Part 19

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

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

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

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

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

Limitations of Chiropractic

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

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

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

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

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

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

Relation of Chiropractic to Other Methods

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

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

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

The Use of Adjuncts

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

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

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

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

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

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

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

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

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

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

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

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

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

Personality

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

Elements of Personality

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

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

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

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

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

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

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

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

CHIROPRACTIC PROGNOSIS

=Prognosis= is the determining, in advance of the fact, of the probable course, duration, or outcome of a disease. A Chiropractic prognosis is a prediction as to the changes which will take place in a case during and after Chiropractic adjustments.

=General Prognosis= is an opinion expressed of a disease without reference to any particular case. It is based upon the experience of the profession and the average result obtained with the disease. It furnishes only a basis for consideration of the =special prognosis= of an individual case. This latter must be based upon the general prognosis of the disease and upon study of every modifying factor present in the case, as general vitality, living habits, facility of adjustment, apparent response to early adjustments, and especially an estimate of the amount and kind of damage done to tissue and the probability of its repair.

Only general prognosis can be set down as a guide to others. To state even this with certainty and safety many precautions must be observed. All cases included as a basis of conclusions must be handled under standard test conditions (see index) as far as may be; in accepting the observations of others one must be sure that they are sufficiently trained and sufficiently careful and veracious to render their statements reliable.

In order to introduce the subject to the literature of the profession and to invite comment and discussion looking toward the ultimate development of a complete Chiropractic prognosis we shall set down, without further preliminary, the general prognosis of those commonly described diseases concerning which we feel qualified to speak. No statement is made without the gathering of reliable evidence.

GENERAL PROGNOSIS

=Abscesses.=--Those abscesses which would tend to discharge externally may be adjusted for with success and will rapidly develop, point, and discharge, with quick recovery. Those which might break internally absolutely forbid adjustment because of the almost certain occurrence of peritonitis, pyaemia, or other grave condition.

=Acne.=--Good, but usually slow.

=Addison’s Disease.=--Few cases reported, and these slow cures.

=Adenoids of Pharynx.=--Prognosis so good as to contraindicate operation in every case. The lymphoid growths gradually and slowly absorb under adjustment.

=Adiposis Dolorosa.=--Only one case seen, the Derkum case. This reduced in six months of adjustment from 360 to 280 lbs. in weight, and was improved in every particular. No final report received.

=Alcoholism.=--Adjustments greatly aid a cure if alcohol be discontinued at once, or if the daily consumption is gradually and steadily decreased. No permanent cure can be secured without the aid of the patient. Acute alcoholic intoxication may be lessened at once by the aid of a single adjustment.

=Amenorrhoea.=--Prognosis excellent. One to several months required. Conservative amenorrhoea, as in tuberculosis or other wasting disease, disappears only with the occasion.

=Anaemia.=--If primary, yields slowly but surely. Secondary anaemia depends upon some disease process and its prognosis is that of the disease which produces it.

=Angina Pectoris.=--A case for careful diagnosis. False angina recovers with general building of nervous system. True angina, usually associated with arteriosclerosis, is frequently fatal and death may occur during any adjustment. If this does not happen most cases recover, though slowly. Let me repeat, there is great danger in handling true angina pectoris.

=Anidrosis.=--Usually responds to adjustments for the kidneys.

=Ankylosis.=--Almost any ankylosis, except that in which there is gross deformity of the bones, would yield to repeated applications of force along right lines. Only vertebral ankyloses are amenable to Chiropractic adjustment and those are usually broken in time.

=Anterior Poliomyelitis.=--Chiropractic experience with “infantile paralysis” has been very extensive and gratifying. During the febrile stage the disease may be aborted by one or several adjustments with only slight and transient paralyses resulting. The chronic paralysis which follows an unadjusted case is curable, but restoration of the motor function and trophic tone of the paralyzed members is delayed while the ventral horn cells are regenerated, the axons rebuilt, and the atrophied muscles redeveloped. Often no apparent results will be obtained for one or several months, after which gradual improvement progresses to a complete cure.

=Aphonia.=--Prognosis excellent. No failures reported.

=Apoplexy.=--The occasional case in which a premonitory partial paralysis precedes real hemorrhage responds remarkably to adjustment so that with care the hemorrhage may be averted. After hemorrhage the absorption of the clot is slow and tedious, but about 50 per cent recover.

=Appendicitis.=--In the early stages of the acute form, and in nearly all chronic cases, recovery is almost certain under adjustments. Signs of suppuration indicate immediate operative interference and drainage, and failure to read the signs may lead to rupture, peritonitis, and death. Acute cases yield very quickly as a rule.

=Arthritis Deformans.=--In well developed cases some almost complete cures have been effected in periods varying from two to four years. Prognosis good as to relief, but poor as to complete recovery.

=Ascites.=--Fair prognosis, depending upon the nature of the portal obstruction. Cirrhotic ascites does not yield well.