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You may copy it, give it away or -re-use it under the terms of the Project Gutenberg License included -with this eBook or online at www.gutenberg.org/license - - -Title: Technic and Practice of Chiropractic - -Author: Joy Maxwell Loban - -Release Date: January 18, 2017 [EBook #54008] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK TECHNIC AND PRACTICE *** - - - - -Produced by Turgut Dincer, Charlie Howard, and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - - - - - - - - - -Transcriber’s Note: Boldface text is enclosed in =equals signs=; -italics text is enclosed in _underscores_. - - - - - 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 - - - - - COPYRIGHT 1915 - BY - JOY M. LOBAN - - - 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. - -Or - -Dietetic error. - -Abnormal chemical action. - -Tissue destruction or nerve irritation by chemical poisons. - -Reflex motor disturbances which further limit digestive power. - -Or - -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. - - - A - - _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. - - - B - - 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. - - - C - - 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. - - - D - - 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. - - - E - - 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. - - - F - - 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. - - - G - - 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. - - - H - - 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. - - - I - - 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. - - - J - - Jaundice D 4. - - - K - - Keratitis C 3 or 4. - Kyphosis See “Curvatures.” - - - L - - 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. - - - M - - 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. - - - N - - 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). - - - O - - 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. - - - P - - 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. - - - Q - - Quinsy C 2 or 3. - - - R - - 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.” - - - S - - 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. - - - T - - 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). - - - U - - 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. - - - V - - 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. - - - W - - 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. - - - X - - Xerostomia C 2. - - - Y - - 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 - - - A - - 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 - - - B - - 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 - - - C - - 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 - - - D - - 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 - - - E - - 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 - - - F - - 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 - - - G - - 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 - - - H - - 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 - - - I - - 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 - - - J - - Jaundice, 335 - - Jejunum, 252 - - - K - - Key, 39 - - Kidneys, 252 - - Klebs-Loeffler bacillus, 187 - - Knee joint, 256 - - Knife move, 144 - - Kyphosis, 54 - - - L - - 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 - - - M - - 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 - - - N - - 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 - - - O - - 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 - - - P - - 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 - - - Q - - Quinsy, 343 - - - R - - 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 - - - S - - 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 - - - T - - 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 - - - U - - Underscoring, 26 - - Ureters, 253 - - Urethra, 253 - - Use of adjuncts, 315 - - Uterus, 254 - - Uteroversion, 345 - - - V - - 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 - - - W - - 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. - - - - - -End of the Project Gutenberg EBook of Technic and Practice of Chiropractic, by -Joy Maxwell Loban - -*** END OF THIS PROJECT GUTENBERG EBOOK TECHNIC AND PRACTICE *** - -***** This file should be named 54008-0.txt or 54008-0.zip ***** -This and all associated files of various formats will be found in: - http://www.gutenberg.org/5/4/0/0/54008/ - -Produced by Turgut Dincer, Charlie Howard, and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - - -Updated editions will replace the previous one--the old editions -will be renamed. - -Creating the works from public domain print editions means that no -one owns a United States copyright in these works, so the Foundation -(and you!) can copy and distribute it in the United States without -permission and without paying copyright royalties. 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