Chiropractic professionalization and accreditation: an exploration of the history of conflict between worldviews through the lens of developmental structuralism

Looking back at the lawsuit that transformed the chiropractic profession part 2: Rise of the American Medical Association

OBJECTIVE

This paper is the second in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated anti-trust law by restraining chiropractors' business practices. The purpose of this paper is to provide a brief review of the history of how the AMA rose to dominate health care in the United States, and within this social context, how the chiropractic profession fought to survive in the first half of the 20th century.

METHODS

This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 papers following a successive timeline. This paper is the second of the series that explores the growth of medicine and the chiropractic profession.

RESULTS

The AMA's code of ethics established in 1847 continued to direct organized medicine's actions to exclude other health professions. During the early 1900s, the AMA established itself as "regular medicine." They labeled other types of medicine and health care professions, such as chiropractic, as "irregulars" claiming that they were cultists and quacks. In addition to the rise in power of the AMA, a report written by Abraham Flexner helped to solidify the AMA's control over health care. Chiropractic as a profession was emerging and developing in practice, education, and science. The few resources available to chiropractors were used to defend their profession against attacks from organized medicine and to secure legislation to legalize the practice of chiropractic. After years of struggle, the last state in the US legalized chiropractic 79 years after the birth of the profession.

CONCLUSION

In the first part of the 20th century, the AMA was amassing power as chiropractic was just emerging as a profession. Events such as publication of Flexner's report and development of the medical basic science laws helped to entrench the AMA's monopoly on health care. The health care environment shaped how chiropractic grew as a profession. Chiropractic practice, education, and science were challenged by trying to develop outside of the medical establishment. These events added to the tensions between the professions that ultimately resulted in the Wilk v AMA lawsuit.

A Vitalism Ethos and the Chiropractic Health Care Paradigm

OBJECTIVE

The purposes of this article are to describe the development of vitalism from its earliest Hellenistic form to that of a contemporary vitalism ethos and to propose the importance of vitalism in the philosophy of chiropractic and the chiropractic health care paradigm.

DISCUSSION

A review of the history of vitalism is offered to clarify the use of the term within the chiropractic literature and to provide a defensible position for vitalism as a foundation for future research in the philosophy of chiropractic. The founder of chiropractic, Daniel David Palmer, drew heavily from spiritualism and vitalism in his construction of early chiropractic philosophy. As chiropractic practice and philosophy have evolved, that vitalistic foundation has become a polemic used by factions within the profession, resulting in political challenges. The controversy within chiropractic mirrors similar debates within academic philosophy regarding vitalism. The philosophy of vitalism has developed beyond its classical constructs, emerging as an ethos amenable to informing research within clinical applications and a perspective capable of informing the identity of chiropractic.

CONCLUSION

Exploring the broad historical context of vitalism may allow for an understanding of the plurality of vitalist ideas and a clarification of the concept within chiropractic literature. Adopting vitalism within the philosophy of chiropractic as an ethos based on the work of Georges Canguilhem provides a view of life as fundamentally original, adaptable, and unpredictable, and therefore not sufficiently understood in purely reductionist terms.

Chiropractic Day: A Historical Review of a Day Worth Celebrating

OBJECTIVE

The purpose of this paper is to review and discuss historical concepts about the celebration of Chiropractic Day.

DISCUSSION

Daniel David Palmer attributed September 18, 1895 to be the day that he delivered the first chiropractic adjustment. As the chiropractic profession grew, the celebration of Chiropractic Day became more widespread throughout the United States and the world. This paper offers suggestions about how to celebrate Chiropractic Day. Activities include educating, learning, honoring, volunteering, and engaging.

CONCLUSION

The chiropractic profession celebrates its birth on September 18. Regardless of the many different names used over the past 125 years, including Chiropractic Founder's Day, Chiropractic Rally Day, Chiropractic Anniversary, and Chiropractic Discovery Day, the celebration of this special day provides an opportunity to reflect on how far the profession has come and how chiropractors continue to help and serve their patients.

The Chiropractic Vertebral Subluxation Part 7: Technics and Models From 1962 to 1980

OBJECTIVE

The purpose of this paper is to review and discuss the history of chiropractic vertebral subluxation (CVS) theories and models between 1962 and 1980.

DISCUSSION

This period was marked by several innovative texts from Weiant, Homewood, and Harper, and Canadian Memorial Chiropractic College's Segmental Neuropathy. Technique developers during this period increased the complexity of models from upper cervical to full spine. The textbooks built upon previous theories, the scientific literature, work by Speransky, and instrumentation research. The texts influenced decades of research and theory. Weiant's book surveyed the medical and scientific literature on CVS. Harper integrated modern neurophysiology with D. D. Palmer's theories integrated with other chiropractic models based on research such as Weiant's photoelectric instrumentation. Homewood's book integrated Selye, Speransky, Verner, and several other models, which led to his neurodynamic model of CVS. Segmental Neuropathy was a completely new innovation of chiropractic theory with neurophysiology. Collaboration among authors developed into several new models. Chiropractic vertebral subluxation was viewed as a global neurological phenomenon and a neurodystrophic process. Technique models from Goodheart, Nimmo, Toftness, Ward, Gonstead, Grostic, Gregory, and Pierce laid the foundation for modern practices.

CONCLUSION

The CVS theories during this period were complex and almost unrecognizable from previous theories. The inclusion of every major theory laid the foundation for this period's wide set of models, research, and methods.

The Chiropractic Vertebral Subluxation Part 8: Terminology, Definitions, and Historicity From 1966 to 1980

OBJECTIVE

The purpose of this paper is to review and discuss the history of chiropractic vertebral subluxation (CVS) between the years 1966 and 1980, with an emphasis on consensus models and terminology.

DISCUSSION

The consensus models on CVS during this time were an outgrowth of previous model building, research, and practice methods. The first consensus models were developed by the radiology diplomates of the American Chiropractic Board of Radiology. Later work was used to develop Medicare standards. Research and theory were influenced by the 1975 National Institutes of Health conference on spinal manipulation in 1975 and the workshops that followed that meeting. A new historical consciousness about the CVS, developed at the National Institutes of Health conference, which was a turning point for the profession in the use of terminology and the focus on functional pathophysiology associated with CVS. The historical view of CVS developed by Watkins, Haldeman, and Janse led to new integrative and historical developments in the profession.

CONCLUSION

Theories during this period included consensus efforts as well as new distinctions about CVS theory and terminology.

The Chiropractic Vertebral Subluxation Part 3: Complexity and Identity From 1908 to 1915

OBJECTIVE

The purpose of this paper is to review and discuss the history of chiropractic vertebral subluxation (CVS) between 1908 and 1915.

DISCUSSION

Evidence from the works of Daniel D. Palmer, Bartlett J. Palmer, Joy Loban, Willard Carver, James Firth, Alva Gregory, John Howard, Arthur Forster, and Harold Swanberg demonstrates that chiropractic during this period was characterized by increasingly complex theories of CVS, which contributed to defining the profession. Critiques of CVS as a central identifier of the profession begin with this early period when students of D. D. Palmer's early graduates became school leaders and theorists. Textbooks were self-published during this period, including D. D. Palmer's final works, 4 books from his son B. J. Palmer, and texts from their students. Chiropractic graduates of subsequent schools also contributed to emerging writings and concepts. Chiropractic vertebral subluxation was central to nearly all texts and schools. There was disagreement about what defined chiropractic, and various schools taught different practices. However, the theories from this period had an important role in the evolution of thought in the profession.

CONCLUSION

Theories presented from 1908 through 1915 built upon previous concepts from earlier years of chiropractic. The plethora of books and ideas about CVS from these early pioneers shaped the profession, and some of these viewpoints still have relevance today.

The Chiropractic Vertebral Subluxation Part 4: New Perspectives and Theorists From 1916 to 1927

OBJECTIVE

The purpose of this paper is to review and discuss the history of chiropractic vertebral subluxation (CVS) between the years 1916 and 1927.

DISCUSSION

Theories during this period were shaped by many chiropractic school leaders and instructors. Unique contributions to theories during this period come primarily from 4 authors, John Craven, Jim Drain, Shelby Riley, and Ralph Stephenson. This period included the first thermographic instrumentation in chiropractic, which led to one of Craven's modifications of CVS theory. He also added to the literature about spinal cord pressure and developed the restoration cycle. Drain and Stephenson also expanded on the cord pressure models of CVS. Drain wrote, in plain language, of many central B. J. Palmer theories and developed protocols for acute and chronic CVS. Stephenson made several contributions to models, including his expansion on B. J. Palmer's theory of momentum of dis-ease. Stephenson's main contribution to theory was likely his vertemere cycle, which was a precursor to proprioceptive models. Riley's combination of Gregory's theories with zone therapy had a significant impact on several reflex theories.

CONCLUSION

Chiropractic vertebral subluxation theory during this period grew in complexity and demonstrated several new perspectives on CVS, which may be still relevant today.

The Chiropractic Vertebral Subluxation Part 10: Integrative and Critical Literature From 1996 and 1997

OBJECTIVE

The purpose of this paper is to review and discuss the history of chiropractic vertebral subluxation (CVS) during 1996 and 1997. The literature during this period offered critical and integrative models emphasized by a need for research into operational and functional definitions.

DISCUSSION

Several integrative approaches emerged, from Rome's 296 synonyms to Bergman's Pain/Tenderness, Asymmetry/Alignment, Range of Motion Abnormality, Tissue Tone, Texture, Temperature Abnormality, and Special Tests (PARTS) analysis adopted by the profession in the United States. Other noteworthy contributions included Ruch's Atlas of Common Subluxations, Epstein's introduction of network spinal analysis, and Kent's review of CVS models. Boone's introduction of the Journal of Vertebral Subluxation Research was accompanied by his 3-part model with Dobson. These years also included the paradigm statement of the Association of Chiropractic Colleges, which was adopted by the American Chiropractic Association, International Chiropractors Association, and World Federation of Chiropractic. Two other papers included Nelson's critique of the CVS paradigm and Keating's 1996 "Hunt for the Subluxation."

CONCLUSION

The CVS reached a new stage of complexity and critique and offered new directions for research, integration, and development.

The Chiropractic Vertebral Subluxation Part 1: Introduction

OBJECTIVE

The objective of this article is to present a rationale for the need of a history of chiropractic vertebral subluxation (CVS) theory based on primary sources.

DISCUSSION

There is a dichotomy in the chiropractic profession around subluxation terminology, which has many facets. The literature around this topic spans social, economic, cultural, and scientific questions. By developing a rationale for a historical perspective of CVS theory, including the tracking of the historical development of ideas throughout the profession, a foundation for future discourse may emerge.

CONCLUSIONS

By using primary sources, ideas in chiropractic on the development of CVS theory are proposed. This introduction presents a basis for the need of a history of CVS theory and suggests how this work may be used to further philosophical dialogs in chiropractic.