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.

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