Osteopathy, Chiropractic, and the Profession of Medicine

I

OSTEOPATHY and chiropractic have, in recent years, grown to such proportions that they are now of considerable importance, not only in regard to the sick individual, but also in relation to the public health. In order that these professions may fit into the community in their proper places, it is important that a definite understanding should exist as to just what they claim to be, and also what, in fact, they are. In this article, therefore, an attempt is made to describe osteopathy and chiropractic, and their relation to medicine in general. Furthermore, suggestions will be offered as to a fair way to handle the problems presented by the growth of these new professions.

Osteopathy was founded in 1874, by Dr. A. T. Still who at that time was practising medicine in a small town in Kansas. It depends upon a theory. There is some divergence of opinion among osteopaths themselves in regard to the details of the theory. In general, however, it is held that there are within the human body all the elements necessary for health, and that, if the circulation is unimpaired, these elements will reach all parts of the body and health will result. Impairment to the circulation, according to this theory, is produced by the action of the vasomotor nervous system (which is the mechanism for regulating the size of the blood vessels). This theory provides that disturbance of the action of the vasomotor nervous system is produced by direct pressure upon these nerves in the region of the spine, from bones, muscles, or ligaments. In addition, pressure upon those nerves may result from reflex disturbance in the tissues about the spine, from abnormalities in any organ or part of the body far removed from the spine.

According to this theory, in all cases of disease, one should be able to find in the region of the spine the so-called osteopathic lesion which produces the disturbance in the vasomotor nervous system. This osteopathic lesion will be described in detail later. Furthermore, the orthodox osteopath should feel that a general knowledge of medicine is not necessary, because, according to the theory, it is only necessary to find the osteopathic lesion in the region of the spine, and remove it by appropriate treatment, and health wilt result.

In support of this theory, after all these years since its development, no satisfactory experimental or other proof can be found in the osteopathic literature or elsewhere. The osteopaths have established research laboratories in California and Chicago, and, although certain results of experimental work have been published from these institutions, the interesting isolated facts reported in their publications can hardly be construed as experimental support for their theory of disease. Therefore, it seems absurd to discard all the accumulation of facts in the science of medicine for this unproved theory.

It is only fair to state that many osteopaths, at the present time, do not adhere rigidly to their original theory, but endeavor to combine with their osteopathic learnings a general knowledge of medicine. It is interesting to note the change in their books that has appeared between those written in the early days of osteopathy and those written recently. In the more recent publications, considerable space is taken up in discussing the symptomatology and diagnosis of disease, as outlined in general medical books. Also, in their later publications, the treatment of disease is often recommended along the lines suggested by doctors of medicine, in such respects as in the use of diet and surgical intervention. One author goes so far as to state that surgery is a part of osteopathy. Furthermore, it is evident from conversations with osteopaths that few of the younger ones consider that osteopathy should replace the general knowledge of medicine, but that it should be used in conjunction with other methods of the treatment of disease.

It becomes important, therefore, to decide just what osteopathy really is at the present time. Since the writers on osteopathy, and many of those who practise it, feel that it. is not. going to replace all general medical knowledge, but that it is one of several therapeutic agents to be used in the treatment of disease, it seems fair to look upon osteopathy as such.

One should realize that, in general medicine, there are already a variety of therapeutic agents employed, such as drugs, surgery, serums, vaccines, hydrotherapy, mechanotherapy, massage, and so forth. If osteopathy may be looked upon as simply another therapeutic agent, — as it seems fair so to consider it, — it is important to study this new agent, and see in what instances it is of value.

Before discussing its value, it may be well to describe what the osteopaths attempt to accomplish by their treatments. They attempt, by manipulation, rubbing, massage, and the like, to remove the osteopathic lesion from the region of the spine. This lesion along the spine manifests itself by three chief signs: abnormal positions of the vertebræ in relation to each other; spasm of some of the groups of muscle along the spine; and a tender point. Only one, or all, of these signs may be present in a given disease, and the location along the spine varies with the part of the body involved. Although there is some specificity of location of the lesion along the spine for various disorders, there is no variation of the lesion recognized for different types of disease in the same organ. Thus, in kidney disease, the osteopath would expect to find the same lesion along the spine, whether it were due to Bright’s disease, cancer of the kidney, acute infection of the kidney, or renal colic from various causes; and, according to his theory, any of these diseases should be cured by the removal of this same lesion.

In addition, the osteopaths in their treatment, endeavor to relieve pain and relax spasm by so-called inhibition, which consists in steady pressure upon a part, or upon the nerve supplying it. This use of inhibition appears more frequently in their later writings than in the earlier ones, and it would seem as if it had not been included in the original theory, but added afterward.

In regard to the actual presence of the osteopathic lesion in various diseases, some doubt has been raised by students of medicine, and even by some osteopaths. It is surprising that, in their literature, satisfactory proof cannot be found of the presence of this lesion in a group of cases of any special disease, compared with carefully selected control-groups. It would be a relatively simple study to have this question of the osteopathic lesion settled by a research conducted by a combined group of osteopaths and regular physicians; and it is interesting to note that the Massachusetts Medical Society has appointed a committee to study this and other related problems.

Even if this osteopathic lesion should be present along the spine in all disease, it is important to try to find out if the treatment, or the removal, of this lesion has been proved to be of benefit. It will perhaps be a little more clear if we divide up diseases into those with well-recognized pathological lesions and those with their exact nature not definitely understood. It is very apparent upon reading osteopathic literature that there is no satisfactory proof of the value of the osteopathic treatment along the spine in diseases of recognized pathology. A careful comparison of a group of cases treated by the methods of the medical profession with a group treated by these same methods, plus osteopathic procedure, has not been reported in such a way as to demonstrate the value of this procedure. Reports of instances in which fever has been reduced and comfort given to the patient by this treatment, in a variety of diseases, are found; but as there are many methods of lowering temperature and giving relief to the patient which do not have any real effect upon the course of the disease, it is not possible to draw conclusions from these isolated reports. There is, therefore, not only doubt about the presence of this osteopathic lesion along the spine in diseases of recognized pathology, but also no really satisfactory proof that the removal of this lesion, if present, influences favorably the course of the disease.

In that group of diseases in which the nature of the abnormal process is not well understood, the value of treatment by osteopathic procedures has not been proved to be of value by any reliable comparative studies. In this group of cases, careful comparative studies are, of course, more difficult to carry out, because the normal course of these vague disorders is not well known. On the other hand, from individual reports, it is quite evident that osteopathic treatment in some of these ill-defined cases gives relief, and in some instances even after regular physicians have failed to make the patient comfortable.

If this form of treatment in certain conditions, such as painful backs, headaches, and the like, is of value in relieving symptoms, it is of importance to find out in what way, in accordance with the known laws of physiology and pathology, this relief is obtained. In this regard, it is surprising that it is impossible to form a satisfactory picture, which will conform to existing established facts of medical science, as to just what has actually taken place in these successful results obtained by osteopathic procedures. That the osteopathic physicians themselves are not quite clear in their own minds as to what happens in these cases is suggested by the variety of theories met with in their writings. Furthermore, a regular physician, who has made a considerable study of osteopathy, has evolved a separate theory of his own in regard to what happens to produce the favorable results in the cases which are benefited. It is, perhaps, not strange that a physiological basis for the cause of the improvement has not been worked out, when it is realized that the character of the disturbance is not clear in these cases, and that no careful experimental work has been conducted to find out just what does happen as a result of the treatments. Replacement of subluxations of joints, the improvement of circulation by massage, the effect of suggestion, the interruption of a vicious circle, and so forth, are some of the suggestions which have been advanced as the cause of the benefit from osteopathic treatment. For the present, at least, one should remain open-minded on this point, and hope that, in the future, experimental work will clear up these questions.

The present knowledge in regard to osteopathy seems to warrant its being considered of value in the treatment of a limited number of abnormal conditions, but it does not warrant looking upon this profession as being a worthy substitute for the established facts in general medical science. Therefore, osteopathy should take its place in the science of medicine as one of the various therapeutic procedures available for the treatment of disease. Like other therapeutic agents, its use should be limited to those cases in which it is of value.

II

Chiropractic, unlike osteopathy, was founded by a layman. Like osteopathy, however, it depends upon a theory in regard to health and disease, although the theory is different from that of osteopathy. The chiropractic theory consists in the belief that all disease results from the pressure upon the nerves as they leave the spinal canal. This pressure is produced by the vertebræ, which have become somewhat displaced. This displacement is spoken of as a subluxation of the vertebræ. These subluxations may be so slight that they cannot be detected by the Roentgen ray. If they are detected and reduced by the special chiropractic method of treatment, health will result.

A general knowledge of the established facts in medicine is not needed by the true chiropractor; and one author states that a medical diagnosis is not even desired. In support of this theory, no experimental or other satisfactory proof is available. The chiropractors apparently have not as yet attempted to stimulate experimental work in research to the same extent that the osteopaths have. It seems quite unreasonable to cast aside all the established facts in medicine for this unsupported theory, especially as many of these established facts are quite contrary to it.

Attention should be called to one feature of the curriculum in the chiropractic schools, namely, the large amount of time given to the pupils in the art and method of advertising. This is so contrary to the established custom among the more sincere practitioners of the healing art, and other scientificprofessions, that it is worthy of consideration.

If there is no reason to consider seriously that chiropractic may replace the established facts in medical science, it is important to determine just what place, if any, it should hold in general medicine; for its growth during the few years of its existence has been remarkable. In order to form an opinion in this regard, it will be well to find what proof there is of the relation between disease and these subluxations, and what benefit, if any, is derived from the chiropractic treatment in various diseases.

The chiropractor makes his diagnosis of diseased conditions by an examination of the spine by means of the Roentgen-ray pictures and digital palpation. His books state that often the subluxations are so slight that the Roentgen ray will not show them, and palpation alone can reveal the abnormality. As a result of his special training, the chiropractor is supposed to be able to detect abnormalities in the relation of one vertebra to another more readily than other individuals, who have been better trained in general knowledge of anatomy, pathology, physiology, and so forth. Additional aids to making a diagnosis appear in certain chiropractic books, such as nerve-tracings, which consist in hunting for tender points along the course of cutaneous nerves, and a study of the markings on the iris of the eye, with the belief that certain pigmented areas on the iris indicate disease in certain parts of the body.

As stated above, the chiropractor believes that in all diseased conditions some type of subluxation of the vertebræ exists; but no careful comparative study can be found to substantiate the correctness of this statement. There is also no reliable information to show the type of subluxation for the various diseases, although some specificity of location of the lesion along the spine is claimed for certain ones. That diseases of all types occur, run their course, and get well, without any attention to the position of the vertebræ, is, of course, an established fact.

Even if it is granted that some subluxation of the spine does exist in all diseases, it must still be demonstrated that this subluxation may be corrected and benefit result from the chiropractor’s method of treatment, which consists in manipulation of the spine. It is quite apparent from reading the chiropractic literature, that no satisfactoryproof exists that any permanent change is made in the position of the vertebræ upon each other by their manipulations. It is also apparent that no comparative studies in groups of cases of well-recognized diseases have been made, in an attempt to show the value of this method of treatment; and, therefore, its value has not been established over other recognized forms of therapy for these cases. In the more vague conditions, there is also no report of careful comparative studies on groups of cases. In this class of cases, however, more attention must be given to the reports of individual cases, because the natural course of these various diseases has not been so well worked out. In the community in which the writer lives, reliable reports of success from chiropractic treatment are too few, and the cases too isolated, for satisfactory judgment to be formed in regard to the results. The growth of the profession, however, suggests that, some benefit, may be derived in a small group of illdefined conditions by this form of treatment; but it is quite clear that the cause of the benefit, if any exists, has not been explained on any satisfactory basis so as to conform with known laws of physiology and anatomy.

It seems fair to conclude, from the existing established facts in regard to chiropractic, that there is no reason to consider that it will ever replace the general science of medicine; that there is some doubt of its being of any value; and that, at the most, it can be looked upon only as another possible therapeutic agent, to be used for the alleviation of human suffering in a limited number of cases.

If it is true that osteopathy and chiropractic are in reality simply methods of treatment valuable in certain conditions, and that there is no evidence to justify the assumption that they may some day replace the science of medicine, it is important that the relation which they should bear to general medicine be understood by the public, and that provision be made to see that this proper relationship is carried out. Like other therapeutic agents, these two methods of treatment should be available to the physicians, to be used in appropriate cases for the relief of suffering and the cure of disease. In order to accomplish this, certain changes must be made in the attitude both of physicians and public toward these professions.

The medical profession, on its part, should not be intolerant of the study and application of any new therapeutic agent, simply because those who advocate it present their claim with more enthusiasm than is justified by the facts, or because the advocates are not trained in general medical knowledge. It is only too well established that methods for the treatment of disease have been taken up with enthusiasm by the medical profession, only to be eventually discarded as either useless or even harmful to the patient. Also, valuable additions to the cure and prevention of disease have been made by individuals who have not. been trained in medical science. The medical profession should, therefore, take up with tolerance, study carefully, and endeavor to fit into its proper place, any new therapeutic agent that is brought forward in a serious manner. It must be admitted that, as yet, very little study or use of osteopathy or chiropractic have been made by the medical profession; and yet osteopathy seems to be well established as of value in a limited number of cases, and it is possible that chiropractic may be.

The public, on the other hand, should be very intolerant of anyone who attempts to practise the healing art without a general knowledge of the established facts in medicine, not only for the sake of the individual but also in the interest of the public health. Medical science has already established beyond doubt that, in the early stages of some diseased conditions, an opportunity for cure by certain procedures exists: such as surgical intervention for acute appendicitis and cancer, serum therapy for diphtheria and meningitis, drug therapy for malaria and syphilis; while a delay in the diagnosis and in the institution of proper treatment in these conditions may lead to death, or to a much more serious illness for the individual. Since the diagnosis of these and other pathological conditions is often exceedingly difficult, it is important that all who profess to cure disease, or are allowed by law to practise any healing art, should be skilled in the general knowledge of disease and its recognition. Not only should those who use therapeutic procedure, which has been proven by careful statistical studies to cure these conditions, know the established facts in regard to these diseases, but even more so should those who offer as a cure procedures, such as osteopathy and chiropractic, which have no proved value in these well-recognized conditions, know the established facts in regard to disease before practising their special curative procedure.

Instances are only too frequent in which the golden opportunity for the cure of a patient has been let pass while osteopathic and chiropractic treatment has been tried out. These instances are especially unfortunate in some cases, because through ignorance the individual felt that he was consulting someone properly trained to handle diseased conditions. The individual can hardly be blamed for the lack of understanding of the situation, since the law, in many instances, allows these special practitioners to treat disease, but does not demand that they shall know how to recognize it.

In regard to the public health, the public should also be intolerant of anyone who takes the place of the physician, unless trained in general medical knowledge. For, although an individual may gamble with his own life regardless of public opinion, he has no right, so far as the public is concerned, to be a factor in the spread of contagious diseases, such as diphtheria, scarlet fever, syphilis, typhoid fever, plague, and the rest, with resulting death and suffering for the public. Such a condition may and does arise, if the public allows individuals to treat diseases who are improperly trained in recognizing them. For a patient may well think that he has consulted a properly qualified physician, when he has been to one of these individuals allowed by law to treat diseased conditions; and therefore considers that his responsibility to the public has been discharged.

In this short summary of the situation as it exists to-day in regard to osteopathy and chiropractic, an attempt has been made to show that, in both these professions, there is something of value in the treatment of certain diseased conditions, even if the exact method by which this benefit is obtained is not understood. It has also been attempted to show that these professions can in no way replace the established facts of medical science; and that those using these methods of treatment should have the same general knowledge of medicine that is required of regular physicians, in order to safeguard the individual and the public health.

In certain states of the Union such is now the case, and the osteopath and the chiropractor have to pass the examination of the state board of registralion in medicine. In other states, special boards of registration exist for these professions, with the result that the state sanctions the practice of these methods of treatment without in any way limiting the type of disease upon which the treatment is used, or demanding reasonable educational requirements in regard to the general knowledge of disease. This latter plan of legislative control has been found to be dangerous not only to the individual, but also to the public, health.

In the states in which all those practising the healing art are compelled to demonstrate a general knowledge of disease, by passing an examination before the state board of registration in medicine, attempts are being made to have special boards of registration created for osteopathy and chiropractic, in order that those who profess them may practise their special therapeutic procedures without a thorough knowledge of disease and its diagnosis. The public should demand that all those who are to practise the healing art, in any manner, as a profession should have a general knowledge of the established facts in medicine, and the relation of special diseases to the public health. In other words, in all the states there should be one general board of registration in medicine, and the standards established by that board should be high. With the education necessary to pass such a board, the sincere therapeutic enthusiast, be he osteopath, chiropractor, electrotherapeutist, faithhealer, or herb-doctor, will probably not do much harm to the individual, or be a source of danger to the public health.