divisions of the
four lower Cervical nerves and the greater part of the first Thoracic.
It is distributed chiefly to the voluntary muscles and integument of
the shoulder and arm, forearm, and hand, but sends branches to some
muscles of the neck and upper back as well. It, like the Cervical
plexus, receives branches from, but gives none to, the Cervical
sympathetic.

The Thoracic nerves are not arranged in plexiform fashion like those
above but pass separately, for the most part, to their destinations.
They are distributed to the walls of the thorax and abdomen following
the curve of the ribs in direction. The last Thoracic sends one
division downward as far as the outer aspect of the ilium.

The Lumbar, Sacral, and Pudendal plexuses are formed of the ventral
divisions of the Lumbar, Sacral, and Coccygeal nerves and distribute
branches to the integument and voluntary muscles of the lower abdomen,
pelvis, and lower extremities. From two of the sacral nerves branches
known as “Visceral” pass through the plexus to terminate in the walls
of the uterus and rectum.

All of the thoracic nerves and the first and second, sometimes the
third and fourth, lumbar give off branches to the sympathetic ganglia,
known as white rami communicantes.

Direct Distribution of Cranial Nerves

The distribution of the 12 pairs of cranial nerves is not so definitely
to voluntary muscles and to areas from which conscious sensation is to
be derived as is the case with the spinal, although the cranial nerves
present many analogies with the spinal and there is abundant reason
for considering them as in one series of 43 pairs. There is direct
distribution of some cranial nerve fibres to secreting glands, but
these fibres are probably merely derived from sympathetic trunks and
carried in company with the axons of cranial origin. There is also some
direct distribution of cranial nerve axons to visceral walls made of
non-striated muscle, as in the case of the vagus distribution to the
respiratory and alimentary tracts and that of the spinal accessory to
the heart. This is a resemblance to the sympathetic.

The cranial nerves carry afferent impressions from the special sense
organs, except those of the sense of touch, which function is divided
with the spinal nerves.

Various intercommunications exist between the cranial and sympathetic
divisions of the peripheral system, by means of which axons starting
with one division may be finally distributed with another, or by which
an axon of the sympathetic may pass to one of the sensor ganglia of the
cranial system and influence its nutrition and condition, and therefore
its power to act. There is a limited intermingling of spinal fibres
with the lower cranial.

Distribution of Sympathetic

The sympathetic system directly innervates most of the nutritive or
vegetative system, the alimentary tract and its accessory organs, the
vascular systems, the genito-urinary system, and the ductless glands.
To a limited degree it shares this control with the cerebro-spinal
and to a much greater degree it brings the central axis into indirect
connection with these viscera.

Gray says, “The distinction of the sympathetic system from the
cerebrospinal system is made merely for reasons of convenience. The two
systems are intimately connected and the sympathetic is morphologically
a derivative of the central axis disseminated in connection with
the nutritive apparatus and establishing relationships among the
vegetative organs.”

Structure of Nerve Pathways

Most pathways which carry nerve impulses from their origin or inception
to the organ in which they are finally expressed as action of some sort
or translated into sensation or into stimuli which pass out reflexly
over a connected neuron, are composed of more than one neuron. The
neurons of a nerve pathway are arranged end to end with the axons all
pointing in one general direction so that the nerve energy travels
always in the same direction over the entire nerve path. Impulses are
transferred from the first neuron in the chain to the second, and from
second to third, etc., by contact of the telodendria of the one neuron
with the dendrites or receptive processes of the next. Part of the
nerve pathway may be within the central axis and part within the trunk
of a peripheral nerve.

Several peripheral pathways for afferent impulses may be joined to an
efferent pathway so as to complete reflex arcs and the efferent cell
be under the controlling influence of some upper neuron coming down
from the central axis with the power either to permit or to inhibit the
reflex acts which would otherwise take place as a result of peripheral
stimuli. Several such lower cells may be under the domination of one
upper neuron.

In some instances the nutrition of ganglia or nerve trunks, or of
parts of the central axis itself, is under the control of sympathetic
neurons terminating in connection therewith, so that interruption of
the normal action of the sympathetic neuron may be followed by effects
manifested through some distant part of the cerebrospinal system. In
the following pages we shall discuss nerve pathways with reference to
the explanation of diseases caused by vertebral subluxation impinging
nerves either by tension or constriction, and therefore our grouping
of parts will differ somewhat from any anatomical or physiological
grouping with another object in view.

Important Nerve Pathways

_To brain_: C 2, 3, or 4 to superior cervical ganglion by direct
impingement, through internal carotid nerve to sympathetic plexuses
following branch arteries from Circle of Willis. The blood-supply of
the brain is under control of the cervical sympathetic and most brain
lesions or diseases are due to vascular changes leading to anaemia,
hyperaemia, inflammation, or hemorrhage.

_To meninges_: Loop between first and second cervical nerves to trunk
ganglion of vagus and through meningeal branches of vagus (P), or
by way of internal carotid nerve to pial sympathetic plexuses. (P)
The connection of the first, second, or third cervical with cerebral
meningitis is established clinically but there is still doubt as to the
explanation.

_Eye and Muscles_, _Retina_, _Optic Nerve_: The external muscles of
the eye, the four recti and two oblique with the levator palpebrae
superioris, are innervated by the Oculomotor, or third cranial, and the
fourth and sixth cranial, which receive branches from the cavernous
plexus of the sympathetic derived from the internal carotid branch
of the superior cervical ganglion. As the ganglion lies in front of
the transverse processes of the second, third, and fourth cervical
vertebrae, direct impingement upon it by subluxation of one of these
vertebrae may cause strabismus or other affection of the external
ocular muscles.

The eye-ball receives filaments from the ciliary or ophthalmic
ganglion, which in turn is connected with the cervical ganglion by way
of cavernous plexus and internal carotid nerve. This pathway controls
the radial fibres of the iris and dilates the pupil as a part of the
light accommodation reflex mechanism. Loss of pupillary reaction,
especially with small pupils, suggests upper cervical subluxation.

The retina, containing the cells of origin of the optic nerve axons and
being the special end-organ of the sense of sight has no direct spinal
or sympathetic connections but its blood-supply, and therefore its
nutrition, is influenced by branches from the sympathetic which enter
with the central artery of the retina. Retinal hemorrhage has been
cured by cervical adjustment, C 2, 3, or 4.

The conjunctiva is innervated by the sympathetic and by the fifth
cranial, or trigeminal.

_Olfactory Nerve_: Nerve of smell, distributed to the Schneiderian
membrane over the upper portion of the nasal septum and over the upper
lateral wall. There is no known connection by which the trunk of the
olfactory nerve can be reached by adjustment but the condition of the
special end organs in the membrane and their ability to functionate
depend not only upon the integrity of their axons but also upon the
nutrition and moisture of the membrane in which they are embedded.
This is under the control of the Vidian nerve and of branches from the
spheno-palatine, or Meckel’s ganglion, both connected with the carotid
plexus of the sympathetic and therefore responsive to adjustment of
C 2, 3, or 4. This is also the route by which epistaxis is usually
checked.

The external nasal muscles, like those of the rest of the face except
some of the muscles of mastication, get their supply from the facial
nerve, which connects with the sympathetic plexus on the middle
meningeal artery. It may be said parenthetically here that peripheral
facial paralysis (Bell’s palsy) yields to adjustment and proves the
value of this connection. The nasal integument is under the sensor
control of the trigeminal and trophic disturbances may result from its
involvement.

_Trigeminal Nerve_: This is the great sensor nerve of the face and
carries a motor division, the inferior maxillary, to some of the
muscles of mastication, as the temporal, masseter, and buccinator. It
has connected with it four ganglia, which also receive sympathetic
roots, and the ganglion of origin of its sensor axons, the Gasserian
or semilunar, also receives direct sympathetic communications. The
importance of this communication is shown by the powerful effect of
adjustment of third or fourth Cervical for tic dolouroux.

_Ear_: The external ear receives branches from the vagus and from
the first and second cervical nerves. The middle ear and Eustachian
tube are supplied by the tympanic plexus made up of branches from
the glosso-pharyngeal, otic ganglion, facial nerve and the small
deep petrosal from the sympathetic on the carotid artery. By all
these routes communication from the third and fourth cervicals is
possible but especially is the latter important. The fourth cervical
is the especially frequent subluxation with middle ear disease. To
the internal ear and auditory or acoustic nerve there appears to be
no direct route from the spine. It has not yet been conclusively
established within the writer’s knowledge that adjustments will
affect auditory deafness but Meniere’s Disease, inflammation of the
semicircular canals, has been cured repeatedly by adjustments of Atlas
or Axis, by what route I am unable to state.

_Teeth and Gums_: It is probable that the only connection between the
vertebrae and the teeth is an afferent one by way of the trigeminal.
Toothache may be stopped by adjustment of C 3, or C 4, but no evidence
is at hand to show that the condition of the teeth is improved or that
more than a temporary effect can be had. Trophic changes in the gums
may be due to vascular disturbances controlled by the sympathetic.

_Tongue_: The hypoglossal, motor nerve to both the intrinsic and
extrinsic muscles of the tongue, receives direct axons from the loop
between the first and second Cervical nerves. Sympathetic fibres pass
to the blood-vessels and secreting glands of the tongue.

_Tonsils_: Receive fibres from the spheno-palatine ganglion and by
this means are brought under the domination of C 2, 3, and 4. Abundant
clinical evidence in tonsilitis, simple, follicular, and suppurative,
proves this to be the practically, as well as anatomically, correct
nerve connection.

_Salivary Glands_: The parotid receives branches from the great
auricular nerve from the second and third cervical, and from the
sympathetic on the external carotid artery, branches from the superior
cervical ganglion. The submaxillary and sublingual glands are connected
with the submaxillary ganglion, which receives a sympathetic root and
which, with the chorda tympani also carrying fibres derived from the
sympathetic, controls the secretions of these glands.

_Pharynx_: The pharyngeal plexus is a mixture of sensory axons from
the glosso-pharyngeal, motor components from the vagus and probably
sensor from the same nerve, and sympathetic branches from the superior
cervical ganglion. All of these may be influenced by the upper cervical
adjustment.

_Larynx_: According to anatomy the larynx is innervated by the superior
and inferior, or recurrent, branches of the vagus and by sympathetic
branches from the superior cervical ganglion. Clinically the sixth
cervical adjustment cures laryngitis and aphonia. The explanation
probably lies in the fact that the thyroid branches of the middle
cervical ganglion, lying in front of the transverses of the sixth,
communicate within the thyroid gland with the recurrent laryngeal and
with the external laryngeal branch of the superior laryngeal.

_Thyroid Gland_: “The nerves to the thyroid are amyelinic and are
derived from the middle and inferior ganglia of the sympathetic.”
(Gray.) The middle cervical ganglia are situated in front of the
transverse processes of the sixth cervical vertebra. Clinically, the
sixth cervical reaches goitre.

_Muscles of Neck_: The platysma is supplied by the facial nerve;
the sternomastoid by the spinal accessory and cervical plexus; the
infrahyoid region by the first three cervical nerves; the suprahyoid
region by the facial and the ansa cervicalis; the anterior and lateral
vertebral muscles by the cervical nerves from second to seventh
inclusive, but especially the second, third, and fourth. It will be
seen that muscular disturbance in the neck may result from any cervical
subluxation. Torticollis, which usually involves the sternomastoid,
yields to the second cervical most frequently.

_Lymph Nodes of Head and Face_: These lymph nodes are controlled by
the cervical sympathetic. Pathological changes in one or more nodes
requires careful cervical palpation to determine the presence of a
subluxation away from the affected side.

_Muscles of Back_: The trapezius is innervated by the spinal accessory
and by the third and fourth cervical nerves; the latissimus dorsi by
the sixth, seventh, and eighth cervical through the middle or long
subscapular. Occasionally a tender nerve, traceable from the lower
reaches of the latissimus to the cervical region has mislead the
practitioner into imagining a cervical connection over the back with
internal viscera.

The second layer of the back is supplied by the third, fourth, and
fifth cervical nerves. The third layer is innervated by the middle and
lower cervical and upper three thoracic nerves except the serratus
posticus inferior which is supplied by the ninth, tenth, and eleventh
thoracic. The fourth and fifth layer are supplied by the posterior
primary divisions of the spinal nerves and any given section of these
layers may be traced to a vertebra directly above, or cephalad.

_Thoracic Walls_: The parietal muscles of the thorax are innervated by
the intercostal nerves and a very definite segmental association with
the spine is traceable.

_Diaphragm_: Phrenic nerve, which arises from fourth cervical chiefly;
lower intercostals, especially eighth and ninth; and phrenic plexus of
the sympathetic which may sometimes be reached from the fourth or fifth
dorsal vertebrae through the gangliated cord. For motor disturbances of
the diaphragm adjust fourth cervical.

_Abdominal Muscles_: These are supplied by the lower intercostals and
the transversalis and internal oblique make connection with L 1 by the
iliohypogastric. Cremaster is supplied by L 1 and 2 by way of the
genital branch of the genitofemoral.

_Perineal Muscles_: The anterior perineal group are supplied by
the perineal branch of the internal pudic which traces to the
second, third, and fourth sacral nerves. The posterior perineal and
ischiorectal region is also supplied by the sacral and coccygeal nerves.

_Trachea and Bronchi_: Vagus and sympathetic filaments from first and
second thoracic ganglia. The latter receive preganglionic fibres from
first dorsal nerve in all probability, as this adjustment reaches the
bronchi.

_Lungs_: The third thoracic ganglia connect with the pulmonary plexus
and establish a connection from third dorsal vertebra direct to the
lung parenchyma. The _Pleurae_ have a similar connection or may
sometimes be reached by the first dorsal.

_Heart and Pericardium_: In 55% of all heart disease or improper
action the second dorsal is responsible; in 40% the first dorsal, and
perhaps in the remaining 5% the atlas or axis. The former nerves (T 1
and 2) furnish pre-ganglionic fibres which stream upward through the
gangliated cord to terminate in the three cervical ganglia in relation
with the dendrites of new neurons (amyelinic) which form the superior,
middle, and inferior cardiac nerves and pass into the thorax to mingle
with vagal fibres to form the superficial and deep cardiac plexuses,
controlling the heart. Probably the upper cervicals occasionally affect
the vagus through the loop between the first and second cervical
nerves.

_Thoracic Aorta_: Controlled by sympathetic from first thoracic
ganglion or last cervical ganglion, and thus by seventh cervical or
first dorsal vertebra.

_Abdominal aorta--Coeliac Axis_: The upper portion of the abdominal
aorta is innervated by the coeliac or solar plexus of the sympathetic.
Sub-plexuses from the coeliac accompany the various branches of the
aorta and are widely distributed to the blood-vessels and to the glands
and non-striated muscle of the abdominal organs. The coeliac plexus
receives fibres from the right vagus and from the greater, lesser, and
least splanchnic nerves, by the latter route making connection with the
thoracic ganglia of the sympathetic from fifth to last. These ganglia
receive pre-ganglionic fibres from the thoracic spinal nerves in the
form of white rami communicantes, so that it is not incorrect to say
that the coeliac plexus and its branches are largely controlled by the
condition of the last eight thoracic nerves.

Through this intricate plexus it is difficult to trace the relations
of each abdominal organ with the particular vertebrae of which
subluxation would produce disease in said organ. By the aid of clinical
experimentation covering a period of years and by diligent search
among anatomies and physiologies, we have arrived at the conclusions
indicated in succeeding statements.

The most important spinal connection with the abdominal blood-vessels
is that of the fifth dorsal vertebra, for the fifth dorsal nerve, by
its rami, seems greatly to influence the caliber of the aorta and
coeliac axis.

[Illustration:

A. Cortico Spinal nerve. B. Spino Ganglionic nerve. C. Ganglio
Ganglionic nerve. D. Ganglio Peripheric nerve. E. Blood Vessel Wall.

Parker

Fig. 32. Schematic representation of nerve pathway from brain to
periphery by way of sympathetic.
]

_Liver_: Fourth thoracic nerves (especially the right) to gangliated
cord, via great splanchnic nerve to coeliac plexus, by hepatic plexus
to interior of liver. The hepatic plexus gives off the cystic plexus
which controls the gall-bladder.

_Stomach_: Sixth and seventh dorsal nerves by white rami to and through
the ganglia of the gangliated cord to coeliac plexus. The gastric
plexus is an offshoot of the coeliac and gives off Auerbach’s plexus
to the muscular coat, and Meissner’s plexus to the submucous and
mucous coats of the stomach. The nutrition of the stomach walls, their
peristaltic action, and the secretory action of the stomach glands are
thus brought under the direct influence of the sixth or the seventh
dorsal subluxation.

_Pancreas_: Eighth dorsal nerve by great splanchnic to coeliac
plexus, to hepatic and superior mesenteric plexuses, and by the
pancreatico-duodenal branches of the former and pancreatic branches of
the latter to the pancreas.

_Spleen_: The coeliac plexus, the left semilunar ganglion, and the
left vagus and right phrenic nerves give off branches which form the
splenic plexus. Spinal connection by way of ninth dorsal nerve, by rami
communicantes to gangliated cord to great splanchnic nerve to coeliac
plexus to splenic plexus. Many nerve pathways like this one are less
indirect than they sound; various names have been given to different
parts of the same pathway through which, often, the axons pass without
interruption. On the way from the cerebral cortex to one of the
abdominal viscera there may be only three, sometimes four or five,
neurons connected end to end.

_Duodenum_: Coeliac plexus by way of duodenal branches of hepatic
plexus and branches from the superior mesenteric plexus. Spinal
connection from eighth dorsal nerve and possibly branches from
the upper lumbar ganglia of the sympathetic may join the superior
mesenteric plexus, as results in duodenal disease are occasionally
reported following specific adjustment of L 1 or 2.

_Jejunum and Ileum_: Connection same as for duodenum, by superior
mesenteric plexus. Adjustment of L 2 in typhoid fever is undoubtedly
correct so that it is probable that the lumbar ganglia send branches to
this vicinity.

_Peritoneum_: Nerve supply to the peritoneum is rather general owing to
its great extent. It is supplied by the sympathetic from both the lower
thoracic and lumbar portions of the gangliated cord through the various
abdominal plexuses and in general it may be said that any localized
peritoneal disease will yield to the same adjustment as would be made
for disease in the immediately subjacent organ.

_Suprarenal Capsules_: These important glands are supplied by amyelinic
fibres derived from the gangliated cord by the lesser splanchnic nerve
and connecting with pre-ganglionic fibres from the tenth dorsal nerve.
The suprarenal plexus is an offshoot of the coeliac.

_Kidneys_: Tenth, eleventh, and twelfth dorsal nerves by way of lesser
and least splanchnic nerves to renal plexus, an offshoot of the
coeliac. McConnell’s experiments and the frequently duplicated clinical
feats of Chiropractors prove this to be a vital and dominant nerve
pathway in kidney disease.

_Ureters_: Nerves derived from inferior mesenteric, pelvic, and
spermatic plexuses. Most important connection seems to be from first
lumbar nerve by lumbar ganglia to inferior mesenteric plexus.

_Caecum and Vermiform Appendix_: The inferior mesenteric plexus, which
supplies these organs probably carries to them chiefly fibres derived
from the lumber ganglia which complete a connection with the second
lumbar vertebra, especially on the right side.

_Colon_: Third and fourth lumbar vertebrae, influencing lumbar ganglia
and thus inferior mesenteric plexus.

_Rectum_: Lower lumbar ganglia by inferior mesenteric and plevic
plexuses, through superior and inferior hemorrhoidal plexus to rectum.
Adjustment L 4 or 5. Visceral branches from the third and fourth sacral
nerves also pass directly to the rectal wall and sacral adjustment may
affect rectum or anus.

_Bladder_: The urinary bladder is innervated by the vesical plexus from
the pelvic, and by sacral nerve fibres direct. It is said that the
vesical plexus contains many spinal nerve fibres which are derived from
the second and fourth lumbar nerves especially. Clinically the second
or the fourth lumbar will control the bladder much oftener than the
sacrum.

_Prostate Gland, Seminal Vesicles, Penis, and Urethra_: By the vesical
and prostatic plexuses derived from the pelvic plexuses, divisions of
the hypogastric plexus, which is formed of the abdominal aortic plexus
and filaments from the lumbar ganglia. The latter receive filaments
from the second and third lumbar nerves. There is a connection with the
sacral nerves also by the pelvic plexus, though the lumbar adjustment
appears the more potent.

_Testes and Scrotum_: Ilioinguinal from second lumbar, genital branch
of genito-femoral from second and third lumbar nerves, internal pudic
nerve from the pudendal plexus, and spermatic and pelvic plexuses. The
most effective adjustment for scrotal or testicular diseases is L 3.

_Uterus and Vagina_: Uterovaginal plexus from the pelvic and containing
spinal nerve fibres from L 4, L 5, and sacrum.

_Ovaries and Fallopian Tubes_: The ovarian plexus receives fibres from
the abdominal aortic and through it from the lumbar ganglia, influenced
by second lumbar adjustment.

_Brachial Plexus_: The brachial plexus of spinal nerves arises from
the nerves from the fifth cervical to the first thoracic inclusive
and controls the voluntary muscles of the upper extremity, with its
integument. Muscle groups, rather than single muscles, are represented
for the most part in the spinal segments giving off these nerves, and
the ramification of the nerves within the plexus is such that almost
any given muscle might be affected by more than one spinal subluxation.
Below are given the principal connections:

_Pectoralis Major and Minor Muscles_: Sixth or seventh cervical through
internal anterior thoracic nerve and first dorsal through external
anterior thoracic.

_Shoulder Joint_: The joint, muscles covering the joint, and integument
of this region are innervated by the circumflex nerve which traces
through the plexus to fifth and sixth cervical nerves. Sixth cervical
adjustment usually affects this joint.

_Serratus Magnus Muscle_: Sixth cervical by long thoracic, or External
Respiratory Nerve of Bell.

_Elbow Joint_: Sixth cervical vertebra by musculocutaneous nerve.

_Anterior Arm Muscles_: Sixth cervical.

_Posterior Arm Muscles_: Seventh cervical and first dorsal.

_Lumbosacral Plexus_: This plexus, derived from the anterior primary
divisions of the lumbar, sacral, and coccygeal nerves, supplies the
muscles and integument of the lower extremity, taking with it axons
derived from the sympathetic by the lumbar ganglia to supply the
blood-vessels, perspiratory glands and sebaceous glands of this region.
The latter are responsive to adjustments of the first or second lumbar
vertebrae.

_Hip-Joint_: Third and fourth lumbar nerves by femoral and obturator
or accessory obturator nerves and fifth lumbar or first sacral by the
nerve to the quadratus femoris or the great sciatic. Fourth lumbar
seems the most potent connection and is usually adjusted for hip-joint
disease.

_Psoas Magnus Muscles_: Anterior branches of the second and third
lumbar nerves.

_Anterior Thigh Muscles_: Supplied mostly through the femoral nerve
from the second and third lumbar nerves.

_Internal Thigh Muscles_: Second and third lumbar nerves (chiefly but
not wholly) through the obturator, accessory obturator and femoral
nerves.

_Gluteus Maximus_: From the fifth lumbar and first and second sacral
nerves through the inferior gluteal branch of the sacral plexus.

_Obturator Externus_: Second, third, and fourth lumbar nerves through
the obturator nerve.

_Posterior Thigh Muscles_: Fourth and fifth lumbar and sacral nerves
through the great sciatic.

_Great Sciatic Nerve_: This great nerve, direct continuation of the
sacral plexus, arises from the fourth and fifth lumbar and first
three or four sacral nerves and is widely distributed to muscles and
integument of the lower extremity. Sciatica, or sciatic rheumatism,
is most commonly relieved by adjustment of fourth or fifth lumbar
vertebra; but there is a condition commonly diagnosed as sciatica which
is really a sciatic neuritis and due to vasomotor disturbance affecting
the blood-supply to the nerve trunk. This responds to adjustment of
first or second lumbar because the amyelinic fibres which control these
blood-vessels are derived from lumbar ganglia of the sympathetic.

_Anterior Leg Muscles_: Fourth and fifth lumbar and first sacral nerves
through the anterior tibial.

_Posterior Leg Region_: Fourth and fifth lumbar and first and second
sacral through the internal popliteal and posterior tibial.

_Knee-Joint_: This joint receives branches from the great sciatic
through both internal and external popliteal, and from the femoral
and obturator. It is therefore connected with the lower lumbar and
sacrum and with the second lumbar. The latter connection seems oftenest
involved in knee joint inflammations.

_Foot_: Fourth and fifth lumbar and sacral nerves through the great
sciatic and its branches.

_Sensor Areas of Lower Extremity_: In general, any given cutaneous area
receives sensor branches from the nerve which supplies the subjacent
muscle area. For accurate diagnostic purposes a good chart of sensor
distribution may be consulted.

DISEASES AND ADJUSTMENTS

The appended list includes the diseases with which the profession has
had experience but is not in any sense a complete list of diseases. It
is merely intended for quick and handy reference. In obscure cases or
diseases not mentioned it is suggested that the practitioner carefully
diagnose the case with reference to the _location_ of the morbid
process and then refer to Special Nerve Connections to find the nerve
pathway between the spine and the organ indicated as the seat of the
disease. Standard works on anatomy and physiology will explain more
fully the paths and functions of the nerves but information gleaned
from them must be sought out and pieced together from scattered
statements and discussions.

_Disease_ _Adjustment._
Abscess According to location.
Accommodative iridoplegia C 3 or 4.
Acid stomach D 6 or 7.
Acne D 11 or 12.
Acoria D 6 or 7.
Acromegaly C 1 or 2, D 10, 11, or 12.
Addison’s disease D 10.
Adenitis According to location.
Adenoids of pharynx C 2 or 3.
Adiposis dolorosa D 8 and D 11 or 12.
Adrenals, tuberculosis of D 10.
Ageusia C 1 or 2.
Ague D 4, D 9, D 11 or 12.
Albuminuria D 10, 11, or 12.
Albumosuria D 8, D 10, 11 or 12.
Alcoholism C 1, D 10, 11 or 12.
Amenorrhoea L 4 or 5.
Amnesia C 1 or 2.
Amyosthenia General.
Amyloid liver D 4.
Amyloid kidney D 10, 11 or 12.
Anachlorhydria D 6 or 7.
Anaemia D 4, D 9 and D 11 or 12.
Sometimes L 4.
Anaesthesia, general C 1 or 2.
Anasarca D 10, 11 or 12.
Aneurism D 1 or according to location.
Angina pectoris D 2.
Aniscoria C 4.
Anorexia nervosa C 1, D 6 or 7.
Anosmia C 1 or 2, C 4.
Anthracosis D 3.
Anterior poliomyelitis C 3 or 4. local zones for
permanent paralyses
following.
Anuria D 10, 11 or 12. Or L 2 or 4.
Aortic stenosis D 2.
Aphasia C 1 or 2.
Aphonia C 6.
Aphthous stomatitis C 2.
Apoplexy C 2, 3.
Appendicitis L 2.
Apraxia C 1 or 2.
Argyll-Robertson pupil C 1 or 2.
Arrhythmia C 2 or D 2.
Arteriosclerosis D 10, 11 or 12 and local.
Arteritis According to location.
Arthritis According to location.
Arthritis deformans D 10, 11 or 12 and according to
location.
Ascarides L 2 or 3.
Ascites D 4.
Asphyxia, gas D 2 or 3, Atlas (First aid only).
Asthenia To correct disease producing
same.
Asthenopia C 4.
Asthma D 1.
Ataxia, cerebellar C 1 or 2.
Ataxia, locomotor General adjustment.
Athetosis C 1 or 2.
Atrophic cirrhosis of liver D 4.
Atrophy According to location.
Aural discharges C 1, 2, 3 or 4.

Back, pain in According to location.
Barber’s itch C 5, D 10, 11 or 12.
Bell’s palsy C 2, 3 or 4.
Biliousness D 4.
Blepharitis C 3 or 4.
Blepharospasm C 3 or 4.
Blindness C 1, 2, 3 or 4.
“Blood poisoning” D 10, 11 or 12 and local.
Boils D 10, 11 or 12 and according to
location.
Bradycardia D 1 or 2, possibly C 2.
Bright’s disease D 10, 11 or 12.
Bronchitis D 1.
Bronchiectasis D 1.
Broncho-pneumonia D 1, D 3.

Caked breast D 3.
Calculi, cystic L 2 or 4.
Calculi, hepatic D 4.
Calculi, renal D 10, 11 or 12.
Cancer No cure.
Cancrum oris C 2 or 3, D 11 or 12.
Canker (mouth) C 2.
Carbuncle According to location.
Carcinoma No cure.
Caries of spine According to location. See
“Prognosis.”
Cataract C 2, 3, or 4.
Catarrh, nasal C 4.
Catarrhal gastritis D 6 or 7.
Catarrhal stomatitis C 2 or 3.
Cerebral abscess C 1 or 2.
Cerebrospinal meningitis C 2.
Cervical glands, enlargement of Any cervical.
Cervico-brachial neuralgia C 6.
Cervico-occipital neuralgia C 1 or 2.
Chickenpox C 5, D 10, 11 or 12.
Chills D 5.
Chlorosis D 4, D 9, D 11 or 12.
Cholangitis D 4.
Cholecystitis D 4.
Cholelithiasis D 4.
Cholera infantum D 5 or 6, D 10, 11 or 12, L 2.
Chorea C 1 or 2.
Chyluria D 8, D 11 or 12.
Cirrhosis of liver D 4.
Claw hand C 6 or 7 or D 1.
Clubfoot L 4 or 5.
Colic, hepatic D 4.
Colic, renal D 10, 11 or 12.
Colitis L 2 or 3.
Collapse C 1, D 2, and according to
associated condition.
Coma According to cause.
Conjunctivitis C 3 or 4.
Constipation D 4, D 10, or L 3, 4 or 5.
Contractures According to location.
Coryza C 4.
Coxalgia L 4.
Cramp According to location.
Croup C 2 or C 6.
Cutaneous eruptions D 10, 11 or 12.
Cyanosis D 2, D 3 or C 2.
Cystitis L 2 or L 4.

Deafness, catarrhal C 4.
Deafness, central C 1 or 2 (P).
Delirium C 1 or 2.
Dementia C 1.
Dengue D 5, D 10, 11 or 12 (P).
Dentition, disorders of D 6 or 7.
Diabetes insipidus D 10, 11 or 12.
Diabetes mellitus D 4, D 8, D 11 or 12.
Diarrhoea D 10, 11 or L 2, 3.
Dilatation of heart D 2.
Diphtheria C 2, C 6 and D 11 or 12.
Dipsomania C 1 or 2, D 11 or 12.
Dropsy, abdominal D 4.
Dropsy, cardiac D 2.
Dropsy, renal D 10, 11 or 12.
Duodenal ulcer D 8 or 9.
Duodenitis D 8 or 9.
Dysentery L 2, 3, or 4 and D 11 or 12.
Dysmenorrhoea L 4.
Dyspepsia D 7.
Dysphagia C 2 or D 6 or 7 (P).
Dyspnea D 1 or D 2 or D 3.
Dysuria L 2 or L 4 or sacrum.

Earache C 2 or C 4.
Ecchymoses D 11 or 12.
Eczema D 11 or 12 and according to
location.
Embolism, cerebral C 2 or 3.
Emphysema D 3.
Encephalitis C 1, 2 or 3.
Endocarditis D 2.
Enlarged glands According to location.
Enlarged heart D 2.
Enlarged liver D 4.
Enlarged tonsils C 2 or 3.
Enteralgia D 9 or 10, or L 1 or 2.
Enteritis D 9 or 10, or L 1 or 2.
Enterocolitis D 9 or 10, or L 1, 2 or 3.
Enteroptosis D 9, 10, 11 or L 1, 2, 3.
Enterospasm D 9 or 10, or L 1 or 2.
Enuresis L 2 or 4.
Epilepsy C 1 or 2, sometimes L 3.
Epistaxis C 4.
Epithelioma No cure.
Eructations D 6 or 7.
Eruptions, cutaneous D 11 or 12.
Erysipelas C 5 and D 11 or 12.
Exophthalmic goitre C 6 or 7.

Facial hemiatrophy C 1 or 2.
Facial paralysis C 1 or 2.
Faecal obstruction L 2, 3 or 4.
Fainting D 2.
False angina C 1 or 2.
Fatty degeneration of heart D 2.
Fatty degeneration of liver D 4.
Fatty infiltration of heart D 2.
Fatty infiltration of liver D 4.
Felon C 6 or 7 or D 1.
Fever D 5. Locate organ of origin.
Fibroid tumor According to location.
Follicular tonsilitis C 2 or 3.

Gallstones D 4.
Gangrene According to location.
Gastralgia D 6 or 7.
Gastrectasia D 6 or 7.
Gastric neuroses D 6 or 7.
Gastric ulcer D 6 or 7.
Gastritis D 6 or 7.
Gastro-duodenitis D 7 or 8.
Gastroptosis D 6 or 7.
Gland, mammary D 3.
Glaucoma C 2 or 3.
Gleet L 3 and D 11 or 12.
Glossitis C 2 or 3.
Glycosuria D 4 and D 11 or 12.
Goitre C 6.
Gonorrhoea L 3.
Gonnorrhoeal rheumatism D 11 or 12 and L 3.
Gout D 11 or 12 and L 4.
Granulated lids C 4 and D 11 or 12.

Hay fever C 3 or 4.
Headache, anaemia To correct anaemia.
Headache, bilious D 4.
Headache, neuralgic C 1.
Headache, neurasthenic C 1 or 2.
Headache, ocular C 2 or C 4.
Headache, of constipation D 4 or D 9 or 10, or L 4 or 5.
Headache, toxic Locate toxin-forming organ.
Headache, uterine L 4 or 5 or sacrum.
Hematemesis D 6 or 7.
Hematuria D 10, 11 or 12.
Hemicrania C 1, 2 or 3.
Hemiplegia C 2 or 3.
Hemoptysis D 3.
Hemorrhoids L 4 or 5 or sacrum.
Hepatic hyperemia D 4.
Hepatoptosis D 4.
Hernia, diaphragmatic C 4 (P).
Hernia, femoral L 4.
Hernia, inguinal L 2 or 3.
Hernia, umbilical D 8.
Herpes facialis C 4.
Herpes zoster (shingles) Vertebra above nerve involved.
Hiccough C 4.
Hodgkins’ disease General adjustment.
Hydrocele D 10, 11 or 12 and L 4.
Hydrocephalus C 2 and D 2.
Hydronephrosis D 10, 11 or 12.
Hydropericardium D 2.
Hydrothorax D 3.
Hyperaemia According to location.
Hyperaesthesia, general C 1 or 2.
Hyperchlorhydria D 6 or 7.
Hypertrophy According to location.
Hysteria C 2.
Hystero-epilepsy C 2.

Icterus D 4.
Icterus neonatorum D 4.
Ileocolitis L 2, 3 or 4.
Impacted gallstones in ducts D 4.
Impotence L 3 or sacrum.
Incontinence of urine L 2 or L 4.
Incompetency, aortic D 1 or 2.
Incompetency, mitral D 1 or 2.
Incompetency, pulmonary D 1 or 2.
Incompetency, pyloric D 6 or 7.
Incompetency, tricuspid D 1 or 2.
Infantile paralysis C 3 or 4 and according to
location.
Inflammation, general D 5.
Inflammation of appendix L 2.
Inflammation of bladder L 2 or 4.
Inflammation of bowels D 9 or 10, L 2, 3 or 4.
Inflammation of bronchi D 1.
Inflammation of kidneys D 11 or 12.
Inflammation of larynx C 6.
Inflammation of lungs D 3.
Inflammation of meninges C 1 or 2.
Inflammation of ovaries L 2 or 3.
Inflammation of pharynx C 2.
Inflammation of pleurae D 3.
Inflammation of stomach D 6 or 7.
Inflammation of vertebrae Next above inflamed one.
Inflammation of uterus L 4 or 5.
Influenza C 4, D 1, D 11 or 12.
Intestinal neuralgia D 9 or 10, L 1 or 2.
Intestinal neuroses D 9 or 10, L 1 or 2.
Intestinal obstruction See “Practice.”
Intussusception See “Practice.”
Insanity C 1 or 2, sometimes L 4.
Insomnia C 2.
Iritis C 3 or 4.

Jaundice D 4.

Keratitis C 3 or 4.
Kyphosis See “Curvatures.”

Lactation, disorders of D 3.
Lacunar tonsilitis C 2 or 3.
La grippe C 4, D 1, D 11 or 12.
Laryngeal paralysis C 6.
Laryngismus stridulus C 6.
Laryngitis C 6.
Lateral spinal sclerosis According to location.
Lead poisoning D 4, D 11 or 12.
Leucaemia D 9 and D 11 or 12.
Leucorrhoea L 4.
Lipoma According to location.
Lobar pneumonia D 3.
Lockjaw C 1, 2, or 3.
Locomotor ataxia General adjustment.
Lordosis See “Curvatures.”
Lumbago L 3, 4 or 5.
Lumbo-abdominal neuralgia Any Lumbar.

Malaria D 4, D 9, and D 11 or 12.
Malignant endocarditis D 2 and D 5 or 6.
Mastoiditis C 1 or 2.
Measles C 5, D 11 or 12.
Memory, disorders of C 1 or 2.
Meniere’s disease C 1 or 2.
Meningitis C 1 or 2.
Menorrhagia L 4.
Metrorrhagia L 4.
Migraine C 1, 2, or 3.
Mitral incompetency D 2.
Mitral stenosis D 2.
Monoplegia According to location.
Mouth breathing C 4 or 5.
Movable kidney D 11 or 12.
Mucous colic D 10 or L 3.
Mumps C 4.
Mutism C 1 or 2 or C 6.
Myelitis According to location.
Myocarditis D 2.
Myopia C 4.
Myositis ossificans According to location, also
D 11 or 12.
Myxoedema C 6.

Nephritis D 10, 11 or 12.
Nephrolithiasis D 10, 11 or 12.
Nephroptosis D 10, 11 or 12.
Neuralgia, trigeminal C 3 or 4.
Neuralgia, brachial C 6 or 7 or D 1.
Neuralgia, intercostal According to location.
Neuralgia, of feet L 4, L 5 or sacrum.
Neurasthenia C 2.
Neuritis According to location.
Nodding spasm C 1 or 2.
Nystagmus C 1, 2, 3 or 4 (P).

Obesity, pathological D 8 and D 11 or 12.
Obstruction, intestinal See “Practice.”
Oculomotor paralysis C 2 or 3.
Oedema According to location.
Optic atrophy C 3 or 4.
Optic neuritis C 3 or 4.
Orchitis L 3.
Otitis media C 4.
Ovarian disease L 2.

Pachymeningitis C 2.
Pallor D 2 or to correct anaemia.
Palpitation D 2 or C 2.
Pancreatic calculi D 8.
Pancreatic hemorrhage D 8.
Pancreatitis D 8.
Paralysis agitans C 1 or 2.
Paralysis, brachial C 6 or 7 or D 1.
Paralysis, crural L 4 or L 5.
Paralysis, facial C 1 or 2.
Paralysis, diplegic C 1 or 2.
Paralysis, hemiplegic C 1 or 2.
Paralysis, monoplegic According to location.
Paralysis, sensory According to location.
Parageusia C 1 or 2.
Paratyphoid fever L 2.
Parosmia C 2 or 3.
Parotitis C 4.
Pericarditis D 2.
Perihepatitis D 4.
Perinephric abscess D 10, 11 or 12.
Peritonitis D 9, 10 and L 2, 3 or 4.
Pertussis C 6, D 1.
Pharyngitis C 2 or 3.
Photophobia C 1 or 2 or C 4.
Plantar neuralgia L 4 or 5.
Pleurisy D 3.
Pleurodynia D 3.
Pneumonia D 3.
Priapism L 3 or sacrum.
Proctitis L 4 or 5.
Prolapsed kidney D 11 or 12.
Prolapsed uterus L 4 or 5.
Prostatic disease L 4 or 5 or sacrum.
Ptosis C 4.
Puerperal fever L 4, D 5, and D 11 or 12.
Pulmonary incompetence D 2.
Pulmonary phthisis D 3.
Pulmonary stenosis D 2.
Pyelitis D 11 or 12.
Pyelonephrosis D 11 or 12.
Pyaemia D 5 or 6 and D 10, 11 or 12.

Quinsy C 2 or 3.

Rabies C 1 or 2, D 10, 11 or 12.
Rachitis See “Adjustment of Curvatures.”
Raynaud’s disease C 6 or 7 or D 1, or L 4 or 5.
Rectal fistula L 4 or 5.
Rectal neuralgia L 4 or 5.
Relapsing fever D 5, D 9 and D 11 or 12.
Renal colic D 10, 11 or 12.
Retinal hemorrhage C 4.
Retinitis C 4.
Retropharyngeal abscess C 2 or 3.
Rheumatic fever D 5 or 6, D 11 or 12.
Rheumatism D 11 or 12 and according to
location.
Rhinitis C 4.
Roseola D 10, 11 or 12.
Rubella C 5, D 6, D 11 or 12.
Rubeola See “Measles.”

Salivation C 2, 3 or 4.
Salpingitis (Eustachian) C 4.
Salpingitis (Fallopian) L 2.
Sarcoma No cure.
Scarlatina C 5, D 6, D 11 or 12.
Scarlet fever C 5, D 6, D 11 or 12.
Sciatica L 4 or 5, or sacrum.
Sclerosis According to location.
Scoliosis See “Curvatures.”
Scrofula D 11 or 12 and locally.
Seminal emissions L 3.
Septicaemia D 5, D 11 or 12, and for site
of entrance of toxins.
Smallpox C 5, D 5, D 10, 11 or 12.
Sneezing C 4.
Softening of brain C 2.
Spasm According to location.
Spermatorrhoea L 3.
Splanchnoptosis Caudad of D 5 according to
palpation.
Splenic enlargement D 9.
Splenitis D 9.
Splenoptosis D 9.
Spondylitis Deformans General adjustment.
Stenosis According to location.
Stomatitis C 2, 3 or 4.
Strabismus C 3 or 4.
Sudamina D 10, 11 or 12.
Sunstroke C 2, D 2, D 11 or 12.
Suppression of urine D 11 or 12.
Syncope D 2.
Syphilis, primary According to location of ulcer.
Syphilis, secondary D 5 or 6, D 11 or 12.
Syphilis, tertiary No cure.

Tabes dorsalis General adjustment.
Tapeworm D 8, 9 or 10, L 2 or 3.
Tenesmus L 4 or 5.
Tension, high arterial D 5.
Testicles, pendulous L 3.
Tetanus C 4, D 5, D 10, 11 or 12.
Thrush C 2 or 3.
Tic dolouroux C 3 or 4.
Tinnitus aurium C 1 or 2.
Tonsilitis C 2 or 3.
Toothache C 4.
Torticollis C 2, 3 or 4.
Toxaemia D 11 or 12 and local according
to indications.
Toxic gastritis D 6 or 7.
Tricuspid incompetency D 2.
Tricuspid stenosis D 2.
Trigeminal neuralgia C 3 or 4.
Tuberculosis of any organ See “Special Nerve Connections”
to organ diseased.
Tuberculosis, general D 5 or 6, D 11 or 12.
Tuberculosis, pulmonary D 3.
Tumor According to location.
Typhoid fever L 2.
Typhus fever D 5 and L 2 (P).

Ulceration According to location.
Ulnar neuritis D 1.
Ununited fracture According to location.
Uraemia D 10, 11 or 12.
Urethritis L 3.
Urticaria D 10, 11 or 12.
Uterine catarrh L 4.
Uteroversion L 4.

Vaccinia D 5, D 10, 11 or 12 and for
site of inoculation.
Vaginitis L 3.
Valvular lesions D 2.
Varicella D 5 or 6, D 10, 11 or 12.
Varicocele L 3.
Varicose veins of lower extremities L 2, 3 or 4.
Variola Same as Smallpox.
Varioloid Same as Smallpox.
Vertigo C 1 or 2. Locally for toxic
vertigo.
Vomiting, pernicious D 6 or 7 or C 1.

Whooping-cough C 6, D 1.
Writer’s Cramp C 6 or 7 or D 1.
Worms, stomach D 6 or 7.
Worms, intestinal Any Lumbar.
Wryneck C 2, 3 or 4.

Xerostomia C 2.

Yellow fever D 4, D 6, D 10, 11 or 12 (P).

CONCLUSION

The correct use of the foregoing table depends entirely upon correct
diagnosis. Knowledge of the vertebra to be adjusted for the correction
of any disease is useless unless the disease be recognized when met.
Diagnosis may be, and usually is, aided by Palpation and Nerve-Tracing,
which may be considered as divisions of diagnosis since the subluxation
and the tender nerve are evidences (symptoms) of disease. But these
two divisions can never wholly take the place of a complete diagnosis
which calls to the aid of the examiner _every_ harmless method of
ascertaining the patient’s condition. The part may not suffice for the
whole.

The Chiropractor has an opportunity to become the best of
diagnosticians because he has at his command all the usually taught
methods and _in addition_ Palpation and Nerve-Tracing, which are
especially useful in differential diagnosis. (See “Schedule of
Examination.”) The profession is at present lamentably weak in
diagnosis and as long as they remain so they will fail to achieve the
possible maximum of results from the application of a theory which,
_per se_, is applicable to all disease but which is often imperfectly
applied in practice.

PRACTICE

Introduction

The ensuing section is intended rather more for the use of the
practitioner than for the guidance of the student but may furnish the
student a preconception which will prepare him somewhat, before leaving
college, to meet the problems of practice.

Just as too frequently the young Chiropractor overlooks the fundamental
logic of Chiropractic which may be epitomized with the terse command,
“Adjust the _cause_,” and considers his practice as requiring him to
dabble in every suggested or discovered method of treating _effects_,
so, too frequently, the young Chiropractor is prone to consider that
his practice consists solely of the adjustment of vertebrae, that he
practices a mechanic art rather than a profession; too frequently
he overlooks the thousand details which lead to and surround the
adjustment and are essential to its success.

The practice of Chiropractic involves more than correct technic. It
includes the use of a vast fund of knowledge; the constant study of
diseases and of patients; the art of controlling and directing others
sometimes in their very trivial acts. Successful practice requires a
proper setting, proper business methods, and a knowledge of psychology.

Anyone entering upon a profession assumes a great moral responsibility
and the greatest responsibility of all falls upon the doctor, of
whatever school. He enters the stricken home at a time when all members
of the household are off guard, as it were, at a time when all turn
to him as to one of higher knowledge and of greater power for their
guidance and often for their strength in affliction; he becomes the
repository of their most sacred confidences. He who is unable to meet
this responsibility, to realize his influence and his power and to
prepare himself with care and conscientious training to acquit himself
well, has mistaken his calling. He is unfit for his ministry.

The thorough student wrestles not alone with the technic and the
text-book branches necessary in practice but also studies his
profession from every possible standpoint, broadening his field of
usefulness wherever possible.

This section does not by any means contain all the information not
found elsewhere in this book but necessary to the Chiropractor in his
practice. It is intended merely to suggest some of the many sides and
phases of our work and to open the way for a life study of humanity and
of professional life as a Chiropractor.

OFFICE EQUIPMENT

Value of First Appearance

The patient, upon first entering an office, consciously or
unconsciously forms an estimate of the personality and standing in his
profession of the occupant of that office. This impression is gathered
from the kind and arrangement of the furniture and visible equipment,
from the neatness or disorder of the room, from countless little things
which play each their part in making up the whole appearance. This
first estimate is sometimes the only one, for an unfavorable first
impression may lead to the loss of a prospective patient. In any case
it will play a part in all subsequent judgments which the patient may
form concerning the Chiropractor and his work.

Many patients entering our offices have no previous knowledge of our
profession; their minds are open and curious, alert for new impressions
of some sort. We may impress them as we choose. Every good business
or professional man realizes the value of the first impression and
strives for a good one. Therefore, upon entering practice, choose for
yourself every article which shall have a place in your office. Your
surroundings will then truly reflect your personality and will attract
those upon whom that personality can work in harmony and understanding.
It is of no avail to attract the type of patients you cannot hold, to
draw through the borrowed judgment or taste of another surroundings
alien to yourself and thus to attract people who will at once sense the
incongruity and be repelled by it.

Yet one may aspire. And if you are able to perceive and appreciate
truly professional surroundings you may hope to school yourself by
association and study to harmonize with them.

Choice of Articles

In choosing the contents of your office keep in mind good taste,
utility, and the psychological effect upon all visitors. Remember
that you expect to spend many hours each day in the company of your
furniture, and select such things as will contribute to a proper
professional state of mind in yourself. A Chiropractor’s profession is
in many ways like, yet in many ways unlike, any other. Therefore his
office equipment, while following in general the equipment of other
professional offices, must be selected with an eye to the special and
particular needs of the Chiropractor and his patients. Too little
attention has been paid thus far by the profession to the selection of
office equipment.

Furniture in General

The furnishing of an office depends upon the amount and disposition
of the room at your command. One must have at least a waiting room
and a private office even if a single rented room must be cheaply
partitioned to make the division. A larger suite is a better investment
when possible. In the waiting-room should be found easy chairs, library
table, hall-rack, mirror, and an easy divan or couch. The floor should
be covered with a good rug or carpet and the walls properly and cleanly
decorated and hung with restful, pleasant pictures. A book-case filled
with carefully selected books is a good addition.

On entering your private office the patient should see your diploma,
which hangs in full view of the entrance and which bespeaks with no
weak voice your fitness to practice, your professional ability. The
importance of this point cannot be overestimated. The intelligent
visitor expects you to have had careful training and to possess
thorough knowledge of your work. If he notes the diploma as evidence of
it and of your pride in your college he is assured.

If only two rooms are at your command the second must be at once
consulting room, adjusting room, dressing room. As such it should
contain your desk, desk chair, chairs for the patient or patients,
adjusting table or tables, towel cabinet, lavatory, and a curtained
recess for a dressing-table, chair, and hooks for hanging clothing.
On the wall hang those charts from which it is at times necessary to
explain a part of the human mechanism to the inquirer.

This room should convey a two-fold impression--business and
professional. It should contain the special paraphenalia of your
profession and some of the suggestive contents of the ordinary business
office, such as desk, card-index file, typewriter, etc.

Let us consider these points more in detail.

Waiting Room

In your waiting room new patients wait and form their estimate of you
before your appearance. They are tired patients, worn perhaps with
years of disease, and their comfort must be considered. Some time
is theirs for use in some way and the use of their minds during the
waiting interval must be studied.

For these reasons first of all the waiting room should be furnished
quietly, in perfect taste, but _well furnished_. A good dark rug
for the floor rather than matting or linoleum with their suggestion
of bareness, a tinted or papered wall done in a soothing shade,
upholstered furniture pleasing to the eye and comfortable for tired,
weak bodies, and a library table with proper literature for the
occupation of the mind--these are the proper furnishings for a waiting
room.

Let the table contain chiefly Chiropractic literature and select that
literature with care. Be sure that it reflects the view-point toward
your profession with which you wish your patients to be impressed. It
must be scientific, well written, not sensational, not dealing coarsely
or vulgarly with the revolting diseases or features of disease, but
quietly convincing. Your literature must impress with the greatness
of Chiropractic without setting forth extravagant claims which your
patients will expect you to vindicate. Your selection of books for the
book-case must convince all observers of your proper literary taste or
the book-case had better be omitted. Likewise the pictures on the walls
must suggest pleasant things, restful things, good to contemplate.

When possible secure a high-ceilinged room with good ventilation,
plenty of fresh air without drafts. And then let all the articles in
the room _harmonize_. One jarring note in form or color may mar the
entire effect, which should be that of comfortable simplicity.

Private Office

Even more important than the contents of the waiting room is the
equipment of your private office. It is in this room that your work is
done. There your patients confide to you their weaknesses; there they
determine finally whether to trust themselves to your knowledge and
skill; in that room they form their judgment as to your cleanliness,
your use of system; _there they meet you_.

Arrangement of Furniture

Every bit of furniture for the private office having been carefully
selected its _arrangement_ should be studied.

When the patient first enters the private office he should be able
to see your diploma. He should also sit where he can notice it as
he consults you and every other object within his vision during the
consultation should be picked so as to avoid attracting his attention
to anything foreign to his visit and its purpose.

Two chairs are placed near the desk, one an easy chair for
yourself, a revolving chair being preferable, and a straight-backed
leather-upholstered chair for the patient. In placing these chairs be
careful of two things: let the strongest light shine over your own
shoulder and bring the face of the patient out in clear detail; and let
your own chair be _higher_ than the patient’s so that he looks slightly
upward to meet your direct gaze. For the last mentioned point there
is a sound psychological reason; to control any dialogue with another
person place yourself on a higher level than he and unconsciously he
will obey the suggestion and lift his thought to meet yours, offering
it rather than commanding with it. The light is arranged for its value
in observing, as a matter of diagnosis, every indication in expression,
gesture, and skin coloring.

Hanging back of the desk where it may be easily reached but where its
gruesome suggestion will not obtrude itself upon the nerves of the
sensitive without your deliberate intention, have a vertebral column
for demonstration purposes. There are many times when it is necessary
to show a subluxation as it would occur.

Beside the desk and within easy reach of your hand should be placed at
least a single book-case section containing those reference works which
you frequently consult. The contents of this section will be considered
later; suffice now to say that they should be well bound and should
be so placed that if a doubtful point arise they can be consulted at
once without your rising. I am not of the opinion that a pretension of
unlimited knowledge is a valuable professional asset. It seems better
frankly to seek authoritative information, even in the presence of
the patient, than to allow an error to creep into your work, and your
more intelligent patients will appreciate your care. Furthermore, this
placing of your books is convenient when you are alone and considering
the cases which have passed before you during the day. It tempts to
study.

The desk should hold a typewriter, significant of business methods,
and a card file for case records. Incidentally, you should have neat
bill-heads and printed stationery for all correspondence, though blank
white paper is better than over-ornate design or profuse coloring.

On the wall hang a few good anatomical and physiological charts upon
which may be pointed out certain facts for the instruction of patients.
It may be suggested that these hang on racks so that the surface charts
may be easily changeable and that those ordinarily exposed to view be
such as will avoid unpleasant suggestion of any kind. For instance, an
X-Ray chart of the body showing the skeleton is but one degree less
repugnant to the average person than the bones themselves. Though your
college training has robbed the subject of all emotion, for _you_, take
thought for the feelings of your visitors.

Adjusting Tables

For all purposes the best type of bench now on the market is probably
that composed of two sections, one fixed and the other--the rear
one--sliding on a track. Both sections should be adjustable at various
angles to the plane of the base and some of the best tables are made so
as to permit changes in the distance from the floor to the entire top
or to any part of the top, a great advantage in that the table height
may thus be made to suit the height of the adjuster.

An abdominal support is now indispensable but must be so elastic as not
to interfere with the adjustment. Leather upholstery is more sanitary
than plush and has come into general use.

An opening in the front section such that the face may look downward
through it and straighten the cervical and upper dorsal spine for
palpation and adjustment has been proven a disadvantage instead of a
help and will be entirely unnecessary to one who follows the technic
laid down in this book.

The Roll

A desirable addition to this table is an upholstered roll of quite
solid material and about eight inches in diameter. This can be placed
under the patient’s thighs on the rear section, thus elevating the
thighs and straightening the Lumbar region so as to separate the
spinous processes. The roll is especially useful for the adjustment of
posterior Lumbar subluxations, being inadvisable with rotation.

With a patient lying on the bifid bench in the ordinary adjusting
position the Lumbar spinous processes are crowded together and the
bodies separated. In rotation, since the adjustment works by using
a short power arm against a long weight arm (distance from contact
point to center of rotation against distance from center of rotation
to anterior margin of body), and since the heaviest portion of the
vertebra--the body--is to be moved most, this position of suspension
secures the easiest adjustment. But if the vertebra be posterior and a
spinous process contact is used the best adjustment can be secured over
the roll or with a table adjustable to an angle equal to that which
would be secured with the roll.

Cleanliness

Everything in the office should be kept scrupulously clean. A lavatory
with towel racks well filled with clean towels is an absolute
necessity. If no lavatory is inbuilt in the office a portable one may
be secured which will answer every purpose. It will be well if the
patient observes that you carefully cleanse your hands before giving an
adjustment.

The office should contain a towel cabinet with a stack of clean towels
and a compartment for used towels. Or tissue towels may be used to
save laundry bills. Before each adjustment a clean towel should be
unfolded and placed upon the front section of the bench so that the
patient rests head and face upon a perfectly clean surface. When the
adjustment is completed toss the towel into the used-towel compartment.
This use of towels minimizes the risk of contagion or infection from
a germ-infested upholstery, suggests care and cleanliness to your
patient, and gives the patient greater trust in you.

Dressing-room

A curtained recess separated by a screen from the remainder of the room
will serve if no separate room is available for a dressing-room. It is
better, if possible, to have a separate dressing-room and better still
to have separate dressing-rooms for men and women. If extra rooms are
not at your command and you use a curtained recess be sure that it
contains good light, a dressing-table with mirror, a small chair, and
hooks for clothing. Provide also a few dressing-sacks for women though
most of them will prefer to furnish their own.

The Rest Room

It is a known fact that the patient who can be kept in a quiet,
restful, and relaxed state for some time following the adjustment
derives the greatest benefit therefrom. Having loosened subluxated
vertebrae by adjustment their tendency is to settle in their old
abnormal position and every movement of the patient for a time aids
this tendency. Quiet permits adaptation of surrounding tissues to the
changed position of the vertebra; action facilitates the re-adaptation
of the vertebra to the state of surrounding tissues.

If possible a special room should be provided in which patients may lie
down in comfort for twenty or thirty minutes following an adjustment.
If more than one patient at a time is to rest, separate rooms should be
provided for men and women. The rest rooms should have high ceilings
and excellent ventilation without drafts. The floors should be carpeted
so as to soften footfalls and suggest quiet and rest. Potted plants
adorn such a room very well and always afford a pleasant suggestion.

The patients lie on cots, foldable for convenience when not in use, and
should lie on their backs as quietly as possible. Some prefer solid
cots on rollers so that the cot may be noiselessly rolled beside the
adjusting table after the adjustment, the patient may by one turn move
himself upon it, and it may then be gently rolled into the rest room.
This is a more finished, if more expensive, handling of the problem.

It may be well to furnish some occupation for the mind and to this
end, since reading in such a position is injurious to the eyes, a good
phonograph is a valuable addition. Equip it with a soft parlor needle
and select only soothing, restful music. Just as you would avoid doing
the walls of the rest room in striking or garish colors, exciting to
a diseased mind, so avoid exciting or harsh music. The object of this
room is _rest_ for mind and body. Let every thought be directed to that
end. With some patients the use of the phonograph or other amusement
must be avoided. Study your cases with care.

The trip to the Chiropractor’s office is too often regarded in the
light of an unpleasant necessity. If proper care be used in equipping
an office and if such means as have been suggested for the rest room
be employed, these in addition to the pleasing personality of the
Chiropractor may make of the visit a pleasant thing, a part of the day
to be anticipated with eagerness.

A Complete Suite

The number of rooms in a perfectly convenient suite depends upon the
approximate number of cases to be handled daily. If it is needful to
economize the practitioner’s time a greater number of rooms will be
required than would be desirable with a small practice.

A waiting room, a consulting room, two or more adjusting rooms, and
two rest rooms make probably the best number and employment of rooms.
It is desirable if possible that the adjusting room be used for that
purpose only and that there be separate rooms for men and women. Each
adjusting room can then have its own dressing room or recess. Or in
addition to the other rooms named above there may be many small rooms
each containing an adjusting table and a rest cot and each serving as
the rest room after the adjustment. If a sufficient number be provided
as many patients can be handled in this way as time permits, the
practitioner need lose no time at all, and each patient may have a room
entirely to himself throughout his visit.

Reference Library

This should consist of those standard works to which you will
necessarily refer most often. Gray, Morris, or other standard
anatomical authority, Brubaker’s or Haliburton’s physiology, Butler or
Osier on diagnosis, Delafield and Prudden on pathology, Morat on the
physiology of the nervous system, Bing on regional diagnosis of nerve
lesions, one or two good works on psychology, gynecology, histology,
etc., a good medical dictionary, and any books on Chiropractic in which
you have confidence make up an excellent list. Any standard works
will suffice and this list is merely suggested for those who may be
uncertain as to their own tastes. Always examine a book before buying
it, even those named above. Next to works on Chiropractic no single
book is as necessary or useful as a good medical dictionary, preferably
a large and complete one.

Door Sign

Your door should bear a sign in gold or black, setting forth your name
and business and perhaps your office hours. It may read, “W. R. Jones,
Chiropractor,” or, “Jones & Jones, Chiropractors,” with office hours
appended. Avoid repetitions such as “Dr. W. R. Jones, Chiropractor,” or
“W. R. Jones, D. C., Chiropractor.”

Advertising

The word of a satisfied patient to his friend is the best
advertisement. Beyond this, considerable diversity of opinion exists as
to what constitutes proper, ethical, and wise advertising. I shall make
no attempt to settle this question but shall simply suggest that while
it is undoubtedly necessary often to explain to the public through
various avenues what Chiropractic is and what it can do it is wise to
be as reserved and dignified as possible and to avoid offense to any.
Thus it is clearly unwise to advertise that your competitor is a fraud,
much wiser to convince your readers by the logic and strength of your
statements that _you_ are not. Consider good taste and avoid unpleasant
references to loathsome or vulgar diseases. Such advertising is
associated in the public mind with quackery, with patent medicines and
medical institutes, and no matter how sincere and right your motives
may be it will be misinterpreted by those you wish to reach.

Consider also the legal side of advertising. Study the laws of your
state and avoid any statement which will conflict with the law. In some
states it is illegal to advertise with the term “Dr.” unless you hold a
medical license. In others to advertise to “treat,” “cure,” or “heal”
disease is to practice medicine technically. Such statements miss the
truth, in any case, because the Chiropractor administers an adjustment
and not a treatment and because Nature alone can cure or heal.

Collection Cards

Different communities respond to different collection methods. With
one class of patients it may be better never to mention fees except to
answer inquiry and simply to submit monthly statements of account to
all patients. With another it is necessary to charge in advance. More
Chiropractors use this method than any other and many use cards for the
purpose.

These cards are best printed with name, address, telephone number,
etc., on one side and on the other six or twelve spaces ruled off at
one end for punching to indicate adjustments given, and the words,
“Good for six (or twelve) Chiropractic adjustments at (office)
(residence) when properly countersigned.” A line should be left below
for your signature and at the bottom the price of the card should be
printed plainly. If desired a space may be left for the patient’s name
so that the card may be made non-transferable.

The card is issued at the beginning of a course of adjustments and
a duplicate is kept on file. Each time the patient is adjusted he
presents his card before leaving and one space is punched out. By this
system both the patient and the adjuster may know exactly the number of
adjustments given and accounts may be easily kept. Without it, a book
entry of some sort must be made for every adjustment.

The best thing about this system is that it reminds the patient that
you expect to be paid in advance without the necessity of your saying
so, since the words “in advance” follow the statement of price on
the card. At the time of payment you give him, as a receipt, a card
entitling him to a certain amount of your service at a stipulated place.

Schedule of Examination

This method of procedure for the investigation of new cases is
offered as a suggestion to be followed as far as the education of
the Chiropractor will permit. If every practitioner adopts some such
method of making his own diagnoses he will advance in ability much
more rapidly than by accepting the diagnoses given his patients by
physicians or others. We should remember, though without arrogance,
that our special ability to discover subluxations and our knowledge
of their significance as the primary causes of disease renders us
better prepared for correct diagnosis than our medical friends, other
education being equal.

It should be quite obvious that in attempting the accomplishment of
any object it is necessary first to have in mind a clear preconception
of the things to be accomplished, and second, to have a clear and
concise, yet complete, outline of the steps to be taken, their order or
sequence, and their relative importance in the accomplishment. These
two needs, as regards a Chiropractic diagnosis, we shall endeavor to
supply in this section.

Chiropractic Diagnosis properly consists of three parts, Vertebral
Palpation, Nerve-Tracing, and Symptomatology, together with the
reasoning necessary to properly weigh and summarize the facts
ascertained. Of these three divisions two fall properly under the head
of Physical Diagnosis and the third, symptomatology, should consist
principally of physical diagnosis.

Everywhere the physical or objective sign is given preference over the
subjective symptom. Before a single question is asked of the patient
relative to the case or its history, every other means of obtaining
information properly coming under the head of a Chiropractic diagnosis
should be utilized. The questions should come last and be very few and
direct. They should serve only to illuminate the few remaining doubtful
points in the mind of the examiner, points which perhaps exist only
because of some fault or weakness in his methods of examination.

The proper order of examination is as follows:

1. General Observation.

2. Vertebral Palpation.

3. Nerve Tracing.

4. Special Examination.

5. History of Case.

6. Summary.

General Observation

Observation of the patient with a view to determining any signs of
disease should begin with the moment the patient steps into the office.
It should continue during your conversation and during the Vertebral
Palpation and Nerve Tracing which follow. The mind of the examiner
should be constantly on the alert to note any sign on any exposed part
of the patient’s body, or any motion which may betray the nature of the
disease or diseases with which he suffers.

Before preparing the patient for palpation observe temperament,
position and carriage of head, body, and limbs, and facies.

Ask male patients to strip to the waist and female patients to remove
all clothing down to the waist except a loose gown or kimono, which
is worn reversed so that it opens behind and exposes the spine to
direct examination. No greater error can be committed than to attempt
examination of the vertebral column through clothing or other covering.
Examine with patient seated on a bench or stool with feet evenly placed
upon the floor. If the patient is for any reason unable to assume this
position the examination may be varied somewhat.

While in this position continue observation of points mentioned above
and observe also condition of skin, whether abnormal in color,
moisture or nutrition, or whether there is flushing, cyanosis, or
pallor, roughness, eruption, etc.; the condition of bones and joints
other than vertebral; general emaciation or obesity, local malnutrition
or hypertrophy; evidences of operation, scars etc.; and action of
muscles more in detail than is indicated under position and carriage of
parts.

Having observed these things discontinue general observation and all
other considerations for the time in favor of Vertebral Palpation.

Vertebral Palpation

The primary object of Vertebral Palpation is the location of
subluxations, or partial displacements, and the determination of the
relative degree and direction of those found. Next comes the recording
of subluxations in such a manner that a perusal of your record will
enable you to reconstruct at any time a mental picture of the spine, as
far as possible. (See Record.) With the making of the record the proper
form of adjustment for the correction of each subluxation is decided.

Finally, by _failing_ to find subluxation in certain segments you may
safely eliminate those segments from consideration and confine your
further attention to the remainder. (See Spino-Organic Connection.) It
must be borne in mind that while the finding of a subluxation is not
always positive evidence of the necessity for adjustment there, the
_absence_ of subluxation of any spinal segment is proof positive that
no disease exists in the corresponding somatic segment. Differential
diagnosis is thus often greatly aided by palpation.

Nerve Tracing

Having thus narrowed the field of operation, trace from spine to
periphery every nerve tender enough to be traced, noting the relation
of the tender nerves to the subluxations already found by palpation.
Whenever it is possible note the _degree_ of tenderness of the various
nerves and keep in mind through the remainder of the examination the
fact that greater tenderness in some one segment indicated either
greater or more acute disease in that segment.

It is best to use great caution about entirely eliminating any segment
from consideration because of negative findings in attempted nerve
tracing. The fact that no nerve is traceable is not always proof that
no impingement exists, but only that no _irritation_ exists. Only light
or acute impingement may irritate a nerve. In forty, and possibly
fifty, per cent of all cases no nerves are traceable at any time. (See
Nerve-Tracing.)

Special Examination

The examiner has by this time formed some concept of the case in
hand. He has a clue to the possible nature of the disease and he has
narrowed his observation to a few segments of the body or a few organs
which demand a more special examination. This may be accomplished by
Inspection, Palpation, Auscultation, and Percussion.

History of Case

Having determined by these methods every fact possible of determination
without information from the patient, it becomes necessary to go
somewhat into the history of the case. The history of falls, jars,
shocks, or injuries of any kind should be taken first and these should
be viewed in the light of their bearing upon the previously ascertained
condition of the spine. Sometimes the definite history of an accident
immediately preceding the development of disease symptoms suggests its
connection with the disease and the exact nature of the accident points
out to us some one of the several recorded subluxations as the one
involved. This in turn may aid a doubtful differential diagnosis. Each
step in the process of examination helps to explain and clarify the
facts elicited by other steps until the facts marshal themselves into a
complete and comprehensible picture.

At this point it will be possible to stop in some cases and rest upon
the evidence gathered. If you are able at this time to state clearly
the nature of the case, the manner of its cause, the site of disease
and of the subluxations causing it, the kind of subluxations, and
the chance of recovery under adjustment, it is preferable to do so.
You will thus have made a complete diagnosis without recourse to
information from the patient except the history of injuries.

Sometimes, however, it will be necessary to go further into the case
and ascertain the presence and nature of subjective symptoms. If this
be necessary, the examiner should confine his questions to the parts
indicated as diseased, and thus limit the number of questions and make
them all direct and essential. It is important to avoid trivial or
irrelevant questioning.

Summary

Finally, having ascertained all necessary facts, mentally summarize
them all, combining the results of Palpation, Nerve-Tracing, and
Symptomatology so as to reach a definite conclusion as to the location
and nature of the morbid process, the subluxation producing it, and the
exact form of adjustment necessary to correct it.

The examiner should be able at the end of the examination to state
exactly what he finds to be the condition of the patient, to give
reasons and nerve connections, and to demonstrate a subluxation to back
every statement.

The case record should contain all essential information relating to
the diagnosis and the correction to be applied.

Necessity for Correct Diagnosis

Diagnosis, in a restricted sense, means merely the naming of diseases.
But in the broader and more proper sense it means disease knowing and
includes a knowledge of the causal factors, the location and nature
of disease, the amount of damage to structure and of functional
disturbance, and the probable duration and outcome of the case either
with or without Chiropractic adjustments. In this broader sense we use
the term hereafter.

The object of diagnosis is correct adjustment. Including as it does
palpation, nerve-tracing, and symptomatology, the Chiropractor’s
diagnosis of a case should embrace all the knowledge upon which he
proceeds with his adjustment.

There are really two all-important questions which constantly recur
to confront the busy practitioner. One is, “What is the matter with
my patient?” and the other, “What can I do to relieve him?” Practice
resolves itself into these two divisions, diagnosis and adjustment.

The real question which should suggest itself to the thinking
Chiropractor is not, then, “Should a Chiropractor study diagnosis?”
but rather, “From what viewpoint should we study diagnosis? Upon what
portions of the subject shall we concentrate our attention?”

Undoubtedly the most important branch of diagnosis to us is vertebral
palpation. By its use we discover those facts about the spinal column
without which we are entirely unable to proceed as Chiropractors.
Knowledge concerning the spine is the _most essential_ part of
diagnosis.

Next in order of importance comes the study of physical or objective
signs throughout the body--the examination of the body for the
discovery of all the changes in the size, shape, position, etc., of
organs which indicate disease. This includes nerve-tracing, which in
some cases is the most important branch of physical diagnosis after
vertebral palpation.

Finally, a certain degree of examination for _subjective_ symptoms may
be necessary. But the Chiropractor of the future should become, and
probably will become, par excellence a _physical diagnostician_.

For many reasons we should be able to rely upon our own diagnoses.
Capability in diagnosis renders us independent of the errors or false
beliefs of others. Since it includes a knowledge of subluxations, not
included in medical training but still vital to correct interpretation
of morbid phenomena, it can be more accurate than any diagnosis which
ignores these causal factors. A habit of diagnosing one’s own cases
enables one, always resting on his own judgment, to correct and improve
himself through all errors, for which he is then alone responsible.

A general knowledge of medical diagnosis, of pathology, bacteriology,
etc., enables a Chiropractor to meet the physician on common ground; in
fact, it gives the Chiropractor a distinct advantage, since he knows
not only what his medical friend knows but also the all-important facts
regarding the spine which are unknown to others. Such knowledge and
the ability to discuss disease intelligently also furnishes common
ground with every patient. Each patient is a specialist in the disease
he believes himself to have and he expects from his doctor a greater
knowledge than his own.

The recognition of contagious or infectious diseases as such is an
absolute necessity in order to obey the laws and safeguard the public
health. The exact condition and degree of vitality of the patient
and the knowledge of the existence of abscess, gangrene, intestinal
obstruction, etc., often warns the Chiropractor that his adjustment
would be dangerous to the patient. Much possible injury is avoided by
accurate diagnosis. Even the frequency with which adjustments should be
given depends upon diagnosis.

Special Cases

There are certain cases which a Chiropractor is powerless to aid
and immediate recognition of such cases will save much trouble. In
intestinal obstruction from intussusception or from strangulated
hernia, for instance, it is best to advise the calling of a surgeon
immediately, while in obstruction from volvulus or intestinal paralysis
the adjustments may afford relief and should at least be tried first of
all.

Any internal abscess presents a possibility of rupture into a serous
cavity or the substance of a parenchymatous organ and is therefore
dangerous, while a superficial abscess, pointing toward the surface,
can best be cared for by adjustment. A badly ulcerated or gangrenous
appendix may rupture under adjustment and be followed by diffuse
peritonitis. The fragile walls of the ileum in typhoid may perforate
under adjustment, while in its earlier stages the disease is easily
curable. The rotted vertebral bodies in Potts’ Disease (spinal caries)
may be crushed under the heavy hand of an ignorant adjuster.

Intelligent case-taking _must_ include accurate diagnosis.

Frequency of Adjustments

The frequency of adjustments in practice should be determined entirely
by the nature of the case and the circumstances in which patient and
adjuster are placed. No hard and fast rules can be laid down but some
general advice may be profitable.

Acute fever cases may be adjusted, until the fever is broken, oftener
than any other type of cases. The chief object is the regulation of the
temperature, after which the body is able properly to repair itself.
Sometimes it may be necessary to give from two to six adjustments in
a day and in at least one tetanus case the adjustments were given
at intervals of about ten minutes for several hours until the fever
was under control. After such a series it is wisest to refrain from
adjusting again for several days so that the patient may recuperate
during the interval, providing the fever does not return. It has been
noticed that after a series of adjustments given at short intervals the
improvement of the patient often extends over a period of days or weeks.

In ordinary chronic cases, with good vitality and reactive power, the
daily adjustment is best at first. Then after a course of from six to
twenty-four adjustments according to the judgment of the practitioner,
the interval is lengthened and adjustments given on alternate days, a
day of rest intervening between each two. In weak patients or those who
are extremely sensitive, the shock of the daily adjustment, even at
first, and the demand on the body’s recuperative power may be greater
than can be met.

In this connection it may be mentioned that the author has encountered
several cases of dorsal lordosis produced by too heavy and too frequent
adjustments, straining the ligaments faster than they could be repaired
and continuing the strain over too long a period. It is possible
to _over-adjust_ a patient, producing a weakened spine and other
deleterious effects, just as it is possible to establish a “tolerance”
for a drug by long continued use.

During a long course of adjustments it is well to allow the patient
an occasional week of complete rest, or even more, and it may be wise
after a time to reduce the number of adjustments to two per week in
some cases.

On the other hand, the practice of giving one adjustment a week
from the beginning, as followed by some practitioners who maintain
offices in numerous localities and visit each one day per week, is not
generally productive of good results and it is the author’s practice
to refuse new cases who profess their inability to take more than one
adjustment weekly. The interval is so long that all repair work started
by each adjustment is completed and an involutionary change sets in
before the next.

Specific vs. General Adjusting

By specific adjusting is meant the selection and adjustment of the
vertebra or vertebrae which are known to be causing definite disease
or weakness. The term “specific adjustment” implies that there is a
particular reason existing and recognized for every vertebra adjusted.

General adjustment, on the other hand means either the adjustment of
all palpable subluxations, or of all the most noticeable ones, or of
all found providing that no two successive vertebrae be adjusted,
according to the beliefs of different elements in the profession.

Specific adjusting relies upon the diagnosis and requires correct
interpretation of disease. General adjusting considers only the
condition of the spine and is given upon the principle that if the
spine is right the man is right--a perfectly correct principle
regardless of whether or not the general adjustment is advisable. Let
us consider some of the arguments for and against each method and reach
a conclusion if possible.

The use of specific adjustment demands of the Chiropractor an accurate
diagnosis and compels him to get his mind into direct contact with the
exact condition of the patient in order to select the proper vertebrae.
Sometimes the less prominent subluxation causes a more acute or
dangerous disease than the more pronounced. Specific adjusting tends to
develop more discriminating and accurate palpation.

Specific adjusting weakens and shocks the weak or nervous patient
less than general adjusting. It also concentrates the recuperative or
reparatory power of the patient on the parts which _most need repair_.
The body possesses only a certain limited capacity for combating
disease or building weakened tissue. To scatter this force widely is to
weaken its effect in any particular locality.

The habit of specific adjustment and of selecting proper vertebrae
enables the Chiropractor to explain definitely at any time just what he
is doing and why he is doing it. We assert that in adjusting a vertebra
we are removing the primary cause of disease. It is sometimes awkward
to be asked if the patient has nine diseases or if it takes nine
subluxations to cause one case of acute coryza. A correct answer to
either question leaves an embarrassing discrepancy between theory and
practice.

In favor of the practice of general adjusting it has been said that
errors in diagnosis become unimportant if all subluxations be adjusted;
that if the spine be straightened the patient _must_ recover. Against
the first statement, which is forceful because diagnosticians are
so notably liable to err, it may be said that errors in palpation
are almost, if not quite, as frequent as errors in other branches
of diagnosis and that one’s tendency to err is less if all possible
methods be checked against each other than if one only is used. The
second statement is quite true; but it is based upon the assumption
that in ordinary practice the spine _may_ be straightened completely.
As a matter of fact this rarely, if ever, occurs. It is practically
impossible ever to thoroughly “line up” a spine. The best that has been
done as yet except in acute subluxations is to so modify subluxations
that disease disappears.

We may interject here the statement that no greater or more conclusive
betrayal of incompetency can be offered by a Chiropractor than the
declaration that he has completely “lined up” a spinal column in one,
six, or a dozen adjustments, as some have declared. If one be honest in
such statements it is proof positive that he is not capable of accuracy
in palpation or else lamentably liable to auto-suggestion. Clinicians
of proven ability, who have examined more than five thousand spines
each, agree that no perfectly normal spine has been discovered, whether
the spine has been adjusted or not.

But the chiefest argument against general adjusting is that it scatters
the reparatory forces of the body throughout many segments, some
of which are not really in need of attention, while the one or two
segments which need all possible concentration of energy receive only a
diluted share.

If my patient suffers from an acute pneumonia and nothing else and if
I require that he submit to a general adjustment including some eight
subluxations, two of which are Lumbars, I am unscientific and unwise.
What that case demands is an immediate localized improvement.

It is highly probable that the efficient Chiropractor of the future
will be a specific adjuster; that every recognized body condition will
suggest a definite and scientifically determined corrective measure;
and that guesswork will be largely eliminated.

Talking Points

The things which it is most important that the Chiropractor should
set before his patient are the theories and facts peculiar to
Chiropractic, perhaps adduced by Chiropractic investigations alone.
These theories and facts have been discussed elsewhere in detail: the
subluxation theory, easily demonstratable with a spinal column as an
object lesson, the relations between primary and secondary causes of
disease, the directness and completeness of the results of vertebral
adjustments, these explanations are more convincing than the display
of a wealth of knowledge of methods and theories used by other schools
of practice. Chiropractic has been builded not by virtue of previously
established truths but solely on the vitality of the new principles
enunciated by it.

These new ideas cannot hope for full and immediate credence and must be
presented carefully, with this fact in mind and with due consideration
for the degree of intelligence of the listener. Avoid argumentative
discussion with patients, seeking rather to enlighten them about those
facts peculiar to Chiropractic and unknown to them than to antagonize
them by contradicting their cherished beliefs. It is much wiser to
begin with that knowledge of disease which you hold in common with the
patient and advance with him, step by step, from that firm foundation
to new truths than to begin by attempting to tear down his beliefs.
Reason from the known to the unknown. Replace an old idea as to the
causation of disease by quietly inserting a new one of greater verity
and it will presently and painlessly crowd out the old. This process is
much the simplest and easiest.

Nevertheless in presenting Chiropractic we must be gently positive.
Chiropractic is known and provable. Always able to fall back upon the
clinical test as a final argument with supreme assurance that it will
not fail to vindicate our claims, we may present an unshaken front
before the most powerful and intelligent attack.

Promises to Patients

The majority of patients will require from the Chiropractor an
expression of his belief in his ability or inability to cure them. They
will desire a statement as to the probable time required for a cure.
They may even ask a guarantee of success.

These questions are hard to meet truthfully and convincingly, for
the truth is that every Chiropractor fails sometimes and is unable
to predict that failure in advance and that no one wise enough to
predict the length of time which will be required for the cure of any
given case has yet arisen. And these truths do not sound reassuring or
convincing.

Explain to the patient that nature alone is the curative agent and that
the cure depends not alone upon the skill of the adjuster but upon
the exact condition of the vertebrae, the exact amount or degree of
damage to tissue, the patient’s habits of living, etc. Any accidental
interjection of other factors into the case may have an important
bearing. You may assure him of the excellent results you have obtained
in other cases similar to his, or even cite individual cases if to
do so does not violate a professional confidence. But you had best
avoid a promise to cure or an exact statement of the time which will
be needed. State your belief or opinion but do not bind yourself to a
promise. Offer your best skill and closest attention; you can do no
more.

The patient should rely upon the skill of the Chiropractor as upon the
skill of his lawyer or his physician. Neither can honestly promise that
he will succeed in his efforts, even though all indications point that
way.

Re-Tracing of Disease

From the original concussion of forces which produces a nerve-impigning
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.

=Arthritis Deformans.=--In well developed cases some almost complete
cures have been effected in periods varying from two to four years.
Prognosis good as to relief, but poor as to complete recovery.

=Ascites.=--Fair prognosis, depending upon the nature of the portal
obstruction. Cirrhotic ascites does not yield well.

=Asthma.=--Spasmodic bronchial asthma is almost always curable except
in the very aged, but the usual posterior curvature in lower cervicals
and upper dorsals requires time and persistent heavy adjustments for
its correction. The asthmatic paroxysm may be relieved instantaneously,
but will recur at intervals for a long period before the cure is fully
established. The cardiac form of asthma depends upon restoration of
compensation for a leaking valve, and yields by irregularly progressive
diminution.

=Blindness.=--As a condition, without qualifying terms, blindness
offers a bad prognosis. Most cases fail to develop sight under
adjustments. Yet some individual cures in optic atrophy, in detached
retina, and in other conditions, attest the possibility. Cataract
blindness perhaps yields best.

=Bradycardia.=--If symptomatic, yields as does the disease. If primary,
a few adjustments are usually sufficient. In one case the first
adjustment increased to 90 a pulse which had been at 60 for fifteen
years. In twenty-four hours, without further adjustment, the rate had
settled at 69 and there remained.

=Bright’s Disease.=--Prognosis good, but some cases terminate abruptly
with intercurrent disease, such as pneumonia. There is danger until
the albuminuria has ceased and the strength of the patient markedly
improved. Probably the diseased kidney area is simply walled off from
the healthy tissue, which then hypertrophies and takes on the work of
the entire organ, or pair of organs. If too much damage has been done,
the case will terminate fatally in time, even though its progress is
checked by adjustments.

=Bronchitis.=--Acute bronchitis is quickly checked as a rule. Chronic
bronchitis may prove intractable, or may require many months for a
cure. There are exceptional quick cures of the most chronic cases.

=Caked Breast--Mammary Inflammations=.--Rapid and positive cure follows
proper adjustments.

=Cerebral Softening.=--Prognosis bad.

=Cerebrospinal Meningitis.=--Serious always, but no fatalities reported
in adjusted cases. Failure to modify fever and cervical retraction
within two or three hours, and with one to ten adjustments, is alarming.

=Chickenpox.=--Like smallpox and the other exanthemata, chickenpox
should be modified at once by adjustment and all cases should be light,
eruption hastened, and fever quickly broken. Sometimes the rash may be
strongly marked and the disease run its usual course in all particulars
except fever and prostration, being a febrile with absence of all the
consequences of fever.

=Cholangitis.=--Recovers quickly under adjustment.

=Cholecystitis.=--Prognosis excellent.

=Chorea.=--Prognosis excellent in acute and subacute cases, less
favorable in chronic. No figures are available, but many chronic cases
fail to respond at all.

=Cirrhosis of Liver.=--Doubtful. No statistics have been compiled, but
it seems probable that most cases are unmodified by adjustment.

=Congestion of Liver.=--Prognosis good.

=Conjunctivitis.=--Readily curable, unless part of a more general
infection.

=Constipation.=--Prognosis usually good, but some cases which have
paralyzed the intestines with drugs, or in which atony of the
intestinal muscles exists from any cause, are very stubborn. One is
led to believe that any case of chronic constipation would respond to
proper adjustments in time, but sometimes the time is prolonged more
than seems reasonable.

=Coryza.=--Some cases respond instantly, others persist and run their
usual course. Chronic nasal catarrh recovers in favorable climates,
and in unfavorable tends to become permanent, though less severe and
annoying under adjustment.

=Croup.=--Always dangerous, but no fatalities reported under
adjustments, which are powerfully effective. Croup requires constant
attention until all symptoms subside, usually within an hour or two.

=Cystitis.=--Usually curable, but some chronic cases prove intractable
for an unknown reason. There is no way of recognizing the curability of
a case before the attempt.

=Deafness.=--Variable outlook. Deafness due to catarrhal occlusion of
the Eustachian tubes is usually curable. That due to middle ear disease
sometimes yields. That due to nerve disease is possibly--though not
certainly--incurable.

=Diabetes Insipidus.=--Prognosis excellent. Few cases fail of cure, and
no fatalities are reported.

=Diabetes Mellitus.=--Always necessitating grave and careful
consideration, this metabolic disease is marvellously controlled by
Chiropractic adjustment. Probably 90 per cent of all cases are curable,
and only those presenting impossible problems of adjustment, or those
in the very last stages, are hopeless.

=Diarrhoea.=--Prognosis depends largely upon secondary causes.
Adjustments sometimes produce diarrhoea to cleanse the intestinal tract
of waste or poisons. Such a diarrhoea, if instituted by Nature without
aid, does not cease with adjustments until its purpose is accomplished.
Nervous and infective diarrhoeas usually respond well.

=Dilatation of Heart.=--Compensatory hypertrophy and strengthening of
the muscle usually follows adjustment.

=Diphtheria.=--Under adjustment the false membrane tends to exfoliate
and to be coughed out entire within a few hours, with rapid recovery.
In children, watch for possible strangulation from loosened membrane.
Constant bedside attention is imperative until fever and membrane
have disappeared. Convalescence, unless antitoxin has been used, is
very rapid, and physicians watching the clinical course of diphtheria
under adjustment customarily doubt the diagnosis unless culture is
made. Antitoxin modifies the prognosis toward gravity, and in spite of
adjustments persistent sequelae often follow its use.

=Dropsy.=--Cardiac or renal dropsy disappears with improvement in the
diseased organ.

=Dysentery.=--In temperate climates death is extremely unlikely.
Recovery is often quick and easy, but some cases persist. The tropical
amoebic dysentery seems hardest to master and may not improve at all.

=Dyspepsia.=--Prognosis good.

=Endocarditis.=--If primary, recovery is the rule. Occurring in the
course of some other disease, as rheumatic fever, it renders the
prognosis less certain and may terminate fatally. Likely to leave
chronic valve weakness or contraction.

=Enteritis.=--Prognosis generally fair. No figures available.

=Enuresis.=--The majority recover within a few weeks or months, with
occasional exceptions. Failure to get results within a few weeks
suggests a change of adjustment.

=Epilepsy.=--Doubtful. Less than half of all cases recover, and no
case can be pronounced cured until all symptoms have been absent for
a year. Cases with anterior cervicals offer the poorest chance. It
is usually possible to restore consciousness and muscular control
by an adjustment during the grande mal, in the instant between
the tonic and clonic spasms, but such immediate response does
not--unfortunately--always mean that a cure will eventually be effected.

=Epistaxis.=--Nose-bleed usually stops at once following proper
adjustment.

=Erysipelas.=--Cases adjusted early show little spreading of the
eruption with but slight constitutional symptoms. After eruption
is fully developed it is more difficult to keep down the fever and
recovery is slower, but none the less certain unless cardiac or other
grave weakness is present.

=Exophthalmic Goitre.=--Like other forms of goitre this may be reduced,
and with its reduction all other symptoms disappear. Many cures are on
record.

=Friedrich’s Ataxia.=--In hereditary cerebellar ataxia (which is
probably congenital, rather) cures are limited to 40 per cent or
less. History of instrumental delivery, with marked upper cervical
subluxation, argue for the natal origin of the disease and increase the
probability of cure.

=Gallstones.=--Prognosis excellent. The calculi absorb under adjustment
by a reversal of the chemical process by which their deposit was
induced. When small they may pass through the ducts and escape, with
slight pain. Adjustment during the painful passage of a gallstone may
act upon the duct so as to lessen greatly the pain and hasten the
passage.

=Gastralgia.=--Like other gastric neuroses, is easily curable but may
sometimes require correction of a neurotic diathesis, which means time.

=Gastric Ulcer.=--Usually recovers, but occasionally leaves a fibrous
cicatrix which cannot be affected by adjustment and which, if located
at the pylorus, may produce stenosis, with consequent incurable
dilatation of the stomach. Operation is required for such a condition,
but the diagnosis is difficult, and it may be best to test with
adjustments for some time.

=Gastritis.=--Prognosis good. To prevent recurrence adjustments should
continue after symptoms subside.

=Goitre.=--Prognosis good. One large goitre under the author’s
observation was reduced in one week so that the neck measurement
decreased one inch. Most cases require several months for complete
reduction.

=Gonorrhoeal Rheumatism.=--More stubborn than other forms of rheumatism
and sometimes defies adjustment. No percentages are available. It
is probable that nothing but a general cleansing of the system will
prevent recurrence.

=Hay Fever.=--Perhaps one-half of all adjusted cases recover fully,
some at once and some after several months. By recovery is meant
failure of the annual appearance of the attack with no symptoms at
any time. No case can be pronounced cured in less than a year. The
remaining half are modified little or not at all.

=Headache.=--Nervous, bilious, ocular, and reflex headaches yield
well. Toxic headaches, or those accompanying systemic infections, give
way slowly with the cleansing of the system.

=Hemorrhoids.=--Excellent, except when lower lumbars are anterior and
defy adjustment.

=Hernia.=--In all sites and forms of hernia, excepting strangulated
hernia, prognosis is good. Strangulation requires immediate surgical
interference. Prognosis is better if a truss be used.

=Hodgkins’ Disease.=--Prognosis theoretically good, but the few cases
under adjustment, while benefited, seem to have died of intercurrent
disease, so that it is well to suspend judgment.

=Hydrocele.=--Theoretically hydrocele should respond well, but in
practice the author has seen several failures, and no cures.

=Hydrocephalus.=--If due to cervical twisting at birth, the prognosis
is fair; otherwise bad.

=Hypertrophy.=--Adaptative hypertrophies, those due to overstrain upon
an organ, do not and should not disappear until the strain has been
relieved. Hypertrophy is sometimes accelerated by adjustment, as in the
case of defective heart valves, when thickening of the wall restores
and maintains compensation. Other hypertrophies tend to disappear under
adjustment.

=Hysteria.=--Good, but slow. Some extreme cases refuse to respond.
Instant recovery from hysterical coma is the rule following adjustment,
but the coma tends to recur.

=Immunity.=--There is no doubt that adjustments often confer immunity
from infection and contagion, but it is so difficult to strengthen
every part of the body against every possible infection or contagion,
and so uncertain that immunity really exists in a given case, that
it is best always to assume the possibility of contagion and act
accordingly. Adjustments following exposure to known contagion are
always wise, but one may never know, if they succeed, that the patient
might not have escaped without them.

=Impotence.=--Variable outlook, according to secondary causes and
pathology. Previous venereal disease renders the prognosis most
doubtful. Nervous or vascular impotence is likely to respond well.
If due to cord disease, the prognosis is to be made on the original
disease.

=Influenza.=--Mortality not more than 2 per cent, and that in the
very aged and infirm. Duration varies greatly. May yield at once,
first adjustment being followed by disappearance of fever, profuse
perspiration, and completed convalescence in from twenty-four to
forty-eight hours; or may require several adjustments at frequent
intervals to break fever.

=Insanity.=--No accurate tabulation of results in different forms of
insanity has been made. Numerous successes, interspersed with fewer
failures, have been reported. The author has both succeeded and failed
with acute dementia, but the failure was a twenty-four-hour trial only,
and included but three adjustments.

=Intestinal Obstruction.=--The prognosis of intestinal obstruction from
intussusception or strangulated hernia is, under Chiropractic, bad.
Such cases are almost surely fatal unless operated. Faecal obstructions
or masses of worms, also volvulus, respond quickly and prognosis is
good. Careful diagnosis is required before taking a case of apparent
complete obstruction.

=Irritable Heart.=--If purely nervous, recovery is quick and easy. If
there is a drug diathesis or organic disease, slow and doubtful.

=Jaundice.=--Yields readily, but if of the obstructive form the
obstruction must first be reduced or removed by adjustments.

=Laryngitis.=--A few adjustments suffice for simple acute cases.
Specific laryngeal infections are more difficult. Laryngitis with
ulceration, which is either syphilitic or tubercular, may not recover
or may recover after a protracted struggle. Chronic laryngitis of other
forms is curable, but requires more time than acute.

=Leucorrhoea.=--Fair prognosis only.

=Lumbago.=--Good, unless pain prevents proper adjustment. True lumbago
is quick to respond.

=Malaria.=--Tenacity varies according to climatic conditions. Malarial
cachexia always yields slowly, sometimes defies adjustment altogether.
No reports are to be had on pernicious malaria. Other forms recover
though paroxysms tend to recur several times before checked, but of
shorter duration than if no adjustment is given.

=Mastoiditis.=--Good results in the few cases observed.

=Measles.=--Excellent. Recovers quickly. Eruption hastened by early
adjustment, runs very mild course with little or no fever, catarrhal
symptoms disappear early. No sequelae.

=Meniere’s Disease.=--Labyrinthine disease of this character has been
cured, without reported failures, but data is meagre, not more than
three or four cases having come under the author’s notice.

=Menorrhagia--Metrorrhagia=.--Results excellent, and usually quick. One
fifty-two-hour intermenstrual hemorrhage from uterus was stopped in one
hour by adjustment, with no recurrence.

=Migraine.=--Migraine, or hemicrania, gives a fair prognosis only. Most
cases require a long course of adjustments.

=Movable Kidney.=--Prognosis good, but change of position and complete
fixation slow. No treatment required--merely adjustment.

=Myelitis.=--Transverse myelitis, if adjusted in the acute stage, may
be checked as any other inflammation, and the damage and resulting
paralysis will be greatly lessened or altogether prevented. The
paralyses which follow myelitis require time for the rebuilding of the
degenerated axons whose course is interrupted at the diseased area, but
tend to recover.

=Myocarditis.=--Reports conflict. It is well to consider this a grave
condition and one open to investigation.

=Myxoedema.=--Only one case known to have been under adjustment, and
this after several years was markedly improved, but not yet quite cured.

=Nephritis.=--Prognosis good. Acute cases show rapid, chronic cases
slow, improvement.

=Neuralgia.=--Prognosis excellent in any form. Trophic neuralgias,
such as herpes zoster, are slowest as a rule, but occasional cases of
tic doloureux will require several months. One may always expect a
cure unless the patient, in long cases, becomes discouraged and stops
adjustments.

=Neurasthenia.=--Good, but will be slow unless mental aid be given in
the form of freedom from worry or strain.

=Neuritis.=--Good, but very uncertain as to time; some cases show quick
disappearance of all pain and some drag interminably.

=Optic Atrophy.=--Complete atrophy with total blindness is rarely
cured, though occasional partial or complete cures have been reported.
Partial atrophy may slowly recover, or recovery may cease at some point
short of completion and case remain stationary thereafter.

=Ovaritis.=--Good, except in suppurative forms. When adhesions have
been formed, results are doubtful.

=Pancreatitis.=--Obscure, hard to recognize, and hard to cure.
Prognosis probably bad.

=Paralysis Agitans.=--Probably in the earliest stages this is curable.
Cure of a fully developed case is exceedingly doubtful and the writer
has yet to see marked benefit in such a case.

=Paralyses.=--Prognosis decidedly variable. Apoplectic hemorrhage
recovers in about 50 per cent of all cases. Paralyses from central
lesions require much more time than peripheral palsies because of the
necessity for rebuilding degenerated nerve cells as well as fibres. The
paralyses following anterior poliomyelitis are almost certain to be
cured if sufficient time is allowed. Most peripheral palsies, except in
the very aged, are curable. Any other paralysis but a purely functional
one recovers slowly, but this form may yield almost in a day.

=Parotitis.=--Mumps respond immediately and may be checked at any stage.

=Pericarditis.=--Usually recovers. Effusions are stubborn and may
become purulent, in which case the prognosis is grave.

=Peritonitis.=--Prognosis grave, but some cases have been reported
as cured under adjustment. These are probably localized rather than
diffuse inflammations, usually pelvic.

=Pertussis, or Whooping-Cough.=--Tends to run its course despite
adjustments, though some aborted cases are reported. All cases mild
under adjustment, with small liability of complications. A nervous
cough is likely to persist for months after the infection has passed.
Adjustments seem seldom to prevent contagion.

=Pharyngitis.=--Acute form yields readily. Chronic pharyngitis is more
stubborn, but usually curable.

=Pleurisy.=--Pleurisy, unless purulent or tubercular, yields well in
varying periods. Purulent and tubercular pleurisy are stubborn and may
not recover.

=Pneumonia.=--The author has had a wide and gratifying experience
with pneumonia. At every stage it seems amenable to adjustment, and
the usual effect of the first adjustment is a drop of from one to two
degrees in the temperature with immediate softening of the consolidated
area. Specific adjustments get best and quickest results. Pneumonia
should =always= recover, unless it occurs as an intercurrent event in
some chronic and wasting disease, as Bright’s Disease.

=Potts’ Disease.=--Tubercular caries of the bodies of the vertebrae
is curable, within limits. Occasional cases are seen in which Nature
has stopped the spread of the disease by walling off the morbid area
with exostosis. Such cases should not be adjusted, and the disease may
remain latent through a long life. When active the disease proves fatal
unless checked, which is possible in the earlier stages, and becomes
impossible when the vertebral bodies are too fragile to stand strong
adjustments. Discernment in case-taking will avoid any fatalities under
adjustment, but by no means all cases of Potts’ Disease are curable.

=Pregnancy.=--We may correct by adjustment any pathological conditions
arising during pregnancy which would be amenable to adjustment under
other conditions. A course of adjustments during a normal pregnancy
will render delivery easier and lessen, but not abolish, the pains.
Great care must be exercised in the manner of adjustment.

=Prostatic Enlargement.=--Varies according to age and recuperative
power. Prognosis is bad in the very aged and infirm, but in more
vigorous subjects quite good for steady reduction of the hypertrophied
gland, with subsidence of attendant symptoms. Venereal history is
unfavorable.

=Pulmonary Tuberculosis.=--In the early stages, where little damage
has been done to lung tissue, recovery is rapid and quite certain. In
fully developed cases, with characteristic symptoms and marked damage
to tissue, prognosis is very grave, and it is usually wisest to advise
a trip to the Southwest in preference to adjustments. Tubercular cases
should be studied with a view to estimating the exact condition and
recuperative power of the patient before taking.

=Rachitis.=--Prognosis excellent. In a period varying from six months
in the best to five to seven years in the slowest cases, all show
complete or nearly complete cures. All deformity may be checked in
a short time and proper bone nourishment established. Correction of
deformities existing prior to adjustment is a growth process. Too
many cases become discouraged at the slowness of the work and stop
adjustments.

=Retinal Hemorrhage.=--Prognosis fair. Undoubted cures have been
recorded, as well as a few failures. At least one case of hemorrhages
followed by partially detached retina has been cured, or nearly so, by
adjustments.

=Rheumatic Fever.=--Hard to adjust because of its painful nature.
Results of proper adjustment usually, but not always, good.

=Rheumatism.=--Muscular rheumatism yields more rapidly than articular.
Acute tends to quick recovery, chronic to more or less lengthened
and slow improvement. Rheumatic diathesis may require many months of
careful adjustment.

=Rubella.=--Simply and easily checked. Rash slight, and no prostration
at all.

=Scarlet Fever.=--Data on quarantinable cases is meagre, but scarlet
fever, or scarlatina, seems to be quickly modified by adjustment. One
may expect a drop of from one to two degrees in temperature after first
adjustment, followed by steady rise, which will again be checked by the
next adjustment. Rash appears early, and all symptoms are mild, but
several days are often required to put the patient at ease. Occasional
sequelae, such as endocarditis, otitis media, or other inflammations,
occur unless case be watched with great care. No fatal terminations
under adjustment except in cases which were at first misdiagnosed.

=Seminal Emissions.=--Prognosis excellent in cases uncomplicated by
masturbation or excessive venery; in such cases bad until habits are
changed.

=Simple Continued Fever.=--Always recovers. Usually drops one to two
degrees shortly following correct adjustment, with amelioration of all
symptoms.

=Smallpox.=--Infections vary in virulence. In temperate climates all
phases are hastened by adjustment and tend to recover without sequelae.
The milder smallpox due to infection by vaccination is also amenable to
adjustment, and prompt handling will often prevent serious poisoning.

=Splanchnoptosis.=--Partial or marked relief is usual--and slow.
Complete natural replacement of all viscera is the exception rather
than the rule.

=Splenic Enlargement.=--Variable prognosis according to cause.
Secondary enlargements due to systematic infection yield with the
disappearance of the infection. Primary enlargements yield more readily
as a rule, with exceptions. Malarial spleen is slow to reduce.

=Splenitis.=--Prognosis presumably good, but few authentic cases
reported.

=Spondylitis Deformans.=--Prognosis favorable for slow, slight
improvement, but not for complete cure.

=Strabismus.=--Excellent in young subjects, less than fair in patients
over thirty.

=Sunstroke.=--Theoretically curable, but no experience.

=Syphilis.=--The primary sore frequently dries under adjustment without
the development of any secondary or tertiary stage. If first adjusted
during the secondary manifestations symptoms may readily disappear and
no tertiary stage ever appear. There are some authenticated cures eight
and ten years past without recurrence of any sign. In the tertiary
stage the organic lesions do not respond. Prognosis is so hopeless in
this stage that it seems useless to apply Chiropractic at all.

=Tabes Dorsalis.=--Posterior spinal sclerosis, commonly called from
its chief symptom “locomotor ataxia,” recovers in 40 to 50 per cent
of cases adjusted. No accurate pre-judgment can be formed as to the
probabilities in any particular case without experiment, nor has any
adequate explanation been offered as to why some cases recover and
others do not. Those cases which improve at all are likely to recover
fully. In any instance, time is required for the regeneration of the
dorsal column axons, and while this is going on no improvement may be
apparent at all.

=Tachycardia.=--If symptomatic, as of exophthalmic goitre, tachycardia
yields as the disease does. If primary, a few adjustments usually
establish a proper pulse rate.

=Tetanus.=--Only one undoubted case has been brought to the writer’s
attention and this one a marvellous cure. Adjustments were given as
often as every ten minutes for a time.

=Thoracic Aneurism.=--Cure exceedingly doubtful, and fatal termination
possible at any time. Little information is at hand.

=Tonsilitis--Quinsy=.--Simple or follicular tonsilitis aborts under
adjustment in from a few hours to two or three days. Quinsy, or
suppurative tonsilitis, runs its regular course as to duration, but is
frequently a febrile after the first day. Spontaneous rupture of the
tonsil will usually occur and sometimes two or three such ruptures
will lengthen the case slightly. Sequalae are wanting, but all forms of
tonsilar inflammation tend to recur unless a long course of corrective
adjustments is applied to the cervical region.

=Torticollis.=--Acute spastic or rheumatic torticollis in which
permanent contractures have not yet set in may be cured almost
invariably in a period varying from a few days to several weeks.
Chronic cases with permanent contractures yield very slowly, but
prognosis is good for a fairly accurate straightening of the neck. Such
cases often leave slight abnormalities even in the most competent hands.

=Tuberculosis, Pulmonary.=--See Pulmonary Tuberculosis.

=Tumors, Benign.=--Unlike malignant growths, benign tumors, fatty,
fibroid, etc., tend to gradual absorption under adjustment. Perhaps 75
per cent or more may be completely cured. Age is a factor, tumors in
young subjects being more readily curable than in the aged or infirm.

=Tumors, Malignant.=--Prognosis bad. If cancer in any form can be cured
proof has escaped the author’s diligent search. It is wisest to refuse
all cancerous cases.

=Typhoid Fever.=--Prognosis excellent if adjustments are commenced
during first week of fever, in which case the fever should be aborted
at once, followed by one or two mild exacerbations, then permanently
checked. Doubtful prognosis after first week, because of liability to
perforation during adjustment. After second week of fever very grave
prognosis under adjustment, and better with nursing alone.

=Uteroversion--Prolapsus=.--Uteroversions and prolapses are corrected,
sometimes rapidly but more often slowly and gradually. Favoring
circumstances are freedom from overwork or overlifting. Some extreme
cases result in failure.

=Valvular Diseases.=--These may be grouped for prognosis. No
percentages have been compiled, but it may be said that the prognosis
is generally good as to relief and restoration of compensation,
but poor as to rebuilding of the valves. Many cases of apparent
permanent and complete recovery are probably simply cases of excellent
compensation. Death occasionally occurs despite adjustments.

=Varicocele.=--Outlook good for a slow, certain recovery.

=Varicose Veins.=--Probability favors cure in subjects not beyond
middle life, providing they are not greatly overweight or too much on
their feet. Cure always slow.

INDEX

Abdominal muscles, 248

Abscesses, 323

Acne, 323

Adenoids of pharynx, 323

Addison’s disease, 323

Adiposis dolorosa, 323

Adjuncts, 215

Adjuncts, use of, 315

Adjusting, contact in, 94
definition of, 89
general, 303
how to learn, 164
principles of, 89
rapid movement in, 93
specific, 303
special technic of, 99
speed in, 131
technic of, 89

Adjusting position, rules for, 127

Adjusting tables, 284

Adjustment, effect of, 186, 189
object of, 90
specific, 230
vertebral, 89

Adjustment of curvatures, 153

Adjustments, coccygeal, 152
frequency of, 302
iliac, 150
sacral, 150
table of for any subluxation, 156

Advertising, 290

Age of subluxations, 84

Alcoholism, 323

Amenorrhoea, 324

Anatomy, comparative, 226
nervous, 234

Anchor move, 116, 118

Angina pectoris, 324

Anidroses, 324

Ankylosis, 58, 88, 324

Anosmia, 324

Anterior cervical move, 102, 103
pisiform, 100

Anterior fifth lumbar, 150

Anterior poliomyelitis, 324

Anterior subluxations, 84

Aorta, abdominal, 250
thoracic, 250

Aphonia, 325

Apoplexy, 325

Appendicitis, 325

Appendix, vermiform, 253

Approximation, vertebral, 82

Arm, anterior muscles of, 255
posterior muscles of, 255

Arteria centralis retinae, 243

Arthritis deformans, 325

Ascites, 326

Asthma, 326

Atlanto-occipital move, 106

Atlas, 18

Atlas move, 106

Atlas palpation, 35

Axis, 19

Axis of body, 223

Back, muscles of, 247

Bag punching, 97

Bent process, 59

Blindness, 326

Bodily excesses, 200

Body axis, 223

Brachial plexus, 225, 236

Bradycardia, 326

Brain, 242

Break move, the 107, 109, 110

Bright’s disease, 326

Bronchi, 249

Bronchitis, 327

Bladder, 253

Caecum, 253

Caked Breast, 327

Cards for collection, 291

Caries of spine, 56, 154

Case history, 297

Causes, accessory chains of, 177
direct chain of, 177

Cause of disease, 165, 167

Cause of disease, primary, 207

Cause of disease, secondary, 185

Cell, effect of impingement upon, 183

Center place, 206

Cerebrospinal meningitis, 327

Cervical move, double contact, 120

Cervical move, posterior, 119

Cervical plexus, 238

Chassaignac’s tubercle, 61

Chickenpox, 327

Chiropractice hypothesis, 172

Chiropractic, limitations of, 312

Choice of furnishings, 178

Cholangitis, 327

Cholecystitis, 327

Chorea, 327

Christian Science, 216, 315

Cirrhosis of liver, 328

Cleanliness, 286

Coccyx, 17, 19, 45, 152

Coeliac axis, 250

Collection cards, 291

Colon, 253

Comparative anatomy, 226

Concussion of forces, 178, 224, 226

Congestion of liver, 328

Conjunctiva, 243

Conjunctivitis, 328

Contact, close, 94

Contact point, 129

Constipation, 328

Coryza, 328

Count, 30, 33
difficulties in, 34
verifying, 33

Cranial nerves, distribution of, 240

Croup, 328

Cure of bodily excess disease, 214
dietetic disease, 212
germ disease, 211
exposure disease, 214
mental disease, 212
poisoning cases, 213
simple subluxation disease, 208
process of, 208

Curvatures, 153
causes of, 55
compensatory, 57
description of, 54
record of, 56
rotatory, 55

Curves and curvatures, 53

Deafness, 329

Diabetes insipidus, 329
mellitus, 329

Diagnosis, 231, 275, 298

Diaphragm, 248

Diarrhoea, 329

Diet, 192, 193

Dietetics, 315

Dilatation of heart, 329

Diphtheria, 187, 190, 329

Direction of subluxation, 25

Disease, cause of, 165
functional, 166
organic, 166

Diseases and adjustments, 257
table of, 258

Displacements, 84

Door sign, 290

Double contact move, 120

Double transverse moves, 135, 138, 139, 148

Dressing room, 286

Dropsy, 330

Drugs, 315

Duodenum, 252

Dysentery, 330

Dyspepsia, 330

Ear, 245

Edge contact, the, 144

Effect of adjustment, 188, 189

Effect of subluxations, 79

Elbow joint, 255

Electricity, 216, 315

Enuresis, 330

Epidemics, 189

Epilepsy, 330

Epiphysis, absent, 60

Epistaxis, 331

Erysipelas, 331

Eustachian tube, 245

Evidence, kinds of acceptable, 234

Examination, schedule of, 292
special, 296

Excesses, bodily, 200

Excitation, 162

Exposure, 198

Eye, 242

Fallopian tubes, 254

Fasting, 215

Fear, 201

Fees, 291

Fever, 205

Fever center, 206

Fibrocartilages, intervertebral, 83

First appearance, value of, 277

Foods, 194

Foot, 257

Force in adjusting, 98

Freidrich’s ataxia, 331

Frequency of adjustments, 302

Furniture, arrangement of, 282
office, 278

Gallstones, 331

Ganglion, ciliary, 243

Gasserian, 244
middle cervical, 247
sphenopalatine, 244, 246
superior cervical, 244, 246

Gastralgia, 332

Gastric ulcer, 332

Gastritis, 332

General adjusting, 303

Germ diseases, 185

Germs, 185
pathogenic, 185

Gland, thyroid, 247
prostate, 253

Glands, salivary, 246
suprarenal, 252

Gluteus maximus muscle, 256

Goitre, 332

Gonorrhoeal rheumatism, 332

Group method, the, 37
example of, 39

Gums, 245

Habits, 15

Hay fever, 332

Headache, 332

Heart, 249

Heat-regulating mechanism, 203

Heel contact, the, 133

Hemorrhoids, 333

Hernia, 333

Hip joint, 255

History of case, 297

Hodgkins’ disease, 333

Hook support, 105

Hydrocephalus, 333

Hydrotherapy, 315

Hyperaemia, 202

Hypertrophy, 333

Hypothesis, chiropractic, 172

Hysteria, 333

Ileum, 252

Iliac adjustments, 150

Ilium, 150

Immunity, 334

Impingement of nerves, 180, 209

Impotence, 334

Individual subluxation, 40

Infection, 186

Inflammation, 202

Influenza, 334

Inhibition, 169, 182, 189

Insanity, 201, 334

Interiliac line, 34, 62

Intervertebral disks, 83

Intervertebral foramina, 18

Intestinal obstruction, 335

Iris, 243

Irritable heart, 335

Irritability, 169

Jaundice, 335

Jejunum, 252

Key, 39

Kidneys, 252

Klebs-Loeffler bacillus, 187

Knee joint, 256

Knife move, 144

Kyphosis, 54

Landmarks, 61

Laryngitis, 335

Larynx, 246

Last finger contact, 102

Lateral cervical move, 107, 109, 110

Lateral displacements, 84

Law of momentum, 98

Leg, anterior muscles of, 256
posterior muscles of, 256

Leucorrhoea, 335

Library, reference, 289

Limitations of Chiropractic, 212

Liver, 251

Location of subluxations, 78

Lordosis, 54, 85

Lumbago, 335

Lumbar, anterior, 150

Lumbar plexus, 239

Lungs, 249

Maladjustment, 89

Malaria, 335

Major subluxations, 39

Massage, 215, 315

Mastoiditis, 336

Measles, 336

Meckel’s ganglion, 244

Mechano-therapy, 315

Medicine, 315, 316

Meniere’s disease, 336

Meninges, 242

Menorrhagia, 336

Mental attitude, 63

Mental states, abnormal, 201

Metrorrhagia, 336

Migraine, 336

Minor subluxations, 39

Mixing, 315

Morikubo move, 99

Motor reaction, 193, 196, 199

Movable kidney, 336

Movement for correction, 27

Muscles of abdomen, 244
of back, 247
of neck, 247
of perineum, 249

Muscular control, 97

Muscular suggestion, 96

Myelitis, 336

Myocarditis, 336

Myxoedema, 337

Naprapathy, 313

Napravit, 313

Neck, muscles of, 247

Nephritis, 337

Nerve, auditory, 245
chorda tympani, 246
great sciatic, 256
hypoglossal, 245
inferior maxillary, 244
internal carotid, 242
olfactory, 243
phrenic, 248
recurrent laryngeal, 246
trigeminal (trifacial), 244
Vidian, 244

Nerve connections, special, 235

Nerve impingement, 180, 182, 209

Nerve paths, 70

Nerve pathways, important, 242
structure of, 241

Nerves, cranial, 240
optic, 242
spinal, 237
splanchnic, 250
sympathetic, 240
traceable, 64

Nerve system, 171, 222
development of, 219, 220
outline of, 235
sympathetic, 171

Nerve-tracing, 64, 296
errors in, 73
place of in diagnosis, 67
suggestion in, 67
technic of, 68

Neuralgia, 337

Neurasthenia, 337

Neuritis, 337

Neurology, 234

Neuron, 220

Observation of patient, 294

Occipital subluxations, 66

Occipito-atlantal move, 106

Occlusion of foramina, 180

Office equipment, 277

Optic atrophy, 337

Optic nerve, 242

Oral suggestion, 95

Organs, effect of impingement upon, 183

Organ-tracing, 64

Osteopathy, 216, 313, 314, 315

Ovaries, 254

Ovaritis, 337

Overadjustment, 303

Palpation, atlas, 35
cervical, 42, 47, 48
coccygeal, 45
difficulties in, 59
dorsal, 43, 46
habits of, 15
lumbar, 44, 46
pelvic, 44
sacral, 44
transverse, 49
vertebral, 15, 295

Pancreas, 251

Paralysis agitans, 337

Parotitis, 338

Pectoralis muscles, 254

Penis, 253

Pericarditis, 338

Pericardium, 249

Perineal muscles, 249

Peritoneum, 252

Peritonitis, 338

Personality, 319

Pertussis, 338

Pharyngitis, 338

Pharynx, 246

Pisiform anterior cervical move, 100

Pisiform contact, 125, 135, 139, 141, 146

Pleurisy, 338

Plexus, abdominal aortic, 253, 254
Auerbach’s, 251
brachial, 238, 254
cardiac, 249
carotid, 244
cavernous, 243
cervical, 238
coelic, 250, 252
cystic, 251

Plexus, gastric, 251
hemorrhoidal, 253
hepatic, 251, 252
hypogastric, 253
inferior mesenteric, 253
lumbar, 239
lumbosacral, 255
Meissner’s, 251
ovarian, 254
pelvic, 253
pharyngeal, 246
phrenic, 248
prostatic, 253
pudendal, 239, 254
pulmonary, 249
renal, 252
sacral, 239, 254
solar, 250
spermatic, 253, 254
splenic, 251
superior mesenteric, 251, 252
suprarenal, 252
uterovaginal, 254
vesical, 253

Pneumonia, 339

Point 2 contact, 144

Poisons, 197

Position A, 22

Position B, 23

Position C, 23

Positions for palpation, 30

Posterior cervical move, 119

Posterior subluxations, 85

Potts’ disease, 56, 154, 339

Practice, 276

Preferable adjustments, 155

Pregnancy, 339

Preparation of patient, 22

Presumptive statements, 235

Private office, 282

Process, bent spinous, 59

Processes, spinous, 20
transverse, 21

Prognosis, 322
general, 323

Prolapsus, 345

Promises to patients, 306

Prostate gland, 253

Prostatic enlargement, 340

Psychoses, 201

Pudendal plexus, 239

Pulmonary tuberculosis, 340

Quinsy, 343

Rachitis, 340

Rami communicantes, 172
white, 250

Recoil, name of, 132, 133
the, 125
uses of, 131

Record, the, 23
the complete, 29
sample of, 29
use of, 30

Rectum, 253

Reference library, 289

Reflex arcs, 241

Relaxation, 95

Rest room, 287

Retina, 242
central artery of, 243

Retinal hemorrhage, 340

Retracing of disease, 211, 309

Rheumatic fever, 341

Rheumatism, 341

Roll, the, 285

Rotary move, the, 111, 115, 116

Rotation, axis of, 80
vertebral, 80

Rubella, 341

Rules for adjusting positions, 127

Sacrum, 17, 19, 149

Sacral adjustments, 149

Sacral plexus, 239

Salivary glands, 246

Sample record, 29

Scarlet fever, 341

Schedule of examination, 292

Schneiderian membrane, 243

Scoliosis, 55

Scrotum, 254

Second metacarpal contact, 103

Segmentation, 219, 229

Selecting movement, 156

Seminal emissions, 341

Seminal vesicles, 258

Sensor areas of lower extremity, 257

Serratus magnus muscle, 255

Serum-therapy, 186, 315

Shoulder joint, 255

Signs, 290

Simple continued fever, 341

Single transverse moves, 141, 142, 146

Smallpox, 342

Smell, 243

Special cases, 301

Special nerve connections, 235

Specific adjustment, 230, 303

Spinal column, 16, 222

Spinal nerves, distribution of, 237

Spine, 16

Spino-organic connection, 217

Spinous, bent 59

Spinous process, 20

Splanchnoptosis, 342

Spleen, 251

Splenic enlargement, 342

Splenitis, 342

Spondylitis deformans, 342

Spondylotherapy, 215, 313, 315

Spread move, 148

Stimulation, 169, 189

Stomach, 251

Strabismus, 342

Subluxation, 217
direction of, 25
effect of, 179
the individual, 40
theory, 172

Subluxations, age of, 87
anterior, 84
contiguous, 37
effect of, 79
increase of, 191, 193, 196, 199

Subluxations, inferior, 83
lateral, 84
law governing location of, 78
major, 39
minor, 39
occipital, 86
posterior, 85
production of, 76
secondary causes of, 77
superior, 83
varieties of, 80

Suggestion, muscular, 96
oral, 95

Suggestive therapeutics, 315

Sunstroke, 342

Supporting head in adjusting, 105

Suprarenal capsules, 252

Susceptibility, 186

Sympathetic, cervical, 242

Sympathetic nerves, distribution of, 240

Sympathetic nerve system, 171

Syphilis, 342

Tabes dorsalis, 343

Table of diseases and adjustments, 257

Table of subluxations and moves, 155

Tachycardia, 343

Talking points, 306

Teeth, 245

Tenderness 69, 71

Tension, 181

Testes, 254

Tetanus, 343

Theory of Chiropractic, 172

Theory, subluxation, 172

Thigh, 255, 256

Thoracic aneurism, 343

Thoracic nerves, 238

Thrust, 91

Thumb move, 121, 123

Thyroid gland, 247

Tipping, vertebral, 82

T. M., 121, 123

Tongue, 245

Tonsilitis, 343

Tonsils, 246

Torticollis, 344

Trachea, 249

Transmitted shock, 91

Transverse adjusting, 135, 138, 139, 141, 143, 146, 148

Transverses, 21

Trauma, effect of, 174, 178

Tube, eustachian, 245
fallopian, 254

Tuberculosis, pulmonary, 344

Tumors, benign, 344
malignant, 344

Typhoid fever, 189, 344

Underscoring, 26

Ureters, 253

Urethra, 253

Use of adjuncts, 315

Uterus, 254

Uteroversion, 345

Vagina, 254

Valvular disease, 345

Variations in number of vertebrae, 60

Varieties of subluxation, 80

Varicocele, 345

Varicose veins, 345

Vermiform appendix, 253

Vertebrae, 16
cervical, 16
dorsal, 16
lumbar, 16
variations in number of, 16, 60

Vertebral palpation, 15, 295

Vertebra prominens, 17, 19

Vital energy, 169

Visceral nerves, 239, 253

Waiting room, 280

Worry, 201

Transcriber’s Notes

Punctuation, hyphenation, and spelling were made consistent when a
predominant preference was found in this book; otherwise they were not
changed.

Simple typographical errors were corrected; occasional unbalanced
quotation marks retained.

Ambiguous hyphens at the ends of lines were retained.

The hierarchy of the Table of Contents has been used as the guide to
the rest of the book, even though the two sometimes differ.

Index not checked for proper alphabetization or correct page references.

Page 26: “P R S” has an underline below “P” and a double-underline
below “R”.

Page 34: “flexed far toward” perhaps should be “forward”.

Page 79: “as well all the details” may be missing “as” after “well”.

Page 117: “all vertebra above, so to speak” perhaps should be
“vertebrae”.

Page 147: “this move is predicated” was printed as “this more was
predicated”; changed here.

Page 158: “Posterior, right, inferior--P. R. I.” was printed as
“P. R. L.”; changed here.

Page 187: “but is claimed” probably should be “but it is claimed”.

Page 307: “has been builded” was printed that way.

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