Technic and Practice of Chiropractic

by Joy Maxwell Loban

General Observation

Observation of the patient with a view to determining any signs of disease should begin with the moment the patient steps into the office. It should continue during your conversation and during the Vertebral Palpation and Nerve Tracing which follow. The mind of the examiner should be constantly on the alert to note any sign on any exposed part of the patient’s body, or any motion which may betray the nature of the disease or diseases with which he suffers.

Before preparing the patient for palpation observe temperament, position and carriage of head, body, and limbs, and facies.

Ask male patients to strip to the waist and female patients to remove all clothing down to the waist except a loose gown or kimono, which is worn reversed so that it opens behind and exposes the spine to direct examination. No greater error can be committed than to attempt examination of the vertebral column through clothing or other covering. Examine with patient seated on a bench or stool with feet evenly placed upon the floor. If the patient is for any reason unable to assume this position the examination may be varied somewhat.

While in this position continue observation of points mentioned above and observe also condition of skin, whether abnormal in color, moisture or nutrition, or whether there is flushing, cyanosis, or pallor, roughness, eruption, etc.; the condition of bones and joints other than vertebral; general emaciation or obesity, local malnutrition or hypertrophy; evidences of operation, scars etc.; and action of muscles more in detail than is indicated under position and carriage of parts.

Having observed these things discontinue general observation and all other considerations for the time in favor of Vertebral Palpation.

Vertebral Palpation

The primary object of Vertebral Palpation is the location of subluxations, or partial displacements, and the determination of the relative degree and direction of those found. Next comes the recording of subluxations in such a manner that a perusal of your record will enable you to reconstruct at any time a mental picture of the spine, as far as possible. (See [Record].) With the making of the record the proper form of adjustment for the correction of each subluxation is decided.

Finally, by failing to find subluxation in certain segments you may safely eliminate those segments from consideration and confine your further attention to the remainder. (See [Spino-Organic Connection].) It must be borne in mind that while the finding of a subluxation is not always positive evidence of the necessity for adjustment there, the absence of subluxation of any spinal segment is proof positive that no disease exists in the corresponding somatic segment. Differential diagnosis is thus often greatly aided by palpation.

Nerve Tracing

Having thus narrowed the field of operation, trace from spine to periphery every nerve tender enough to be traced, noting the relation of the tender nerves to the subluxations already found by palpation. Whenever it is possible note the degree of tenderness of the various nerves and keep in mind through the remainder of the examination the fact that greater tenderness in some one segment indicated either greater or more acute disease in that segment.

It is best to use great caution about entirely eliminating any segment from consideration because of negative findings in attempted nerve tracing. The fact that no nerve is traceable is not always proof that no impingement exists, but only that no irritation exists. Only light or acute impingement may irritate a nerve. In forty, and possibly fifty, per cent of all cases no nerves are traceable at any time. (See [Nerve-Tracing].)

Special Examination

The examiner has by this time formed some concept of the case in hand. He has a clue to the possible nature of the disease and he has narrowed his observation to a few segments of the body or a few organs which demand a more special examination. This may be accomplished by Inspection, Palpation, Auscultation, and Percussion.

History of Case

Having determined by these methods every fact possible of determination without information from the patient, it becomes necessary to go somewhat into the history of the case. The history of falls, jars, shocks, or injuries of any kind should be taken first and these should be viewed in the light of their bearing upon the previously ascertained condition of the spine. Sometimes the definite history of an accident immediately preceding the development of disease symptoms suggests its connection with the disease and the exact nature of the accident points out to us some one of the several recorded subluxations as the one involved. This in turn may aid a doubtful differential diagnosis. Each step in the process of examination helps to explain and clarify the facts elicited by other steps until the facts marshal themselves into a complete and comprehensible picture.

At this point it will be possible to stop in some cases and rest upon the evidence gathered. If you are able at this time to state clearly the nature of the case, the manner of its cause, the site of disease and of the subluxations causing it, the kind of subluxations, and the chance of recovery under adjustment, it is preferable to do so. You will thus have made a complete diagnosis without recourse to information from the patient except the history of injuries.

Sometimes, however, it will be necessary to go further into the case and ascertain the presence and nature of subjective symptoms. If this be necessary, the examiner should confine his questions to the parts indicated as diseased, and thus limit the number of questions and make them all direct and essential. It is important to avoid trivial or irrelevant questioning.

Summary

Finally, having ascertained all necessary facts, mentally summarize them all, combining the results of Palpation, Nerve-Tracing, and Symptomatology so as to reach a definite conclusion as to the location and nature of the morbid process, the subluxation producing it, and the exact form of adjustment necessary to correct it.

The examiner should be able at the end of the examination to state exactly what he finds to be the condition of the patient, to give reasons and nerve connections, and to demonstrate a subluxation to back every statement.

The case record should contain all essential information relating to the diagnosis and the correction to be applied.

Necessity for Correct Diagnosis

Diagnosis, in a restricted sense, means merely the naming of diseases. But in the broader and more proper sense it means disease knowing and includes a knowledge of the causal factors, the location and nature of disease, the amount of damage to structure and of functional disturbance, and the probable duration and outcome of the case either with or without Chiropractic adjustments. In this broader sense we use the term hereafter.

The object of diagnosis is correct adjustment. Including as it does palpation, nerve-tracing, and symptomatology, the Chiropractor’s diagnosis of a case should embrace all the knowledge upon which he proceeds with his adjustment.

There are really two all-important questions which constantly recur to confront the busy practitioner. One is, “What is the matter with my patient?” and the other, “What can I do to relieve him?” Practice resolves itself into these two divisions, diagnosis and adjustment.

The real question which should suggest itself to the thinking Chiropractor is not, then, “Should a Chiropractor study diagnosis?” but rather, “From what viewpoint should we study diagnosis? Upon what portions of the subject shall we concentrate our attention?”

Undoubtedly the most important branch of diagnosis to us is vertebral palpation. By its use we discover those facts about the spinal column without which we are entirely unable to proceed as Chiropractors. Knowledge concerning the spine is the most essential part of diagnosis.

Next in order of importance comes the study of physical or objective signs throughout the body—the examination of the body for the discovery of all the changes in the size, shape, position, etc., of organs which indicate disease. This includes nerve-tracing, which in some cases is the most important branch of physical diagnosis after vertebral palpation.

Finally, a certain degree of examination for subjective symptoms may be necessary. But the Chiropractor of the future should become, and probably will become, par excellence a physical diagnostician.

For many reasons we should be able to rely upon our own diagnoses. Capability in diagnosis renders us independent of the errors or false beliefs of others. Since it includes a knowledge of subluxations, not included in medical training but still vital to correct interpretation of morbid phenomena, it can be more accurate than any diagnosis which ignores these causal factors. A habit of diagnosing one’s own cases enables one, always resting on his own judgment, to correct and improve himself through all errors, for which he is then alone responsible.

A general knowledge of medical diagnosis, of pathology, bacteriology, etc., enables a Chiropractor to meet the physician on common ground; in fact, it gives the Chiropractor a distinct advantage, since he knows not only what his medical friend knows but also the all-important facts regarding the spine which are unknown to others. Such knowledge and the ability to discuss disease intelligently also furnishes common ground with every patient. Each patient is a specialist in the disease he believes himself to have and he expects from his doctor a greater knowledge than his own.

The recognition of contagious or infectious diseases as such is an absolute necessity in order to obey the laws and safeguard the public health. The exact condition and degree of vitality of the patient and the knowledge of the existence of abscess, gangrene, intestinal obstruction, etc., often warns the Chiropractor that his adjustment would be dangerous to the patient. Much possible injury is avoided by accurate diagnosis. Even the frequency with which adjustments should be given depends upon diagnosis.

Special Cases

There are certain cases which a Chiropractor is powerless to aid and immediate recognition of such cases will save much trouble. In intestinal obstruction from intussusception or from strangulated hernia, for instance, it is best to advise the calling of a surgeon immediately, while in obstruction from volvulus or intestinal paralysis the adjustments may afford relief and should at least be tried first of all.

Any internal abscess presents a possibility of rupture into a serous cavity or the substance of a parenchymatous organ and is therefore dangerous, while a superficial abscess, pointing toward the surface, can best be cared for by adjustment. A badly ulcerated or gangrenous appendix may rupture under adjustment and be followed by diffuse peritonitis. The fragile walls of the ileum in typhoid may perforate under adjustment, while in its earlier stages the disease is easily curable. The rotted vertebral bodies in Potts’ Disease (spinal caries) may be crushed under the heavy hand of an ignorant adjuster.

Intelligent case-taking must include accurate diagnosis.

Frequency of Adjustments

The frequency of adjustments in practice should be determined entirely by the nature of the case and the circumstances in which patient and adjuster are placed. No hard and fast rules can be laid down but some general advice may be profitable.

Acute fever cases may be adjusted, until the fever is broken, oftener than any other type of cases. The chief object is the regulation of the temperature, after which the body is able properly to repair itself. Sometimes it may be necessary to give from two to six adjustments in a day and in at least one tetanus case the adjustments were given at intervals of about ten minutes for several hours until the fever was under control. After such a series it is wisest to refrain from adjusting again for several days so that the patient may recuperate during the interval, providing the fever does not return. It has been noticed that after a series of adjustments given at short intervals the improvement of the patient often extends over a period of days or weeks.

In ordinary chronic cases, with good vitality and reactive power, the daily adjustment is best at first. Then after a course of from six to twenty-four adjustments according to the judgment of the practitioner, the interval is lengthened and adjustments given on alternate days, a day of rest intervening between each two. In weak patients or those who are extremely sensitive, the shock of the daily adjustment, even at first, and the demand on the body’s recuperative power may be greater than can be met.

In this connection it may be mentioned that the author has encountered several cases of dorsal lordosis produced by too heavy and too frequent adjustments, straining the ligaments faster than they could be repaired and continuing the strain over too long a period. It is possible to over-adjust a patient, producing a weakened spine and other deleterious effects, just as it is possible to establish a “tolerance” for a drug by long continued use.

During a long course of adjustments it is well to allow the patient an occasional week of complete rest, or even more, and it may be wise after a time to reduce the number of adjustments to two per week in some cases.

On the other hand, the practice of giving one adjustment a week from the beginning, as followed by some practitioners who maintain offices in numerous localities and visit each one day per week, is not generally productive of good results and it is the author’s practice to refuse new cases who profess their inability to take more than one adjustment weekly. The interval is so long that all repair work started by each adjustment is completed and an involutionary change sets in before the next.

Specific vs. General Adjusting

By specific adjusting is meant the selection and adjustment of the vertebra or vertebrae which are known to be causing definite disease or weakness. The term “specific adjustment” implies that there is a particular reason existing and recognized for every vertebra adjusted.

General adjustment, on the other hand means either the adjustment of all palpable subluxations, or of all the most noticeable ones, or of all found providing that no two successive vertebrae be adjusted, according to the beliefs of different elements in the profession.

Specific adjusting relies upon the diagnosis and requires correct interpretation of disease. General adjusting considers only the condition of the spine and is given upon the principle that if the spine is right the man is right—a perfectly correct principle regardless of whether or not the general adjustment is advisable. Let us consider some of the arguments for and against each method and reach a conclusion if possible.

The use of specific adjustment demands of the Chiropractor an accurate diagnosis and compels him to get his mind into direct contact with the exact condition of the patient in order to select the proper vertebrae. Sometimes the less prominent subluxation causes a more acute or dangerous disease than the more pronounced. Specific adjusting tends to develop more discriminating and accurate palpation.

Specific adjusting weakens and shocks the weak or nervous patient less than general adjusting. It also concentrates the recuperative or reparatory power of the patient on the parts which most need repair. The body possesses only a certain limited capacity for combating disease or building weakened tissue. To scatter this force widely is to weaken its effect in any particular locality.

The habit of specific adjustment and of selecting proper vertebrae enables the Chiropractor to explain definitely at any time just what he is doing and why he is doing it. We assert that in adjusting a vertebra we are removing the primary cause of disease. It is sometimes awkward to be asked if the patient has nine diseases or if it takes nine subluxations to cause one case of acute coryza. A correct answer to either question leaves an embarrassing discrepancy between theory and practice.

In favor of the practice of general adjusting it has been said that errors in diagnosis become unimportant if all subluxations be adjusted; that if the spine be straightened the patient must recover. Against the first statement, which is forceful because diagnosticians are so notably liable to err, it may be said that errors in palpation are almost, if not quite, as frequent as errors in other branches of diagnosis and that one’s tendency to err is less if all possible methods be checked against each other than if one only is used. The second statement is quite true; but it is based upon the assumption that in ordinary practice the spine may be straightened completely. As a matter of fact this rarely, if ever, occurs. It is practically impossible ever to thoroughly “line up” a spine. The best that has been done as yet except in acute subluxations is to so modify subluxations that disease disappears.

We may interject here the statement that no greater or more conclusive betrayal of incompetency can be offered by a Chiropractor than the declaration that he has completely “lined up” a spinal column in one, six, or a dozen adjustments, as some have declared. If one be honest in such statements it is proof positive that he is not capable of accuracy in palpation or else lamentably liable to auto-suggestion. Clinicians of proven ability, who have examined more than five thousand spines each, agree that no perfectly normal spine has been discovered, whether the spine has been adjusted or not.

But the chiefest argument against general adjusting is that it scatters the reparatory forces of the body throughout many segments, some of which are not really in need of attention, while the one or two segments which need all possible concentration of energy receive only a diluted share.

If my patient suffers from an acute pneumonia and nothing else and if I require that he submit to a general adjustment including some eight subluxations, two of which are Lumbars, I am unscientific and unwise. What that case demands is an immediate localized improvement.

It is highly probable that the efficient Chiropractor of the future will be a specific adjuster; that every recognized body condition will suggest a definite and scientifically determined corrective measure; and that guesswork will be largely eliminated.

Talking Points

The things which it is most important that the Chiropractor should set before his patient are the theories and facts peculiar to Chiropractic, perhaps adduced by Chiropractic investigations alone. These theories and facts have been discussed elsewhere in detail: the subluxation theory, easily demonstratable with a spinal column as an object lesson, the relations between primary and secondary causes of disease, the directness and completeness of the results of vertebral adjustments, these explanations are more convincing than the display of a wealth of knowledge of methods and theories used by other schools of practice. Chiropractic has been builded not by virtue of previously established truths but solely on the vitality of the new principles enunciated by it.

These new ideas cannot hope for full and immediate credence and must be presented carefully, with this fact in mind and with due consideration for the degree of intelligence of the listener. Avoid argumentative discussion with patients, seeking rather to enlighten them about those facts peculiar to Chiropractic and unknown to them than to antagonize them by contradicting their cherished beliefs. It is much wiser to begin with that knowledge of disease which you hold in common with the patient and advance with him, step by step, from that firm foundation to new truths than to begin by attempting to tear down his beliefs. Reason from the known to the unknown. Replace an old idea as to the causation of disease by quietly inserting a new one of greater verity and it will presently and painlessly crowd out the old. This process is much the simplest and easiest.

Nevertheless in presenting Chiropractic we must be gently positive. Chiropractic is known and provable. Always able to fall back upon the clinical test as a final argument with supreme assurance that it will not fail to vindicate our claims, we may present an unshaken front before the most powerful and intelligent attack.

Promises to Patients

The majority of patients will require from the Chiropractor an expression of his belief in his ability or inability to cure them. They will desire a statement as to the probable time required for a cure. They may even ask a guarantee of success.

These questions are hard to meet truthfully and convincingly, for the truth is that every Chiropractor fails sometimes and is unable to predict that failure in advance and that no one wise enough to predict the length of time which will be required for the cure of any given case has yet arisen. And these truths do not sound reassuring or convincing.

Explain to the patient that nature alone is the curative agent and that the cure depends not alone upon the skill of the adjuster but upon the exact condition of the vertebrae, the exact amount or degree of damage to tissue, the patient’s habits of living, etc. Any accidental interjection of other factors into the case may have an important bearing. You may assure him of the excellent results you have obtained in other cases similar to his, or even cite individual cases if to do so does not violate a professional confidence. But you had best avoid a promise to cure or an exact statement of the time which will be needed. State your belief or opinion but do not bind yourself to a promise. Offer your best skill and closest attention; you can do no more.

The patient should rely upon the skill of the Chiropractor as upon the skill of his lawyer or his physician. Neither can honestly promise that he will succeed in his efforts, even though all indications point that way.

Re-Tracing of Disease

From the original concussion of forces which produces a nerve-impigning subluxation to the stage of chronic disease with which the patient usually approaches the Chiropractor for relief, disease develops by a series of gradual steps. Successive changes take place from time to time in the degree of subluxation as it is augmented by further jars, strains, etc., or by the reaction of secondary causes upon it and with these changes come corresponding changes in the development of the disease.

Perhaps the first effect of the bad subluxation is irritation of a nerve and acute functional disturbance such as pain, fever, etc. The later effect may be paralysis and its attendant train of evils.

When the Chiropractor begins adjustment he does not at once return the long-displaced and misshapen vertebra to its normal position. He merely tends to do so, his adjustments making slight and gradual changes from the abnormal back to normal.

Thus it is that the subluxation passes back in reverse order through the successive stages of its development, following a process which may be called the involution of the subluxation. At the same time the morbid process resulting from the subluxation tends to retrace its steps, passing in reverse order through the stages by which it developed. Pains which have not been felt for years may unaccountably return under the reawakening of the long dormant nerves. Headache, long absent but once a prominent feature of the disease, may again make its appearance. The patient feels worse.

These changes, however, take place much more rapidly during the correction than during the development of the disease. To a certain extent they are probably always present, although in many cases they occur so rapidly or are modified so much by changed environment as to be unrecognizable. In many cases it is possible by securing an accurate history and by careful observation of the patient’s progress to observe a definite reappearance, in reverse order, of every important event in the history of the disease. For instance, if the patient has at one time had a severe fever, perhaps lasting many weeks, and has later developed a chronic weakness marking the increase in degree of subluxation, the fever may reappear during adjustments, last a day or two, and disappear forever, having been corrected beyond that stage.

If explained in advance to patients with chronic diseases, the facts of retracing may not cause the patient to become discouraged as he would if he failed to understand them. If he knows before your work is commenced that he may expect such phenomena but may possibly escape them he meets them as necessary parts of the process of cure. If they are not explained in advance he is likely to feel that you are doing him injury and to discontinue your service just at the time he most needs them. In fact, it occasionally happens that if adjustments are stopped at some irritant stage of the cure that condition will remain and do great damage.

This theory of retracing has been much abused. Chiropractors have used it to cover a multitude of errors in practice. With some it becomes a habit to call all unfavorable events which occur during adjustments retracing, thus shifting the blame from their own shoulders to Nature’s. This is a pernicious practice because it deceives the patient and also because too frequent repetition of this explanation finally deludes the practitioner into the belief that all such events really are retracing. This view withdraws his attention from his own technic and he ceases to discover his own mistakes by ceasing to look for them.

It is best in the face of any painful or apparently unfavorable development always to examine our own work thoroughly to detect any possible error in diagnosis, palpation, or selection of move for correction. It is always possible for us to err and our cases should be observed at every stage with the most minute care to insure accuracy in detail.

Limitations of Chiropractic

There are many things which can be done better by others than by a Chiropractor. There are others for which the Chiropractor’s training does not fit him at all and to which his methods do not in any sense apply. Knowledge of these limitations is just as essential as acquaintance with the powers of the vertebral adjustment.

Bony dislocations other than vertebral, fractures, wounds causing, or likely to cause, hemorrhage or severe internal injury, should at sight be diverted into the hands of a surgeon. The Chiropractor receives no training in handling such cases and has neither legal nor moral right to attend them. In obstetrics likewise no practical training is given which would prepare the practitioner for delivery and he is unprepared to use necessary asceptic or antiseptic measures.

Some individual cases of disease usually curable will have advanced so far as to require surgical interference. Abscesses or suppurative diseases internally located or having any liability to discharge internally must be avoided. Gangrene, cancer, the advanced stages of tuberculosis (usually) are incurable.

Quarantinable diseases as a class yield readily to adjustment unless some serum treatment has been administered, when the chances of recovery are greatly lessened. But such cases must be reported in conformity with the laws of the state and will probably then be taken out of the hands of the Chiropractor—unfortunately. The laws of the various states should be modified to permit Chiropractors, with precautions required of physicians to safeguard the public health, to pass quarantine. Every effort should be put forth to secure such legislation but until it is secured in any state and the Chiropractor’s work is brought under the supervision of the authorities, the laws must be respected strictly.

Syphilis and gonorrhoea, communicable diseases, should be recognized and refused in practice. The former in the primary and secondary stages (not tertiary) and the latter in all stages is corrective by adjustment but the liability of transmission of the disease warns against contact with it unless all precautions known to science be used to avoid possible transmission.

Congenital anomalies of structure do not yield to Chiropractic and are best let alone although no harm is likely to arise through any attempt to correct them by vertebral adjustment.

Relation of Chiropractic to Other Methods

There are certain other methods which present a superficial resemblance to Chropractic which leads many to believe them closely related. Such methods are Spondylotherapy, Osteopathy, etc. There is a system called Napravit or Naprapathy which may be dismissed with the statement that it is Chiropractic, renamed.

Spondylotherapy, on the other hand, is a system of treating disease which takes no account of the vertebral subluxation as its primary cause and seeks to cure disease by stimulating or inhibiting nerve action through the use of mechanical, thermic, or electrical means. Its resemblance is due solely to the fact that most of the treatment is applied to the spine. As well might we say that serum injection for meningitis is Chiropractic because the serum is introduced by lumbar puncture into the spinal canal.

Osteopathy, since the profession has become aware of the superior results obtainable by vertebral adjustment, is rapidly adopting many Chiropractic methods and counterfeiting it as far as possible. Perusal of their literature of various periods clearly shows that this is a new growth and that they have never adopted in theory what they sometimes use in practice. In fact both the above methods treat disease, following the theory of medicine with the use of different remedies only, while Chiropractic adjusts the cause of disease and avoids treatment of any kind. Chiropractic is not a branch of medicine, never can be a branch of medicine because it is inherently and fundamentally antagonistic to the very basic principles of medicine, and no statute can change the fact of such antagonism. But unless we adhere strictly to the fundamental principles of our own practice and limit ourselves to the methods which grow from those principles Chiropractic may become a part of medicine. Which brings us to

The Use of Adjuncts

There are many methods of treating disease which are more or less beneficial to the patient just as there are some which are always injurious. Shall we employ such of these methods as are beneficial as adjuncts to the practice of Chiropractic? Or shall we adhere to the principle that the treatment of disease is erroneous and the adjustment of its cause the only logical method of procedure? There is much to be said on both sides of this question which has so long agitated the profession.

In the class of beneficial adjuncts may be placed massage, hydrotherapy, spondylotherapy, dietetics, osteopathy, Christian Science, suggestive therapeutics, mechano-therapy, and many others. Each of these has its field of usefulness; each taken alone is productive of some good in some cases at least. Each might possibly augment the results of Chiropractic, or hasten them in some cases, if judiciously used. By judiciously used we mean the avoidance of any method which would in the least interfere with proper vertebral adjustment or its results or which might carelessly cause subluxation. Osteopathy and mechano-therapy frequently cause subluxation because of the ignorance on the part of their users; they need not do so.

Among the pernicious adjuncts, or those which are harmful if combined with adjustments or harmful whenever and however used, may be mentioned drug medicine, serum therapy, and electricity. The first two may sometimes prove the lesser evil if used alone. With Chiropractic they are always unnecessary and always tend to lessen the good effect of adjustments. The latter alone is beneficial but in combination with Chiropractic proves a double stimulant to the nerves and should be avoided. The effect of these methods when used with Chiropractic can never be accurately predicted. One can only be certain that some unfortunate effect will follow.

As a secondary consideration the Chiropractor has neither legal nor moral right to practice medicine unless he has received a state license to do so.

Having admitted that the forms of “mixing” indicated as beneficial to the patient may be sometimes justifiable on the score of immediate good to the patient, let us consider another side of the question.

Just as surely as we admit into our practice any method which attacks the disease itself, or which treats any other than the primary cause of the disease, or which seeks to stimulate or inhibit the functions of the body without freeing the natural channels through which the natural healing power of the body should be manifested, just so surely are we adopting the medical theory and making our profession a branch of medicine. Medicine uses many remedies for the cure of disease. Medicine is now broader than the mere administration of drugs. And no matter how we vary the remedy, or what treatment we select, we are denying the truth of the Chiropractic theory and admitting the truth of the medical principle when we use adjuncts in our practice.

Nor are these adjuncts necessary. It has been demonstrated by repeated observations that the Chiropractors who use only the vertebral adjustment secure just as high a percentage of results as those who combine one or more other methods with it. This is due to various reasons: the greater perfection attained in Chiropractic by those who apply themselves with concentration to the task of settling every problem by that means; the fact that adjuncts often detract from the effect of adjustment as much as they add results of their own; the tendency of the patient to prefer and to insist upon the easier and less painful methods rather than the adjustment.

The lay patient and the ignorant public are inclined to give credit for results obtained to the best known method used upon them. Thus in spite of the fact that Chiropractic alone obtains a far greater percentage of results than any other combination of methods, the patient is prone to believe that the change of diet or the massage effected a cure and to overlook entirely the least pleasant part of his “treatment,” the adjustment. He does not understand and cannot understand with a mind divided for the consideration of several methods, the connection of the spine with his disease. Often he fails to understand if Chiropractic is used alone but he is forced to conclude that the spine has such connection because adjustment of the spine cured him.

The use of adjuncts has done more to hold back the advance of the profession in the public mind than any other single factor except ignorance within the profession. Furthermore, the Chiropractor who knows that he can rely upon various other methods if his adjustment fails does not feel impelled to study his Chiropractic as he should. He weakens in practice, relying more and more upon adjuncts.

It has been repeatedly proven that the Chiropractor who uses only Chiropractic becomes the better practitioner by necessity. It has also proven that the man who is expert in Chiropractic needs nothing else, providing only that he refuses those cases to which Chiropractic cannot apply at all.

The only real problem in Chiropractic is the problem of adjustment. All failures may be attributed either to lack of knowledge and proper application of Chiropractic or to the fact that the patient has not vitality enough to recover from the disease. Do not shift the responsibility for failure upon the system, since with one or two exceptions every known disease has been cured by some Chiropractor, thus proving its possibility. Realize that the work can be done and that its doing depends upon your own skill in diagnosis and technic.

It is inevitable that at some future time Chiropractic will be used in connection with other beneficial methods which will enable us to get results sooner, though not more surely. It is also inevitable that Chiropractic will fail to receive its proper place among healing methods unless we force the world to believe in it as we believe; to know it as we know it. If we develop our system in its purity until it obtains general recognition at its true valuation we shall have accomplished an infinite good for humanity for all time.

We should endeavor to accomplish the greatest good for the greatest number, laboring rather for the ultimate recognition of the subluxation theory and its application at its real value than for immediate slight good or personal gain.

Personality

He who would succeed in Chiropractic must have, in addition to a thorough education in his profession, a proper personality. This is the medium through which his education becomes effective, the channel through which he reaches the public, gaining their confidence and approval that he may utilize his knowledge to their good. Many skillful and well-educated practitioners have failed because they lacked the proper personal qualities for attracting patients.

Elements of Personality

The most essential elements of a proper personality are Courage, Conviction, Confidence, Honesty, Sympathy, and Aggressiveness.

Courage, not recklessness or carelessness but a fearless willingness to assume responsibility—the heavy responsibility of our profession—is indispensable. He who accepts the easy case or the chronic and slowly progressive one and refuses to face the appalling rush of a dangerous and acute malady; he who shrinks through fear for his reputation from a grave risk, has no right in Chiropractic. He has mistaken his calling. While we acquire the knowledge of Chiropractic we acquire also a great responsibility for its use; we must utilize it wherever and whenever it is best for the patient, whenever our chances of effecting a cure are the best chances, without regard to ourselves or any personal risk.

By conviction is meant a firm and well-grounded belief in the greatness and efficiency of Chiropractic. Sincerity in one’s practice is a prime requisite for success. A belief grounded in knowledge girds the Chiropractor with an armor so strong that no adversity can pierce it. He who practices Chiropractic without believing in it is in his own mind a cheat and a fraud and cannot expect ultimate prosperity.

Confidence in one’s own ability and knowledge, in one’s power and skill to contest with disease, begets confidence in others. Not conceit, not exaggerated egotism, but a healthy and sane assurance and faith in oneself, engender that steadiness of mind and of hand which make for accuracy and excellence.

Without honesty with oneself, one’s profession, and one’s patients, one forfeits public confidence—and justly. If we promise that which we cannot perform, if we deceive our patients by misleading explanations of untoward events, we deserve failure. It is not intended here to refer to the cheerful and optimistic manner and habit of speech which often aids in the sick room to keep the patient’s mind at rest. This may sometimes deceive the patient as to the gravity of his condition and such deceit may be justifiable; but it should never be extended to the family or to those who have a right to know the real condition and cannot be harmed by such knowledge. Strict honesty, whenever harmless to others, should be the fixed policy of all practitioners.

The weak, strained minds of the very ill require and demand sympathy; not the sort which expresses itself in fixed words or phrases of condolence with the unfortunate and at once forgets their needs and sorrows, but the deeper, unspoken feeling of desire to aid, which springs from the heart and finds its best expression in active assistance. If you do not care whether your patient is or is not benefited, if you have no other feeling for him than a business interest in holding a case, you lack the strongest impulse to hard work and study, the desire to aid.

Chiropractic is new. Its principles are yet unknown to the general public. Also this is an age of keen competition and it is our duty to our profession and to the world that instead of hiding our light under a bushel we proclaim our mission to all who will hear. We must be intelligently and wisely aggressive. We must bring ourselves into contact with the public in every legitimate way, compelling it by force of logic and personality to see the reasonableness and greatness of our work.

Question yourself in regard to these things. Examine your own characteristics to discover whether any of these essential elements of personality are lacking. If one be found wanting cultivate it assiduously. Having chosen Chiropractic as a life vocation, work at it not alone for the acquisition of ever-increasing knowledge but for the unfoldment of a powerful and winning personality.

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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.