History Volume 32, No.1 59 Chiropractic and Type O (Organic) Disorders: Historical Development and Current Thought

STEVE TROYANOVICH, DC* AND JENNIFER TROYANOVICH, BA#

The chiropractic profession originated at a time when the healing arts were comprised of a medley of capricious theories, practitioners, and prac- tices. Early chiropractors claimed to treat and cure a wide spectrum of ail- ments; however, in this era, the diagnosis and treatment of was, by definition, the practice of or . To avoid conflict with the law and differentiate chiropractic from medical practice, the profession abandoned medical terminology and chiropractic as a disease-specific inter- vention in favor of a distinct lexicon and a doctrine of chiropractic as a non- ‘therapeutic’ philosophy, and art. This allowed for the possibility that analysis, detection and correction of the chiropractic lesion could indi- rectly cure or improve a wide range of clinical conditions – both muscu- loskeletal and organic (Type O) – without infringing upon the practice of licensed healthcare providers. On the surface, improvement or cure of organic disorders by manual treatment methods seems to be " . . . a fantastic and totally unacceptable claim.” Is improvement or cure by manual treatment methods of non- musculoskeletal conditions possible? Or are such notions implausible and unlikely? The evolution of the profession's claims, management, clinical success or failure with Type O disorders is generally discussed in the his- torical context of the healing arts and scientific evidence.

Introduction by manual treatment methods will be ex- The genesis of the chiropractic profes- plored in the historical context of the heal- sion occurred when a self taught healer of ing arts. Additionally, manual treatment of the late nineteenth century, Daniel David Type O disorders will be broadly discussed Palmer, manually manipulated the upper in light of a government investigation and dorsal spine of a partially deaf janitor, re- the scientific literature. storing his sense of hearing.1 Today, this claim would be met with skepticism or dis- The Healthcare Landscape and counted as outright ; however, Medical Education circa 1800-1900 during the 19th century, people would find During the early nineteenth century, this claim acceptable, if not likely. healthcare was a hodgepodge of capricious In this treatise, the origination of the chi- theories, practitioners and practices: ap- ropractic profession and claims of improve- proaches included allopathy, herbalism, ment or cure in cases of Type O disorders Thomsonism, , Grahamism, hydropathy, Seventh-day Adventism, phre-

*Private practice of chiropractic, 322 Susan Drive, Suite B, Normal, IL 61761 nology, Fletcherism, , [email protected] #President and Executive Director, Central Illinois Neuroscience Foundation, magnetic healing, osteopathy, patent medi- 1015 S. Mercer Ave., Bloomington, IL 61701 www.cinf.org cines, Mesmerism, electro-medicine, divine

Reprinted by permission of the Association for the Chiropractic History Volume 32, No.1 60 healing and physical culture,2 among oth- from sixteen to twenty weeks; ers. More was known about human anat- D) Laboratories and libraries were all omy than ever before, yet the healing arts but non-existent in most institutions; still reflected local customs, traditions and E) The primary method of instruction spiritual influences in ridding the body of was lecture with little personal contact physical ailments. between student and professor, or be- Although is the pri- tween student and patient; mary method of care in today's society, at F) At many schools, students could fail the turn of the twentieth century, a visit to several courses and still obtain a medical an allopath was often a last resort. Allo- degree; and, pathic believed that the harsh- G) 120 of the more than 150 medical ness of the remedy should be proportional schools in operation should be closed. to the severity of the disease, meaning the Flexner’s report also suggested that the sickest patients often received the most in- quality of medical education, with variable vasive treatments.2 "Heroic therapy," in- curricula and training, was further diluted cluding regimens of bloodletting, purga- by insufficient funding for facilities and the tives and emetics, was often more harmful faculty necessary to effect a scientifically than the disease itself.3 Ludmerer notes, “It rigorous course of study.6 When the Johns was estimated that a patient in 1900 stood Hopkins School of Medicine was opened in only a fifty-fifty chance of benefiting from 1893, the school Flexner held up as ideal,7,8 an encounter with a random .”4 American theological schools had endow- Thus, it is not surprising that alternatives to ments of approximately eighteen million "orthodox" allopathic medicine existed at dollars, whereas medical school endow- this time as patients were commonly afraid ments totaled five hundred thousand dol- of accepted techniques. lars.9 Funding for medical education was In the late 1800s, however, medical edu- as lacking as the scientific discoveries cation in the United States was primarily needed to advance appropriate care and by apprenticeship with no formalized aca- treatment. demic standards for the training of physi- While medicine was practiced haphaz- cians.2 Consequently, most allopathic phy- ardly in the late 1800s, there were also few sicians were no better off in terms of the reliable treatments available. For example, foundation of their methodologies than penicillin would not be discovered until their "unorthodox" counterparts. It was not 1928 and would not be mass produced until until 1910, with the publication of the Flex- 1943.9 The most common cause of death in ner Report describing medical education as the era of the founding of the chiropractic a shambles, that the orthodox medical es- profession was infectious disease, namely tablishment made sweeping changes to im- and tuberculosis.8 Mankind prove the quality of medical education. In was involved in a death match against his his landmark report,5 Abraham Flexner ex- own filth and the bacteria and viruses that posed the following: thrived in the relatively poor sanitation of A) Most medical schools required only a the period. high school diploma as eligibility for It was in this environment that rival enrollment; methods to allopathic medicine found fer- B) Few schools assigned grades or gave tile soil in which to grow and flourish. examinations; These rivals found equal footing with allo- C) A standard course of study lasted pathic medicine for the relief of human suf-

Reprinted by permission of the Association for the History of Chiropractic Chiropractic History Volume 32, No.1 61 fering, claiming to have solutions to all Figure 1 is a reproduction of the adver- manner of ailments. In this milieu, it is not tisement for the Palmer School and Infir- surprising that D.D. Palmer, practicing his mary. newly established healing art of chiroprac- tic in the Ryan Building in downtown Dav- Chiropractic and the Law enport, Iowa, claimed improvement or cure Prior to chiropractic licensing laws, chi- of a wide variety of disease entities pre- ropractors were routinely arrested, indicted senting to his clinic. A full-page advertise- and convicted on charges of practicing ment from a local broadside contains the medicine or osteopathy without a license.12 following Palmer proclamation: D.D. Palmer himself was convicted on 28 I treat all , but it might be well to March 1906 of practicing without a license mention here a number of diseases in the and was sentenced to a fine of $350, or 105 treatment of which medical doctors rarely meet with success, whereas days in the Scott County jail. Palmer re- seldom fail. fused to pay the fine and was incarcer- 13 Diptheria--People say: "We can readily ated. Palmer's early writings and broad- understand how your treatment will cure side advertisements provide evidence that rheumatism or diseases of the joints, but you the language he used to describe his meth- certainly do not claim to cure diphtheria." I ods included the diagnosis and treatment of do claim to cure diptheria in its most ma- 11 lignant forms. disease. By definition, diagnosing and Bowel Troubles--Diarrhoea, flux, consti- treating disease was the practice of medi- pation, and, in fact all diseases of the stom- cine or osteopathy. ache, intestines and peritoneum are re- The first acquittal of a chiropractor ar- lieved by restoring harmony to the vital forces. rested on the charges of unlicensed practice Insanity--Has in many cases yielded to was secured, in part, due to the legal strat- chiropractic treatment. Many cases are egy employed by defense counsel Tom caused by mechanical injury. Morris. As described by Troyanovich and Fevers--By taking off the pressure upon Keating,13 and Rehm,14 the saga concerning nerves and controlling the caliber of small . Japanese immigrant and Palmer School of Smallpox being cured by one or two Chiropractic graduate Shegetaro Morikubo treatments. on the charges of the unlicensed practice of Female Diseases--Are very successfully osteopathy in La Crosse, Wisconsin in treated. Local treatment is not necessary. 1907, was strategically devised to legally Goitre--Is always caused by pressure upon the nerves, and we know how to take differentiate chiropractic from the practice off the pressure. of medicine. The story is revisited here to Asthma--Medical men will tell you that provide context as to why medical termi- only a change of climate will bring relief. nology was abandoned in favor of a vo- The trouble is, they don't know the cause. cabulary and practice philosophy different Asthma has been cured by Chiropractic treat- ment in one treatment. Irritation of nerves from that espoused by either allopathic or causes the spasmodic contraction, and re- osteopathic medicine: moval of the irritation cures the disease. To mention all the diseases treated suc- Prior to the Morikubo v. Wisconsin case cessfully by Chiropractic would take more in 1907 in La Crosse, two other chiroprac- printer's ink than I could afford to buy, but tors, G.W. Johnson and E. J. Whipple, had perhaps I have mentioned enough to con- vince the reader that my method of treatment been arrested on unlicensed practice charges is not limited to the cure of a few simple and Whipple had been convicted (11 Octo- troubles.11(author's emphasis) ber 1905). At Whipple's trial, D.D. Palmer

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Figure 1. 14 June 1902 Davenport Times advertisement for the Palmer Chiropractic School and Infirmary

Reprinted by permission of the Association for the History of Chiropractic Chiropractic History Volume 32, No.1 63 had served as the expert witness for the de- caused interferences to nerve transmission fense, but his efforts in this case—as with by pinching nerves at the intervertebral fo- his own case five months later—would fail ramen. With vertebral subluxations re- to convince the jury that his beloved chiro- duced, pinched nerves were released from practic was different in principle or prac- pressure, normal nerve transmission was tice than medicine or osteopathy. restored to end-organs and “Nature” ef- In a carefully thought out plan, Shege- fected the cure. Therefore, spinal adjust- taro Morikubo was dispatched to La Crosse ments applied by chiropractors were not to establish his own chiropractic practice therapeutic in character, but instead an in- with the intent of enticing the authorities to tervention aimed at fortifying the mechan- arrest him on unlicensed practice charges. ics of human structure which in turn re- This did in fact occur and local attorney, sulted in improved nervous system activity. Tom Morris was hired to mount a defense. This is how the profession differed from Morris did not use the expert testimony either medicine or osteopathy, according to of either D.D. or B.J. Palmer; the younger the Langworthy tenets. Palmer had never testified in court and the elder Palmer had not demonstrated himself The Langworthy Doctrine to be a skilled or convincing witness. Also, Further evidence of the difference in the literature produced by the Palmers which the Palmers and Langworthy pro- would be of no help to Morris or his client, moted their chosen profession can be seen Morikubo. Instead, Morris turned to the in an advertisement for the Langworthy writings of one Solon Massey Langworthy, school and practice. Figure 2 is a repro- a dual degree holder in both osteopathy and duction of a public notice from a 1904 Ce- chiropractic, who established the American dar Rapids, Iowa broadside. In contrast to School of Chiropractic in Cedar Rapids, Palmer’s 1902 advertisement, Langworthy Iowa in 1903. proclaimed that nature—not the chiroprac- Langworthy was responsible for a num- tor—effected the cure of patients’ ills. ber of improvements to the profession. He Langworthy rejected medical terminol- was the first to use the term "subluxation" ogy in favor of a different lexicon and a in chiropractic; established a systematic doctrine of chiropractic as a non- curriculum of lectures and clinical work for therapeutic philosophy, science and art. his school; published the first regular jour- This also allowed for the possibility that nal; co-authored and published the profes- analysis, detection and correction of the sion's first textbooks; and, was the first to chiropractic lesion could result in improve- sponsor legislation to regulate the profes- ment or cure of a wide range of clinical sion.15, 16 conditions—both musculoskeletal and or- As a dual degree holder, Langworthy ganic—without infringing upon the prac- was uniquely qualified to outline the differ- tice of other licensed healing arts. Under ences between chiropractic and osteopathic the guidance of Tom Morris, B.J. Palmer manual methods. Additionally, he was adopted the Langworthy doctrine as a able to articulate the difference between means to protect chiropractors and the pro- chiropractic theory and practice philosophy fession from persecution under existing and that of medicine or osteopathy: chiro- laws.13,14 practors did not diagnose and treat disease. By 1918, due chiefly to personal diffi- Rather, chiropractors analyzed the spine culties, Langworthy disappeared from and adjusted vertebral subluxations that healthcare. His influence on the chiroprac-

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Figure 2. American School of Chiropractic advertisement circa 1904 from a Cedar Rapids, Iowa, broadside.

Reprinted by permission of the Association for the History of Chiropractic Chiropractic History Volume 32, No.1 65 tic profession would be indelible, though internal organs. He states: largely invisible, as B.J. Palmer seized the There is little room for controversy if our helm of the profession from both his Cedar present knowledge about referred and radiat- ing is taken into account. Melzack and Rapids competitor and his father. The Wall (1965) and Milne et al. (1981) have Langworthy doctrine was propagated by shown that nociceptive stimuli from all struc- B.J. Palmer until his death in 1961, and tures in a segment converge to cells in lamina influenced how the profession described V of the basal spinal nucleus. This, of the potential effect chiropractic adjust- course, also applies to pain coming from in- ternal organs. It is, therefore, easy to see that ments might have on any or all body sys- the locomotor system can readily simulate tems for decades. visceral pain, and vice versa, and that this constitutes an important aspect to be taken Organic Disorders, Manual Treatment into account in differential diagnosis. If this is clear, then the therapeutic consequences Methods and Modern Allopathic Medicine 19 Although it may seem implausible that should not cause much controversy. (author’s emphasis) manual treatment methods could result in Lewit suggests that the spine may play a any improvement or cure of organic disor- role in promoting organic/visceral disease ders, medical practitioners have described and terms this possibility as conditions the phenomenon of patients who have been having a "vertebrogenic factor."19 He goes helped by the use of manual treatment on to describe his experimental and clinical methods for Type O conditions. For exam- experience using spinal to ple, orthopedic surgeon J. F. Bourdillon, treat conditions as varied as heart disease, physical medicine and rehabilitation physi- digestive problems, dizziness, respiratory cian E.A. Day, and physiotherapist M.R. difficulties, , gynecological disor- Bookhout have made the following state- ders, tonsillitis, and an assortment of other ment about the account of Harvey Lillard, human ailments after serious pathology has the man whose hearing was restored by a been ruled out. at the hands of D.D. G.P. Grieve, a British physiotherapist, is Palmer: the author and editor of several publica- On the face of it this is a fantastic and totally unacceptable claim. As a result of tions regarding manual treatment methods. personal experience, however, there is no In his text, Mobilization of the Spine, he doubt in the mind of at least one of the au- states: thors that dysfunction in the joints in the up- All those experienced in manipulation per thoracic spine can affect the function of can report numerous examples of migrainous the inner ear, presumably by way of its sym- headaches, disequilibrium, subjective visual pathetic innervation.17 disturbances, feelings of retro-orbital pres- Kunert, a German medical physician sure, dysphagia, dysphonia, heaviness of a states, limb, extrasegmental paraesthesia, restriction . . . lesions of the spinal column. . . are per- of respiratory excursion, abdominal nausea fectly capable of simulating, accentuating or and the cold sciatic leg being relieved by manual or mechanical treatment of the verte- making a major contribution to organic dis- 20 eases. There can . . . be no doubt that the bral column. state of the spinal column does have a bear- Thus, chiropractors are not the only ing on the functional status of the internal healthcare practitioners to observe the po- organs.18 tential effect spinal manual methods may Lewit, a practicing neurologist and ad- have on the organs or viscera of the human vocate of manual treatment methods has body. discussed the role of the interplay between the musculoskeletal system and the body's

Reprinted by permission of the Association for the History of Chiropractic Chiropractic History Volume 32, No.1 66 The Commission of Inquiry Into Chiro- that such results were impossible, simply practic because knowledge of neurophysiology had not advanced to a point where the possibility Over thirty years ago, the effect chiro- of such results from spinal manual therapy— practic manipulation might have on organic however remote he might think they were— disorders was addressed as part of a gov- could positively be excluded.21 ernment commissioned study. The inquiry Due to the compelling neuroanatomic took place in New Zealand and the pub- and anecdotal evidence presented, the com- lished proceedings became known com- mission concluded that occurrences of im- monly as The New Zealand Report.21 The provement or cure by manual treatments in purpose of the inquiry was to consider cases of organic disease were possible. whether chiropractic services should be However, the commission also concluded included for reimbursement in New Zea- that the results obtained by manual treat- land's socialized healthcare benefits pack- ment methods in cases of visceral disease age. The Commission of Inquiry sought were so unpredictable that the patient evidence from a wide variety of sources in should be under concurrent medical care. New Zealand as well as Australia, the It is also important to note that the New United Kingdom, Canada, and the United Zealand Report clearly stated that chiro- States. The Commission received 264 ex- practors DO NOT treat organic disease, but hibits and acquired over 3,600 pages of rather, treat spinal column dysfunction. To oral testimony.21 The New Zealand study emphasize this point one may look again to is considered the most in-depth investiga- the New Zealand Report for an explana- tion of the chiropractic profession ever un- tion: dertaken. The chiropractor does not set out to cure Chapter ten of the published report spe- or relieve a particular ailment. What he sets out to do is to ensure that the spinal column cifically addresses the potential effect chi- is functioning normally. If a particular ail- ropractic manipulation might have on or- ment clears up or is relieved following ther- ganic or visceral disorders. The Commis- apy, so much the better. If it does not, then at sion referred to these conditions as "Type least the patient, now with no spinal impedi- O" disorders to distinguish chiropractic ment to the working of his nervous system, ought to be in a generally better condition management of these types of conditions and better able to cope with the ailment. 21 from musculoskeletal disorders (that the This explanation should seem familiar to Commission designated as “Type M” dis- the reader as it is simply a restating of the orders). Langworthy doctrine already discussed. The Commission of Inquiry found that As a result of the testimony and evi- essentially all practitioners of manual treat- dence presented regarding chiropractic care ment methods (chiropractors, osteopaths, and Type O disorders, the Commissioners medical manipulators, physical therapists, of the New Zealand Report came to several and lay manipulators) can report improve- specific conclusions and recommendations. ment or cure in cases of organic disorders. The report states: The Commission of Inquiry’s published If a patient with a Type O disorder report states: wishes to consult a chiropractor in the hope A number of medical experts told the that some relief can be obtained, there is no Commission that the results chiropractors and reason why he should not do so, provided their patients claimed in Type O (organic) there are no contraindications to spinal man- cases were unlikely to be the results of spinal ual therapy, and provided he is encouraged to manual therapy. . . However, at the same remain under medical care. . . Chiropractors time no medical expert was prepared to say should be careful to avoid giving any impres-

Reprinted by permission of the Association for the History of Chiropractic Chiropractic History Volume 32, No.1 67 sion that spinal manual therapy will necessar- domized clinical trial did not appear in the ily be beneficial to a patient with a Type O medical literature until 1948,28 Palmer's disorder. In particular chiropractors should in such cases do nothing which discourages a efforts were praiseworthy for their day. patient from remaining under medical care. Ideally the chiropractor should regularly con- Chiropractic Research and Evidence in sult the patient's own doctor, although pre- the 21st Century sent medical attitudes may rule that out as a Many have followed in BJ Palmer’s realistic possibility.21 footsteps to document the effectiveness of The B.J. Palmer Research Department chiropractic, and with great success. At In 1935, B.J. Palmer established a re- present, there are at least fifty prospective search department in the B.J. Palmer Chi- randomized clinical trials published in the ropractic Clinic to document improvement indexed medical literature supporting the of patients with a wide variety of ailments efficacy of chiropractic for neck, back and presenting for chiropractic evaluation. The headache pain. However, the evidence for research department had a medical unit and the effectiveness in treating Type O disor- chiropractic unit. In the medical unit, two ders remains mixed. "medical men" were staffed to document In 1995, Troyanovich authored an article in the popular chiropractic literature titled, symptoms and pathology and derive a 29 medical diagnosis for each patient.22 This “I Don’t Believe in Chiropractic!” He allowed Palmer to retain documentation in argued that belief implies faith or trust the standard medical format of the period without proof and, in the case of chiroprac- that, he believed, validated his care of pa- tic, it was proven that chiropractic was ef- tients and provided evidence of improve- fective in treating neck, back and headache ments made in various human physiologic pain. Troyanovich also reviewed the evi- parameters as a result of chiropractic care. dence for Type O disorders, presenting a Palmer published the results of his find- table with thirty-nine citations pertaining to ings in a series of bulletins. Five of the the chiropractic care of non- bulletins (Figure 3) issued from the re- musculoskeletal conditions from the in- search clinic covered changes in val- dexed literature. These articles reviewed ues,23 urological values,24 audiometric chiropractic patients receiving care for measures,25 electrocardiographic improve- headache, infantile colic, hyperactivity, ments,26 and basal metabolic improve- enuresis, premenstrual syndrome, dys- ments27 that Palmer reported were a result menorrhea, child birth, cardiovascular con- of specific chiropractic adjustment of the ditions, seizure disorders, otitis media and upper cervical area. blindness (Figure 4). While the list of con- B.J. Palmer's efforts at validation and ditions aided by chiropractic spinal manual clinical research are commendable consid- methods may be impressive, it is not scien- ering he had no formal training in research tifically compelling as the majority of the methodology. Perhaps one of the most sig- reports are anecdotal in nature. In an anec- nificant shortcomings of Palmer's research dotal case report the number of subjects is is that there are no control groups against equal to one (n=1). Even if one were to which to make comparisons. With no con- amass hundreds of case reports about the trol groups, all patient improvements may same condition, the evidence would still be have been due to natural history or regres- anecdotal at best. A plurality of anecdotes sion to the mean. However, if one consid- is not equivalent to scientific data derived ers that the first published prospective ran- from properly controlled and randomized

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Figure 3. Five of the bulletins issued from the B.J. Palmer Chiropractic Clinic and Research Department.

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Figure 4. Table of Type O disorders cared for by chiropractors from the indexed literature. Reprinted with permission of the author. clinical trials. against the utility of for these kinds of conditions.30 In 2002, Meeker, Mootz and Halde- 31 man authored a report on the status of chi- Finally, in 2007 Hawk et al. published ropractic research. In their review of the a systematic review of the scientific litera- literature they discuss the findings of ten ture with respect to chiropractic care for randomized clinical studies of chiropractic nonmsuculoskeletal conditions. Their care for a number of Type O disorders. In search located 179 articles addressing 50 regard to the findings of these clinical trials different nonmusculoskeletal diagnoses. they state: These articles were comprised of 122 case Randomized clinical trials for primary reports or case series, 47 experimental de- , , chronic asthma, signs (14 of which were randomized clini- enuresis, infantile colic, and premenstrual cal trials), nine systematic reviews of the syndrome have been completed in recent literature and one cohort study. They con- years with variable results. Two systematic reviews, one on extant trials at the time and clude: one recently on asthma sponsored by the Evidence from both controlled studies Cochrane Collaboration, concluded that the and usual practice is adequate to support the results so far do not argue convincingly for or 'total package' of chiropractic care, including

Reprinted by permission of the Association for the History of Chiropractic Chiropractic History Volume 32, No.1 70 spinal manipulative therapy, other proce- One might speculate as to Hurwitz et dures, and unmeasured qualities such as be- al.’s findings: Is it possible that modern lief and attention, as providing benefit to pa- tients with asthma, cervicogenic vertigo, and medicine has evolved to the point where infantile colic. medicine’s effectiveness for many or most Evidence was promising for the potential Type O disorders has essentially eliminated benefit of manual procedures for children chiropractic care as a reasonable option for with otitis media and for hospitalized elderly most patients? Or perhaps, chiropractic has patients with pneumonia. Evidence did not appear to support chiro- evolved in the public’s consciousness to a practic care for the broad population of pa- profession with a singular musculoskeletal tients with hypertension, although it did not focus? Or is it that the influence of third rule out the possibility that there may be sub- party reimbursement has resulted in chiro- populations of hypertensive patients who practors only documenting musculoskeletal might benefit. Evidence was equivocal regarding chiro- conditions in their patient records to insure practic care for dysmenorrhea and premen- payment? Or perhaps, the unpredictable strual syndrome . . . nature of chiropractic’s effect on organic There is insufficient evidence to make disorders has reduced the number of pa- conclusions about chiropractic care for pa- 31 tients seeking this type of care? Only future tients with other conditions. research will be able to address the veracity The findings summarized by Meeker, of these speculations. Mootz and Haldeman and Hawk et al. echo the unpredictable nature of the effects of Summary and Conclusion chiropractic care on Type O disorders that The chiropractic profession originated at the Commissioners of the New Zealand a time in history when many types of heal- study described over 30 years ago. Hawk ers, health theories, and health practices co- and colleagues, work, however, seems to existed. Suffering humanity sought help have a slightly different perspective in that from the many players in this motley collec- they attempt to define those conditions for tion due to the lack of effective treatments which chiropractic care may have more for scores of mankinds’ ills. Both govern- beneficial results. mental and scientific investigators have un- covered strong neuroanatomic and compel- Chiropractic Management of Type O ling anecdotal evidence for the success of Disorders in the Modern Era spinal manual methods in treating Type O The entire discussion presented above disorders; however, investigators also recog- may be purely academic in the present nize that patients’ results are unpredictable. time. In 1998, an article published in the In the future, researchers may identify American Journal of Public Health re- some types of organic disorders with a ver- ported on the demographics of 1,916 pa- tebrogenic etiology. If this occurs, medical tients whose records were randomly se- physicians and doctors of chiropractic will lected from 131 chiropractic offices in five have a better understanding about which cities in (four U.S., one Ca- organic entities might respond predictably to nadian). Hurwitz et al.32 reported that low spinal manual therapies. Currently, how- back problems constitute two-thirds of the ever, improvement or cure in cases of or- patients treated by chiropractors with head- ganic disorders as a result of chiropractic ache, neck pain and extremity complaints treatment remains an unpredictable side- making up almost all the rest. Interest- effect of restoring mechanical integrity to ingly, only one percent of chiropractic pa- patients’ spines. tients had non-musculoskeletal diagnoses.

Reprinted by permission of the Association for the History of Chiropractic Chiropractic History Volume 32, No.1 71 Acknowledgement American Medical Association, 303(15), The authors wish to thank Ms. Samantha 1465-66. Labak and Ann Stroink, M.D. for their con- structive input and advice regarding revi- 8Duffy, T.P. (2011). The – sions to this manuscript. The authors also 100 years later. Yale Journal of Biology wish to thank Drs. Joseph Sweere and J.C. and Medicine, 84, 269-76. Smith who serve as manuscript reviewers for Chiropractic History; their valuable 9Barry, J.M. (2009). The great influenza. critiques improved the quality of this sub- London, England: Penguin Books Ltd. mission. 10Kelly, K. (2010). The history of medi- cine: Medicine becomes a science, 1840- 1999. New York, NY: Facts on File, Inc.

Notes 11Palmer, D. D. (1902, June 14). What we

1 treat with the chiropractic science. Daven- Wardwell, W.I. (1992). Chiropractic: port Times, p. 14. history and evolution of a new profession. St. Louis, MO: Mosby-Year Book. 12Keating, J.C., Cleveland, C.S. & Menke,

2 M. (2004). Chiropractic history: A Armstrong, D. & Metzger-Armstrong, E. primer. Davenport, IA: Association for (1991). The great American medicine the History of Chiropractic. show. New York, NY: Prentice Hall. 13 3 Troyanovich, S.J. & Keating, J.C. (2005). Rothstein, W.G. (1987). American medi- Wisconsin versus chiropractic: The trials cal schools and the practice of medicine: a at LaCrosse and the birth of a chiropractic history. New York, NY: Oxford Univer- champion. Chiropractic History, 25(1), 37 sity Press. -45.

4 Ludmerer, K.M. (1999). Time to heal: 14Rehm, W.S. (1986). Legally defensible: American medical education from the turn Chiropractic in the courtroom and after, of the century to the era of managed care. 1907. Chiropractic History, 6, 51-55. New York, NY: Oxford University Press. 15 5 Troyanovich, S.J. & Gibbons, R.W. Flexner, A. (1910). Medical education in (2003). Finding Langworthy: The last the United States and Canada. New York, years of a chiropractic pioneer. Chiroprac- NY: The Carnegie Foundation. tic History, 23(1), 9-17.

6 Beck, A.H. (2004). The Flexner report and 16Troyanovich, S.J. & Coleman, R.R. the standardization of American medical (2004). Origins of the use of mechanical education. Journal of the American Medi- traction for reduction of the chiropractic cal Association, 291(17), 213-40. subluxation. Chiropractic History, 24(2), 1

7 -10. Mitka, M. (2010). The Flexner report at the century mark. A wake-up call for re- 17Bourdillon, J.F., Day E.A., & Bookhout, forming medical education. Journal of the M.R. (1992) Spinal Manipulation. Ox-

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25Palmer, B.J. (1949). Audiometric changes 32Hurwitz, E.L., Coulter, I.D., Adams, under specific chiropractic adjustment: A.H., Genovese, B.J., & Shekelle, P.G. Research on 1029 cases in the B.J. Palmer (1998). Use of chiropractic services from Chiropractic Clinic. Davenport, IA: 1985 through 1991 in the United States and Palmer School of Chiropractic. Canada. American Journal of Public Health. 88, 771-776.

Reprinted by permission of the Association for the History of Chiropractic