TECHNIC AND PRACTICE

OF

CHIROPRACTIC
BY

JOY M. LOBAN, D. C, Ph. C

Professor of Anatomy and of Theory and Practice of Chiropractic
at the Universal Chiropractic College. Formerly
Professor of Chiropractic Analysis at the
Palmer School of Chiropractic

SECOND EDITION
Revised and Enlarged

PUBLISHED BY

UNIVERSAL CHIROPRACTIC COLLEGE

DAVENPORT, IOWA
1915
Copyright 1915
BY
JOY M. LOR AN

HAMMOND PRESS
B. CONKEY COMPANY
CHrCAGO
 THIS BOOK IS

Dedicated
TO THE GIRL WHO HAS BEEN MY STAFF
AND LANTERN, AIDING AND LIGHTING
ME ON MY WAY IN THIS NEW FIELD
My mifc
 TABLE OF CONTENTS

Page
Preface to First Edition 9
Preface to Second Edition 11

Introduction 13

Vertebral Palpation 15
Definition 15
General Propositions 15
Habits of Palpation 15
Facts Concerning the Spine 16
Preparation of Patient 22
Position of Patient 22
The Record 23
The Count 29
Atlas Palpation 35
The Group Method 37
The Individual Subluxation 40
Palpation in Position B 46
Palpation in Position C 48
Transverse Palpation 49
Curves and Curvatures 53
Difficulties in Palpation 59
Landmarks 61
Mental Attitude 63
Nerve Tracing 64
Organ Tracing 64
What Nerves are Traceable 64
Suggestion 67
Place in Diagnosis 67
Technic of Nerve Tracing 68
Subluxations l(i

Definition — How Produced 76

Law Governing Location of 78
Varieties of Subluxations 80
7
8 Table of Contents

Page
Technic of Adjusting 89
General Principles of Adjusting 89
Special Technic (Thirty-two Moves) 99
Preferable Adjustments 155

The Cause of Disease 165

Simple Subluxation Disease 184
Secondary Causes 185
Germ Diseases 185
Diet 192
Poisons 194
Exposure 198
Bodily Excesses 201
Inflammation 202
The Process of Cure 208
Adjuncts 215

Spino-Organic Connection 217

General Discussion 217
Special Nerve Connections 235
Table of Diseases and Adjustments 257

Practice 276
OfficeEquipment 277
Schedule of Examination 292
Necessity for Correct Diagnosis 298
Frequency of Adjustments 302
Specific vs. General Adjusting 303
Talking Points 306
Promises to Patients 308
Retracing of Disease 309
Limitations of Chiropractic 312
The Use of Adjuncts 315
Personality 319

Chiropractic Prognosis 322

General Discussion • •
322
Practical Prognosis 323
 Preface to First Edition

THIS little work is offered to the profession without

apology for its brevity or its form. It has been
prepared because of an immediate and pressing need
for such a guide in our colleges, and is offered abroad under

the impression that many practicing Chiropractors feel the

same need.
It is intended for handy reference and clinical use and
is arranged as systematically as possible, style being every-
where sacrificed to utility.

The author lays no claim to the origination of any of

the subject matter of this book nor to having invented any

of the movements described under Technic of Adjusting.

The arrangement and phraseology are in the main original.

The intention has been merely to condense into practical

and convenient form for students and practitioners certain

knowledge now held and utilized in our profession.
The author feels himself indebted to the entire profes-

sion for the information embodied in this work, and to

scientists of all time upon the results of whose infinite and
painstaking research are based our present day advance-
ment; to the many friends and co-workers whose valuable
criticisms and suggestions have aided in this labor; and to

his students, past and present, who have furnished the nec-
9
10 Preface to First Edition

essary encouragement and inspiration for the achievement

of this, the author's first text-book.

The chief merit of this effort — if merit there be — is its

honesty. The author has endeavored to set forth fairly and

simply the facts and hypotheses v^ith which we have to

deal. Its chief offense, in the eyes of many, will lie in its

being just what it purports to be —a book on Chiropractic.

Constructive criticism and suggestion are invited from all

sources, for by our interchange of thoughts we grow.

J. M. L.
 Preface to Second Edition

THE republication of this book has been made

by the sustained friendship of the profession for
possible

it,

and the author's thanks are due its many buyers and
readers who, by their recommendation, have made it both
possible and necessary that this book should live and grow.
The new edition has been somewhat enlarged by the

introduction of additional matter into each section and by

the addition of two entire new chapters on ''Preferable

Adjustments" and "Chiropractic Prognosis." New plates

have been added and old errors corrected. In every way an

attempt has been made to express with conservatism the

real advance made by Chiropractic since the first edition

was put on the press. J. M. L.

11
 INTRODUCTION

NO two students, approaching for the

study of Chiropractic,
first

approach from the same

time the

angle. Their viewpoints differ. In order that all

may gain as nearly as possible the same viewpoint from

which to consider in turn the sections of this book, it will

be well if each student reads the entire book before begin-

ning to memorize its parts and convert them into practical

working knowledge.
An effort should be made, abandoning all other, to ac-

quire the Chiropractic viezvpoint. This accomplished, the

rest of the task requires time and patience alone, without
waste labor. The section on Vertebral Palpation should be

studied step by step, the study of each step being combined

with practice in it. Likewise the section on Nerve-Tracing,
theory preceding practice. The study of the Technic of

Adjusting should occupy those months immediately preced-

ing the commencement of actual adjusting practice and
continue during such practice. The chapters on Practice
are intended for the student about to enter the field. The
table of Spino-Organic Connection can be best understood
by those who have studied or are studying the anatomy and
physiology of the nervous system.
Let every page be studied with a good medical diction-

13
14 Introduction

ary open at the elbow of the reader. Pass no word without

comprehension, no detail without mastery. He who would
seek to modify the life processes of the human body must
fortify himself against fatal error with every bit of knowl-
edge he can acquire.
 VERTEBRAL PALPATION
Definition
Vertebral Palpation consists in the use of the tactile
sense to detennine the position, relation, size, shape, and as
far as possible the condition, of the segments of the spinal
column, in order thus to discover the primary causes indica-
tive of disease.

Or, Vertebral Palpation is the name given the manual

examination of spinal vertebrae.

General Propositions
Every palpation should be made with the adjustment of
the vertebrae in mind. The record of palpation should be
a correct guide as to direction of adjustment. No subluxa-
tion impossible of adjustment should be recorded.

The two essentials of correct palpation are accurate per-

ception and correct reasoning. To secure the first, a certain

approved manner of using the hands is herein laid down
and a considerable amount of tactile sense development by
practice is required. Correct reasoning depends upon
knowledge of all the important facts concerning the spine
and of the rules governing palpation.
Absolute concentration is required and to this end many
of the following rules are directed.

Habits of Palpation
Every palpater unconsciously forms habits of thought
and action. These habits may be good or bad We delib-
15
16 Technic and Practice of Chiropractic

erately form a habit of holding the first three fingers closely

together or the habit of using a downward glide, but we
should avoid the habit of finding certain subluxations be-
cause they are usual and expected rather than because they
are actually there. For instance, one may easily form a

habit of listing every other vertebra in the spine, his whole

record thus depending upon his first choice.

Because of this perfectly natural tendency to establish

a routine of thought and action and to follow it precisely,

it is best not to attempt palpation without the aid of an ex-

perienced teacher until after correct habits have been

formed. Once formed, a palpation habit, right or wrong,
is very hard to break. Many a teacher has expended him-
self uselessly in the effort to undo some technical fault ac-

quired by the student in a blundering undirected trial.

Facts Concerning the Spine

The spinal column is composed of twenty-six segments
called vertebrae, twenty-four movable and two fixed. The
movable vertebrae are divided for convenience in study into
three sections. There are seven Cervical vertebrae, twelve
Dorsal, and five Lumbar in the normal individual. The
number of Dorsals or Lumbars may vary by one in a rare

case. These variations occur in about one spinal column in

each five hundred and are usually in the Lumbar region,
which may contain four or six vertebrae. A prominent first

sacral spinous process may be mistaken for an extra Lumbar.

Five vertebrae have special names. The first Cervical
is called Atlas ; the second Cervical, Axis ; the seventh Cer-
 Vertebral Palpation 17

vical is commonly known as Vertebra Prominens on ac-

count of its long and large spinous process, although this

long process belongs to the sixth Cervical or first Dorsal
instead in 35% of all cases; the large, irregularly fusiform

vertebra just below the Lumbars and between the ilia is

called the Sacrum and ; the smaller one below it, the Coccyx.

The latter is occasionally missing.

Each vertebra except the Atlas is composed of a body

and an arch; the arch is made up of two pedicles, short,

thick plates of bone extending outward and backward from

the postero-lateral surface of the body nearer its upper than

its lower border, two laminae, thin plates of bone extending
backward and inward from their union with the pedicles and
joining behind to form the spinous process, and has pro-
jecting from it seven processes, two transverse, one spinous,
and four articular, two of which are superior and two in-

ferior. The foramen enclosed by the body, pedicles, and

laminae is called the neural or vertebral foramen and the
canal formed by the connection of these foramina and com-
pleted by the ligaments which unite the arches is called

the neural, vertebral, or spinal canal. It contains the spinal

cord with its membranes and the roots of the spinal nerves.
By means of the four articular processes each true vertebra
except the first articulates with its fellows above and below.
The body of the vertebra is its largest portion and is

joined to its fellows by fibrocartilaginous disks which are

sufficiently elastic to permit some torsion and compression.
Nine sets of ligaments, including the intervertebral sub-
18 Technic and Practice of Chiropractic

stance just mentioned, bind the vertebrae firmly together.

Many muscles are attached to the spinal column.
The intervertebral foramina are openings at the sides

of the vertebrae, formed by the notching of apposed pedi-

cles. These openings are surrounded by bone, cartilage, and
ligaments and vary in shape in different sections of the
spine. They permit the exit of the spinal nerves and their
sheaths, the re-entrance of some nerve fibres into the neural

canal, and the passage of blood-vessels to and from the cord.

The entire philosophy of Chiropractic focuses at the inter-

vertebral foramen because there we find the primary cause

of all pathological changes in the body.

The spinous and transverse processes merit particular

description since they are the levers by which vertebrae are
adjusted and nerve impingements at the intervertebral for-
amina corrected. But it will be found easiest to describe
these processes separately in different sections of the spine
and before proceeding to this description, a brief picture
of the peculiar vertebrae will be presented.
The Atlas is a bony ring composed of two arches, an
anterior and a posterior, separated in the recent state by a
transverse ligament. Its body is detached and appears as
a tooth-like projection upward from the body of the Axis,
the odontoid process, which articulates with the anterior
arch of the Atlas and around which the Atlas rotates, a
ring around a pivot. The Atlas supports the head upon
its lateral masses, two wedge shaped bodies between the
anterior and posterior arches, thinner internally than exter-
 Vertebral Palpation 19

nally. It has no spinous process but merely a tubercle

where the laminae join, so that it can be palpated only from
the sides upon the tips of its long transverses. The first

Cervical, or suboccipital, nerves emerge by a groove above

the pedicles instead of through a foramen.
The Axis, or second Cervical, is distinguished by its

large, strong spinous process, which is bifid at its tip, by its

superior articular processes which rest upon body, pedicles,

and transverses, and by its odontoid process, upreared from
the body.

The Seventh Cervical, or Vertebral Prominens, usually

has a large spinous process, presents no foramina in its

transverse processes, or only one, the left, and shows no

facets on body or transverse for the rib articulation, as do
the Dorsals.

The Sacrum is the largest vertebra; is curved with its

convexity backward; is commonly made up of five fused

segments ; has only rudimentary spinous and transverse
processes except the first ; and shows sixteen openings, eight
anterior and eight posterior, or four on either side of the
median line in front and the same number and arrangement
behind. These openings permit the exit of the anterior and
posterior primary divisions of the sacral nerves separately.

The Coccyx, usually composed of four fused segments,

is a triangular bone which articulates with the Sacrum
above and is free at its distal extremity. Its portion of the

neural canal is open posteriorly and contains merely the

thread-like termination of the cord membranes. It is fre-
20 Technic and Practice of Chiropractic

quently ankylosed to the Sacrum, sometimes in an abnormal

position so as to impinge the single pair of coccygeal nerves.

The different regions of the spine show decided differ-

ences in structure, though all resemble each other. The

Cervicals are smallest, the Dorsals next in size, and the
Lumbars largest and strongest of the movable vertebrae.
The Dorsals have facets and demi-facets for the articulation

of the twelve pairs of ribs with their bodies and interverte-

bral substance, as well as oval facets upon the anterior
aspect of their transverses for articulation with the tubercles

of the ribs.
The spinous processes are smallest and usually bifur-
cated down to and including the fifth. The sixth may show
a plain bifurcation, or on any Cervical the bifurcation may
be so small as to be imperceptible to touch. The spinous
process of the second overlies that of the third so as to
make the latter very difficult of detection. Indeed, all cer-

vical spinous processes down to the sixth are harder to

palpate than those in other regions, owing to the anterior

cervical curve. The processes lie in a groove between

prominent muscle ridges.
Dorsal spinous processes are usually single, although the
last four, three, two, or one may show plain bifurcation in

certain individuals. They are somewhat pointed and over-

lap, except the lower ones, the obliquity being greatest in
the mid-dorsal region and least at the first and last dorsals.

Lumbar vertebrae have broad, flat-tipped spinous proc-

esses much larger than the others. The last Dorsal may
 Vertebral Palpation 21

sometimes appear like a Lumbar in shape, so that the change

in shape commonly supposed to mark a division between
Dorsals and Lumbars is not always an infallible guide.

The transverse processes in the cervical region are very

short and lie close in front of the articular processes. They
are pierced by foramina for the vertebral artery and vein,
except the seventh, which may have one foramen or none.
They are difficult of access for palpation because of their
shortness and the amount of overlying muscle, but may be
reached from the front and side by drawing back the
sternomastoid. They increase in length from the second
to the seventh.

In the dorsal region the transverses are larger and

stronger and more constant in size, shape, and direction,
serving to support rib articulations. They extend in a

curved direction outward, backward, and slightly upward

from the union of laminae and pedicles and terminate in a
large subcutaneous club-shaped extremity which may be
readily palpated. The eleventh and twelfth dorsal trans-
verses do not articulate with the ribs and must therefore
be used with caution or not at all as levers for adjustment.

The dorsal transverses are located on a higher level than

the spinous processes. In the case of the upper three dor-
sals the transverse lies in a plane which would cross the
mid-spinal line between its own and the next superior spin-

ous. In the mid-dorsal region the transverse is even with

the spinous of the vertebra above, though the relation may
vary slightly. The lower dorsals return to the same relation

as the upper.
22 '
Technic and Practice of Chiropractic

The transverse processes of the Lumbars are rela-

tively light compared with the general structure of the ver-

tebrae and are found just even with the interspace between
their own and the adjacent superior spinous process. They
vary greatly in size, length and strength and may be used
as levers for adjustment only when they are large enough
to be clearly palpable through the muscle mass which sepa-
rates them from the body surface.

Preparation of Patient

In all cases where a complete spinal examination is in-

tended the preparation is essentially the same. Have patient

arrange clothing so that the spine is exposed to the touch

throughout. Avoid bands of cloth across the spine, as these

interfere with the necessary continuous gliding movement

of the fingers. Advise the patient, if a female, to wear
waist or dressing sack, reversed, and have skirts loosened
at the waist. If a man, he should strip to the waist and
wear coat or coat shirt reversed.

Position of Patient

This varies widely according to circumstances but for

general purposes use position:
(A) Place patient on stool, feet even on floor and body
in an easy, relaxed position. This may be modified by ask-
ing him to lean forward and rest elbows on knees, evenly,
to facilitate Lumbar palpation. Patient's head may be erect
or flexed forward or backward but should never be rotated
or laterally flexed during Cervical palpation except for the
purpose of locating some particular transverse process.
 Vertebral Palpation 23

(B) In emergency cases, where haste is urgent or

patient is unable to assume a sitting posture, or as a means
of re-verifying previous palpation, place the patient on
adjusting table prone, face down. (See Fig. 2.) Remember
that with the head lying upon its side the upper dorsal
vertebrae will assume a curve with its convexity away from
the face. Palpation in position (B) should precede every
adjustment and, to guard against error, should be con-
sidered as a necessary preliminary to the movement of any
vertebra.

(C) For palpation preparatory to using the Rotary,

the Break, and other moves, have patient lying on his back
with his head projecting beyond upper end of bench and
resting on the hands and wrists of the palpater, or have

the patient's head rest on the bench, a less accessible

position.

General Observation
Each spinal examination should begin with a general

survey by which curvatures, marked prominences, etc., may

be appreciated. Frequently some very important fact may
be noted which would escape attention upon minute exami-
nation.
THE RECORD
The record of spinal palpation, when completed, should
be an accurate history of the irregularities found in the
spine and an accurate guide to adjustment. It must be
brief and concise as well as readily comprehensible. One
should be able to see at a glance any desired point on the
M Technic and Practice of Chiropractic

record, so that it may be used during the adjustment with-

out undue loss of time or attention. Obviously the intro-
duction of any useless mark or sign, such as the inclusion

of a number and blank space for each vertebra of the spine,

or all possible subluxations with indications as to which

do or do not exist in the given case, is a mistake.
The record should contain three parallel columns. In
the first column place the number of the vertebra chosen
for adjustment. In the second, place the direction of sub-
luxation. In the third, place the word or sign which stands
for the indicated movement for correction.

Number of Vertebra
The letter C is used to indicate Cervical, D Dorsal, L
Lumbar, and S Sacrum in the record. Immediately follow-
ing the letter which designates the region, place the number
which shows the position in that region occupied by the
vertebra in question, the relation of that vertebra to its fel-

lows. For instance, the third Cervical vertebra is C 3, the

eleventh Dorsal D 11. To the S for Sacrum append B or

A to indicate that the Base or Apex is described as to
position. This locates the subluxation. For a record of full

spine palpation it is unnecessary to use the letters C, D, or L

more than once, as subluxations are recorded in the order
of their occurrence from above downward. A dash should
always follow the number of the vertebra to separate it

from the letters in the second column for convenience in

reading.
 :

Vertebral Palpation 25

Direction of Subluxation

The directions considered in palpating or recording sub-

luxations are six in number, namely

Name Abbreviation Meaning

Posterior P Toward the rear (Dorsad)

Anterior A Toward the front (Ventrad)

Right JR Toward the right hand
Left L Toward the left hand
Superior S Toward the head (Cephalad)

Inferior I Toward the feet (Caudad)

As the fingers glide down the spine the posterior ver-

tebra is the one which interposes itself in the path of the

fingers, forcing them to describe an outward curve. It

is the hill on the automobile road which forces the sur-

mounting of a curved departure from the evenness of the
road. It is relatively posterior to its fellows above and
below.
The anterior vertebra, to the gliding fingers, means a

depression, a valley. It causes the fingers to dip inward

from the level of their course.

The right or the left subluxation is appreciated by run-

ning the tips of the fingers down the sides of the spinous
processes. It really indicates rotation of the whole vertebra
more often than any other malposition.
We say that a vertebra is superior when its spinous
process is nearer the one above than the one below. It

requires a measuring of relative distances. The degree

26 Technic and Practice of Chiropractic

to which a vertebra is superior is measured, not by its actual

closeness to its fellow, but by the relation between the space
above and the space below.
Likewise a vertebra is inferior when it is closer to its

fellow below than to its fellow above.

Anterior subluxations are rarely recorded as such, ex-
cept of the Cervicals or the last Lumbar, because no means
of properly adjusting them is known to Chiropractic.

Order of Letters

In the second column, that devoted to direction of sub-

luxation, the letter P or A should appear, if at all, as this
antero-posterior relation is the first thing to be determined
concerning any individual subluxation chosen except the
Atlas. With the Atlas the first letter will be R or L. Next
the laterality or rotation is indicated by R or L in every

case except Atlas subluxation. Finally the S or I indicates

the last point to be determined, the approximation of the

vertebra to its fellows. This last letter usually shows thin-

ning of intervertebral fibrocartilage, which will be discussed

elsewhere.
If you desire to emphasize any direction as being more
important than another, underscore the letter which stands
for that direction with a single line. If two directions are
to be emphasized, one more than another, underscore the
one with two lines and the other with one. For example,
if a vertebra is found to be quite decidedly posterior, more
plainly to the right, and slightly superior, the record will

show it thus : P R S.
 Vertebral Palpation 27

Movement for Correction

This is indicated in the third column, separated from the

second by a dash, by means of some brief word or words
which describe a certain movement used in adjusting. The
descriptive words and terms used in this work are all given
and explained under Technic of Adjusting. (See p. 89.)

Each word or term stands for a definite method of pro-

cedure. The best movement for the correction of any

subluxation of any vertebra may be found by reference

to the section on Preferable Adjustments, p. 155. If other

terms are more familiar to the student, or in time replace

those which are now common usage in the profession, they
will be brief and clear and may be easily substituted for
those g^ven.
Palpation, fixing in the mind of the palpater the manner
and direction of the subluxation, should also suggest as the
obvious correction a movement calculated to reverse the
procedure by which the subluxation was first produced. In
other words, a certain kind of subluxation stands as the
effect of a certain application of force along definite lines
determinable by examination. Its correction made
should be
in a reverse direction along the same lines. By recording
with the record of subluxation the desired correction, the
adjuster may be reminded daily without new palpation of
the movement best fitted to the case. If on trial it is

decided that some other movement than the one first indi-

cated will better overcome the abnormality, the record

should be changed to correspond to the decision, and there-
after followed.
28 Technic and Practice of Chiropractic

Complete Record

The completed record in three columns separated by

dashes can be conveniently read. It contains no super-
fluous mark of any kind. It conveys all the necessary in-
formation leading to adjustment except diagnosis and case
history. This palpation record should be a part of a more
comprehensive record concerning the case in full and is

best kept on a card, the reverse side of which carries case

history. If kept in an indexed card file it may be referred
to daily without loss of time and an accurate handling of
each case be assured.
Have card perfectly blank on palpation record side.

For convenience in reading draw a heavy line beneath the

last Cervical subluxation recorded and another beneath the
last Dorsal, thus dividing the record as the spine is divided,
into three divisions.

Below follows a sample palpation record. It will be

seen that here in a very small space may be recorded a
great deal of information, for this record contains an accu-
rate list of the primary causes of every disease, weakness,
or tendency to disease with which the patient is afflicted,

together with the methods for their removal.

Sample Record

C 1 R Break
4 P L S Double Contact
7 L I Rotary
 Vertebral Palpation 29

D 3 P R.... Recoil
7 L S Pisiform Single Transverse
10 P S Heel Contact

LI PL I Recoil
4 R Lumbar Single Transverse

Use of Record

The above record is made with patient sitting. It is to

be used while patient is lying upon the adjusting bench.

The most convenient way is to begin palpation in the Dorsal

region after patient has been placed for adjustment, in this

way. If first subluxation recorded is D 2 —P R I, find the

vertebra in the region of D 2 which appears P R I to the

touch. To avoid error, let the fingers then glide downward
to the next recorded subluxation. If this be found to agree
in number and direction with the record, it is safe to as-
sume that the first one found was correctly numbered in

the palpater's mind; if not, that an error was made. This

can be quickly done. Before each adjustment the vertebra
adjusted should be found to agree with the record; by
doing this constant accuracy may be assured.

THE COUNT
Having described the preparation of the patient and the
different positions in which he may be palpated, noted that
all records should be made in position A, mentioned that
general observation which should immediately precede actual
palpation, and interpolated a description of the record to
30 Technic and Practice of Chiropractic

be made during the palpation, with its use afterward, we

are now ready to consider the technic of the palpation
itself. This should begin with a count of the vertebrae and
continue with Atlas palpation, general examination of a
group of vertebrae, and special examination of individual

subluxations in the group. Each of these tasks will be

considered in turn.

Position of Palpater

This depends upon the position of the patient. The

letters which follow correspond to the letters describing
the position of the patient, q. v.

(A) If you desire to palpate with the right hand stand

at patient's left and face toward him with left hand resting
on his shoulder or supporting his forehead as you palpate
Dorsals or Cervicals respectively. To use left hand stand
similarly at patient's right. Have palpating arm relaxed
and easy, extending as nearly as possible so that the fore-

arm and hand make a right angle with the patient's spine.

Let the arm and hand remain close to the patient's body
at all times. Keep the the elbow close to your own body
and avoid flexion of wrist on forearm, or of forearm on
arm at more than a right angle, since such flexion would
bring about too great muscular tension for close apprecia-
tion of tactile impressions. If necessary lean sidewise and
elevate shoulder and palpating arm in order to preserve
the proper relation between hand and arm when hand must
be elevated as in palpating upper Cervicals.
 Vertebral Palpation 31

(B) As above, if you desire to use right hand stand

on left side of patient and if left hand stand on right. If

the patient lies on a bench so constructed that the head

lies on one side, his face must be toward the palpater in

order that the same hand may be used in Cervical as in

other regions. It is inadvisable to change hands except
when absolutely unavoidable. If the patient's head must
be turned from you palpate the Cervicals by standing with
feet pointed away from patient and turn your body with
one hand resting on patient's head to hold it steady and
the other palpating as if you were standing on the other
side. This is difficult and it is rarely necessary to count

Cervicals in position B if the record be used as advised

on page 29.

(C) Palpation preparatory to the Cervical adjustment

will be made in this position or in position A, according
as you intend adjusting the Cervicals in the prone or the
sitting posture. For the prone position have the patient's

head supported by either hand, while the other hand is

applied with the tips of the first three fingers resting on

the tips of the spinous processes, from which position they
may glide smoothly down, noting deviations from normal
in position as well as mentally numbering the vertebrae.
While this method of palpation is not so accurate as those
given elsewhere, and should be used only as an additional
means after record has been made, it will always be neces-
sary to make a count before adjusting any Cervical.
32 Technic and Practice of Chiropractic

Use of Hands
In general it may be stated that the first three fingers
of one hand are used with an easy downward gliding move-
ment in which only the tips of the three fingers, evenly

placed, are in contact with the patient's body. This con-

centrates the attention upon a very small tactile surface
which may become extremely sensitive by the concentra-

tion. Indeed, it may be said that vertebral palpation only

became an art through the application of the principle of
concentration in practice. The gliding movement is always
doimnvard, because to palpate upward will mass the super-
ficial tissues under the fingers and confuse the palpater.
If there is uncertainty in the mind of the palpater, as he
proceeds, as to the identity of any vertebra he should go
back to the second Cervical, or to any certainly recogniz-
able vertebra previously fixed in mind, and recount.
The use of the hands for Atlas palpation differs from
their use elsewhere and will be described under separate
head. The use of the hands with the patient lying face
upward is also different. If the patient be lying prone,

the same three fingers are used and the same downward
glide as with patient sitting.

With patient sitting, the palpater should step from side

to side, changing hands frequently and usually palpating

each vertebra with each hand before reaching a conclusion.
There are three reasons for this. More accurate records
may be made by combining two different impressions on
each vertebra; with frequent change of hands one may
Fig. 1. Position of hands in palpation for record.
 Vertebral Palpation 33

prevent tiring and consequent loss of sensibility of fingers;

this practice develops the tactile organs of both hands
equally so that if occasion demand the use of either hand

alone it is fitted for the task. To be antbidexterous in all

departments of Chiropractic is an invaluable attainment,

too often neglected.

The Count
Commence at the second Cervical, the first spinous

process below the occiput, and let the fingers glide smoothly

downward over the tips or along the sides of the spinous

processes, without interruption of motion, until they reach

the Sacrum. The palpater notes each vertebra passed and

its number —mentally—so that when he reaches the Sacrum

he knows that he has passed every intervening vertebra and
received a touch impression from each. The Sacrum itself

may usually be recognized by its peculiar shape and also by

its articulations with the ilia.

If the fingers are raised from their contact during the

count, the palpater must recommence at the second Cervical.
It is impossible to be accurate in replacing the hand, once
removed, until the count has been established and the
peculiarities of certain vertebrae remembered, together with

their numbers.
To determine the location of the fourth Lumbar where,
on account of obesity, lipoma, Cervical lordosis, etc., the

count of Cervicals or Sacral palpation is difficult, drop on

heels behind the patient and place the second finger of
34 Technic and Practice of Chiropractic

each hand on the crest of the ileum. Then let the thumbs
meet in the mid-spinal line in the same horizontal plane
as the two second fingers, which spot should correspond
to the interspace between third and fourth Lumbars. This
measurement is accurate in about 98% of all cases, when
patient sits erect; when it varies it will vary by about half
the width of a Lumbar spinous process.
The count should be repeated until the palpater is cer-

tain that he is able to palpate every spinous process dis-

tinctly or to locate accurately any impalpable one. In mak-

ing the count, palpater may note the number of some very
prominent and easily recognizable Dorsal or Lumbar verte-
bra to be referred to as a starting point for a recount if

confusion arises later. This recounting from some promi-

nent vertebra is permissible only after the first accurate
count has been made, but then will save the full count,
especially when the patient is in an unfavorable position,
as lying on table during adjustment.

Difficulties in Counting

The commonest difficulties met with in counting are

the following:
Inaccessibility of third Cervical, which lies closely be-

neath the spinous process of the second and, unless unusu-

ally large or somewhat out of its proper position, cannot
be readily felt.

An occasional anterior fourth or fifth Cervical which

may escape notice unless the head is flexed far toward or

the transverse processes examined.

 Vertebral Palpation 35

Lipoma or other adipose tissue covering part of the

spine.

A missing epiphyseal plate resulting from fracture and

absorption, which absence may simulate a wide interspace
and be overlooked without careful and detailed observation.
Cervical or Lumbar lordosis. This difficulty may be at
least partially overcome by having head bent far forward

or body leaning forward with elbows resting on knees and

a deliberate attempt on the patient's part to render the
dorsolumbar spine convex backward.
An anterior fifth Lumbar.
The occasional extra vertebra which confuses the

palpater.

Finally, the greatest of all difficulties is the imperfect

touch of the untrained palpater or the imperfect concen-

tration of the trained. And this is always remediable.

ATLAS PALPATION
With patient in position A stand behind him and place
the tips of the second fingers on the tips of the transverse

processes of the Atlas, or first Cervical. It can be felt on

each side just anterior and inferior to the mastoid process

of the temporal bone. Let the first and third fingers rest

respectively above and below the transverses and determine

whether the Atlas is subluxated as a whole to the Right

or to the Left.
Another convenient method is:

Place first fingers on mastoid processes, second on Atlas

36 Technic and Practice of Chiropractic

transverses, and third on angle of jaw. The three fingers

of each hand then constitute the points of a triangle. Im-
agine the base line between the first and third fingers and
measure the altitude as a line at right angles to this base

line and reaching to the tip of the second finger as the apex
of the triangle. The relation of the two altitudes deter-

mines the laterality of the Atlas. Thus, if the altitude of

the right triangle is less than that of the left, the Atlas is

laterally displaced to the Right.

The second matter to determine is the rotation of the

Atlas. This is done by using the first and third fingers as

probes to determine the amount of space between the trans-

verse and the mandible in front or the mastoid behind. The
intention is to compare the laterally prominent side with
the other so that the letter A or P on the record will indicate
the position of the prominent transverse compared with its

fellow.

Next decide as to tipping. Still comparing the promi-

nent transverse with the other, decide whether it is above
or below the level of the other by the following method.
Placing first three fingers one above the other with the
second finger on the tip of the process, note which trans-
verse is highest in the space beneath the ear. List the
prominent side as S or Superior, I or Inferior.
Atlas palpation is rendered especially difficult by the
special technic and by the interposing tendons of the sterno-
cleido-mastoid muscle.
 Vertebral Palpation 37

Position of Head
There are three head positions for Atlas palpation. Head
erect, face forward ; head flexed forward on chest ; head
flexed backward. Sometimes it is necessary to test in all

three positions in order to reach a decision, but ordinarily

the first is sufficient.

THE GROUP METHOD

In general palpation of the spine the author has had
the greatest success and attained the greatest accuracy
through which is called the Group Method. This consists in
dividing the spine mentally into five groups or sections,
each of which overlaps its fellows except the end groups.
This is of advantage for several reasons.
It limits somewhat the attention of the palpater so that
he may examine thoroughly and in detail the various ver-
tebrae without holding his attention so closely to one that
he fails to perceive its relation to its surroundings. It fur-

nishes five or six vertebrae at a time for comparison so

that one may determine which is inost subluxated, and
therefore most in need of adjustment, and then allows one
to reason upon the remainder of the group with this major
subluxation in mind.
The use of the Group Method may best be understood
by the study of certain didactic instructions, which follow:
Never record or adjust two subluxations of contiguous
vertebrae except in those unusual cases where they are
equally subluxated and in the same direction; even then it

is wisest to adjust them on alternate days. Let it be under-

38 Technic and Practice of Chiropractic

stood that only in exceptional circumstances should two

adjacent vertebrae be listed. The Group Method is chiefly

valuable because of this rule, to prevent the overlooking

of the most important subluxation by selecting that one
iirst.

Consider the spine as divisible into five groups; in the

first group belong the Cervicals below the Atlas; in the

second, the seventh Cervical and first five Dorsals; in the

third, the vertebrae from the fourth to the eighth Dorsals

inclusive ; in the fourth, the last five Dorsals and some-

times first Lumbar; and in the last group, all of the Lum-
bars and the base of the Sacrum. Consider the first Sacral
spinous process here rather than the whole Sacrum and
remember that this process should seem to complete the

regular Lumbar curve. This grouping may be modified

somewhat by the exigencies of palpation in any given case,
but the group considered should always include from four
to seven vertebrae.

In each group proceed in the same manner to select

subluxations. Let the fingers glide over the group, first

on the tips and then along the sides of the spinous pro-
cesses, and note that some one vertebra stands out as the

sharpest, most abrupt deviation in the group, thus indicating

its selection. Remember that neither the one above this
nor the one directly below may be adjusted. This narrows
your field of observation for this group to two, three, or
four remaining vertebrae.
Select then such others in the group as need to be listed
 Vertebral Palpation 39

yet do not conflict with the rule against adjacent subkixa-

tions. Proceed to discover and record the exact direction

of each. When this is done examine the next lower group
in the same way and continue until the whole spine has
been palpated.
The Atlas must be considered alone and not as a part
of any of the above mentioned groups and its position is

judged rather by its relation to the head than to other

vertebrae; the Sacrum also requires individual attention,

being compared with the Lumbar curve and with the ilia.

The one most pronounced subluxation in a group is

often mentioned as the "key" to the group, since its cor-

rection would eflfectually loosen the entire group and some-

times partially correct the apparent abnormalities of the
rest. It has also been called ''major subluxation" to dis-
tinguish it from "minor subluxations" which are the others
of less importance in the group. This term is not a good
one because it suggests what is not always true, namely,
that the mechanically greatest subluxation is more potent
than any other. Occasionally a slighter subluxation irri-

tates nerves so as to produce a disease more serious and

immediately alarming than the condition following the

greater displacement.

Example of Group Method

If, in the Cervicals, it is noticed upon gliding downward

over the spinous processes that the fifth is badly subluxated
and must be adjusted, this fact is held in mind for a moment
40 Technic and Practice of Chiropractic

while the palpater remembers that he cannot adjust and

must not list the sixth or fourth. This leaves only the
second, third and seventh for consideration, the Atlas hav-
ing been separately examined. The seventh may best be

included in the next group when such a selection is made,

so that the palpater need only decide between the second
and third Cervical, providing Atlas has not been chosen, as
to which, if either, most requires attention. If Atlas has

been listed, then there remains instead only the question as

to whether the third is or is not subluxated.
In using the Group Method no preference is given to
subluxation in any particular direction, save only that below
the Cervicals we discriminate against the anteriors, because
we cannot adjust them. The Group Method has to do with
determining the points of greatest pressure on nerves and
this depends upon one's impression as to the interrelations
between all the members of the group. (See p. 80 under
Subluxations.)

THE INDIVIDUAL SUBLUXATION

Having prepared our patient, surveyed the entire spine,
carefully counted the vertebrae to secure a proper orienta-

tion, and specially examined the Atlas, then divided the

spine into groups and selected the vertebrae to be adjusted
with regard to their degree of malposition, let us confine
our attention definitely for the first time to the single ver-
tebra below the Atlas.
Reread ''Direction of Subluxation" under "The Record,"
p. 25. Also read article on "Subluxations," p. 76.
 Vertebral Palpation 41

Bear in mind that each subluxation recorded is intended

for adjustment and indicate nothing impossible on your
record. For instance, an anterior subluxation in the Dorsal

region cannot be corrected and should not be recorded for

correction.

Remember the six capital letters used in describing a

subluxation.
Use only the dozL'uzvard gliding movement of the three
palpating fingers.
Keep in mind the count as you have established it for

that particular spine, recalling one or two very prominent

and noticeable vertebrae whose numbers you have noted.
Use a light touch. If necessary, change the patient's

position to make the vertebra more accessible instead of

pressing with more force.

When in doubt as to direction, change sides and use

the other hand. If still in doubt, take a longer glide, cov-
ering six vertebrae instead of three or four.
Keep your mind on your work, forgetful of everything

else.

And picture to yourself the entire vertebra and its sur-

roundings ; its body, pedicles, and laminae, its transverse

processes and all articulations ; above all, mentally visualize
the foramina and nerves. Estimate from the position of
each vertebra the pressure at each foramen. Decide whether
the vertebra is rotated, tipped, laterally displaced, anterior

or posterior, or whether the subluxation partakes of several

of these directions.
42 Tech NIC and Practice of Chiropractic

Decide in what direction movement of the vertebra would

release most pressure and list accordingly.
Never hesitate to change your opinion if you discover
evidence that you have made a mistake. Keep at all times
an open mind in palpation.

Cervical Palpation

The third Cervical, lying under the projecting spinous

process of the larger second, may be hard to find, and there-

fore the full count is always required before listing any
vertebra. By requiring the patient, who is in position A,
to drop his head forward and rest its weight in the hand
which is not palpating, the Cervicals may be more easily
palpated. Remember that this posture widens the inter-
spaces and also makes the spinous processes appear more
posterior than they really are, this difference being most
noticeable at the fourth.

One bifurcation of a Cervical spinous process may be

longer than the other and prove confusing unless care be
taken always to palpate both bifurcations and note their
form. This can almost always be successfully accomplished.
Sometimes the posterior neck muscles and ligaments
will be rigid so that they interfere with palpation and at

the same time make it impossible for the patient to flex his
head forward. Having found that this is due to real con-

trachire and is therefore not susceptible of voluntary relaxa-

tion by the patient, support the head in front and push
aside the muscles with the fingers, gliding underneath the
 Vertebral Palpation 43

muscle layers as much as possible and close to the spinous

processes.

Transverse palpation in the Cervicals is used to verify

findings from the spinous processes or to differentiate be-

tween rotated and laterally displaced vertebrae and bent

spinous processes when the spinous swerves to right or left.

Dorsal Palpation

The Dorsals are usually considered in three groups. It

must be remembered that the form and obliquity of spinous

processes vary considerably in this region. The upper
processes are very slightly oblique, slanting downward, the
middle Dorsals very oblique, and the inferior ones again
only slightly so. There is a form change, most commonly
at the eighth Dorsal, which may be mistaken for a pos-
terior subluxation. The process here becomes more hori-
zontal and more blunt.

Among the first four Dorsals a bad lateral or rotated

vertebra may be listed as well as a posterior one, since we
can readily adjust it. In the middle group either the pos-
terior or rotated vertebra is chosen according to the esti-

mate as to which causes greatest nerve impingement, either

being adjustable. In the lower group, however, preference
is usually given the posterior vertebra when possible, be-

cause rotary subluxations indicate transverse adjustments

and it is somewhat dangerous in this region to use the
transverses as levers.
44 Technic and Practice of Chiropractic

Lumbar Palpation

The Lumbars and Sacrum are considered in one group.

The Lumbars, with patient erect, should curve anteriorly
and the first Sacral spinous process should complete the
regular curve. This is rarely found, however; the normal
is the exception in any part of the spine.
In the Lumbars we usually choose the rotated rather
than the posterior vertebra, but solely because rotation here
produces the greatest degree of impingement. The lateral-
ity of spinous processes, indicating rotation of the whole
vertebra around an axis lying in the transverse line be-
tween the articular processes, can best be perceived, as a
rule, with patient sitting quite erect. If in doubt, have
patient lean forward and rest elbows on knees, which pos-

ture separates the Lumbars, rendering the individual spinous

process easier to discover but the relative position more
difficult of determination.
The fifth Lumbar, if anterior, may be so listed, forming
an exception to the general rule.

Sacral Palpation —Pelvis

First palpate Sacrum as if part of Lumbar region. Note
whether the base (upper portion) is posterior or not. Then
stand behind the patient and use both hands to examine
the sacroiliac articulations. Use palmar surfaces with the
flat hand toward patient's body, and carefully compare the
two sides to detect inequalities, which indicate iliac sub-
luxation, or rotation of Sacrum between the ilia on a trans-
 Vertebral Palpation 45

versely disposed axis passing through the two articulations,

in which case the Sacrum is to be adjusted. Do not mis-
take a dislocated hip with compensatory tilting of the whole
pelvis, or faulty sitting posture with only one tuber ischii

supporting the body, for pelvic subluxation.

Be not in undue haste to record pelvic subluxations lest
your haste bring its immediate reward in the difficulty of

adjustment.

The Coccyx
The Coccyx may be detached from the Sacrum by
various accidents and later re-ankylosed thereto in an abnor-
mal position so as to impinge upon the rectum or other
structures. Impingement of the coccygeal nerves is usually

unimportant. Chronic and intractable rectal constipation,

with its attendant train of evils, may result from coccygeal
displacement with ankylosis. In spite of numerous trea-
tises to the contrary, the writer avers that other symptoms
are extremely rare.
To examine the Coccyx use a rubber covering on the
second finger. Place patient face down and insert second

finger per rectum with the palmar surface upward. If

subluxated Coccyx be found, it must usually be fractured

with a sharp jerk, in order to relieve the condition. After
fracture, it may be absorbed or may re-ankylose to the
Sacrum in a better position, or it may remain freely

movable.
46 Tech NIC and Practice of Chiropractic

PALPATION IN POSITION B
This is the position for the majority of adjustments,

and as the palpation of each vertebra to be adjusted is a

necessary preHminary to the adjustment, this method,
though not so accurate as the one already described, must
also be used.

The use of the first three fingers of each hand and the
relation of hands to patient's body is the same as in Posi-

tion A, except for palpating Cervicals when the patient's

face is turned away. It will be found very difficult to make
a correct full count, especially to count Cervicals, in this
position, and is better to use a record already prepared.

Dorsals
Begin at, or near, the first Dorsal to palpate in this posi-
tion. Find the vertebra which agrees in direction with the
first Dorsal subluxation recorded ; let the fingers glide down-
ward until they reach the vertebra which, according to the

first decision, would correspond in number with the next

subluxation on the record. If this also agrees in direction

with the record it may safely be assumed that you are accu-
rate in your numbering. Thereafter, during that adjust-
ment, the count can be made or repeated from any promi-
nent vertebra the number and identity of which are easily
recognized.

Lumbars
It may be difficult to count or otherwise to palpate the
Lumbars in this position because of the increase in the
m

Ph

^
 Vertebral Palpation 47

normal anterior curve when patient is suspended between

the two sections of the bench. This will be obviated if a

roll be placed under the thighs or if the bench has an ad-

justable rear section.

Cervicals

If a solid front bench is used remember the spiral turn

in the Cervicals, which occurs because of the resting of the
head on one side. The curve due to this rotation of the

head is compounded with the ever present anterior curve to

make a spiral. Do not expect the vertebrae in this position

to agree in apparent direction with a record made with the

head straight. It is better to make all decisions as to direc-

tion of Cervicals in position A and merely to count them

in other positions.

In position B, if the patient's face be away from the

palpater it will be necessary to stand with back toward

patient and body twisted, and to change hands for counting,
resting the free hand on patient's head to insure its

steadiness.

Disagreements

If there be any apparent disagreement between findings

in positions B and A, re-examine carefully in both posi-
tions, whereupon that which seemed a disagreement will

probably prove to have been an error in one or the other

palpation. If apparent disagreement persists after search-
ing examination, position A furnishes the safest guide to
48 Technic and Practice of Chiropractic

adjustment because the patient is in his most usual attitude

as regards the spinal curves, muscle tension, etc. But it

is usually wisest When in grave doubt not to adjust the

doubtful vertebra at all.

PALPATION IN POSITION C
Since palpation in this position, patient lying on his
back with head supported by palpater's hands, cannot be so
reliable as that done in position A, the chief point to be
observed is an accurate count. Only the Cervicals below

the first can be properly palpated in this position.

Induce the patient to relax the neck muscles as much
as may be, and use in palpation the first three fingers of
one hand if the count alone is desired or the first three
fingers of both hands if you desire to ascertain the direction

of any vertebra. In the former case let the fingers press

aside the muscles and glide doimiward from the second Cer-
vical, being careful to lift the head high enough so that
the third Cervical is not overlooked beneath the overlapping
second. In the latter case let the fingers of both hands
glide gently downward while the patient's head rests upon
the palpater's wrists or knee. Palpate the transverses in
much the same manner, paying special attention to their

laterality, felt as a prominence on one side lateral to a

transverse process and a corresponding depression on the
opposite side. Do not be deceived by exceptionally long
transverses where both project outward to an equal degree.
Since the greater mass of the vertebra is divided with
Locative palpation of Cervical spinous processes in Po-
sition C, preparatory to Rotary or Break.
 Vertebral Palpation 49

fair equality by the intertransverse line, laterality of trans-

verses indicates laterality of the whole vertebra with the
possible exception of the anterior portion of the body.
Laterality of a Cervical spi}ioiis process may indicate later-

ality of the entire vertebra or merely rotation around its

vertical axis, in which the one articular process is separated

from its fellow of the adjacent vertebra while the other
remains in partial apposition.

Disagreements

If disagreements appear between palpation made in posi-

tions A and C, re-palpate in both positions. If still uncer-

tain call a consultation or follow finding in position A. The
Rotary adjustment may sometimes aid in deciding difficult

questions if gently attempted and free movement secured.

With this adjustment a vertebra will not usually move with-

out rather extreme force unless the articular process on
the side sought to be moved has lost its apposition with its

fellow of the adjacent vertebra. In any case of disagree-

ment nerve-tracing, the discovery of sensitive nerves on
one side only may aid in decision. A knowledge of proba-
bilities, previous experience, and the diagnosis may also

serve as partial guides.

TRANSVERSE PALPATION
Palpation of the transverse processes is easiest in the

Cervical and mid-dorsal regions and most difficult in upper

Dorsal and Lumbar regions. It has two uses : first, to assist
50 Technic and Practice of Chiropractic

in making a record by verifying the work done on the

spinous processes; second, to locate a given transverse
process in order to use it as a lever for the adjustment of
the vertebra.
It will be seen that fulfillment of the first purpose re-
quires careful examination of the direction and position of
the transverses as compared with each other and with the
spinous process of the same vertebra, while the second re-
quires only the discovery of the exact location of some
particular transverse. It will be best to consider the three
divisions of the spine separately, excluding from the pres-
ent chapter Atlas palpation, which has been thoroughly
described.

Cervicals

These can' be best palpated in the position for Atlas

palpation ; that is, standing behind the patient and using
the palmar surfaces of the fingers of both hands. From
the Atlas transverses follow the anterior border of the
sternomastoid muscle downward, and opposite each spinous
process draw the muscles backward and inward until the
tips of the transverses are found with the middle fingers.

Their position on the two sides may then be easily com-

pared as well as their relation to those above and below
them.
The transverses of the second Cervical may sometimes
be so prominent laterally that they are, or one of them is,

mistaken for an Atlas transverse. As a rule, however, the

Fig. 1. Locative palpation of Dorsal transverse processes.
 Vertebral Palpation 51

width of the Cervicals increases from the second downward,

the second being narrowest. Chassaignac's tubercle, on the
transverse process of the sixth Cervical and opposite the
lower border of the cricoid cartilage, is a prominent point
easily felt as a rule. The transverses of the fourth are
usually opposite the upper border of the thyroid cartilage.
The Cervical transverses lie very close to the articular
processes and the determination of their relation is a better
guide to the condition of the articulation than is spinous
process palpation. It is also more difficult.

Palpation of Cervical transverses to determine laterality

of the vertebra as a whole or its rotation is possible in

position C and has been described under that head.

Dorsals

Palpation for direction can be done best in position B.

Use three fingers with a gliding movement along the line
of the transverses, passing over several to determine which
is most posterior. Then repeat the glide on the other side
of the spine to determine whether the transverse correspond-
ing to the anterior one is posterior or vice versa, showing
that the entire vertebra is merely rotated or is displaced
backward. Some palpaters prefer using both hands and

palpating both transverses at once and there is no serious

objection to this method, if confined to palpation in position
B. In many cases, however, it leads to similar palpation of
spinous processes, a most execrable habit.
It should be remembered that with the first two Dorsals
52 Technic and Practice of Chiropractic

the transverse will be found in a transverse plane which

would pass between its own spinous process and that above.
This is also true of the last three Dorsals, while in the

middle Dorsals the transverse is usually (not always) level

with the tip of the spinous process of the next superior
vertebra.

Before adjusting, to determine the location of a trans-

verse process in order to direct an adjustment against it,

first palpate spinous process and hold it with the tip of the
middle finger. Then approximate with the first finger a
point even with the tip of the spinous process above and
about one inch from the spine — this of course in mid-dorsal.
Then let second and third fingers follow the first so that
all three rest on or near the transverse to be palpated.
Pressing gently, but firmly, move the three fingers until the
process can be felt beneath them. Hold the process with
the middle finger so as to direct with it the contact of
the adjusting hand to a point exactly over the transverse
process.

Lumbars
The Lumbar vertebra lie just even with
transverses of a
the interspace between their own and the adjacent superior
spinous process. They are deeply embedded in muscle
tissue and very hard to palpate. They may vary consider-
ably in size or length and the last one or two may be abso-
lutely impalpable. It is sometimes advisable to adjust a
rotated Lumbar by using the transverse as a lever, but this
 Vertebral Palpation 53

should never be attempted unless the process can be dis-

tinctly felt. The method of locating in Lumbar is prac-

tically the same as in the Dorsal region.

Transverse Palpation with Patient Sitting

Palpation of Cervical transverses in position A has been
described and is frequently done. Palpation of Dorsal or
Lumbar transverses in the same position may sometimes
be desirable. It can be done with the same movement as
spinous process palpation, and may serve to detect a bent
spinous process.
If it is necessary to palpate both transverses at the same
time, stand in front of the patient and lean over his shoul-

der, letting his shoulders rest against your body. Use

palmar surface of fingers of both hands and note which
transverse is posterior to its fellow, if either, or whether
both are posterior to the line of the others above and
below them.
It is rarely possible to find if a transverse process be
superior or inferior to its normal position, except the Atlas

transverses, although this may occasionally be detected.

Fortunately this is a rare form of subluxation, or appears
rare, although it must be said that this apparent rarity may
be due to our comparative inability to detect it in the living

subject.
CURVES AND CURVATURES
For convenience, curve is used to denote the normal
curvilinear deviation from a straight line naturally present

in the normal spine or naturally assumed in response to

54 Technic and Practice of Chiropractic

the need for equilibrium during the erect position of the

body: Curvature means either the abnormal increase of
any normal curve or the appearance of any abnormal curvi-
linear deviation of vertebrae from their normal position.
Deviations from normal must contain at least three vertebrae
to be considered curvatures.

Visual Examination

The general inspection of the spine which precedes the

count should bring to light, in addition to prominent sub-
luxations, and general symptoms observable by inspection
of the back, any marked curvatures. Their general locality
and direction will be noted by this observation and their
details left to be discovered by closer examination.
During palpation with a long and rapid glide one may
also note these general points with respect to any curvature.

Do not mistake the four normal curves, the anterior

Cervical and Lumbar and the posterior Dorsal and Sacral,
for curvatures. The normal Lumbar curve is so unusual
in practice that a novice has been known to name it a

lordosis.

Description of Curvatures

Four varieties of curvature are commonly described.

Kyphosis is a curvature with its convexity directed back-
ward, usually, but not always, found in the Dorsal region.
Lordosis, the opposite of Kyphosis, is an anterior curva-
ture, usually in the Lumbar in which case it is an accentua-
 Vertebral Palpation 55

tion of the normal curve. Scoliosis has its convexity di-

rected laterally either to the right or the left. It is com-
monly also Rotatory, having its vertebrae rotated around

their vertical axes so as to make the outer or the inner

transverses more prominent than those on the other side.

In a Scoliosis the rotation may swing either the bodies

or the spinous processes toward the convex side of the

curvature; the latter is much the easier of adjustment while

the former furnishes one of the most intricate problems of

adjustment.

Cause of Curvatures

Without entering here into a discussion of those dis-

turbed metabolic processes —themselves the result of sub-

luxation —which result in curvature by general softening of

the bone, as in rachitis or spondylitis deformans, we will

simply state the general proposition that almost all curva-

tures which are in any degree angular result from a single

subluxation to be found at the point of the angle. It has

been demonstrated in such cases that adjustment at that
point will correct the curvature in time but it is usually

wiser to hasten matters by selecting other points of attack

by a method to be presently suggested.

Long, regular, but not pronounced, Scoliosis, usually in

the Dorsal, may be an example of occupation curvature,

following the continued use of muscles in a fixed position
and not due to. subluxation. Another example is the mail-
man's Lordosis. These in themselves are not detrimental
56 Technic and Practice of Chiropractic

to health and are negligible unless some special point of

impingement through individual subluxation exists within

them.
The sharp, angular kyphosis of Pott's Disease, tubercular

caries of the vertebrae, the curvature involving three or

four vertebrae which are extremely tender to palpation,

should warn against adjustment unless one can be very
certain that the vertebrae are sufficiently intact. Fracture
of a decayed vertebra is easily possible under adjustment.
The cause of Pott's Disease is usually at the angle point,
most frequently the tenth Dorsal but possibly any Dorsal
from fifth to twelfth.

Record on Curvatures

If it is the purpose of the examiner to straighten the

curvature he should choose for adjustment a series of non-
adjacent vertebrae which are most prominent in the direc-
tion of the curvature; thus in a right scoliosis he should

choose only those vertebrae most prominently out to the

right, and in a kyphosis only posterior ones. A lordosis

as such cannot be properly adjusted except in the Cervicals,

but lordosis is usually a compensating curvature (see below)
and can be otherwise corrected.
If the patient suffers from some disease which assumes

more importance than the curvature and demands attention,

select the one vertebra which is causing the disease, without

reference to its position in the curvature, and adjust that
vertebra into a proper relation with the adjacent ones, even
 Vertebral Palpation 57

though you adjust directly toward the convexity of the

curvature. Disease may often be reHeved by making a
curvature regular more quickly than by eliminating the
entire curvature. Sometimes both considerations may influ-

ence the selection of vertebrae.

In a curvature there is not necessarily pressure on nerves
at every foramen. In fact, such pressure is the exception
rather than the rule in curvature and a careful study of
the spine must be made in order that adjustments may be
accomplished without causing temporary impingement here
and there.

A foot-note describing curvature may be appended to

the record of palpation. It should contain the special name
of the curvature, whether simple or compound, and the
numbers of the first and last vertebrae in it. For instance,

note may read : "Right rotary scoliosis from D 3 to L 1

inclusive."

Compensatory Curvatures

When a primary curvature is present one or two second-

ary curvatures usually appear to preserve the equilibrium of
the body. With a Dorsal kyphosis there is often a Lumbar
lordosis and sometimes less marked lordosis in both Cer-

vical and Lumbar. With a primary right scoliosis in the

Lumbar there will be a secondary left scoliosis above. The
secondary curvature is called compensatory. In selecting
vertebrae for adjustment it is well to neglect the compen-
satory curvature as much as possible, leaving it to right
58 Technic and Practice of Chiropractic

itself as the primary one is corrected. If, however, the

primary curvature be a lordosis, and not adjustable, work
on the secondary curvature may gradually aid in reducing
the primary, to a certain extent at least.

Ankylosis

This topic is discussed here partly because it is so often

associated with curvature.

Ankylosis can be appreciated only by detecting the lack
of normal movement between adjacent vertebrae. Place a
finger in the interspace between suspected vertebrae and ask
the patient to perform the movement calculated to separate

the spinous processes in a normally movable spine. If in

the Dorsals, ask him to drop the head and shoulders as

far forward as possible without bending at the hips. Alter-

nate repetitions of this movement with straightening and the

spinous processes should alternately separate and approach

each other. Test several successive vertebrae so as to note
that all change their position except two.

In the Lumbars have the patient repeatedly bend the

body forward from the hips striving to make his spine

convex backward. In the Cervicals forward flexion of the

head will serve. Occasionally general ankylosis is found
with curvature, as in Spondylitis Deformans.
Many Chiropractors mistake failure to move a vertebra

with an attempted adjustment for evidence of ankylosis.

In nine cases out of ten such failure is due to other reasons,
ankylosis being very infrequent. It is a much abused excuse
 Vertebral Palpation 59

for incapability. Free movement between spinous processes

is absolute proof that the vertebrae are not ankylosed.

DIFFICULTIES IN PALPATION
The chief difficulty arises from failure to observe some
of the rules herein laid down.
Carelessness or inattention precludes accuracy.
Pain may cause the patient to assume an unnatural or
cramped attitude simulating curvature, especially of the

Cervicals. More errors occur from this cause in judging

the laterality of C 2 than with any other vertebra.

The occasional bent spinous process in Cervical or

Dorsal regions may deceive the palpater unless transverse

palpation is employed. But the frequency of slightly bent

processes in dry spines and a superficiality of reasoning

upon the subject have led to great overestimation of their

importance. As a matter of fact only a very few malad-

justments arise from deception of the palpater in this way,
though the profession contains few practitioners who make
a routine method of verifying by the transverses. The
reason is simple. Bent processes are caused by direct vio-
lence applied before the union of shaft and epiphysis is

complete. Sufficient force to produce a change of direc-

tion usually produces subluxation in the same direction.

Adjustment continued until the offending process was quite

aligned with its fellows would constitute overadjustment,

but adjustment is not usually continued after all symptoms

have subsided, so that actually small harm occurs through
failure to detect bending.
60 Technic and Practice of Chiropractic

An epiphyseal plate may be absent, having been broken

off by trauma and absorbed, This can be discovered by
noting the too-wide space between apparently adjacent
vertebrae, and careful palpation will disclose the apparently

much anterior vertebra, an appearance not borne out by

the position of the transverses. When an epiphysis is ab-
sent a patient has a somewhat weak back from lack of
muscular attachment.
Lipoma, or the heavy cicatrix following a burn or car-
buncle, may render palpation of two or three vertebrae
impossible. In such a case only the palpater's experience
and his knowledge of the characteristics of various vertebrae
will enable him accurately to number the remainder.
Patients with much adipose tissue may require palpating
in several positions in order to permit certainty.
A deep third Cervical which is absolutely impalpable
may mislead one, but a careful count which shows one
vertebra overlooked indicates the necessity for a careful
re-examination of the Cervicals, by which the gap at the
third at least may be appreciated. If the Axis is very much
inferior the third is especially likely to be overlooked.

Anomalous cases have been found in which there were

more or less than the usual number of movable vertebrae,
the usual deviation being the presence of twenty-five, and
the extra one being most commonly a Lumbar. In one case
under my observation there were twenty-five movable verte-
brae, apparently thirteen Dorsals according to shape, and
only eleven pairs of ribs posteriorly, two pairs being dichot-
 Vertebral Palpation 61

omoiis so that there appeared thirteen pairs anteriorly.

Deviations in number occur, in my experience, about once

in five hundred cases.

LANDMARKS
The regional location of vertebrae by means of certain

landmarks (so called) in or near the spine, is a much dis-

cussed question in the profession. Without discussing the

various arguments in favor of this method, chief of which
is the inability of the untrained to count vertebrae, let us

set forth the principal landmarks used and the facts in

regard to them.
The seventh Cervical, called Vertebra Prominens, is usu-
ally considered a guide to the count. In over three hundred
cases examined for that purpose the seventh Cervical was
found to be Vertebra Prominens in about 65%, the other
35% showing the sixth Cervical or first Dorsal to be the
prominent one. This method is two-thirds as accurate as
counting.
The tubercle (Chassaignac's) of the sixth Cervical
transverse is said to be directly opposite the lower border

of the cricoid cartilage and this is a better guide than the

above.
The third Dorsal spinous process is said to be on a level

with the root of the spine of the scapula, and with arms
hanging at sides, the upper angle of the scapula to be on a
line between first and second Dorsal spinous process. This
is not at all constant.
 — —

6'2 Technic and Practice of Chiropractic

The inferior angle of the scapula is said by some writers

to be on a line with the tip of the seventh Dorsal spine.
Others locate it opposite the interspace between seventh and

eighth Dorsals. Still others give it as opposite the eighth

Dorsal spine. All are correct sometimes. In truth, the

inferior angle may be opposite any part of the spine between
the sixth and ninth Dorsals. There is nothing constant
about it.

The twelfth rib may be followed to its articulation with

the twelfth Dorsal vertebra. This is a good guide, providing

that the rib can be palpated. The lower margin of the last
rib is usually even with the spinous process of D 12 about
one inch and a half from the mid-spinal line. The humor
lies in the fact that the patient upon whom the count is so

difficult as to require this verification is usually obese and

obesity renders the rib impalpable.
The line drawn between the iliac crests falls between
the third and fourth Lumbar spinous processes in about

98% of all cases. This is our most reliable latidmark. It

is used as described under the Count.

All landmarks except the last two show such variance
in different individuals as to be quite unreliable. The cor-

rect method of numbering spinous processes is the obvious

and logical method count them. The skill and accuracy

of touch required for successful counting is invaluable in

determining direction of subluxations.

 Vertebral Palpation 63

MENTAL ATTITUDE
In order to secure that absolute concentration without
which it is impossible to appreciate properly those tactile
impressions for the very reception of which such continued
practice is necessary, the hands should leave the spine as
little as possible during palpation; a second person should
record subluxations found so that the palpater need only
state, and not write, his conclusions ; light pressure on the
spine should always be used, as a heavy pressure desensi-
tizes nerve-endings in the fingers ; and silence should be
maintained except for the necessary statement of points
to be recorded.

Palpate as rapidly as is consistent with good work. The

more rapid the palpation, if concentration is absolute, the

more accurate the impressions received.

The end and aim of palpation is to determine the means
by which impingement of nerves may be removed with the
greatest rapidity and success. Palpation includes such a
study of the vertebral column as will fix in your mind a
clear thought-picture of the impinged nerves throughout
its length.
FINALLY
If you would achieve success in Vertebral Palpation, be
persistent. Spare no labor to acquire that accuracy of

detail which distinguishes the expert from the amateur.

You can make of yourself what you will. There is no
limit to the ability which may be acquired. Another may
guide your hands but with you lies your success.
 NERVE-TRACING
Definition

Nerve-tracing is that branch of palpation by which the

tenderness of irritated spinal nerves is discovered and their
paths demonstrated.

Organ-Tracing

Organ-tracing is that branch of palpation which deals

with the outlining of the boundaries and surface markings
of a tender organ or part.

Palpaters frequently confuse tenderness of one of the

parenchymatous viscera for the tenderness of interlaced and
branching nerve filaments, especially in the abdominal re-

gion. The fact that the tender area takes on the charac-
teristic shape of one of the viscera is conclusive evidence
that an organ, and not nerves, have been traced.

What Nerves Traceable

Any spinal nerve may be traceable for at least a part

of its course. The cranial nerves are made inaccessible to
palpation by their location, except the spinal portion of the
spinal accessory and the terminal portions of the nerves to
the face. Likewise the sympathetic trunks, except perhaps
in the neck, are untraceable.

64
 Nerve-tracing 65

Nerve-tracing is comparatively easy in tlie upper and

lower extremities, neck and back. The superficial nerves of
the scalp are hard to follow on account of the hair. The
superficial nerves of thorax, abdomen, and pelvis are acces-
sible under the conditions mentioned below ; the deep or

visceral branches, never.

Of those nerves mentioned as traceable, only such as

are irritated and consequently swollen and tender, can be
followed. If a nerve is very heavily impinged, especially if

the impingement be chronic, it is partially or wholly par-

alyzed and not traceable. If the heavy impingement be
acute, or if there be a light impingement serving as a
mechanical irritant, nerve-tracing is a real aid to diagnosis.

Proportion of Cases with Traceable Nerves

About one-half of all the cases which visit Chiropractors

for adjustment are susceptible of nerve-tracing. In the
remaining half it is absolutely impossible to acquire any
information in this way. Of the half who are at all sus-

ceptible, it is possible in perhaps four-fifths of all cases to

secure some accurate or reliable information.

The patient in whom all accessible nerves seem tender

to light palpation is hyperesthei:ic and unavailable for tracing.
In the usual case one or two nerves will be found easily
traceable, while the rest exhibit no tenderness on pressure.
Such a case furnishes the most reliable information secur-

able by this method and the tender nerves may be con-

sidered as lightly or acutely impinged.

5
66 Technic and Practice of Chiropractic

Preconception of Nerves Essential

Knowledge of the anatomy of the nervous system is a

part of the necessary equipment of the Chiropractor who
would trace nerves and this knowledge should be so thor-
ough as to enable the palpater to recognize each tender line
found as an anatomically described nerve-path or an error
on his part. The examiner must kr^ow the paths of all

nerves and be able to predict from the first tender points

discovered the probable course which the tenderness will
follow, so as to direct his search along that probable path.

He must be able to detect unconscious deception on the

part of the patient through his knowledge of the anatomical
imipossibility of the apparent tracing. For instance, if for
any reason he may appear to have traced a nerve upward
beside the spinal column from D 10 to the eye by way of
the vertex, he must know that this is an illusion —because
such nerves do not exist and cannot be anatomically dem-
onstrated —or accept the well merited ridicule of any edu-
cated person who discovers his absurdity.
Because of the difficulty of determining whether the
tender structure found be muscle, nerve, or viscus, and
because of the natural suggestibility of both palpater and
patient, nerve-tracing cannot be so reliable a guide to
nerve-paths as is dissection. It should not be necessary to
state this obvious truth but the calm acceptance, by many,
of the weird conclusions based upon a belief in the infalli-
bility of nerve-tracing testifies that it is necessary.

Nerve-tracing is valuable only where the nerve-path

 Nerve-tracing 67

outlined as being tender corresponds to the known path

of some nerve.

Suggestion

Paradoxically, knowledge of nerve-paths may lead to

error. By the law of expectancy, we are prone to find what
we look for and if we hold too strongly to the belief that

because we have found one or two points of tenderness we

must find a series of points extending along a mentally pic-
tured nerve-path, we may search until we falsely believe

that we have found this series.

Likewise the patient, having been carefully informed as

to the manner of procedure and knowing what we expect
to discover, may unconsciously deceive us by feeling tender-
ness in response to suggestion, where no real impingement
exists.

Place in Diagnosis

The value of nerve-tracing in diagnosis has been much

overestimated by many, though the tendency of the profes-
sion seems to be toward rationalism along that line.

Whereas, in palpation of the spine every real subluxa-

tion gives evidence of disease, or tendency to disease, while

every normally aligned pair of vertebrae furnish proof that

no disease can exist in the area of distribution of the nerve

emerging between them, nerve-tracing is much less reliable.

If the tender nerve be traceable to a vertebral subluxation

it may be taken as additional evidence that the effect of that

68 Technic and Practice of Chiropractic

subluxation is disease, rather than tendency to disease, truly

an important distinction, but scarcely broad enough to sup-

port a diagnosis without aid.

The absence of tenderness from nerves does not negative
a disease in any instance, whereas the absence of subluxa-
tion does. Like all other expedients for the selection of
vertebrae for adjustment without admitting the necessity for
first acquiring much skill by much labor, nerve-tracing has a

great weakness. Olily irritated nerves are tender and the

effects of subluxation may be either irritation or paralysis.
If accurately done, sources of error carefully eliminated,

and the results of nerve-tracing found to correspond with

the condition of the spine and the other symptoms, this

method of demonstrating to the patient the connection be-

tween the vertebrae and the diseased region of his body

is valuable. It aids in convincing him of the validity of

the Chiropractic theory.

TECHNIC OF NERVE TRACING

Where to Begin
The palpater, having made his vertebral palpation, may
begin at some point in the body indicated by the -symptoms
as diseased and, finding tenderness, follow the path of a

nerve back to the spinal column where the nerve may be

fairly presumed to enter the intervertebral foramen.
Or he may use his palpation record as a guide and
follow the tender nerves outward to their periphery. This
is the better method.
.^ .
 Nerve-tracing 69

Palpation as Guide

When palpation has been made, remember that the im-

pinged nerve is usually found on the side opposite to the

direction of the spinous process in its departure from the
median line. With a left subluxation the tenderness is

usually, though not always, on the right side. If in the

Lumbar, and the subluxation a rotation, the impinged nerve

will be found belozv the transverse process of the subluxated

vertebra. In the Cervical and Dorsal regions the tender

nerve is usually below, but may be either above or below,
the transverse of the subluxated one.

Examine the nerves having exit from the foramina of

each subluxated vertebra in turn from above downward.
When a tender point is found about an inch from the mid-
spinal line, attempt to follow the nerve and palpate until

it has been traced as completely as possible.

Where to Expect Tenderness

The region immediately surrounding the spinous process

of the subluxated vertebra may be tender because of im-

pingement of the axons of the posterior primary division of
that spinal nerve which emerges below the vertebra. Such
tenderness is more common with anterior subluxations than

with others. It is not to be confused with the soreness

which often appears after adjustment and is due to bruising

or straining of the tissues.

Nerve tenderness may be discovered at a little distance

from the mid-spinal line and at a level slightly lower than

70 Technic and Practice of Chiropractic

the emergence of the nerve. If a nerve is irritated, the

finger inserted between the ribs near their articulation with
the transverse processes will elicit tenderness. The dis-

covery of tender points along the spine is the most impor-

tant part of nerve-tracing.

Nerve-Paths
Detailed description of the paths of all the spinal nerves
may be studied from any standard work on anatomy and
will not be included here, but it may be well to remind the
reader of certain general tendencies.
The spinal nerves do not cross the median line in front

except perhaps fine interlacing fibres.

In the Dorsal region the nerves are usually found follow-

ing the interspaces until the lower ones debauch upon the
abdominal wall anteriorly. There are, however, some Dor-
sal and lower Cervical nerve bundles which pass obliquely
downward and outward to innervate back muscles.
Reference to the section on Spino-Organic Connection
will make clear the tissues supplied by each nerve.
Slight deviations from the usual course of nerves are
common ; marked deviations very infrequent.

Use of Fingers

Use second finger of either hand for the palpating finger,

choosing the hand which can be most conveniently used as

determined by the position of patient and the part of the
body to be examined. There is no set rule. Reinforce this
second finger by the pressure upon it of the first and third
and, if desired, by pressing thumb against it. (See Fig. 5.)
 Nerve-tracing 71

Apply the tip of the palpating finger to the nerve with

a motion such that it crosses the path of the nerve at right
angles back and forth. Meanwhile the probable path of
the nerve must be kept in mind. As the finger crosses
the nerve-path it makes steady and even pressure upon any
structures passing beneath it. The motion of the hand is

almost a rolling motion, the finger tip probing, as it were,

for a tender spot.

Tenderness —How Recognized

The irritated condition of the nerve which has thus been
rolled beneath the finger may be recognized in one of three
ways; the patient may involuntarily flinch, betraying the
hurt; or he may inform the palpater of the hurt; or the
swollen, cord-like nerve may be felt.

The two former are the reliable guides, while the latter
is only occasionally possible. In children and in feeble-
minded, insane, or mute adults, the first mentioned method
must be relied upon entirely. Muscular contraction is the

unconscious or reflex response to pain and often occurs

independently of the intelligence or state of mind of the
subject.

Of all the three methods the one most commonly relied

upon is the second — the statements of the patient.

Instruction to Patient

The patient should be informed of your intentions when

palpation is begun and should be asked to answer every time
you apply your finger, saying, *'Yes," if the spot is tender
72 Technic and Practice of Chiropractic

and, "No," if not. He should speak promptly each time

so as to avoid self-deception which might come with rea-

soning upon his sensations. Occasionally vary the steady

rhythm of your movements by omitting one and note if the

patient responds mechanicallly when you do not press.

At times during the tracing, it is well to depart from
the probable nerve-path and to touch again a point marked
as tender, to see if the patient's information may be relied
upon. Whenever you leave the nerve-path his answer
should be, ''No," immediately changing to, ''Yes," when
you re-cross the tender line.

Marking Tender Points

At each tender point noted a small mark should be made

with an eye-brow pencil or other grease-paint, which leaves
a distinct but easily removable mark. These tender points
should be noted and marked at intervals of about an inch.

Connecting Line

When the entire nerve-path has been traversed in this

way, draw a line with the eye-brow pencil, passing through
all the marks indicating points of tenderness. This line

should be a sufficiently accurate rough outline of the nerve-

path to make clear the spinal connection with the diseased

area. The significance of this connection will be better

understood when the section on Spino-Organic Connection
has been studied.
Fig. (J. Anterior half of completed nerve tracing.
 Nerve-tracing 73

Common Findings

In muscular rheumatism, neuralgia, neuritis, or in case

of a local boil or abscess indicating local disturbance of the
trophic influence of nerves, clear and definite tracings are
common. Muscular spasm, such as wry-neck, usually has
a very tender nerve associated. Localized painful disease
of any kind is likely to be associated with a very definite
nerve tenderness, as is the case frequently with appendi-
citis, ovaritis, hepatic colic, etc.

The painless disorders, or various disorders of spleen,

diaphragm, heart, lungs, etc., though they be of a very

serious nature, seldom are discoverable by nerve-tracing
unless their serous membranes are involved. Tracings may
be made from D 2 or 3 to anterior thoracic walls in heart

or lung disease but are not common.

Any spinal nerve may be traceable at times through at
least a part of its course.

Sources of Error
Several of these have been mentioned, such as the nat-
ural suggestibility of both examiner and patient. Among
others are : failure in the back, thigh, or leg to reach the

really tender nerve because of the interposition of several

muscle layers between it and the finger, ignorance of nerve-

paths, failure to apply equal pressure to all parts of a nerve,

application of such heavy pressure that muscle tissue is

bruised and hurt, and failure of full co-operation on the

part of the patient. Let us consider these in turn.
74 Technic and Practice of Chiropractic

If several muscle layers interpose themselves between

the searching finger and the nerve, it is proper to push
aside the intervening layers, using a twisting and rolling
movement until the finger feels underneath the muscles.
This done, and a tender nerve found underneath several
muscle layers, the same amount of overlying tissue must
be pushed aside each time the finger searches for the nerve.
Only exhaustive study of the anatomy of the typical nervous

system will enable the examiner to know exactly at what

point a nerve will become more or less superficial. Unless
he does know this it is best to follow the neutral rule that

nerves tend to follow the long axes of ribs and limbs and
to maintain their depth beneath the surface throughout
their course. This statement is too general for accuracy.
Care should be taken that equal pressure be made on all

points palpated on one nerve. If the nerve pass over a

bone, less force is needed to exert the same pressure than

if it overlie muscle or other soft structure. The force used
varies constantly as the hand moves from place to place,

according to the density and hardness of the structures

overlying and underlying a nerve.
Sufficiently heavy pressure will elicit tenderness in all

except anaesthetic patients. But if a nerve be irritated it

will be tender without heavy pressure, when the finger really

makes a close contact with it.

If the patient willfully attempts to deceive the palpater,

nerve-tracing might as well be abandoned except in those

extreme cases where the patient will flinch against his will

on account of extreme sensitiveness.

 Nerve-tracing 75

Use of Second Hand

As far as possible, the second hand is placed opposite

the tracing hand and steadily supports the body ; its position

changes with changes in the position of the first. If the

arm is to be examined it had best be held away from the

body, and the part to be examined held between the two
hands.

Position of Patient

For tracing nerves in the neck, back, and upper ex-

tremities, the patient should sit easily. For lumbar, abdomi-

nal, or pelvic tracing, or for tracing in the lower extremi-
ties, have patient lie on side or back. Do not hesitate to

change the position of the patient as often as is necessary

to secure easy access to the part to be examined and relaxa-

tion of the patient's muscles. Never allow the assumption

of a strained position during tracing; the sensation of
cramped muscles may be confused with sensations of nerve
tenderness.
 ;

SUBLUXATIONS
Definition

A vertebral subluxation is a displacement, less than a

dislocation, in which the chief element is the partial loss
of normal apposition of the articular surfaces of the sub-
luxated vertebra with those of the vertebra above or below,
or both. Or, Vertebral subluxation is a permanent partial
dislocation.

How Produced

Subluxations are primarily caused by trauma — falls,

blows, strains, etc., being the chief factors. Hereditary

weakness in structure of some part predisposes by render-
ing that portion more easily displaced.
Subluxations are never hereditary but may be congenital
through violent or instrumental delivery into the world or
may appear hereditary because they occur shortly after birth
through the effect of light jars upon the hereditarily weak-
ened segments of the spinal column.
They are always the result of concussions of forces
never of forces acting entirely within the organism. They
result from the contact of the body with its environment.
It has been said that muscular action in response to
peripheral irritation may produce subluxation. The laws
of reflex action render this impossible. Given a normally
76
 Subluxations 77

aligned vertebra, and consequently normal nerves and a

normal reflex arc in that segrnent, the ventral horn cells

respond to a slight peripheral stimulus by exciting muscular

contraction on the same side with the irritation. If the irri-

tation be sufficiently increased, the response occurs on both

sides but most strongly on the side from which the irritation

comes. Greater irritation merely serves to cause greater

distribution of the responsive action. (See any standard
physiology on reflex action.) In no case will the difference
between the contractions of muscles on the two sides be
sufficient to displace a normally aligned vertebra. Nature
has provided against that contingency.
Given a subluxated vertebra causing nerve impingement
and thus interruption of the normal action of the reflex arc,

irritation may result in greater contraction upon the op-

posite side than upon the side of the irritation. This is an
abnormal condition and accounts for the increase of pre-
viously existing subluxations under pain or peripheral irrita-
tion. But in every instance trauma must and does precede
and cause subluxation.

Reaction of Secondary Causes

Once produced, however, a subluxation may not cause

noticeable effect until it has been increased in degree by the
reaction of forces within the body such as poisons, general
fever, etc. Thus germs, dietetic errors, exposure to sudden
temperature changes, waste of energy through abnormal
mental activities, as hate, fear, worry, etc., or through
 :

78 Technic and Practice of Chiropractic

physical excess — in fact, all the secondary causes of disease

may appear to have produced a subluxation. In fact, they
have merely accentuated that which already existed and
have done so through the muscular contractions which they
induced.
General thinning of intervertebral substance through a
condition of disturbed metabolism itself produced through
the agency of some one serious subluxation, may narrow all

the foramina and increase impingement of nerves at any

point where a slight subluxation previously existed. An
irritated nerve may become swollen and the nerve im-
pinged at the foramen.

Law Governing Location

So definite is the law governing the effect of force applied

to a given portion of the body upon an associated vertebral
segment that the skilled Chiropractor who has studied ver-

tebrate segmentation thoroughly may determine, from the

history of a fall or injury, the vertebra which would tend to

be subluxated by that injury and the tissues controlled from
that part. The rule is this
Force applied to any body segment tends to snhluxate
the segmentally associated vertebra. This subluxation tends
to produce disease throughout the area of distribution of the
subjacent pair of spinal nerves.
The task of explaining this law seems hopeless unless
the student is familiar with human embryology and the life

history of the vertebrata, as well all the details of human

 Subluxations 79

anatomy. To such a student tlie law will be self-evident, so

interwoven with the threads of higher organization as prac-
tically to form its pattern.
In simple terms we might offer this general statement.

Any force applied to the body with sufficient violence will

produce subluxation of the vertebra above the spinal nerves
supplying the injured area. Thus, the brachial plexus con-
trols the arm and shoulder and connects with the spine by
way of the 5, 6, 7, 8, Cervical and 1 Dorsal nerves. Any
force striking the arm or shoulder tends to produce subluxa-

tion of the sixth or seventh Cervical or first Dorsal vertebra

so that all permanent disease conditions resulting will be

found in the arm or shoulder or nearby tissues of the

neck.
This theme presents a magnificent field for individual

study and research but is, per se, beyond the limitations set

for this work.

Effect of Subluxations

Slight subluxations may exist, because of the adaptation

of surrounding parts and the slight play within the inter-
vertebral foramen, without producing noticeable effect. They
always, however, evidence a tendency to disease.
The majority of subluxations do produce disease, to
some degree, and do so by impinging nerves. Impingement
may be either by pressure against a nerve or ganglion or by
constriction of a nerve where it passes through an inter-
vertebral foramen; the former occurs in the case of the
80 Technic and Practice of Chiropractic

Cervical sympathetic, the sub-occipital nerves, and the sacral

nerves ; the latter is the commoner form in Dorsal and
Lumbar regions of the spine. Probably the most positive
constriction of a nerve which can occur within the body is to

be found in rotation of Lumbar vertebrae; the body of the

rotated vertebra encroaches upon the inferior nerve on the
side opposite to the direction taken by the spinous process.
Either variety of impingement produces disease, morbid
structure or function, by irritation of the nerve: light im-
pingement irritates, heavy impingement partially or com-
pletely paralyzes, the nerve.

VARIETIES OF SUBLUXATION
According to the abnormal relations between vertebrae
subluxations may be variously described as rotated, tipped,
anteriorly, posteriorly, or laterally displaced. They com-
monly combine two or more of these forms, so that the
purely rotary or the entirely lateral subluxation is uncommon.

Rotation

Every vertebra has a vertical axis around which it tends

to rotate. This axis is not always the center of mass but
depends upon the arrangement of mass, the fixity of

cartilages, ligaments, and muscles, which tend to hold some

parts of the vertebra more fixed than others, and the ap-
position of articular processes, which tends to prevent move-
ment in certain directions.

The axis of rotation of the first Cervical is the center of

 Subluxations 81

the odontoid process of the second Cervical, which articulates

with the transverse ligament and anterior arch of the first.

A frequent subluxation of the Atlas is a rotation around this

process so that the one transverse is permanently posterior

to its normal position and the other correspondingly anterior.
The axis of rotation of the Cervicals below the Atlas is

in the extreme anterior portion of their bodies. This part

remains relatively fixed in rotatory subluxation while the tip

of the spinous process describes the greatest arc.

In the Dorsals the axis of rotation lies in the posterior
portion of the centrum near the neural canal. When the

spinous process appears laterally displaced in rotation the

anterior portion of the body is slightly displaced in the op-

posite direction, twisting and straining the fibres of the

intervertebral disk.

In the Lumbar region rotation is the commonest form

of subluxation, the axis of rotation being laterally movable
upon a transverse line between the articular processes in

the beginning and shifting, as soon as the vertebra leaves its

normal relations, to the junction of the articular process

with that of the adjacent vertebra on the side toward which

the spinous process is moving. Thus, in rotation of the
vertebra so that the spinous is to the right, the axis will be

found on the right side, the superior articular process of the

next vertebra serving as a support on which the inferior
articular process of the rotating vertebra may turn. The
processes are so firmly locked that unless the whole vertebra
be quite posterior little lateral movement of the spinous
82 Technic and Practice of Chiropractic

process is possible without marked rotation. The body

describes the greatest arc because it is further removed from

the center of rotation than is the tip of the spinous.

Tipping

This is a subUixation in which the one transverse process

is, or appears to be, superior or inferior to the other. It

occurs frequently to the Atlas in combination with lateral

subluxation. In fact, the shape of the occipito-atlantal
articulations is such that, if the remaining Cervicals main-
tain their proper relation to each other, the Atlas cannot be
laterally displaced without a certain amount of tipping. It

will be relatively superior on the prominent side and the

head will be tipped toward that side; that is toward the

side of the lateral displacement. Thus, on account of the
wedge-shaped lateral masses, if the whole Atlas be to the
right of its normal position the right side will be superior

and the head tipped toward the right. This is only true

when the vertebrae below maintain a normal interrelation.

Approximation

This is a name applied to that condition in which, on

account of changes in the intervertebral disks due to subluxa-
tion interfering with metabolic processes, the bodies or

spinous processes of vertebrae are crowded too closely

together.

Occasionally a spine is found in which, on palpation,

 ;

Subluxations 83

the spinous processes are found to be crowded together in

groups, sometimes of two or three, sometimes of five or six

no two interspaces appear equal, a very wide one being
succeeded by one or two which arc ahiiost inappreciable
the variation in width of the interspaces does not corres-

pond to the known normal variation in those regions where

the changing obliquity of spinous processes should modify
the relative width of successive spaces. We expect, for

instance, to find a wider space between third and fourth

Dorsals than between second and third ; if we do not find
this difference it is doubtless due to cartilage change and
the vertebrae are approximated.

In case of general thinning of intervertebral substance

unequally divided between different sections of the spine the
record will show that almost every vertebra is listed either

S or I, and if a system of underscoring is used that these

two directions are frequently indicated as most noticeable.
A study of the spine will make clear the fact that if the

cartilage between any two Dorsal vertebrae be thinned in

front the bodies of the vertebrae will be closer together and

the spinous processes more widely separated ; the spinous
process of the upper vertebra will be crowded against the
one superior to it and that of the lower against the one
inferior to it. These spinous processes are said to be ap-

proximated.
The correction of S or I subluxations, then, depends

upon correction of disturbed nutritive processes.

84 Technic and Practice of Chiropractic

Lateral Displacements

According to the usage of earlier writers on subluxa-

tions this term (lateral displacement) included rotation of
the vertebra as well as those changes in position in which
the whole or nearly all of the vertebra deviates sidewise
from its normal position. Since the introduction of the
term "rotation" into the description of subluxations, the
meaning of the term "lateral displacement" is much more
restricted. It refers now to a condition which probably
occurs in the strictest sense only in the Cervical region, most
frequently with the first and second Cervical, the two being
subluxated together.
We have already stated that the most important fact to

be determined regarding the Atlas is its lateral displacement,

since this produces the greatest impingement of nerves.

Lateral displacement of any other Cervical can best be
judged by examination of the transverse processes, since
by palpation of the spinous process alone it is quite impossi-
ble to distinguish between lateral and rotary subluxation.
In the Dorsal and Lumbar regions the R or L used to
describe the position of the spinous process most often
indicates rotation of the vertebra. While it is perfectly
proper thus to describe the subluxation on a record, in the
determining of the form of adjustment to be used the posi-
tion of the whole vertebra must be considered.

Anterior Subluxations

Forward displacements may occur anywhere in the

spine. In the case of the first Cervical they are usually.

 —

Subluxations 85

though not ahvays, forward displacements of only one side

rotation —though the whole Atlas may be anterior if the

Axis has moved with it or is tipped so that the spinous pro-

cess is much superior. This is rare.

Any Cervical may be anterior ; usually a series are

anterior (if any) amounting to an increase in the Cervical

curve —a lordosis. This condition may be corrected by

transverse adjustments given from the front and side.
A Dorsal vertebra is only relatively anterior, the adjacent
ones being relatively posterior, and the only possible cor-
rection at present is the adjustment of the posterior ones.
A Lumbar cannot be anterior unless those below it are also
anterior, on account of the locking of articulations. Dis-
covery of anterior Lumbars is quite common. The fifth

Lumbar may be subluxated anteriorly by slipping forward

on the Sacrum ; it must be superior at the same time, on

account of the shape of the articulating surfaces which face
downward and forward. The spinous process is crowded
closely against the fourth while the body of the fifth is too
widely separated from that of the fourth.

Posterior Subluxations

There are many Chiropractors who have always con-

sidered the posterior subluxation more than any other, not

because it produces greater nerve impingement than others

but because it is easiest to detect ; it intrudes itself upon the
attention of the unskilled examiner most persistently. Nor
should its importance be underestimated, though we now
86 Technic and Practice of Chiropractic

realize that in some instances a rotated or anterior vertebra

may cause more nerve impingement than a posterior one.
The posterior subluxation in the lower Dorsals and
Lumbars is the easiest variety to adjust; in this region a
posterior displacement of one vertebra tends to bring with

that one the next adjacent superior one, the sharpest devia-
tion occurring between the posterior one and the one be-
low it.

Any vertebra may be posterior: the Atlas is rarely so

as a whole, and never unless the Axis is also displaced

backward the Cervical and Dorsal regions present frequent
;

variations of this sort, which must not, however, be con-

fused with long, prominent, or overdeveloped spinous pro-
cesses ; the Sacrum may be posterior to the ilium on one side,
or to both ilia.

Occipital Subluxations

Mention should be made here of a form of subluxation

not strictly vertebral —displacement between the condyles of
the occipital bone and the lateral masses of the Atlas. This
occurs when the head has been moved too violently upon
the Atlas so as to cause an immediate nerve irritation and
muscle tension sufficient to hold it in its abnormal position.

The Cervicals may be quite normal below the Atlas though

this, of course, is not the rule. Correction of occipital sub-
luxations is made by applying force to the Atlas and to the
skull, sometimes by holding Atlas and rotating the skull.
 Subluxations 87

Age of Subluxations

The relative age of subluxations may be determined,

within rather wide limits, it is true, by a study of the form
of the spinous process. Newly acquired subluxations are

sharply defined, having noticeable edges on the spinous

process. In time they tend to become rounded and blunt
and appear to cover more surface, just as the mountain
range which, when first upheaved, is sharp and rugged,
gradually rounds into regular curves through the work of

the elements.
In this way Nature protects the subluxated vertebra
from further contact with the environment surrounding
man, the rounded process offering less opportunity for a
blow or shock to affect it.

Changes in Shape
Bone diseases such as rachitis osteomalacia, etc., and
especially Potts' Disease, or spinal caries, make marked
changes in the shape of vertebrae. Also a subluxated
vertebra may gradually assume a shape suited to the ab-
normal position it occupies, the commonest change being
the assumption of a wedge shape by the centrum. This is

a great obstacle to adjustment, as the abnormal shape of the

vertebra m'akes it tend to settle after each movement into

the old abnormal position.

There are few spines without some more or less mis-
shapen vertebrae.
Ankylosis also makes great changes in the shape of
88 Technic and Practice of Chiropractic

vertebrae. There are two kinds of ankylosis — true and

false. The first is a deposit of bone cells upon bone, often
the formation of a bridgelike structure to hold contiguous
vertebrae together. This may bind any portions of the
vertebrae but most commonly holds the bodies, in which
case it can only be appreciated by detecting the lack of
movement between normally separable vertebrae. False
ankylosis occurs with fever in bone and consists in an
exudation of bone substance which sometimes produces
remarkable distortions of shape.
 TECHNIC OF ADJUSTING
Definitions
Vertebral Adjusting is the art of correcting by hand
the malpositions of subluxated vertebrae.

A Vertebral Adjustment, strictly speaking, should mean

the complete restoration of normal relation between pre-

viously subluxated vertebrae. As used in Chiropractic, it

means either a partial or complete restoration of such nor-

mal relation.

Maladjustment, as used in the profession, designates any

movement of vertebrae by hand which produces or increases
subluxation.

GENERAL PRINCIPLES OF ADJUSTING

It will be well for the student to master first the general

rules and principles which govern vertebral adjustment and

then to proceed to a detailed investigation of each move-
ment, in turn, before practicing it. The art of adjusting

can only be acquired by practice, and a high degree of ex-

cellence in it only by long-continued practice. However, the
rapidity with which it can be mastered depends largely upon
the formation of a clear pre-conception of the work to be

done and the manner of its doing.

As the student progresses in the art he finds himself
occasionally guilty of errors which mar, in some degree,
89
90 Technic and Practice of Chiropractic

the efficiency of his work. These may arise from uncon-

scious modification of the technic first learned or from
unconscious repetition of some necessary modification de-
manded by a special peculiarity in one or more cases.

This section is intended to furnish the proper pre-con-

ception and also to serve as a monitor to adjusters who, by
reference to the precepts herein set down, may discover and
remedy their own errors. It is not intended to furnish
sufficient education to warrant practice without clinical in-

struction, which is unwarrantable, but rather to accelerate

the education which practice alone can furnish.

Object of Adjustment

The vertebral subluxation being an abnormality of

relation between vertebrae, it is obvious that its correction
must be a return of normal relation. This can only be ac-
complished by bringing about a change of relative position.
Movement of a section of the spine composed of several
vertebrae is not, in the true sense, an Adjustment. It is the

single vertebra which must be moved.

The movement should be one calculated to bring the
vertebra to its normal position in the most direct mminer
possible. Such a movement should be used as will reverse

the direction of the forces which subluxated the vertebra.

It should be applied to the transverse or spinous processes,

or to the lamina, as is sometimes done in the case of the

Atlas, according to the kind of subluxation. Different sub-

luxations require different handling. Cases vary. Select
 Technic of Adjusting 91

the move best suited to the case. This can be determined

most properly by correct palpation which fixes in the mind
of the adjuster the position of every part of the vertebra,
its relation to its fellows, the points of greatest nerve im-

pingement, etc., all of which should suggest the best method

for correction.

The prime object of adjustment is the removal of im-

pingement from nerves.

Transmitted Shock vs. Thrust

The movement used in adjusting has been variously

described. Many writers and teachers have used the termi
"thrust" to describe the movement of the hands, and the
term is correctly applied to the movement used by many
Chiropractors. But a careful study of the methods of ap-
plying force in use among the most successful adjusters,

those who have attained the greatest results with the slight-

est percentage of failures and a minimum of pain to the

patient, discloses the fact that the chief element of their

adjustment is transmitted shock.

The hand is held in close contact with the vertebra to be
adjusted and the arms and shoulders describe such move-
ments as to deliver the required amount of force with the

slightest possible change in the position of the hands. The

vertebra bounds away from the contact hand. In the delivery
of a thrust the hand would follow the vertebra, forcing each
portion of the movement. The real effect of a thrusting

motion, since the hand cannot enter the body as a sharp

92 Technic and Practice of Chiropractic

instrument would, is that of pushing. Pushing neither

subluxates nor adjusts vertebrae so readily as does a rapidly
applied shock.

Let us illustrate with a comiiion experiment in physics.

Suspend a number of ivory balls by cords of equal length
in such a manner that each is in contact with its fellow and
all are in a straight line. When the balls are properly ad-
justed a straight line should connect their centers. Hold one
end ball firmly in the hand or with an instrument which
renders it absolutely fixed. Then strike sharply with a
light hammer. The balls will all remain stationary except
the one on the opposite end which will fly off to a distance
exactly measurable according to the force of the blow.
How does this occur?
A shock is transmitted through the molecules of the ivory
until it reaches the end ball, wdiich is not held back by an-
other. Here the transmitted force is expended in molar
motion, the ball leaping away from its fellows as if it had
been hung alone and had been struck with the same force.
It is well known that by placing an elbow firmly against
a man's jaw and then sharply striking the closed fist with
the other hand, open, a very heavy blow can be given ;
yet
the forearm, through which the shock is transmitted, does
not move.
Now ivory is very like human bone. Further, it has been
demonstrated that the law illustrated by the above experi-
nient is equally applicable to the movement of vertebrae.
The pushing or thrusting movement may move a specific
 Technic of Adjusting 93

vertebra, but it is probable that the chief factor in so doing

is the element of transmitted shock contained in the move-
ment and delivered at the instant of release of the hand from
the spine at the end of the movement.

On the other hand it is obvious that a pushing or

thrusting movement may move several vertebrae in addition

to the one directly in contact with the adjusting hand, in

consequence of the way in which the spinal segments are

closely bound together. If a steady strain is used, in which
muscles and ligaments have time to act, one of three results
may occur: (a) the specific adjustment; (b) the move-
ment of several vertebrae at one time, which does not con-
stitute an adjustment; (c) the giving way of the spine at
its weakest point, which may be some distance from the
point of contact with the adjusting hand, the ligaments and
muscles having communicated and diffused the strain

throughout a large area. In the latter contingency the

result is usually a new subluxation or the increase of an
old one, instead of an adjustment.

The Rapid Movement

Thus Speed becomes an important factor in correct ad-

justment.
A good illustration of the value of speed may be taken
from a pile of stakes bound together by a cord. If a man
with a hammer desires to remove the center stake of the
group, and attempts to do so with a slow pushing movement,
the result is a change of position of many stakes, which
94 Technic and Practice of Chiropractic

adhere to the center stake and to each other. If, on the

contrary, he strikes a sharp, quick blow with his hammer,
meeting squarely the center of balance of the one stake, it

will fly straight from its position leaving the others unmoved.
This is exactly what we desire to accomplish with an ad-

justment. By the speed of the movement we expect to

move ane vertebra before adhesion or the contraction of

muscles or inelasticity of ligaments can diffuse the force.

Close Contact

In order to accomplish the transmitted shock it would

seem wisest, at first thought, to draw back the hand and
strike the vertebra sharply. On the contrary, it has been
found advisable to place the hand carefully in close and
immediate contact with the vertebra to be adjusted. Nature
herself shows us the way in the delicate shock-transmitting

mechanism of the tympanum.

Also the hand of the adjuster will cover much more
than merely the spinous or transverse process which is used
as a lever and to which it is desired to transmit the shock,
unless carefully placed so that only a small portion is in

contact by such a contact diffusion of the shock

; is prevented
and its efficiency within a limited area is increased. A car-

penter wishing to countersink a nail places in contact with

the nail head a small instrument called a countersink, which
he then strikes sharply with a hammer. The contact hand
of the adjuster represents the countersink and is used by the
two arms as a passive instrument for transmitting shock.
 Technic of Adjusting 95

The close contact of the hand, which remains passive,

renders the adjustment much less painful to the patient than
it would otherwise be, and one of the prime objects in the

mind of the adjuster should be the minimizing of pain in-

flicted, by any means which does not lessen the resulting

benefit. Also any drawing back of the hand before the
movement warns the patient and tends to induce involuntary
muscular contraction which interferes with adjustment.

Relaxation

In an adjustment it is necessary to overcome two kinds

of resistance — the passive resistance of inertia, of Hgaments,
or of superincumbent weight, and the active resistance of
muscular contraction. It is important that both forms be
minimized.
The first may be lessened through the position of the
patient's body; he is placed so that the vertebra to be ad-
justed is in the freest possible position. The second is re-

duced to the least possible quantity, amounting to no more

than muscle tonus, by using two methods: (a) Oral Sug-
gestion, and (b) Muscular Suggestion.

Oral Suggestion

Explain to the patient the need for relaxation. Make it

clear to him that less force will be required if his muscles

are passive. Remind him frequently of this and assume that

he desires to relax. A word immediately before the ad-

justment often induces a temporary relaxation during which

96 Technic and Practice of Chiropractic

the adjustment is given. Anything which detracts the

attention from the coming shock is an aid. Sometimes ask-
ing the patient to inhale and exhale slowly and deeply will
sufficiently take his attention from the adjustment. Ex-
perience will teach him that he suffers less pain when re-

laxed and presently relaxation becomes a habit. Instructing

patients to think of sleep, turning the eyeballs upward, has

been effective with some.

Muscular Suggestion

This can only be given by maintaining a state of relaxa-

tion in one's own muscles, which in itself is desirable in

most cases, for reasons to be presently explained. In han-

dling Cervical vertebrae move the head gently from side to

side with your own hands relaxed as much as possible. The

lazy motion suggests relaxation. Then when it is felt that

the neck is thoroughly relaxed, vary the motion with a quick

adjusting movement.
In Dorsal and Lumbar regions after the hands are in
correct position the adjuster should pause a moment both
to be sure that the direction of movement and his purpose
to move are clearly fixed in his mind and to be certain that

both himself and the patient are relaxed. The adjustment is

given instantly and from a perfectly lax muscle, as a boxer

strikes.

An added advantage is the greater amount of speed and

control which may be commanded in this way. The lax
arm, being in a neutral state as regards motion, can be con-
 Technic of Adjusting 97

tracted in any desired direction without loss of force or of

lime, whereas a taut muscle cannot further effect motion of

the arm without relaxation of its antagonistic muscles, which

lakes time.

Muscular Control
Considerable contral over one's own muscles is neces-
sary in order perfectly to relax arm and shoulder muscles
just before the adjustment and then to utilize a measured
and determined quantity of force in a desired direction. To
acquire this much practice is necessary — practice on the liv-

ing subject. The desired end may be hastened, however, by

acquiring the abstract property of muscular control or by
developing control already gained.
Many different forms of exercise will aid in the ac-

quisition of muscular control and the ability to relax and

then to follow the relaxation with an instantaneous whip-
like contraction in a given direction. The best of these is
without doubt hag-punching. The movements employed
with a punching-bag, especially the lateral quadruple move-
ment with both elbows and both hands, tend to develop
precisely the sort of control needed for correct adjusting.

The beginner can do no better than to practice in this way,

by which, it must be remembered, only a necessary property,

and not by any means the exact movement, may be acquired.

Amount of Force
The amount of force used in an adjustment varies so
much in different spines and in different parts of the same
 ;

98 Technic and Practice of Chiropractic

spine that it is quite impossible to state any correct estimate

of it in terms of physical units. In general the Cervicals
move with least resistance, then the Dorsals, then the Lum-
bars, and finally the Sacrum and Ilia as hardest of all to

displace or replace.

In developing additional force when it is found that

the force first used on any vertebra has been insufficient to
move it, remember this law : Work equals one-half Mass
times the square of the Velocity. In other words, doubling
the speed of the movement increases its effectiveness four-

fold ; tripling it, nine-fold.

The increase in force should never be effected by in-

creasing the zi'eight or pressure upon the patient's body, for
reasons which should be clear from a study of previous
pages, but always by increasing the speed of the movement.

Names Used to Describe Movements

The names herein employed to indicate certain move-
ments, each a well-defined method of procedure for the
accomplishment of some special end, are the names or de-
scriptive terms which seem to be in the most general use at

this time. Few of these movements have arrived suddenly

most of them are the result of gradual growth and evolu-
tion : so with the terms by which they are known ; they have
gradually become a part of the common language of the
profession. Usage sanctions them, though some of them are
cumbersome, unwieldy, or entirely inappropriate.
Morikubo Move. For correction of a lateral and rotated
Atlas (L. A.), Pisiform contact with anterior trans-
verse.
 Technic of Adjusting 99

SPECIAL TECHNIC

MORIKUBO MOVE
A movement for the correction of a lateral and rotated
Atlas, indicated for use only when the Atlas is recorded as
R. A. or L. A. The position of the patient's head renders

the transverse process inaccessible unless it be anterior on

the side from which adjustment is to be given.

Position of Patient

Place two sections of the bifid bench together so as to

secure the effect of a solid bench with an upward sloping
front. Have patient lying on back with back of head resting
firmly on bench, chin slightly uptilted. Then turn patient's

head so that it faces sidewise and rests flatly on the side of

the least prominent transverse. This exposes the anterior
transverse in front of the tendons of the sterno-mastoid
muscle.

Use of Hands
Stand leaning over head of bench and carefully place
the pisiform bone of adjusting hand upon the tip of the
transverse procees, being careful to push aside the sterno-
mastoid tendons if they interpose themselves between the
pisiform and the process. The fingers of the adjusting
hand extend downward toward the clavicle and rest lightly,
100 Technic and Practice of Chiropractic

very lightly, upon the patient's neck. With the other hand
firmly grip the wrist of the adjusting hand, fitting the pisi-

form of the upper hand into the hollow below the styloid
process of the radius.

Movement
This is delivered straight downward toward the bench.
It should be light and quick and the hand should not follow
the process in its movement.
This movement is painful and should not be used if

avoidable. When used it requires the utmost care and a

careful measuring of force. Err, if at all, on the side of

overcaution. The technic will be better understood after

study of the more detailed description of 'The Recoil,"
since the position and use of hands, arms, and shoulders is

much the same for both.

PISIFORM ANTERIOR CERVICAL MOVE

Indicated for rotation of a Cervical vertebra in which one
transverse process is anterior to its normal position or more
anterior than its fellow which may also be somewhat, though
less, anterior.

Placing Patient

As for the Morikubo Move place the patient in the dorsal

recumbent posture with head resting on bench and chin
uptilted. Turn patient's face slightly away from' the side of
the selected anterior transverse and steady the head with the
free hand while palpating.
Fig. 8. Pisiform anterior Cervical
 Technic of Adjusting 101

Making Contact
Palpate downward from the Atlas transverse along the

posterior margin of the sterno-mastoid, dipping deeply into

the neck and exploring with the tips of the first three fingers
until the offending process is felt as a nodule of bone plainer
to the touch than those above and below. Always reach
across the neck to the selected transverse ; if it be the right,
stand on the patient's left and use left hand for palpating

and for contact hand as well.

Having found the process, gently move aside any tissues

which tend to interpose between the finger and the bone,

change hands so that the palpating hand is free and the
other holds the contact spot clear of interposed tissue and
plainly points it out, then place pisiform bone of contact
hand gently but firmly against the front of the process so
that a mass of bone is felt between the pisiform and the
bench when downward pressure is made.

Completing Position

It will be noted here that the head is unstable and tends

to rock with slight pressure or movement of the contact
hand. Steady the head by placing the knee upon head of
bench and against side of patient's head, not roughly but
so that the head cannot move further toward the adjuster.
Now reinforce the contact hand by gripping the wrist
with the other, press slightly downward to tighten the con-

tact and avoid slipping, and you are ready for

102 Technic and Practice of Chiropractic

The Movement
which is directed sharply downward toward the bench. This
move rotates the vertebra around its vertical axis and puts
a strain in a backward direction on the whole column at

this point.

Care must be used, because the move at best is painful.

It is easy to slip across the end of the transverse. Take every

precaution to avoid imprisoning a muscle, nerve, or blood-
vessel between the contact hand and the vertebra. Rightly
used this move is valuable, perhaps most valuable of all

anterior Cervical moves, but it requires nice judgment.

LAST FINGER CONTACT

This movement differs from the preceding one in two
important particulars ; the contact hand must be so selected

with relation to the side of vertebra adjusted that the fingers

will extend upward toward the patient's head, and the oppos-
ing hand supports the head instead of reinforcing the contact
hand.

Placing Patient

As for preceding move. The head will remain in this

position only until the contact is made, after which it will be

raised by the supporting hand until a tight contact is felt and

the neck muscles drawn fairly taut.

Making Contact
Palpate with left hand if standing on patient's left to

adjust a right, anterior subluxation. Find the offending

Fig. 9. Last finger contact for anterior Cervical.
 Technic of Adjusting 103

anterior transverse, draw tissues away with middle finger of

palpating hand, change to middle finger of free hand which

marks and holds the point of contact. Now place (with
care) the base of the little finger of the hand which was
used for palpating, at a point just below the condyle of the
last metacarpal and a little to the palmar side, in direct con-
tact with the front of the transverse. The last finger will be
flexed toward the radial side and a shallow depression thus
left for the contact.

Completing Position
Hold contact lightly and slip the free hand under the
patient's head, which faces slightly toward the adjuster.
Raise the head, bending the neck away from the adjusting
hand and toward patient's chest until it is felt that the

contact is secure and that further movement would put the

neck upon a strain. You are ready for

The Movement
which is delivered entirely with contact hand, downward
and toward the back of the neck. The delivery is difficult

because the force arm is flexed at the elbow and the position

awkward. Practice, however, will soon render one adept.

Uses
For rotated vertebrae which haive one transverse anterior
to the other, Cervicals only. This move gives a slightly less

advantageous force angle than the preceding, but is less

likely to be painful.
104 Technic and Practice of Chiropractic

SECOND METACARPAL CONTACT

Position of Patient

Place patient supine on bench so that his head extends

beyond the end of bench and is supported by the upraised
knee of the palpater. Stand at head of bench so as to face
patient's feet.

Use of Hands
DifTering from their use in the preceding moves the
hands are so placed that the adjusting hand for a right,

anterior subluxation will be right hand, for a left anterior

the left hand. The opposite hand supports the head after
contact is made.

Making Contact

Contact point on hand is second metacarpal at the end of

the condyle, or second metacarpo-phalangeal joint. This is

placed in front of the offending transverse, the head having

been rotated away from that side and other tissues drawn
carefully aside from the bone. The back of the hand is

downward toward the clavicle, fingers semi-flexed on palm,

thumb resting on jaw.

Supporting Head

The following position is the correct one for supporting

the head in all Cervical adjustments delivered in the above
position of patient and adjuster.
 Technic of Adjusting 105

Cup the supporting hand sHghtly and fit the patient's

ear into the cupped palm. Let fingers extend toward the
base and back of the neck, the finger position varying ac-
cording to the amount of rotation of the head so that the
fingers are in all cases directly under the head weight. The
wrist then flexes on the hand, and wrist and forearm are
brought up across the patient's forehead so that a force
delivered from the opposite side cannot cause the head to roll
or move upon the supporting hand. After placing both
hands draw the head so that the chin is tilted upward until

it is felt that contact is snug and tight. This supporting

position is invaluable and much neglected by adjusters, who
might save themselves much annoyance and many failures

by its constant use. In the study of succeeding Cervical

moves refer to this description frequently. We shall call it

the Hook Support, because the arm and hand resemble a

hook which grasps the under side of the head and curves
over the upper.

Movement
This is delivered entirely with contact hand and in a

direction as much posterior as can be achieved without

slipping past the end of the process. If the head is sufficiently

rotated away from the contact side the angle of force is

better than with a straight lateral adjustment, which it some-

what resembles, but not so good for anteriors as either of

the two preceding moves. It is chiefly useful when the other

two fail.
106 Technic and Practice of Chiropractic

OCCIPITO—ATLANTAL MOVE
To move an Atlas so disposed that its one side is posterior
while the whole vertebra is laterally displaced in the same
direction ; to move, for instance, an Atlas R. P.
Have patient lying on back in position C with head pro-
jecting beyond bench and supported by adjuster's knee.

Placing of Hands
Place the first three fingers of one hand under the most
laterally prominent transverse so as to hold it firm, first

placing the first finger carefully just behind and against the
end of that transverse and then reinforcing it with the
second and third fingers, slightly tensed, and resting their
tips on the lamina close underneath the occipital bone.

Next place the other hand so that the thumb rests

firmly upon the patient's jaw and the first finger extends
backward along the lower margin of the occipital bone.

To complete the position rotate the head gently toward

the side of the laterally prominent Atlas, until it rests, face
toward the side, and is supported by the three fingers of the
one hand and the heel and wrist of the same hand. It will

be noted that when the head is rotated the first finger of

supporting hand slips to a position directly upon the tip of
the transverse process and the other two take its place
against the posterior aspect of the tip of the transverse. The
Atlas now rests with its intertransverse line almost vertically

upward from supporting fingers, which hold it against fur-

ther rotation.
 Technic of Adjusting 107

Movement
When the neck muscles have been thoroughly relaxed by
slight and gentle movement, throw the upper elbow sharply
away from your body, which has the effect of transmitting

force through the thumb to the jaw and sharply rotating

the head still further, loosening its articulation with the now
firmly held Atlas. The condyloid joints thus loosened tend

to settle into their proper relations, the weight of the head

causing it to slip downward — laterally upon the Atlas.

Uses

This is really a movement of the head rather than of

the Atlas and is an easy movement when practicable. It

requires complete relaxation and will often fail. It is

probable that many apparent Atlas subluxations are really

subluxations of the head upon that bone which leave Atlas
and Axis in normal relation. This move is most used to

loosen the Atlas when it resists ordinary adjustments.

"THE BREAK" No. 1

(Lateral Cervical Move)

The principle involved in this and the three succeeding
moves is the same. The contact is made with the end of the

laterally prominent transverse process of a Cervical vertebra

other than the Atlas, and the movement is directed entirely

from side to side. It is to be used only for lateral and not

for rotary or anterior or posterior subluxations, a point to
108 Technic and Practice of Chiropractic

be remembered as it is just as easy to produce as to correct

subluxation with this move.

Position

Have patient lying on back in position C, with head

projecting beyond bench and supported by adjuster's knee.
Following a record previously made count downward to a
subluxated vertebra and palpate both transverses with the
two hands at once to find if one is prominent laterally, re-

membering that the record indicates merely the position of

the spinous process.

Having found the laterally prominent transverse, place
the tip of the finger of the corresponding hand on the spinous
of the subluxated vertebra; that is, if a right subluxation,
use right hand and if a left, use left hand. Then draw the
hand around until the middle of the proximal phalanx of the
first finger rests against the end of the transverse. The tip

of the finger will be freed from the spinous by this move-

ment.
Hold the adjusting hand tense, edgewise to the neck,
fingers together and pointing downward. The thumb may
rest against the patient's jaw or may be free; the essential
thing is the snug contact of the first finger against the

transverse.

Movement
With the hand in position and the head supported by the
Hook Support, bend the head laterally, keeping the face up-
 m

Fig. 1*1. "The Break," Xo.1, from right. Contact; first phalanx
with end of right transverse.
 Technic of Adjusting 109

ward, until it is felt that further movement would strain

the muscles.

Deliver the movement in a straight lateral direction,

quickly and entirely with the contact hand.

"THE BREAK" No. 2

For the Atlas only, and for straight lateral displacement

of that vertebra.

Position and Contact

Position of patient's head and of supporting hand ex-

actly as in using Break No. 1. Contact is made with the end

of the Atlas transverse on the laterally prominent side. Con-

tact point on hand is second metacarpo-phalangeal joint, or

rather, the condyle of the second metacarpal.

Movement

As for Break No. 1.

"THE BREAK" No. 3

Position

Have patient sitting erect on bench or stool and stand

before him. For a right subluxation use left hand and for
a left, right hand. Contact point is the middle of the prox-

imal phalanx of the first finger and the fingers reach back-
ward and downward, thumb upward so as to be out of the

way.
110 Technic and Practice of Chiropractic

Movement

Force should be applied entirely with the contact hand

to avoid the possibility that movement of the head may bring
about movement of some other vertebra than the desired one.
But in practice the force is usually divided between the head
and the vertebra. The Hook Support cannot be used in ^^^'-,

position.

Uses

The use of this position for the Break avoids the neces-
sity for the patient to lie down again in a new position after
having Dorsals and Lumbars adjusted. It is extremely
convenient. But on the other hand it is undeniably harder
for the patient to relax his muscles when sitting up with
head flexed sidewise and a sense of lost equilibrium than
when lying down. The Break No. 1 will be found the bet-
ter for the average case.

*'THE BREAK" No. 4

Position

Same as Break No. 3 except that adjuster stands behind

patient and rests the thumb upon the base of the neck pos-
teriorly while the fingers extend downward and forward to-

ward the clavicle. As with No. 3, the supporting hand rests

against the opposite side of the head and forces it sidewise

to tighten the contact.
Fig. 11. "The Break," No. 3.
 Technic of Adjusting 111

Movement
Properly, a quick lateral movement of contact hand
while the head is firmly held by the opposing hand.

Note: "The Break" is unfortunately named and it

would be well if some less suggestive term were generally

substituted.

THE ROTARY No. 1

For the correction of rotation only, and usable in the

Cervicals from 2 to 7 inclusive.

Philosophy of the Rotary

A study of the Cervical articulations will make it clear

that if a force be applied laterally to the spinous process

the probable result will be a rotation of the vertebra, which

swings one articular process back from its fellow but leaves

the other in close, but modified, contact. Thus the spinous

process may appear to the left while the left articular process
is fitted firmly against that of the adjacent vertebra, while
those on the right are separated. Similar rotation, modified
only by the diflFerence in shape of the vertebrae, occurs in the
Lumbar region.
A movement applied to the spinous process might correct
this condition or might complicate it according to the man-
ner of application. But the most direct line of force for cor-

rection is along a line which would pierce the separated

articular processes almost in an antero-posterior direction.
The Rotary approaches this very closely. It is a setting
112 Technic and Practice of Chiropractic

forward of the articular process against its fellow by apply-

ing a movement directly to the transverse process, which

lies very close to the articular process.

The great safety of the movement lies in the fact that it

is impossible with any reasonable amount of force to move

the transverse process too far. If the vertebra is not sub-
luxated so as to indicate this movement, gentle attempts to
use it will fail. The deceptive bent spinous process may
sometimes be detected in this way.
The chief objection to Rotary Nos. 1 and 2 is that the

Dorsals and Lumbars cannot be adjusted in this position

and the patient must rise from the bench and lie down again
to have his Cervicals adjusted. This is obviated if No. 3 is

used but the latter position fails to secure the perfect relaxa-

tion of muscles of Nos. 1 and 2, and is therefore recom-

mended as an alternative only.

The commonest obstacle to the use of this move is the

voluntary or involuntary contraction of the neck muscles.
The Hook Support, q. v., will limit this resistance by afford-
ing a sense of perfect security to the patient. If muscles are
contractiired a slight "check" will be felt as the head reaches

a certain degree of rotation, and beyond this point it will

refuse to move though easily movable within the radius

limited by the ''check." It is as if the head were held by an
inelastic cord. It is best when contracture is present not
to attempt moving the head too far but to deliver the move-
ment with the muscles as much relaxed as possible.
Fig. 12. The Rotar}-, Xo. 1. Ready for the movement.
 Technic of Adjusting 113

Position and Palpation

Place patient in position C as described under Technic of

Palpation. Stand at head of bench with patient's head sup-

ported by one knee and perhaps also by one hand. Palpate

chiefly to discover the numbers of vertebrae, following a

record previously made. Finish palpation with the tip of

the first finger of either hand resting upon the spinous pro-
cess of the vertebra to be adjusted.

Placing Contact

Consider here which way the vertebra is to be moved ; if

toward the right use right hand and if toward the left use
left hand for adjusting. Draw the adjusting hand straight
around until the first finger, about the middle of the proximal
phalanx, rests against and behind the transverse process.
It is important that the finger be drawn straight around,
and not upward op downward, except with the second Cer-
vical with which the finger may pass slightly upward to the

transverse. To insure correct placing of finger let patient's

head be absohitely at rest, supported by the Hook Support

with face turned slightly away from the adjusting hand.

Reinforce contact finger with the other three fingers held

close together behind it. The thumb may or may not be
placed against patient's jaw as desired, but one must be
careful not to lose exact contact by drawing adjusting hand
upward from a lower Cervical in an attempt to reach the

jaw.

8
114 Technic and Practice of Chiropractic

Use of Second Hand

Meanwhile the other hand supports the head and holds

its weight as described under the Hook Support, q. v.

Turning Head

Next, holding the first finger gently but firmly pressed

against the transverse process, turn the head in the direction

of the subluxation and away from the adjusting hand. That
is, if the vertebra be subluxated to the right turn the face

toward the right, the use of the terms ''right" or "left"

referring to the spinous process.

Movement
When the head is drawn around so that the vertebrae

are thoroughly separated on the side toward which move-

ment is to be directed, and the patient's muscles are thor-

oughly relaxed though it is felt that further rotation of the

head would put them upon a tension, give the movement. It

consists in a quick throw of the adjusting hand, force trans-

mitted from shoulder through an outward fling of the elbow,
directed upward and inward against the transverse process.

It replaces the articular process against its fellow, moving

one vertebra, smoothly and easily.

All force should be delivered with contact hand. The

hand moves through very little space. The principle of the

movement is transmitted shock.

Fig. 18. The Rotary, No. 2.
 Technic of Adjusting 115

THE ROTARY No. 2

A transition in technic between No. 1 and No. 3.

Position

Patient lies face upward on closed table, head resting

upon forward section. Adjuster stands at side of patient,

choosing the side according to the subluxation so as to face
across the table in the direction toward which spinous pro-
cess is to move. Palpation is difficult in this position on
account of the increase in the curve of the Cervicals, so that
it is best to follow a record previously made.
Having found the subluxation make contact as follows.

Contact

Reach across patient's neck with right hand for a right

subluxation or left hand for a left, and find spinous process.

Then draw the middle finger straight around until the pal-
mar surface of the middle finger just below the second joint
fits snugly behind the transverse process. Place the other
hand under the head and with both hands working together
turn the head toward you, chin upraised, and draw the neck
into a greater flexion until it is felt that contact is firm and
close.

Movement
The movement is a quick drawing toward the adjuster
of the second, or contact, finger, which has been, as it were,
hooked over the transverse. The transverse is thus drawn
116 Technic and Practice of Chiropractic

sharply forward and the vertebra rotates around its vertical

axis so that the spinous follows, or tends to follow, the trans-

verse in the same arc of movement.

ROTARY No. 3
Position

Patient sitting erect, both feet evenly on floor and hands

not braced. Stand in front of the patient but to one side or
the other as for Rotary No. 2. Use right hand for adjusting

right subluxations and left hand for lefts.

Contact

As for No. 2, contact is with palmar surface of second

finger but may be shifted to third finger for the lower verte-
brae if desired. The thumb is usually placed on the mandible

and aids the opposite hand, placed on the other side of the

head, in turning and otherwise controlling the head.

Movement
Turn the head away from the adjusting hand until the

neck muscles feel taut as a result of position and not of

contraction. The movement then is given as a sharp jerk of
the contact hand forward.

ANCHOR MOVE No. 1

Theory
It is held that a vertebra often loses its proper relation
with the vertebra below, and consequently with all the verte-
Fig. 14. The Rotary, Xo. 3.
Fig. 15. "Anchor Move," Xo. 1. For a P. L. subluxation.
 :

Technic of Adjusting 117

brae, or the entire column of the spine below, without being

disturbed in its relation to the one, or ones, above ; that, in

other words, the column may be divided into two sections

by subluxation, the upper section set askew upon the lower.

With this reasoning it would clearly be desirable to so adjust

the spine as to move a given vertebra, and with it all verte-

bra above, so to speak, upon the vertebra below. To do

this all vertebrae above the one to which force is applied

must needs be firmly anchored to prevent strain between

them.
Such a move has been devised by Bunn for Cervical

use and is here described from the author's few observations

only. Further study may modify the technic somewhat.

Position

Patient is placed as for Dorsal and Lumbar adjust-

ments in position B. Move is applied to rotated, postero-
rotary, and antero-rotary subluxations and face turned to-

ward side from which move is to be made. Adjuster, after

palpation which discovers the vertebra to be moved and the

direction of movement, stands at the head of table facing

patient's feet.

Contact

With the palms of both hands resting against the side of

the neck and thumbs extended at right angles to hands,

make contact with both thumbs on one vertebra as follows

If vertebra is to be rotated toward patient's left, place
118 Technic and Practice of Chiropractic

right thumb against spinous process on its left side and

left thumb upon right transverse process from behind it.

Press firmly with the palm and fingers of each hand against
the vertebrae above, gripping around neck and base of skull
so as to hold all parts together.

Movement
The move is delivered simultaneously with the two
hands, forcing spinous process toward the right and trans-
verse in an anterior direction. The head must be raised

from the bench and wholly supported by the hands and the
head turns with the vertebra.

Uses
A powerful comparatively easy move which has the ad-
vantage of wide applicabiHty and of avoiding the change
of posture of the patient which mars many Cervical moves.

ANCHOR MOVE No. 2

Position

Same as for No. 1.

Contact

For a left subluxation to be moved toward the right,

place the left thumb upon the right side of the spinous

process so that it hooks over the spinous in position to draw

or pull the spinous. Place right thumb against the end of
Fig. 1(3. Posterior Cervical move.
 Technic of Adjusting 119

the left transverse as much on the anterior side as possible

so that it may exert a prying force in a posterior direction.

Movement
Simultaneous application of force with the thumbs tends
to rotate the vertebra as does No. 1, but unlike No. 1 the
tendency is to bring the vertebra out in a posterior direction

instead of driving it more anteriorly.

Uses
This move is applied to rotated Cervicals which are
anterior, more on one side than on the other.

POSTERIOR CERVICAL MOVE

Uses
For a posterior Cervical below the Atlas. The common
and careless practice of moving such a vertebra with the
Rotary, or the dangerous practice of using the Recoil may
be avoided by this move and much better results obtained.

Position

Patient in position C, head projecting well beyond bench

so as to allow for a dropping backward of the head. Pal-
pate as for the Rotary and hold palpating finger on tip of
spinous process of posterior vertebra while contact is made.

Contact

Contact point is middle of radial surface of first phalanx

of first finger and is placed against the tip of the spinous
120 Technic and Practice of Chiropractic

process, directly between it and the floor, as the patient lies.

Hand is held rigid and edgewise, fingers together so that

the contact finger is well supported.

Completing Position

Use the free hand to hold the head with the Hook Sup-
port, q. V. Turn the patient's chin slightly away from the
adjusting hand and drop the elbow of adjusting arm down
until a straight fine could pass through elbow, spinous pro-
cess, and patient's chin. It may be well to crouch and rest
the elbow against one knee for solidity. Then allow the
head to drop backward until chin is elevated and further
backward flexion would strain the muscles. You are ready
for the movement.

Movement
A quick throwing movement upward and inward, or to-
ward patient's chin. As nearly as may be the force should
tend to pass along the spinous process in a direction exactly
anterior to the (then) plane of the vertebra.

Note: Either hand may be used with this movement.

DOUBLE CONTACT MOVE

Uses
This is indicated for postero-rotary or postero-lateral
subluxations. Its line of force is a bisector of the angle be-
tween the straight anterior and the straight lateral move-
ment.
Fig. 17. Movement for correction of a lateral Atlas whose
prominent transverse is posterior.
Fig. 18. A movement for Atlas when laterall}' displaced. Con-
tact; metacarpo-phalangeal joint with end of promi-
nent transverse.
 Technic of Adjusting 121

Contact
There are two points of contact, both on the first finger,

one (first secured) on the radial side of the second phalanx

and the other on the radial side of the proximal phalanx.
The first contact point is placed against the tip of the
spinous, the other behind the transverse process.
Press slightly against the two processes with the finger so
as to feel them plainly.

Completing Position
Hold the head with the Hook Support and turn the face
away from the adjusting hand (right hand for a P. R., left

hand for a P. L.). Drop elbow low and hold it well away
from your body so that there appears an obtuse angle be-
tween wrist and forearm with the point of the angle toward
you. Be careful of this point as the tendency is to make an
angle with the point away from^ you —a weak position.

Drop head backward until firm resistance is felt.

Movement
Force is delivered in an antero-lateral direction as above
described, entirely with adjusting hand.

THE "T. M." No. 1

Uses
For subluxations listed R or L but not Posterior and
upon C 6, C 7, D 1, and D 2 only. This movement applies
a lateral force to the spinous process so as to correct rota-
123 Technic and Practice of Chiropractic

tion of the vertebra, but I repeat that it is inappropriate for

posterior or posterolateral subkixations.

Position

Patient lying in position B as for Dorsal adjustment.

Find the subluxation by following the record and perceiving

that the count assumed to be correct permits the subluxations

to correspond to those recorded and that a vertebra in this

region is R or L, R. A. or L. A., R. S. or L. S., R. I. or L. I.

The laterality of the spinous process determines the next

step.

For a right subluxation turn the face toward the left

and use right hand for contact hand. For a left subluxation
turn the face to the right and use left hand for contact hand.

Contact

Thumb of contact hand is placed upon and against the

side of the spinous process so that it presses firmly. The
thumb is extended almost at right angles to the hand which
rests upon the patient's shoulder with fingers extending, and
gripping, over the clavicle. Be sure of the soHdity of the
position.

Next place the other hand upon the patient's forehead

and press the head backward, or toward the side of the con-

tact hand, until the neck is well flexed and the tissues tight-

ened between the now opposing hands.

Fio. 10. The "T. M.," No. 1,
 Technic of Adjusting 123

Movement
When this tightened condition is reached a quick decisive
movement of both hands in opposite directions, but chiefly

of the hand apphed to the head, will secure an easy move-

ment of the vertebra.

This move is a very valuable adaptation of the old crude

and other dangerous "T. M.," of which No. 2, below, is

another, more like the original move but possessing several

"safety" features.
"T. M." No. 2
Position of Patient
The patient sits erect on a flat seat witlg both feet resting

upon the floor as during palpation.

Placing Hands
After careful palpation and selection of a vertebra to be
adjusted in this way, stand directly behind the patient. If

the vertebra is subluxated to the right use right hand for

adjusting (or contact) hand, if to the left use left hand.

Hold the hand so that the thumb is at right angles to the

hand and tense and firm. Place the palmar surface of the
end of the thumb against and upon the tip of the spinous
process and grasp the neck firmly with the fingers, which
extend over the base of the neck and toward the clavicle.

The other hand is placed easily on the top of the head.

Position of Head
The completing of position after contact has been made
is governed by two considerations ; the need for relaxing the
124 Technic and Practice of Chiropractic

neck muscles and for so supporting the vertebrae above

the contact that movement will take place only at the point

of contact. If the neck muscles are contracted the movement

is almost always defeated and should always be abandoned
to avoid strain.

To secure the desired position ask the patient to relax his

muscles and allow you to place his head as desired. If he
seeks to place it himself the necessary muscular contraction
on his part will defeat the movement. The movements of
the head must be passive.

With thumb and remainder of adjusting hand properly

placed, use the other hand upon the head as follows : First

flex the head forward on the chest as far as possible, then

rotate it slightly so that the face is turned a little toward

adjusting hand. Then flex the head sidewise until a resist-

ing pull of muscles indicates that they have been stretched

taut. It is well during the third movement described to let

the forearm swing down at right angles to the hand so that

it presses firmly against the ends of all the Cervical trans-
verses, distributing the force among them.
Or, after placing contact hand rest the elbow in the
angle at the base of the neck and let the forearm extend up-
ward along the side of the neck. Then flex the wrist until

the hand will rest upon the patient's head and perform the
movements of the head as described above.

Movement
A quick, simultaneous movement of both hands in op-
posite directions, two-thirds of which is given with the hand
Fig. 20. The "T. M.," Xi Xote position of right arm and
hand of adjuster.
 ;

Technic of Adjusting 125

which holds the head. The thumb in contact with the spinous
process moves sHghtly inward toward the median line but

its chief use is to hold the vertebra very firmly. To this

end part of its force is directed forward against the shoulder

and through the ball of the thumb.

Failure to place the head properly or in securing suffi-

cient flexion of the neck before move is attempted are the

chief causes of failure. Force must be delivered quickly
and sharply and the best adjustment of this kind is usually

the one in which the head and hands move through the least

space.

Uses
This movement is obviously useful only for the correction
of rotation, since the force is directed sidewise against the

spinous process.
The "T. M." was originally intended as a Cervical ad-

justment, but its greatest use is now from C 6 to D 2 inclu-

sive. Above the sixth its use is questionable because of the

possibility of moving more than one vertebra or some other

than the one desired.

"THE RECOIL"
(Pisiform Contact)
Position of Patient
This movement is best given on bifid bench of the type

commonly known to the profession. Place patient on for-

ward section so that its rear edge rests just below the axilla

this may be ascertained by passing a hand under patient's

126 Technic and Practice of Chiropractic

arm after he is in position, when the edge of the bench

should be felt about an inch below the hanging arm. The

thighs should rest on rear section so that the pubic sym-
physis is free of the bench. The semicircular pubic cut is

an advantage in that it avoids injury without making neces-

sary too great a suspension between sections.
Thus the abdomen and the lower part of the thorax are

suspended between sections. Under them an abdominal

support may be used but it must have the quality of elasticity

in a high degree and must lie always below the plane of the
other two sections or it will interfere with a perfect ad-

justment.
For adjustment of the last two Cervicals or any Dorsal
down to the sixth, it is best to turn patient's head toward
the direction of the subluxation. This curves that section
of the spine into an arc toward the convex side of which
movement may be made more easily than toward the con-
cave.

The patient's hands may lie under the table, loosely, or

may reach back and rest upon the buttocks, palm upward.
Whichever position secures best relaxation is to be used in
any case.

This movement may be used with the roll. (See Fig. 30

and p. 285.)

Position of Adjuster

Stand on either side of patient, feet apart for base and

poise. The direction of the feet and position of body will
Fig. 21. After palpation. Finger ready to guide contact hand
to a spinous process.
 :

Tech NIC of Adjusting 127

vary according to the direction of the adjustment, by the

following two rules

Rule 1. For movement of a vertebra aiuay from the side

on which you stand, place your arms and hands in such a

position that the pisiform bone of adjusting hand, both el-

bows, and both shoulder joints (shoulders being dropped

loosely forward) will fall in the same plane and that the

plane of direction in which the vertebra is to be moved. In

other words, let the force be applied in a line straight from

your body through the vertebra. Always shift your feet to

a proper position from which to direct the movement.

Rule 2. To move a vertebra tOK'ard the side on which

you stand, step close to patient's body and support yourself

with one knee against the adjusting table at the most con-
venient point. Then place arms so that contact point, elbows,
shoulders, and the mid-point of the body's base, between

the feet, are all in the same plane. This insures balance dur-
ing and after the movement and is the attitude from which
the greatest and most carefully measured force can be de-

livered.

It will be seen that the desire is always to deliver all

force in one plane and thus avoid conflict of forces and

waste or misdirection through the predominance of one

force over the other, and to use both arms with equal facility

in the move. There are at least a hundred ways to hinder

this movement by varying the preliminary positions. And

no one can know the real efficiency of the move who has not
become instinctively adept at taking position.
128 Technic and Practice of Chiropractic

Use of Hands and Arms

Use of hands for palpation has been described. (P. 46.)
The palpating hand comes to rest with the middle finger
on the spinous process of the vertebra to be adjusted. The
heel of the hand is raised, the first and third fingers doubled
back, and the heel lowered again. Now the middle finger

alone is a slender pointer guiding to the contact point.

Place pisiform bone of other hand snugly against the
process to be moved. The hand should rest in a slight arch,

pisiform against spinous, fingers rigid and flexed on hand,

last finger firmly anchored, or pressed into the flesh, to
prevent slipping. (Fig. 22 shows the position.)

The anchoring fingers must always extend away from the

adjuster. To turn the fingers back across the spine, in mov-
ing a vertebra toward you, is always an error, and the price
is partial loss of use of one arm.
With the adjusting hand satisfactorily placed, grasp its

wrist firmly with the other hand so that the pisiform of the
supporting hand rests in the hollow between the wrist and
the metacarpal bone of the extended thumb. By this con-
tact force is driven directly through the chain of bones
across the wrist and to the pisiform bone without spreading.
In grasping the wrist let the thumb extend around the fore-
arm in one direction and the four fingers in the other. Be-
ware of gripping only with thumb and first finger in which
case the edge of the supporting hand will rest on the back
of the contact hand and spread the delivered force too
widely.
Ci^
 Technic of Adjusting 129

Movement
I have said, but have not sufficiently emphasized the
command, that the shoulders must be dropped loosely for-

ward. Let me add that just before the movement is given

the head should be allowed to sag downward and the mus-
cles to become relaxed. This movement given with stiff

shoulders and upraised head becomes a push.

The desired movement is a throwing movement.

Force is released from both shoulders at once, concen-

trated at the same instant by a slight shifting forward of

the elbows, and strikes the spinous process as one force,

which is the resultant of the two meeting at the wrist of

contact hand and being united there. The two arms use the

contact hand as a passive instrument for driving the ver-

tebra.

The objective point, the distance to which the movement

is mentally thrown at the instant of delivery, should be the
center of mass of the vertebra, varying according to the
section of the spine.

Contact Point

The exact contact point of hand with vertebra varies. If

the vertebra is to be moved toward the right the pisiform

rests against (not upon) the left side of the spinous; if to-

ward the left and inferior, against the right side and just

above, in the notch between it and the next superior process.

The rule is to so place hand that the spinous process is be-
130 Technic and Practice of Chiropractic

tween the pisiform and the direction to which movement is

given.
On the hand the contact may be said to vary, according

to the direction of subkixation and position of adjuster, so

as to describe a circle around the pisiform in the course of
the various changes of position necessary to the use of this
movement. No error could be greater than to attempt to
use always the same face of the pisiform and to adapt the
position of hands and arms to this end, when any face or

aspect of the little bone is equally good with any other.

Which Hand Used

When standing on patient's right use left hand for pal-

pating hand and right hand for contact with the vertebra,
using left hand again to grip and reinforce the contact hand.
Exception to this is made by introducing an extra change of
hands with C 6, or 7, D 1, L 4 or 5, and Sacrum. The
change is necessitated by the insecurity of the usual position
or the fact that it cramps the wrist of contact hand. To
make the change: palpate as usual, hold subluxation with
second finger of palpating hand, substitute second finger of
other hand and withdraw palpating hand, which is then
free to make the contact.
When standing on left side exactly reverse the use of

hands. Palpate with the same hand which would be used if

patient were sitting. Introduce no unnecessary move into

the placing of the hands. This will be found to produce

better results than any other technic for this portion of the

move.
 Tech NIC of Adjusting 131

Delivery of Force

In using this movement it is perhaps best to deUver

nearly equal force with both hands ; certainly whatever
forces are released by the arms should be simultaneous. It

is possible, however, to allow one arm to preponderate in

the movement without marring its efficiency, but the amateur

adjuster will do well to balance his forces at first.

Speed and Concentration

Speed is a prime essential. By its employment a very

ordinary amount of muscular strength can be made to ac-

complish a large amount of work and very difficult adjust-

ments may be accomplished.
Concentration of mind at the instant of adjustment, so
as to secure muscular control and perfect co-ordination of
the two arms as well as to direct and concentrate the forces
used at a given and strictly limited area, is also essential.

Uses

For ordinary adjustments of Dorsal or Lumbar sub-

luxations, excepting the middle four Dorsals, for breaking

ankyloses by repeated applications of force, and for over-

coming muscular resistance in patients who are unable to
relax at all, this form or style of adjusting is probably the
best. It is most useful in the Dorsals. In many instances
Lumbar vertebrae will move better by application of a
slightly slower force, especially if a roll is used. The Recoil
may be used with the roll.
132 Technic and Practice of Chiropractic

While it is easily possible to move any Cervical in this

way, making no change in the technic except to use the ulnar
side of the fifth metacarpal bone for the contact instead of
the pisiform, it is inadvisable in most cases above the sixth,
and in some instances absolutely unpardonable. The shock
to the nervous system and the danger of moving two or
more vertebrae or of subluxating a normal one are too great.
In at least one instance hemiplegia instantly followed the
use of this move on the Axis, and headaches and nerve
exhaustion are frequent sequelae.
For these reasons it is probably best never to use "The
Recoil" above the sixth Cervical. For every form of sub-
luxation there is an easier and safer mode of correction.

Name
This has been called 'The Recoil" because of a belief
that if force be applied to a vertebra in the form of a very
rapidly transmitted shock the vertebra will rebound to the
shock and settle in its normal position, the intelligence within

the body utilizing the force thus blindly applied to bring

about this result.

This belief is erroneous. First the vertebra and all sur-

rounding tissues are misshapen to fit their abnormal position

and relation and this shape gives them a tendency, if rapidly

loosened, to settle into the old abnormal position. Second,
there is no such conscious intelligence which has power to

replace a subluxated vertebra. If this supposition were

correct, then the Innate Intelligence would do well to utilize
 Technic of Adjusting 133

those jars and shocks which ordinarily produce subluxation

to bring about normality and keep the spine perfectly

aligned.

There is no such internal rebound or recoil as stated

above. The chief value of the movement lies in its speed,

according to principles equally applicable to other moves,

and in accord with the Law of Momentum.

Sources of Information

This movement as described above contains many es-

sential principles which follow Parker and Palmer, de-

velopers of ''The Recoil," but the technic is considerably

modified to suit the author's own views. It cannot be claimed,

therefore, that this is "The Recoil" as now taught by Pal-
mer, since the chief stress is here laid upon the movement
of the vertebra in a predetermined direction and not upon

the withdrawal of the hands to let "Innate" do the work.

The name "Recoil" is really inappropriate for the move as

described.

THE HEEL CONTACT

A movement for the adjustment of posterior, postero-

superior, or postero-inferior subluxations in the Dorsal

region (except middle four) and in the Lumbar. May also

be used for postero-laterals when laterality is very slight.

Given with patient in position B. Contact point, heel of hand

with spinous process.
134 Technic and Practice of Chiropractic

Heel Contact

By the "heel of the hand" is here meant the depression

between the scaphoid and pisiform bones. This hollow
forms a natural receiver for a spinous process and thus
avoids lateral slipping.
The four fingers of adjusting hand are spread out and
anchored upon the patient's body. The wrist is held at a

right angle to hand and the arm straightened, the elbow

being outrotated until it ''locks," that is until it will move no
farther. The other hand grasps the wrist of the adjusting
hand.

Adjusting Hand
The rule is to use the right hand for adjusting hand if

standing on patient's right and palpating with left, or to

use left hand if on left side and palpating with right. The
fingers are to be directed toward the patient's feet. Excep-
tion to this rule is made with the last two Lumbars, where
it is more convenient to change hands and direct the fingers
toward the head.

Movement
This is given almost entirely with adjusting arm ; that
is, with the arm whose hand is in contact with the vertebra.
The supporting hand serves merely to guide the force to a
definite point as if a straight rod were working through a
fixed circlet. Indeed, the force in this movement is de-
Fig. 23. "Heel contact.
 Technic of Adjusting 135

livered almost straight down from the shoulder. Shoulder

should be dropped well out of its socket so as to secure
play for a sudden downward movement without raising the

hand from its contact. If the shoulder is stiff or the head

of the humerus remains in the glenoid cavity the movement
cannot be properly given without raising the hand. Move-
ment is quick, sharp, and deep, i. e., directed to the center of

mass of the vertebra.

It may be directed straight toward floor to correct a
posterior, inclined slightly toward the head or feet to cor-

rect approximation, or —as some aver —sHghtly sidewise to

correct a mild degree of rotation.

PISIFORM DOUBLE TRANSVERSE No. 1

An adjustment to be used only in the Dorsals from

fourth to ninth inclusive, for posterior or postero-rotary sub-
luxations. It is probably best to use this movement only for
straight posterior subluxations and to apply either the Pisi-

form Single Transverse or the Two Finger Double Trans-

verse to the rotary displacements in this region.

Contact

Both pisiform bones, each upon a transverse process

and both upon the smne vertebra.
With patient in position B and the adjuster standing
upon his left the contact should be made by the following
exact method. Palpate with right hand, which comes to
rest upon the spinous process of the subluxated vertebra.
136 Technic and Practice of Chiropractic

Note if it be P. R. or P. L., because this fact will govern

the next movement. Let the first finger of palpating hand
reach outward about one inch and upward to a point opposite

the tip of the next superior spinous process, which point

w^ill approximate the position of the transverse. This

first upon the side of the posterior transverse, which will be
the right with a left subluxation or the left with a right

one. Let second and third fingers, now abandoning the

spinous, follow the first and rest over the assumed position
of the transverse.
Now palpate with a deep, limited, massage movement
until the club-shaped extremity of the transverse is felt

under the middle finger. Hold this point with the middle
finger, drawing away the other two, and guide the free hand
to an exact contact upon the transverse. Thus if standing
on the left, as predicated, the left hand will be first to make
contact and with the most posterior transverse, with which
most exact contact is necessary.
With pisiform placed, let the fingers extend away from
your body ; if on the side of the spine opposite you, let them
extend downward so as to follow the curve of the rib and to

be anchored upon the rib connected with the transverse of

contact; if on the same side, let fingers extend downward
parallel with the column.
Now — still using the original palpating hand —palpate
on the other side from the first contact until the other trans-
verse is discovered. Mark its tip with a quick, deep pres-
sure and a sharp withdrawal of the fingers, so that a spot
Fig. 24. Pisiform double transverse adjustment as it should be
given, elbows locked.
 Technic of Adjusting 137

of anaemia appears momentarily. Carefully place the pisi-

form of the palpating hand in contact, guided by the anaemic
spot. If this second contact is on the side on which you
stand the fingers will be toward the head ; if on the opposite
side, they will follow the rib curve outward and downward.
Re-read the above directions carefully. It will be seen
that the technic is quite free from unnecessary movements.
The two hands are now placed almost exactly at right
angles to each other, arched fingers anchored to prevent
slipping.

If you stand on the patient's right the use of hands is, of

course, exactly reversed, the left hand being palpating hand,
and making the first contact.

Completing Position

When hands are in position and adjuster standing so as

to face directly across the spine, the arms are rotated out-
ward until the elbows "lock." The adjuster leans over so
as to have shoulders directly over the spine, draws the body
back from the shoulder girdle to secure freest play in the
shoulder joints, and drops head loosely between the shoulders
so as to relax the trapezius and present any checking of the
force.

Movement
Directly downward from the shoulders through straight,
stifiF arms. The force is delivered separately with the two
arms and yet simultaneously. If the vertebra is straight
138 Technic and Practice of Chiropractic

posterior, equal force must be applied on the two sides ; if

it is posterior and slightly rotated (P. R. or P. L.), most

force must be applied to the more posterior transverse.

Considerable practice and looseness of shoulder are re-

quired to use this movement properly. It is a regrettable

fact that few adjusters do use it correctly, most of them

giving a thrust instead of a transmitted shock.

PISIFORM DOUBLE TRANSVERSE No. 2

This modification of the pisiform double transverse move

is here described because of its popularity rather than be-
cause the author wishes to recommend it. The position is

the same as for No. 1, and the uses also, except that it tends
to correct postero-inferior subluxations and is not at all

adapted for use with superiors.

Contact

Both pisiforms below the two transverses (caudad).

After palpation which discloses the posterior transverse the
hands are placed as follows: Palpating hand rests always
on the side of the spine next the operator; opposite hand
crosses the spine. Both are slanted upward so that the
fingers point toward the head with the axes of the hand
slightly diverging above. The wrists are thus crossed in
such a way as to force the forearms to be somewhat flexed

on the arms and to slant away from the wrists at an obtuse

angle. This with the contact below the transverses, renders
it impossible not to force the vertebra in an upward (supe-
rior) direction when movement is given.
Fig. 25. Two linger double transver.se.
 Technic of Adjusting 139

Movement
A comparatively slow thrusting movement, which tends
to spring the spine. The merit of this method lies in its

comparative painlessness. Its technic is not attractive.

TWO FINGER DOUBLE TRANSVERSE

A movement for posterior or postero-rotary displace-
ments from fourth to ninth Dorsal inclusive. It serves the

same purpose as the Pisiform Double Transverse but is less

painful and often easier of delivery. The palmar surface of

the fingers, with the flesh of the patient's back, make a com-
pound cushion which acts as a shock-absorber.

Palpation — Contact
The usual downward gliding movement of left hand if

standing on right or of right hand if standing on left will

serve for the discovery of the vertebra listed for adjustment.

The gliding hand stops with the second finger indicating the
spinous process. The first finger reaches upward and out-
ward to the assumed location of the transverse on the side

nearest the adjuster; then the second finger reaches to a

similar point on the other side, both fingers pointing toward
patient's head. Now the fingers are rolled a little to make
sure that they are in contact w^ith the ends of the transverse,
the palmar surface of the tip of each finger being the proper

contact point. The heel of the contact hand rests near, but

not on, the surface of the body over the midspinal line.
140 Technic and Practice of Chiropractic

Supporting Hand
The ulnar edge of the free hand is now placed across
the tips of the two contact fingers so that it rests directly

above the ends of the transverses but separated from them

by the finger tips. The upper arm is then straightened and
the elbow outrotated until it locks firmly so that the arm
makes a straight line directly above the transverses. The
body is drawn away from the shoulder girdle, pulling the

head of the humerus out of its socket as far as possible to

allow free play, for all force is to be given by this straight
arm.

Movement

If the subluxation is a straight posterior the force is

driven directly downward so as to be distributed equally to

the two contact points. If it be a postero-rotary, most force
is directed to the more prominent (posterior) transverse.
Force should be delivered quickly, keeping in mind the prin-

ciple of transmitted shock.

Contrary to the general belief, as much force can be

developed with this move as is needful for any ordinary
adjustment. The fact that it is often recommended for use
with children or with sensitive or frail patients has led to
the belief that it is a relatively ineffective move, whereas its

value in such cases lies only in the fact that it inflicts less

pain than some others.

Fig. 26. Pisiform single transverse move. No. 1.
 Tech NIC of Adjusting 141

PISIFORM SINGLE TRANSVERSE MOVE No. 1

Like the movement just described, this adjustment may

be used in the Dorsals from fourth to ninth inclusive. It

should be limited to those subluxations which are rotated

without being posterior. In such an instance the spinous
process appears to be laterally displaced without being pos-
terior, or may appear slightly anterior because it is de-

scribing an arc about a fixed center of rotation in the body

of the vertebra. One transverse process appears anterior

and the other posterior to the line of their fellows.

Palpation

Palpate as for the Recoil and use the same adjusting

hand as in that movement, i. e., right hand if standing on
right side and palpating with left, or left hand if standing
on left and palpating with right. When the palpating fingers
have discovered the subluxated spinous process, the first

finger seeks a point even with the tip of the next superior

spinous process and about an inch to the side on which is

the posterior (prominent) transverse. The second and

third fingers follow and, dipping inward with a rolling or
massage motion, discover the end of the transverse.

Contact

Now the adjusting hand is placed with its pisiform rest-

ing directly upon the blunt end of the transverse. If the

contact is on the same side of the spine with the adjuster

the fingers of adjusting hand extend across the spine and
142 Technic and Practice of Chiropractic

are anchored on the other side, the hand arching sharply

and fingers extending somewhat downward. If contact is

on opposite side of spine the fingers follow the rib curve

downward and outward and are similarly anchored. In
every case the fingers should extend away from, and never
toward, the adjuster's body. To violate this rule renders

one arm almost useless through its position.

At this juncture the palpating hand becomes a reinforcing

hand, to grip the wrist of the other and to aid in the move-
ment.

Movement

The force is directed in a straight anterior direction,

quickly and decisively, as if a spinous process were the
lever used. Remember that contact must always be made
with the posterior transverse. To drive this anterior is to

rotate the vertebra around its vertical axis and to bring the
spinous process toward the median line, while the opposite,
and more anterior, transverse becomes more posterior, as it

should be.

PISIFORM SINGLE TRANSVERSE No. 2

Uses

For rotated first or second Dorsals with which, for any

reason, the "T. M." fails. This move involves a use of the
head as a lever, as does the "T. M." No. 2. Inadvisable un-
less the posterior transverse of the rotated vertebra can be
 —

Technic of Adjusting 143

palpated —but often used in cheerful disregard of this detail

by those sublimely capable adjusters who do not need to

find a vertebra before moving it.

Palpation Contact

Palpate as for Xo. 1 above. A'ery deep palpation will

be necessary because the spinous process here is nearly

horizontal to the body and the transverse is very deeply

placed, overlaid with heavy muscles.

When process is found place pisiform bone of free hand

upon it, pressing the muscles aside as much as possible to

avoid bruising and resting a considerable amount of weight

upon the contact hand. Fingers of contact hand may ex-

tend across the spine or downward and parallel with the

spine. Or, the hands may be changed so that the palpating

hand becomes the contact hand and is placed with the fingers

gripped over the base of the neck toward the clavicle.

Head Leverage
The free hand is now placed upon the forehead and the
head, which faces toward the contact hand, is flexed back-

ward until the muscles seem taut.

Movement
Is a quick, but fairly gentle, movement of both hands

together, so that the head is rocked still further backward

at the instant an anteriorly directed force is applied to the

144 Technic and Practice of Chiropractic

prominent transverse. The result is rotation of the vertebra

—unless there be a loose articulation in the Cervicals which

gives way under the force applied to the head.

THE EDGE CONTACT

("Point 2 Contact"—"Knife Move.")
Name
This movement has various names. The name "Point
2 Contact" is handed down from the days when Palmer
used three contact points and three moves and designated
the middle of the ulnar side of the fifth metacarpal bone as
"Point 2." The name "Edge Contact" was applied later,
during the improvements in its technic when the hooking
of the thumbs stiffened its efficiency and made it very val-
uable. It has since been rediscovered (though in constant
use) and re-named "Knife Move."

Uses

A movement which uses the spinous process as a lever

and is applicable to D 2, 3, or 4, and to any Dorsal or Lumbar
from D 8 down, when posterior, postero-superior, or postero-

inferior. It does not correct rotation except insofar as the

shape of articular processes may aid an anteriorly directed

move in rotating the vertebra.

Some Chiropractors have used the Edge Contact in the

Cervicals but this is always improper, as it is practically

Fig. 27. The edge contact in Lumbar region.
 Technic of Adjusting 145

impossible in some, and difficult in all, cases to cover only one

spinous process when the head is resting on its side.

Palpation

Same as for Recoil or Heel Contact, q. v.

Contact

Using the same adjusting hand as for the Heel Contact,

place the middle of the ulnar edge of the fifth metacarpal
bone in contact with the spinous process. If the vertebra

be superior, place the edge of hand above, if inferior, place

the hand below. This contact is especially good for S or I

vertebrae.

Position of Hands and Arms

The fingers of adjusting hand cross the spine at a right

angle to its long axis. The back of hand will be toward

patient's head except in adjusting the last two Lumbars,
with which a change of hands is made necessary by the

upward slant of the lower half of the Lumbar curve.

The palpating hand now grips the adjusting hand so

that the fingers of the upper hand, held close together, press

against and reinforce the lower on its dorsum and just

above the contact point. The thumbs are hooked together

as shown in Fig. 27, so that the hands may be stiffened and
their tendency to roll avoided.

The elbows are outrotated and locked as in the Pisi-

form Double Transverse Move and both shoulders are
loosened.

10
146 Technic and Practice of Chiropractic

Movement

This is chiefly delivered with the upper arm, using upper

hand to drive the lower. Force should be quickly delivered
when patient is relaxed. The direction of force should be
determined by the direction of subluxation and by the slant
of the spinous process. Thus, when patient lies prone upon
a bifid bench and sways downward against a lax abdominal
support, the spinous processes of the lower dorsal make an
acute angle with the plane of the floor. If one be superior,
contact above it and force driven straight toward the floor

will tend to correct the subluxation. There is a slightly

different force angle for every subluxation correctable by
this move.
This move is less painful than the pisiform contact and
may often be used to advantage, especially in the Lumbar
region.

LUMBAR SINGLE TRANSVERSE

For the correction of a rotated Lumbar. Best used on
second and third. This movement should never be attempted
unless the transverse process can be palpated. Lumbar
transverses are sometimes short or fragile, and unless they
can be distinctly felt no force should be applied where they
are believed to lie.

Contact

Pisiform bone with posterior transverse.

Fig. 28. Lumbar single transverse move.
 Tex:hnic of Adjusting 117

Palpation and Placing of Hands

Palpating as if for other movements, pause with the
second finger of palpating hand indicating the spinous pro-
cess of the vertebra to be moved. Note that if the spinous

process be to the right of the median line the left transverse

will be posterior, if to the left, the right transverse.

The transverse may then be found as in the Dorsals ; it

should lie even with the interspace above the spinous pro-
cess, deeply overlaid with strong muscles. When the trans-

verse has been located by a deep, probing movement of the

fingers, place adjusting hand, pisiform on transverse, close

to the spinous process for greater solidity and fingers ex-
tending downward and outward from the midspinal line

parallel with the lower rib curve.

If the adjuster stands on the side of the patient opposite

to the transverse to be moved the hand opposite the palpating
hand becomes the contact hand, as in other moves. But if

the posterior transverse is on the same side with the adjuster,

a change of hands is made and the palpating hand becomes
contact hand. To accomplish this the adjuster must turn
and face away from the patient with arm extended straight
downward to the contact. After contact is made the re-

maining hand reinforces the adjusting hand by gripping the

wrist.

Movement
In making the contact press downward, deeply and
firmly, so as to crowd the muscles aside and place +he pisi-
148 Technic and Practice of Chiropractic

form directly upon the transverse. Movement is given after

the patient's body has been swung downward for a con-

siderable distance, and is sharp and decisive, directed

straight toward the floor.

LUMBAR DOUBLE TRANSVERSE MOVE

A movement sometimes appUed to posterior or postero-

rotary Lumbars.

Palpation and Contact

From the spinous, find first the more posterior transverse

and make contact with it, since most force must be directed
there. Stand facing patient's head and place right hand on
right transverse and left hand on left.

Contact point in this move is the tuberosity of the

scaphoid with the posterior surface of the transverse. Fingers

curve away from median line so as to avoid the rib curve.

Movement
After heavy, steady pressure downward, force is de-
livered with a quick, throwing movement, most force on
the posterior side.

THE **SPREAD" MOVE

Upon the theory that when two forces are simultaneously
applied, the one to drive some vertebra cephalad (by its

spinous process) and the other to drive some lower vertebra

caudad, the intervening vertebrae tend, if anterior, to be
 Technic of Adjusting 149

drawn outward or toward a more posterior position, this

more is predicated.

The author does not believe that it accomplishes its

purpose, but will briefly describe it for the benefit of those

who do.

Position

Patient is placed over a roll which rests under the thighs

so as to flex thighs and pelvis on the Lumbar spine, or an

adjustable table is so tilted, both sections sloping down-

ward from the middle, as to accomplish the same result.

Contact
The usual method, if only a single vertebra is anterior,

is to make contact with the vertebrae immediately adjacent,

crossing the hands and having fingers of upper hand point-
ing toward head and of lower hand toward Sacrum. But
some adjusters use this move differently, making contact
with Sacrum and with the mid-dorsal region in general
and applying a slow force with both hands. Contact is with
heel of hand upon spinous process.

SACRAL ADJUSTMENTS
The adjustment of the comparatively fixed sacrum is

difficult at best and requires a very considerable force, vio-

lently applied. It is probable that nine-tenths of all at-

tempts to move sacra fail. In children, when sacrum does

not articulate properly with the ilia, and in adults in whom
the sacrum has been loosened by trauma and remains in
150 Technic and Practice of Chiropractic

an abnormal relation to surrounding structures, il can be

moved.
The sacrum is described as being posterior at the base
or at the apex, and its axis for rotation is believed to be a
transverse line through the sacroiliac articulations. Force
for its adjustment is applied at right angles to the curve of
the sacrum at the point of contact. The best contact is with
the heel of the hand against a part of the sacrum, the wrist
of the adjusting hand being gripped and reinforced by the
other hand. If standing on patient's left, the right hand
becomes adjusting hand for sacrum as for the last two Lum-
bars, if on the right, the left hand.

Another contact is with the pisiform and adjacent soft

part of hand upon the sacral base, the pisiformi hooking
against the first sacral spinous process.

Do not mistake an anterior fifth Lumbar for a posterior

sacral base. Discriminate between iliac and sacral subluxa-

tions by noting that with the latter both sacroiliac articula-

tions, and with the former only one seems abnormal.

ILIAC ADJUSTMENTS
Palpation

With patient sitting erect on flat surface, feet on floor,

stand behind and examine both sacroiliac articulations at

once with the palmar surfaces of the fingers of both hands.
If the two articulations are similar in every line neither
ilium is subluxated, though the sacrum may be rotated on
Fig. -2^.K P.oheniian Move" for correction of anterior fifth Lum-
bar b}' transmitting shock through spine.
 Technic of Adjusting 151

its transverse axis between the ilia, so as to be posterior or

anterior at base or apex.

But no examination of the iha is complete without in-

vestigating also the lumbosacral articulation. It sometimes

happens that though the first sacral spinous process naturally

completes the lumbar curve and there is no lumbosacral

subluxation the crests of both ilia appear much posterior to

their normal relation to the upper part of sacrum: this is

a double iliac displacement.

Usually the ilia are both normally articulated; this is

one of the most difficult joints to weaken and is seldom,

affected except by the most extreme force. When iliac

subluxation exists one side is affected alone nine times out

of ten. The tenth case may show double subluxation.

Movement
Nine-tenths of the so-called ''iliac adjustments" are
quite amusingly ineffective. The force required really to juovc

an ileum (save in joint disease or in children) is tremendous

and not to be commanded by the ordinary adjuster. The
light jars applied as a routine procedure by so many Chiro-
practors are in reality nothing more than single percussion

strokes which stimulate the sacral nerves.

Place patient in position B and apply the hands to a

posterior ilium as to a posterior sacrum, making contact
with the most prominent portion of crest or posterior border
and driving in a direction which would represent a part of
the circumference of a circle of which the transverse sacral
153 Technic and Practice of Chiropractic

axis of rotation touches the center, or the center of fixation

in the sacroiliac joint.

COCCYGEAL ADJUSTMENTS
Examination
Place patient on an angle table, i. e., one which rises in

the center and slopes away toward either end. Separate

the thighs slightly, patient lying face down, and insert the

rubber-covered second finger, palmar surface upward, very

carefully into the rectum. The tip of the coccyx may then
be felt and its movability and position determined. Unless
it is immovably fixed in an abnormal position it should not be
molested; the movable coccyx responds to mere muscle
tension by changes of position and cannot act as a primary
cause of nerve impingement.
Usually this examination will be rendered unnecessary
by the external palpation which may disclose the movability
of the coccyx and at once render further exploration super-
fluous.

When the coccyx is anteriorly subluxated and ankylosed

in that position it may be a factor in producing constipation,
hemorrhoids, etc., but its influence in other diseases, espe-
cially of the nervous system, has been greatly overrated by
those who have not yet fully accepted the doctrine that
nerve impingement is the primary cause of all disease.

Movement
When it has been decided that the coccyx must be
moved, the position and use of hand is the same as for the
Fig. 3U. Edge contact with "Roll," q. v. Attitude of patient
for coccygeal adjustment.
 Technic of Adjusting 153

palpation. The finger hooks under the tip of the coccyx,

draws upon it until a tight contact is secured and then

jerks sharply backward upon it with a view to its abrupt
fracture. No mitigation of the jerk in the hope of

previously loosening or gradually replacing the bone is of

value for osseous tissue must be broken before any move-
ment may take place.

This movement is painful and the region of the newly

fractured coccyx may remain sore for a period ranging
from a few days to several weeks. It is wise to warn the
patient of the facts before proceeding.

The fractured coccyx may be absorbed, or may be re-

ankylosed in a proper position or in a new abnormal posi-

tion, or may remain loose and movable.

ADJUSTMENT OF CURVATURES
We have previously discussed in detail the nature and
discovery of curvatures. A few words should be said here
about their correction.
If the sole object of the adjustment is to correct the

curvature it is best to select for adjustment those vertebrae

which are most subluxated in the direction of the curvature.

According to the length of the curvature a series of from

two to six, separated by some distance, are chosen. These
are adjusted until they cease to be the most prominent ones
in the curvature and then others, then most prominent, are
chosen and adjusted until they in turn cease to be most
prominent. In this way the curvature may eventually be
154 Technic and Practice of Chiropractic

straightened, or nearly so. It is doubtful if any curvature

can be absolutely eradicated, although it may be straightened
until unnoticeable except by the expert.
To overcome a curvature it may be necessary to break
every rule which governs ordinary adjusting and to invent
new ways of placing the hands or of delivering force. No
two require exactly the same measures and he is most suc-
cessful with curvatures who is most adaptable to changing
conditions.

One rule may be safely laid down. Do not alternate

from day to day, loosening at the same time many vertebrae,
but choose the ones most in need of adjustment and follow
your choice as long as it is indicated. The chief vertebra is

nearly always the one at the angle or point of the curvature.

The sharp, angular curve of Potts' Disease, involving

two or three vertebrae, should warn against adjustment,

usually, since in this disease the vertebrae are fragile and
easily fractured. If a case has not progressed too far a
cure may be effected, but great caution in taking such cases
must be exercised. Every Chiropractor should be well
informed on the diagnosis of Potts' Disease, or spinal caries.

Many months are usually required for the straightening

of a curvature —how many can scarcely be estimated in

advance of the experiment with any case. Often the case

which seems simplest requires the longer time, while a very
pronounced curvature, as in some cases of rachitis, may
vield in a few months.
 Technic of Adjusting 155

PREFERABLE ADJUSTMENTS
The selection of the move with which to correct each
subhixation depends upon the adjuster's concept of the kind
and direction of the subluxation and of the mechanics of
the different corrective moves in his repertoire. The move
used should be one in which the application of force is

exactly along opposite lines to the lines of force which

originally produced the subluxation.

Omitting involved explanations as to the elements of
each displacement and the manner of change in bone,

muscle, ligament, cartilage, etc., and presupposing a com-

prehension of the principles of each adjustment named,
there follows here a list of possible subluxations of each

vertebra in turn, from Atlas down, with a simple statement

of the RIGHT MOVE for that subluxation.

In each instance there are other moves than the one

listed which would move the vertebra and some which would
partially correct it, but none which would quite so definitely
tend to correct the displacenv£nt. Unfortunately it is not a
fact that every movement of a vertebra is an adjustment. If

this were true subluxations would not exist, because they

could never have been produced. Too often the adjuster

uses a move because it is easy, because its use has become

habitual with him, rather than because it is indicated by the

conditions of the case —then blames Chiropractic because his

results are negative or bad.

The move which is suited to a certain kind of subluxa-

 156 Technic and Practice of Chiropractic

tion of one vertebra may be quite out of place with another,

in a different part of the spine. Thus the Recoil is quite
proper for a posterior Lumbar and in contraindicated with
a posterior middle Dorsal.
If all vertebrae were shaped exactly alike, if all were
equal in size, if subluxation were possible only in one direc-
tion, then one method of adjustment would be quite suffi-

cient. Diversity of technic is demanded, but a discriminat-

ing diversity, with a good reason for every move used.

First Cervical
Subluxation. Adjusstment.
Right—R Break, or straight lateral.

Right, posterior—R. P Rotary lateral.

Right, anterior — R. A Morikubo.

Right, superior —R. S Break.
Right, inferior— R. I Break.
Right, posterior, superior —R. P. S.. Rotary lateral.

Right, posterior, inferior—R. P. I... Rotary lateral.

Right, anterior, superior — R. A. S Morikubo. . .

Right, anterior, inferior— R. A. Morikubo.

I ...

Left—L Break.
Left, posterior —L. P Rotary lateral.

Left, anterior —L. A Morikubo.

Left, superior — L S Break.
Left, inferior —L. I Break.
Left, posterior, superior —L. P. S... Rotary lateral.

Left, posterior, inferior — L. P. Rotary

I lateral.

Left, anterior, superior — L. A. S Morikubo.

. . . .

Left, anterior, inferior — L. A.I Morikubo.

Anterior (entire Atlas) — A Morikubo (both sides).
Posterior (entire Atlas) — P Rotary lateral (both sides).
Note. — All right subluxations adjusted from right side, all left
from left side.
 Technic of Adjusting 157

Second Cervical
Subluxation. Adjustment.

Posterior —P Posterior Cervical move.

Posterior, right — P. R Double contact on right side.

Posterior, left — P. L Double contact on left side.

Posterior, right, inferior — P. R. L.. Double contact on right.

Posterior, right, superior — P. R. S.. Double contact on right.
Posterior, left, inferior — P. L. IDouble contact on left side.

Posterior, left, superior — P. L. S. .Double contact on

.. side. left

Right (lateral)— R Break (Same if R. I. or R. S.)

Right (rotary) —R Rotary (Same if R. I. or R. S.)
Left (lateral) —L Break (Same if L. I. or L. S.)
Left (rotary) —L Rotary (Same if L. I. or L. S.)
Superior —S Posterior Cervical move.
Inferior — I Posterior Cervical move.
Anterior (entire Vertebra) —A Ventral transverse contact on
most anterior side.

Anterior, right (lateral) —A. R Second metacarpal contact from

right.

Anterior, right (rotary) —A. R Pisiform Ant. Cerv. contact on

right.

Anterior, left (lateral) — A. L Second metacarpal contact from

left.

Anterior, left (rotary) —A. L Pisiform Ant. Cerv. contact on

left

Third Cervical
Same as second.

Fourth Cervical
Same as second.

Fifth Cervical
Same as second.
158 Technic and Practice of Chiropractic

Sixth Cervical

Subluxation. Adjustment.

Posterior —P The Recoil, hands reversed.

Posterior, right — P. R Recoil, hands reversed.

Posterior, left — P. L Recoil, hands reversed.

Posterior, right, superior — P. R. S.. Recoil, hands reversed.

Posterior, right, inferior — P. R. L.. Recoil, hands reversed.
Posterior, left, superior — P. L. S Recoil, hands reversed.
Posterior, left, inferior — P. L. I Recoil, hands reversed.
Right (lateral) —R Break (Same if R. I. or R. S.)
Right (rotary)— R Rotary (Same if R. I. or R. S.)
Left (lateral) —L Break, from left (Same if L. I.

or L. S.)
Left (rotary) —L Rotary (Same if L. I. ,or L. S.)

Superior — S Edge contact move.

Inferior — I Edge contact move.

Anterior (entire vertebra) —A Pisiform Ant. Cerv. contact on

most anterior side.

Anterior, right (lateral) — A. R Second metacarpal contact from

right.

Anterior, right (rotary) —A. R Pisiform Ant. Cerv. contact on

right.

Anterior, left (lateral) —A. L Second metacarpal contact from

left.

Anterior, left (rotary) — A. L Pisiform Ant. Cerv. contact on

left.

Seventh Cervical

Same as sixth Cervical, except that T. M. may be used on right or

left rotary subluxations.

 Technic of Adjusting 159

First Dorsal

Subluxation. Adjustment.
Posterior —P Recoil, hands reversed.
Posterior, right — P. R Recoil, hands reversed.

Posterior, right, superior — P. R. S.. Recoil, hands reversed.

Posterior, right, inferior — P. R. I... Recoil, hands reversel.
Posterior, left — P. L Recoil, hands reversed.

Posterior, left, superior — P. L. S... Recoil, hands reversed.

Posterior, left, inferior — P. L. I.... Recoil, hands reversed.
Posterior, superior — P. S Heel contact.
Posterior, inferior — P. I Edge contact.

Superior —S Heel contact.

Inferior — I Edge contact.

Right — R T. M. (Same if R. S. or R. I.)

Left— L T. M. (Same if L. S. or L. I.)

Anterior —A No correction.

Second Dorsal

Posterior —P Heel contact.

Posterior, superior — P. S Heel contact.
Posterior, inferior — P. I Edge contact.

Posterior, right — P. R Recoil.

Posterior, right, superior — P. R. S.. Recoil.

Posterior, right, inferior — P. R. I . . Recoil.

Posterior, left— P. L Recoil.

Posterior, left, superior — P. L. S. .. .Recoil.

Posterior, left, inferior — P. L. I Recoil.

Left —L T. M. (Same if L. S. or L. L)
Right— R T. M. (Same if R. S. or R. L)
Anterior —A No correction.
160 Technic and Practice of Chiropractic

Third Dorsal
Subluxation. Adjustment.
Posterior —P Heel contact.
Posterior, superior — P. S Heel contact.
Posterior, inferior — P. I Edge contact.

Posterior, right — P. R Reooil.

Posterior, right, superior — P. R .S.. Recoil.

Posterior, right, inferior — P. R. I... Recoil.

Posterior, left— P. L Recoil.

Posterior, left, superior — P. L. S Recoil.

Posterior, left, inferior — P. L.I Recoil.

Right —R Pisiform single transverse (on

left) (Same if R. S. or R. I.)

Left —L Pisiform single transverse (on

right) (Sameif L. S. or L. L)
Anterior —A No correction.

Fourth Dorsal
Same as third Dorsal.

—
Note. While the Recoil is here, the preferred move for posterior
and postero-lateral subluxations, the pisiform double transverse or
the two finger double transverse may be used if both transverses are
palpable.

Fifth Dorsal

Posterior —P Double transverse move.

Posterior, superior — P. S Heel contact.
Posterior, inferior — P. I Double transverse.
Posterior, right— P. R Double transverse.
Posterior, right, superior — P. R. S.. Double transverse.

Posterior, right, inferior — P. R. L.. Double transverse.

Posterior, left — P. L Double transverse.

—
Note. The pisiform double transverse and the two-finger double
transverse, apply force in exactly similar directions and may there-
fore be used interchangeably. The latter is preferable for children.
 Technic of Adjusting 161

Subluxation. Adjustment.
Posterior, left, superior — P. L. S Double transverse.
Posterior, left, inferior — P. L. I Double transverse.
Right —R Pisiform single transverse
(Same if R. S. or R. I.)

Left —L Pisiform single transverse,

(Same if L. S. or L. I.)

Anterior —A No correction.

Sixth Dorsal
Same as Fifth Dorsal.

Seventh Dorsal
Same as Fifth Dorsal.

Eighth Dorsal
Same as Fifth Dorsal.

Ninth Dorsal
Same as Fifth Dorsal.

Tenth Dorsal
Posterior —P Heel contact.
Posterior, superior — P. S Edge contact.
Posterior, inferior — P. I Edge contact.
Posterior, right — P. R Recoil.

Posterior, right, superior — P. R. S.. Recoil.

Posterior, right, inferior — P. R. I... Recoil.
Posterior, left— P. L Recoil.
Posterior, left, superior — P. L. S Recoil.
Posterior, left, inferior — P. L. I Recoil.
Right— R Recoil (Same if R. S. or R. I.)*
Left —L Recoil (Same if L. S. or L. I.)*
Anterior— A No correction.

Eleventh Dorsal
Same as Tenth Dorsal.

—
Note. The use of this move is not quite mechanically correct,
but it is advised because of the possible danger of using the trans-
verse processes as levers.
162 Technic and Practice of Chiropractic

Subluxation. Adjustment.
Twelfth Dorsal
Same as Tenth Dorsal.
First Lumbar
Fosterior —P Heel contact.
Posterior, superior — P. S Heel contact.
Posterior, inferior— P. I Heel contact.
Posterior, right, superior — P. R. S.. Recoil.
Posterior, right, inferior — P. R. I... Recoil.

Posterior, left— P. L Recoil.

Posterior, left, superior — P. L. S Recoil.

Posterior, left, inferior — P. L. I Recoil.

Right — R Lumbar single transverse move,

if transverse is palpable,

otherwise Recoil. (Same if

R. S. or R. I.)

Left —L Lumbar single transverse move,

if transverse is palpable,

otherwise Recoil. (Same if

L. S. or L. L)
Anterior —A No correction.

Second Lumbar
Same as First Lumbar.
Third Lumbar
Same as First Lumbar.
Fourth Lumbar
Posterior —P Heel contact.
Posterior, superior — P. S Heel contact.
Posterior, inferior — P. I Heel contact.
Posterior, right — P. R Recoil, hands reversed.

Posterior, right, superior — P. R. S.. Recoil, hands reversed.

—
Note. The Heel contact may be substituted for the Recoil above
if force be carefully directed in the proper direction in delivery.
 Technic of Adjusting 163

Subluxation. Adjustment.

Posterior, right, inferior — P. R. I... Recoil, hands reversed.

Posterior, left — P. L Recoil, hands reversed.

Posterior, left, superior— P. L. S. .. .Recoil, hands reversed.

Posterior, left, inferior— P. L. I Recoil, hands reversed.

Right —R Lumbar single transverse move,

if transverse is palpable,

otherwise Recoil. (Same if

R. S. or R. I.)

Left —L Lumbar single transverse, if

transverse is palpable, other-

wise Recoil. Same if L. S.

or L. L)
Anterior— A No correction.

Fifth Lumbar
Posterior —P Heel contact.
Posterior, superior — P. S Edge contact.

Posterior, inferior — P. I Edge contact.

Posterior, right — P. R Recoil.

Posterior, right, superior — P. R. S.. Recoil.

Posterior, right, inferior — P. R. I . . . Recoil.

Posterior, left— P. L Recoil.

Posterior, left, superior — P. L. S Recoil.

Posterior, left, inferior — P. L. I.... Recoil.
Right— R Recoil (Same if R. S. or R. L)
Left —L Recoil (Same if L. S. or L. L)
Anterior— A "Bohemian" anterior fifth Lum-
bar move. (Not always ad-
visable.)
164 Technic and Practice of Chiropractic

Subluxation. Adjustment.
Sacrum
Posterior base — B. of S. — P Heel contact on base.
Posterior apex —A. of — P S. Heel contact on apex.
Entire Sacrum posterior Sac. P Heel contact between sacroiliac

articulations.

Coccyx
To be adjusted only when ankylosed in an abnormal position and
then by leverage of finger through rectum.

A FINAL WORD
Some useful information pertaining to adjustment will
be found in section entitled, "Practice," q. v.

After a careful and painstaking study of the foregoing

pages it will still be found that the student is not by any
means equipped for the work. He must practice these
things to learn them. We learn to do by doing. The chief

use of this section will be as a reference and guide during

the practice of adjusting.
 THE CAUSE OF DISEASE

Disease a Morbid Process

Disease has been variously regarded as an entity, a pro-

cess, a condition. It has been mentioned in terms which
would almost personalize it, such as, ''attacked by pneu-
monia," "seized with cramps," ''in the clutches of tuber-

culosis." Men have endeavored constantly to discriminate

between diseases and to learn the appearance and peculiarity
of each, and have resolved each into its peculiar elements

only to learn that the merging lines between two diseases or

between cases of the same disease are imperceptible. It is

no more possible to define any one disease within exact limits

and to distinguish it from all others than to consider one
function of the human body without studying its inter-

dependence with others.

Disease is a process. It is a natural process. It follows

certain well-defined laws and consists in the abnormal per-

formance of function in some bodily organ or organs, or in

the untimely performance of some function which would be

normal in its proper chronological relation with other func-
tions or at another period of the body's development. The
balance of function of the body is destroyed —some function
intensified or diminished —that is all. Every disease, prop-

erly studied, reveals its functional base.

165
166 Technic and Practice of Chiropractic

Disturbances of the functions of grozvth, nutrition, and

repair produce changes in structure, physical evidences of
disease. It is probable that every disease has a certain
amount of structural change connected with it ; it is hard
to conceive of functional derangement v^ithout structural
change, in a universe in which Nature is eternally building,

destroying, or modifying organic peculiarities to meet chang-

ing functional demands. But in many instances this struc-

tural change is so slight as to be undiscoverable ; such

diseases are called ''functional" to distinguish them from
those in which structural pathologic changes are directly
discernible, called ''organic."

Beginning of the Process

Recognizing the fact that disease consists in a succession

of steps or a series of events, each depending upon the

next preceding one and making possible its successor, and
desiring to arrest or check this process and correct the
damage done, in other words, "to cure disease," the question
arises, "Where does this process begin?"
If we wish merely to check the process or to modify it,

as does medicine, the etiology of the disease is less important

than the present state. It is then more important that we
understand the changes which are taking place in the body
at the time of our attempt, the condition of each organ at
that time, and the general recuperative or resisting power of
the individual.
But if we would correct all the damage done instead of
 The Cause of Disease 167

merely preventing further damage or building up internal

resistance against a still active destructive process ; if we
would so eliminate the effects of the earlier steps as to make
the resumption of the disease process most improbable, we
must know each step from the beginning to the present,

understand their sequence and relation, and go back to the

beginning with our correction, ronoving the cause

The Cause of Disease

Since each event in the morbid process depends upon

the preceding one and makes possible those which follow, it

is possible to stop at any point in the chain of events and

declare, "Here lies the Cause of Disease." This explains

the various etiologies adhered to each by a school of intel-

ligent and scientific men, yet each apparently disagreeing

most flatly with the others. No matter which step we select

as our ''ultimate cause" it truly is the cause, or one of the

causes, of succeeding steps, which succeeding steps may well

stand in our minds as the whole of the disease. Thus the

physician, having found a germ, is quite content to look

forward from the invasion of the germ and consider that

as the primarily necessary requisite for disease production.

In retrospect he follows disease back within the body to

the time of entrance of the germ and then leaves the body to

study the life habits of the germ and its favorite mode of

conveyance. He has unwittingly left the direct line of

investigation and followed a spur-track.
So with the osteopath who discovers contractured mus-
168 Technic and Practice of Chiropractic

cles drawing a member, or a bone, from its normal position.

He proceeds to a study of the effect of such contracture upon

other tissues and strives to relieve it by treatment —of the

muscle.
The dietist discovers that certain food combinations
cannot be properly cared for by an individual and that if

taken they tend to develop toxins deleterious to the system.

Whereupon he undertakes to discover food combinations

which the body can care for and believes that he has solved
the question of etiology.

Now it is fnost important that we find the primary cause,

the one which makes possible the operation of all the rest

and without which all would be powerless to harm man.

This we shall expect to find at the point of entrance of dis-

ease into the human organism. The primary cause must

be the first step which concerns man, the first change from
normal to abnormal, on which all subsequent changes de-
pend. It is useless to pass outside of the consideration of
man and those forces which directly affect man, in our
search for the cause of disease. We are powerless to
affect outside forces or to control or amend the laws of

nature through which disease exists.

Let us attempt then to resolve disease into its successive
steps and to find the first which concerns man. Correcting
that, we shall have corrected, fully and completely, the
process which constitutes disease. By striking at the root

we may destroy the entire growth.

 The Cause of Disease 169

Vital Energy
Irritability is the property of being susceptible to excite-
ment or stimulation. Stimulation is the process of increasing

the functional activity of any organ. Inhibition is the act of

checking, restraining, or holding back the functional activity

of any organ. These definitions, taken from Gould, are
here introduced as a necessary preface to an attempt to set
forth, without unnecessary reference to, or discussion of,

any other theory as to the etiology of disease, the Chiro-

practic explanation of its presence.

Chiropractic maintains that all the chemical and physical

activities of the human organism are controlled, directly

or indirectly, through a third form of energy transmitted

through the Nerve System; that while all three forms of

energy are interdependent and closely related in their ulti-

mate expression, one of the three is the primary and most

essential form, and especially indicative of life. We may

call this third form Vital Energy.
There are several good reasons for believing that this

nerve force is the primary form in which energy is expressed

in man and for believing that it controls and directs the

others in greater degree than it is controlled and directed

by them.
Of the four forms of tissue of which the body is com-
posed — connective, epithelial, muscular, and nervous —the
latter is the one damage to which is followed by the greatest
and most permanent consequences.
170 Technic and Practice of Chiropractic

It is a fact that there are several organs whose removal

leads to certain death because of their importance in the

general economy of the bo.l ', but it is also true that section

of the nerves leading to these organs just as certainly

causes death by the cessation of their functions. There is

no organ in the body aside from the nerves themselves

which does not immediately cease to act upon withdrawal
of its nerve force and at once begin a process of degenera-
tion or atrophy.

Pathologic changes in the Nerve System invariably are

followed by pathologic changes in the organs controlled by
the diseased segment but the converse is not true. Excita-
tion or inhibition of nerve activity produces corresponding

and responsive change in the activity of the organs inner-

vated, but excitation of an organ does not necessarily pro-

duce similar changes in the Nerve System. That system

possesses the power of inhibiting or permitting responsive
action, in other words, the power of choice.

Research in Comparative Anatomy develops the fact

that the differences in power of complex action possessed

by different organisms are entirely measurable by differences
in the structure and complexity of their nerve mechanisms.
Further, by studying the effects of removal or extirpa-
tion, or of pathologic changes in various parts of the nerve
system it has been demonstrated that the Brain is the center
for those higher forms of activity known as psychic, for the
power of accelerating or inhibiting the responses of the
lower centers of the nerve svstem to stimulation from with-
 The Cause of Disease 171

out, and for the conveyance of authority to act to all the

lower centers. The Nerve System is the morphologic,

physiologic, and dynamic center of the organism and the
Brain the center of the Nerve System. We may, then,
logically expect to find in the Brain, or in the channels by
which power is distributed from the Brain to lower cen-
ters or organs, the initial step in the disease process, which
is our present quest.

One Nerve System

All nerve tissue in the body is organized and linked to-
gether in a complicated aggregation of individual units,
communicating by contact, and forming one great Nerve
System having its directing center in the Brain. It is said

by some writers to consist of two distinct systems —cerebro-

spinal and sympathetic —but would better be described as

consisting of central organs —brain and spinal cord —and

peripheral organs — cranial, spinal, and sympathetic periph-
eral axons connecting with cells in the central axis and
linked together in a net-work improperly separable into

separate or distinct divisions, the fibres of different parts

being bound together in such a way as to estabhsh an intri-

cate intercommunication, closest on the one hand between

the cranial and sympathetic and on the other between the
spinal and sympathetic. The sympathetic system may be
regarded as nothing more than a medium for proper dis-

tribution of impulses originating in the cerebro-spinal

system, and a series of reflex centers deriving their power

172 Technic and Practice of Chiropractic

to act from the central axis. The proper action of sym-

pathetic gangHa has been demonstrated to depend upon the
integrity of the spinal nerve fibres, or rami communicantes,

which pass to and terminate in the ganglia with their telo-

dendria (terminal arborizations) in contact with the dend-

rites (cellulipetal processes) of the ganglion cells.

It will appear that interference with one division or

part of the nerve system may be followed by effects partly
manifested through a distant part ; that excitation or inhibi-
tion of a spinal nerve may correspondingly excite or inhibit
sympathetic fibres.

Chiropractic Hypothesis

Chiropractic has accepted, as a convenient working

hypothesis amply justified by years of clinical experiment
and anatomical and physiological research, the proposition
that all disease in the human body is primarily made possible

by injury to (stimulation or inhibition of) some part of the

nervous mechanism.
Injury to other tissues, unless the injury also involves
nerve tissue, is quickly repaired and the body goes on with-
out disease. Or the injury is sufficient at once to render the
body untenable and death ensues. Few pathological changes
follow trauma unless nerve tissue be injured.
This theory to be logical must and does include the
entire nerve system. Also, since it is noted that each nerve
cell presides over the nutrition of it:- own processes and
possesses its own power of repair, it follows that unless an
 ;

The Cause of Disease 173

injury be of fatal nature or of permanent duration, even in-

juries to nerves tend toward automatic cure. We must
seek a permanently operating interference with nerve tissue.
The brain, enclosed within the comparatively solid

cranium, is so well protected that nothing except fracture

of the skull, violent concussion, or shutting off of its

blood supply from without, will produce permanent change

there. Also, unless there be pressure by foreign substance
against the brain, an injury will be repaired in time and
the body resume its normal functional activity. It has been
demonstrated that comparatively few diseases occur in this

way. Such as do are called traumatic ; i. e., caused by

wound or injury.
In the broadest sense all disease is caused by trauma, as
we shall presently show.
The upper or cephalic peripheral nerves, called cranial,

leave the skull by foramina in its base (except the auditory)

and are so protected by the immobility of the bones of the
skull as to be comparatively free from direct injury. Periph-

eral injuries occur to cranial nerves but are repairable

even section of the trigeminal for neuralgia is usually fol-

lowed after an interval by a reunion of the severed parts.

As will be showm later, the special end organs of the cranial

nerves are not free from the effects of spinal subluxation
and their nuclei (deep origins) often share in morbid
changes in the brain tissue due to nutritional disturbances.

The sympathetic portion of the nervous system might

be classed with the cranial as regards infrequency of per-
174 Technic and Practice of Chiropractic

manent interference were it not for the proximity of the

great gangliated cord to the transverse processes and bodies
of the vertebrae. This proximity renders it liable to sustain

permanent impingement in vertebral subluxation.

Trauma Affects Spinal Nerves

With the exception of the first pair of Cervical nerves

and the Sacral and Coccygeal, all spinal nerves pass through

foramina of exit which are composed each of two movable

vertebrae. The Chiropractic hypothesis is based upon the
discovery that in addition to the part these vertebrae may
take in general movements of the spine it is possible that

their relation to each other may be changed by the applica-

tion of force from without, and that this change once pro-
duced tends to remain permanently. These permanent verte-
bral subluxations occur with great frequency, a fact clini-

cally demonstrable by palpation and by the X-Ray.

The discovery of this fact led to the ascertaining of two
more, namely,
No disease is ever found without accompanying sub-
luxation.

Since each organ or tissue is connected with some defi-

nite and special vertebra, subluxations accompanying dis-

ease bear a relation to disease which is controlled by a

general law, operative alike on all human organisms.

The latter fact required one other for its complete dem-
onstration; namely, that the removal of the subluxation is

always followed by the complete disappearance of the dis-

 The Cause of Disease 175

ease. Given more perfect methods of correcting subluxa-

tions it would follow that proof of the Chiropractic theory

would be so complete and overwhelming as to meet at once

with general acceptance. The difficulty lies in the fact that

with our present methods much time is often required for

complete correction of the vertebral displacement and much
skill is needed even for successful investigation of the results
obtainable. The theory is too often judged by unskilled or
imperfect applications of it.

Every school of Chiropractic accepts the presence of the

subluxation and has spent much thought and time in the
effort to deduce the law governing its connection with dis-
ease. Diverse conclusions have been reached owing to the
difficulty experienced in completely eradicating the subluxa-
tion. When it is accompHshed the results are absolutely

conclusive. When it is partially or relatively accomplished

the results are so good in a great per cent of cases as to

lead sometimes to the erroneous belief that the subluxation

did not cause the disease since mere partial correction of

the subluxation suffices to bring about the apparent total

removal of the disease. In every case of thorough experi-
ment the results warrant the recommendation of the sub-
luxation theory as at least a proper working hypothesis.
Without attempting here to review all the various con-

clusions reached or the methods by which they have been

attained, we would simply state our own conclusion, which

we believe is the only one compatible with demonstrable

facts. It is briefly this : Since every portion of the body is
176 Technic and Practice of Chiropractic

connected through the nervous system with the spinal nerves

and since it has been proven that this connection is rea-

sonably constant and anatomically demonstrable ; since the

removal or correction of a subluxation leads in all cases to

the complete disappearance of disease from the organs or

tissues innervated from the subluxated portion of the spinal

column, we conclude that the subluxation is the primary

cause of disease.
The final test of the correctness of any theory is the
result of its application. Since Chiropractic secures a larger
percentage of results than any other known system of heal-
ing it is safe to assume, at least, that it has discovered the
way to remove the primary cause of disease.

That the Chiropractic theory, or more properly the sub-

luxation theory, does not include all of the etiology of dis-
ease is evidenced by the facts of contagion and infection,
by the effect upon the organism of the introduction of poison,
by the consequences of worry, anger, and other abnormal
mental states and conditions. These facts do not in the least

invalidate the theory. They merely require explanation which

will make clear their relation to the subluxation. That such
explanation is abundantly at hand strengthens the position
of Chiropractic more than would negation of all other causes
save the one we concentrate upon.
The Mentalist who holds that all diseases exist in and
are but figments of the mind is as far afield as the Physicist
who holds that special nerve energy is nonexistent. The
Chiropractor views Man as a complex psycho-physical unit.
 The Cause of Disease 177

self-operating and internally self-healing until environmental

forces disturb the nice adjustment of the machinery.

Disease is produced by, and is, a series of events, chief

and most permanent of which is the subluxation. We may

consider its etiolog}' according to the order in which the
events take place thus :

Direct Chain

Concussion of Forces.
Subluxation of \^ertebra.
Impingement of Nerve.
Excitation or Inhibition.
Disease —x\bnormal Function.

Accessory Chains

Between the last two steps above, or following the last,

are often introduced one or more of the following accessory

chains which modify or increase the final effect and are

themselves made possible by the first four steps in the direct
chain.

Pathogenic germ.
Poisonous excretions from germs
Tissue destruction by chemical action of such toxins.
Reflex muscular tension tending to increase subluxation
and thus augment nerve impingement and its effects.

Or
Dietetic error.

Abnormal chemical action.

12
178 Technic and Practice of Chiropractic

Tissue destruction or nerve irritation by chemical poisons.

Reflex motor disturbances which further Hmit digestive
power.
Or
Abnormal mental condition.

Waste of nerve energy with production of toxins.

General metabolic disturbance.
Increased disease wherever disease previously existed.
These are oflfered merely as illustrations. There are many
accessory chains which aid in the production or development
of disease and act as secondary causes.

Concussion of Forces

Man was so created, so provided with means for repair,

growth, etc., that the body tends to maintain its own func-
tional balance —perfect harmony among all its parts —unless
interfered with by some outside agency. There are certain
natural laws such as the law of gravitation and the law of
momentum and inertia which operate without regard for
man or man's welfare. If man, wittingly or unwittingly,
allows himself to come into violent conflict with one of
these laws by falling to the ground or in meeting sudden
and unexpected opposing force or mass while in motion,
that which may be termed a concussion is produced by the
meeting of the outside force and the internal bodily resis-

tance.

Many such concussions may occur without serious dam-

age. Some produce wounds or injuries which it is possible
 The Cause of Disease 179

for the body to heal without causing serious disturbance of

function. Other concussions are so violent a$ to produce
displacement of structure which tends to remain perma-
nently. Under Spino-Organic Connection will be found an
explanation of the manner in which force appUed to various
parts of the body tends to affect the spine.

Now the displacement of a bone cannot be corrected by

the body without outside aid. No method is provided for

such correction. Produced by outside force affecting the

body, it can only be reduced by outside force. It is this

failure of Nature to make man adaptable to every untoward

circumstance which renders him susceptible to disease.

Subluxation

As has been previously stated by no means all con-

cussions of forces produce subluxation. (All subluxations,

however, are produced by concussion of forces.) It may be

added that not all subluxations impinge nerves and that when
they do not so encroach upon nerve tissue they produce no
noticeable effect after the first temporary soreness has dis-

appeared.
Every subluxation, however, evidences a ten^dency to

disease. Once moved from its normal position and the

poise and symmetry of the body disturbed, there are in-

fluences which tend more readily to affect the same vertebra.

The subluxated vertebra is more easily disturbed by jars,

strains, etc., than the normal one because such jars are
less regularly distributed to all its parts. A reflex muscular
180 Technic and Practice of Chiropractic

tension due to other and more pronounced subluxations

and their disease effects may in turn increase the slight
deviations throughout the spine, rendering them in their
turn capable of producing disease. When the spine or any
part of it has lost its perfect regularity disease is made
possible, if not a fact at once. The average number of

subluxations in each individual is about nine and one-third.

Of this number probably not more than one-third (though
no accurate figures are available) are actually productive
of conditions nameable as disease at any given time. Dis-

crimination between those which do, and those which do

not, produce discoverable symptoms in a given case is a

matter which requires a nice technical skill and perfect

judgment.

Impingement of Nerves

When a vertebra has lost its normal articular relations

with its fellows and occupies an abnormal position as a
consequence in regard to all surrounding or adjacent tis-

sues itmay impinge nerve tissue in two ways, by tension

or by constriction. By the displacement of one vertebra of
a pair the size and shape of the intervertebral foramen may
be altered (occlusion) constricting the nerve which passes
through the opening. That this change in the size and shape
of the foramina does frequently occur is shown by the fre-

quency with which alterations in the shape of vertebrae

appear in dry spines, by post-mortems which have demon-
strated the altered foramina in the cadaver and by per-
 The Cause of Disease 181

manent occlusion of the foramina in ankylosed spines so

that the occlusion may be preserved. Adding cartilage

changes in the intervertebral disks to alterations in bone

shape and position, especially the latter, we find full and
sufficient reason for all the pathological phenomena which
follow the subluxation. Explain it as you will, these morbid
results do follow subluxation and can be experimentally
produced in animals. ^^loreover, the disease may be directed
to a desired organ or region by selection of the particular
vertebra to be displaced.
The suboccipital, sacral, and coccygeal nerves cannot be
constricted as they pass through the foramina because they

do not emerge through complete rings formed of separate

and movable bones. But these nerves may be pressed upon
or stretched by displaced bone, as may also the great gan-

gliated cord of the sympathetic, especially the Cervical por-

tion of it. Tension of the Cervical sympathetic cord by

subluxation of vertebrae is a very common occurrence.
Whether the impingement be by constriction or by ten-
sion the effect is much the same depending upon the degree
to which the molecular continuity of the nerve substance
is impaired —interference with the function of the organ
connected with the nerve and sometimes swelling and pain in
the nerve itself followed by degeneration. The effects are

chiefly noticeable in peripheral tissues. S. Weir Mitchell

says (1872), "A continuous pressure upon a nerve results
in the degeneration of the nerve and a disturbance of func-
tion of the parts innervated by that nerve." No clearer

statement can be made.

182 Technic and Practice of Chiropractic

It must not be understood that all nerve impingement

is due directly to subluxation of a vertebra. A dislocated

shoulder would produce a similar effect of nerve tension.

But dislocated shoulders are seldom met with as permanent
conditions. Likewise there may be secondary impingement
from new growths, themselves due to some primary sub-
luxation. Aneurism of the thoracic aorta often produces
hoarseness by impingement of the recurrent laryngeal.
Not all impingement is sufficient to produce noticeable
disease. To a certain extent the power of adaptation in-

herent in the body can overcome its deleterious effects and

suppress all signs of its existence until an overtax upon

bodily energy lessens this adaptative power. Then disease

appears and we say that the overtax caused it.

Excitation or Inhibition

A slight impingement serves as a mechanical irritant to

increase the action of the nerve and the functions of the

attached peripheral organs. Such stimulation beyond the

normal is always followed by a reaction, or fall to subnormal

action.

Heavy impingement, especially the impingement due to

marked occlusion of foramina, partly or wholly paralyzes

the affected nerves. Often the impingement produces only
a latent weakness in some organ, a weakness which may be
brought to light only through the introduction of some sec-
ondary cause which takes .advantage of the susceptibility of

the organ to produce some definite disease. As an instance

 The Cause of Disease 183

of this we may mention typhoid fever. No typhoid case is

found without subluxation in the region of the second

Lumbar ;
yet the latent weakness produced by that subluxa-

tion may not have been observed until the typhoid germ
found a fertile feeding and breeding ground in the weak-
ened tissue and proceeded to multiply there and develop its

toxins.

Effect Upon Single Cell

Each nerve cell is trophic to its processes and to the

tissue cells to which these processes are distributed. The

growth, nutrition and repair of each cell of the body is

dependent upon the integrity of the axon which supplies it.

The effect of nerve impingement upon the single cell is a

weakening of cell structure and a disturbance, slight or

great, of the special function possessed by that cell. Dun-

glisson says of diseases, "All ... are dependent upon
modified cell^action."

Effect Upon Organs

Each organ is but an aggregation of cells of some special
type or kind. Nerve Impingement usually involves either a

whole nerve trunk or many of its fibres and thus weakens

either the entire organ or many of its cells and increases or
diminishes its special function. Some organs are innervated
by more than one nerve and may be injured only in part by
a localized impingement.

Alteration of the action of one or«:an often tends to

184 Technic and Practice of Chiropractic

affect the entire body, as in subluxation of the fourth Dorsal

interfering with the nerve supply to the liver the secretion

of bile becomes altered in character or quantity and the en-

tire system suffers, through deranged digestion, from this

alteration in a necessary secretion. Every disease presents

symptoms only indirectly referable to the organ which is

primarily affected and the problem of the diagnostician

is to so discriminate between direct and indirect symptoms

as to be able to locate disease.

Simple Subluxation Disease

We have considered a chain of events by which disease

is produced without the intervention of any secondary cause.
Such a condition may be called, for convenience, a simple

subluxation disease. Its existence depends directly upon

the subluxation which is the first change manifest in the

individual and upon which all the other changes depend.

The two facts that not all subluxations impinge nerves

and not all nerve impingements cause demonstrable disease
explain why we do not, in practice, find a disease to corres-

pond with each subluxation discovered by palpation. It

must be remembered that there may be latent weakness

following a subluxation and of importance because it

renders the patient susceptible to infection or to the action

of other secondary causes.

 The Cause of Disease 185

SECONDARY CAUSES
Among the secondary causes of disease may be men-
tioned the pathogenic germ, poisons, dietetic errors, ab-
normal mental states, bodily excesses, exposure to sudden
temperature changes, and inhalation of non-poisonous but
irritating substances as the most common. Many others

might be included but these will suffice for complete illus-

tration of the principle. It will be our endeavor to show

how each of these secondary causes operates by virtue of

a previous susceptibility, or breaking down of the normal

resisting power of the organism caused by subluxation, and
how each in turn may bring about increase in subluxation

and thus, both directly and indirectly, increase disease.

Bear in mind these two all-important facts. None of

these secondary causes can operate zintJiout previous sub-

hixation. A suhhixation may produce disease unthout the

aid of any secondary cause.

GERM DISEASES
These comprise a large portion of the febrile affections.

Most germ diseases are characterized by fever and the

presence of circulating toxins with resulting disturbance of

the metabolic processes of the body.

It is generally agreed among pathologists that the

greater number of varieties of micro-organisms found at

times in man are not pathogenic. Some aid in the decom-

position of food in the alimentary canal ; others have various
186 Technic and Practice of Chiropractic

beneficial functions to perform. But some, under proper

conditions, feed upon and destroy living tissue. These are
the so-called pathogenic germs.
The pathogenic germs are many. They enter the body by

various routes, in the air we breathe, the food we eat, the

water we drink; sometimes they are communicated by

direct contact with other persons or with objects infected

with them. The term "contagious" is applied to those dis-

eases whose germs may be carried through the air from

one to another ; ''infectious" refers to those communicable
only by contact.
In every healthy individual are found multitudes of
germs of both the pathogenic and harmless varieties. We
are constantly exposed to the influence of the former yet by
no means all bodies into which pathogenic germs find en-
trance contract disease. This fact has caused much study
and among pathologists and bacteriologists generally the
conclusion has been reached that the development of col-
onies of micro-organisms sufficiently to produce disease de-
pends upon what is known as "susceptibility" of the organ-
ism. There must be a latent weakness of which the micro-
organisms take advantage.
This amounts to the admission that the body contains
the inherent property of successfully resisting all germ
action. Indeed, the fundamental proposition of Serum-
Therapy is that under stress of the presence of dilute germ
infusions the body does develop special chemicals which
neutrahze the germ poisons and kill the germs and which
 The Cause of Disease 187

remain after the inoculation to guard against any further

entrance of germs of the same kind and vulnerable to the
same protective chemicals.
This theory is sufficiently correct to have served as
an unassailable basis for a most illogical procedure. The
truth is that the auto-protective power of the body must
be lower than normal and the germs must find a weakened
area for development and multiplication before they can
develop sufficiently to produce disease. Once they gain a
foothold they tend to multiply with great rapidity and to
develop alarming symptoms often leading to death.
Only in a few instances does modern science believe
that a pathogenic germ can successfully attack a healthy

body, but is claimed that there are a few germs, such as

the Klebs-Loeffler bacillus (diphtheria producer) and the
bacillus of anthrax, which may find lodgment in any or-
ganism, healthy or unhealthy, to produce disease.
Now, the susceptibility of the body to germ invasion re-

quires explanation. Merely to say that one is susceptible

and another is not leaves too wide a field of possibility for

error. It is easy to reason from the fact that all persons

are at some time exposed to contagious or infectious diseases

while comparatively few contract them that some persons

are vulnerable to certain diseases while others are not. It

is plain that while a person may be susceptible to typhoid

fever because he has a weakness in the intestines, he may be
quite immune from pneumonia or tuberculosis or any other

infectious or contagious disease. But why this difference?

Let us look at the problem from another angle.

188 Technic and Practice of Chiropractic

Chiropractors find with every contagious or infectious

disease certain subluxations whose location with relation to
the disease is constant and demonstrable. Thus all cases
of pulmonary tuberculosis show a third Dorsal subluxation
with only enough exceptions to prove the rule; tonsilitis is

invariably accompanied by subluxation of the second, third

or fourth Cervical. Correction of the subluxation is, in all

except the most fully and virulently developed cases, fol-

lowed by a radical cure. Indeed, in many of the germ

diseases it is possible to abort the fever with improvement
of all symptoms in from five minutes to twelve hours. We
are so accustomed to checking germ diseases at once that
failure to do so leads us to immediate investigation of our
palpation and adjustment to discover some technical error
in the application of the principles of Chiropractic to the

case in question.
It is manifestly impossible by vertebral adjustment to
raise the body beyond normal pozver. Nothing is added to

the body ; no energy is utilized other than the energy of

the body itself which is provided by Nature and released
through restoration of the normal carrying capacity of
nerves. The highest goal attainable is normality, and it is

observed that no matter whether the impingement be in

the nature of an excitation or an inhibition of nerve action

the effect of a correct adjustment is always in that direction

—toward normality. It may be as well to digress here

long enough to remark that abnormal change is never the
result of adjustment but always of maladjustment, and those
 The Cause of Disease 180

who claim to be able to produce stimulation by moving a

given vertebra one way and inhibition by moving it an-

other are entirely wrong.

It is evident from the results of adjustment in germ
disease that the normal body is entirely capable of throwing
off the poisons and exterminating the germs, which conclu-
sion quite agrees with science. The fact, not known by
other branches of science, and asserted by Chiropractic is

simply that the subluxation is the factor zvhich determines

susceptibility.

Upon ascertaining that a certain vertebra is in normal

alignment we may say with absolute certainty that the or-
gans innervated by the nerves passing through its foramina
are not and cannot be the site of any pernicious germ
activities. To go further, it has been demonstrated in a
number of cases that the subluxation existed before the con-

tagion or infection developed. A man has been known

to have a second Lumbar subluxation for many years

without effects other than a tendency to constipation and

on the appearance of a typhoid epidemic to contract the dis-

ease. Correction of the subluxation afforded a cure. Such

instances might be cited in great numbers. No person with-
out the necessary subluxation ever contracts a germ disease

and the necessary subluxation can be exactly located for

the vast majority of such diseases. Unfortunately it is

impossible to find a person who has not some subluxations

and is not, therefore, subject to some form of contagion or

infection.
 ;

190 Technic and Practice of Chiropractic

So far Chiropractic agrees with general knowledge of

germ disease and its etiology, simply adding the explanation
of susceptibility which all other modes of investigation have

failed to afford. In one particular we find apparent dis-

agreement.
We have said that several bacilli are supposed to have
power to cause disease in healthy bodies. Diphtheria is a

disease caused by one of these. Yet Chiropractic adjust-

ments have rapidly aborted diphtheria, apparently proving
that the body has power to react strongly enough to conquer
even this germ, providing the nerve channels be opened
to allow of exertion of its full activity. It is probable that
all diseases fall under the same law and that no germ can
find lodgment in healthy tissue. Chiropractic affirms this as
a truth and as yet no experience has tended to disprove it

the belief is strengthened by the years.

The experiments which are said to have proven that

certain micro-organisms can attack healthy tissue are based

upon the supposition that careful examination demonstrated

the absence of disease in the animals experimented upon by

inoculation. Since these experiments and these examinations

were made without any knowledge of vertebral subluxations,
and consequently without discovering whether or not there
existed latent weaknesses of various organs, we doubt the

validity of the experiments. Our own examination of

human and animal spines has thus far failed to discover any

perfectly normal specimens.

 The Cause of Disease 191

Oiir clinical experience with diphtheria at least absolutely

disproves the conclusions of Pasteur and others in regard

to its origin.

Increase of Subluxations

It has been observed that in many instances the subluxa-

tion which existed previous to infection or contagion is

greater and more noticeable during the febrile and active

stage of the disease than before, and this fact has led some
careless or insufficiently skilled palpaters to assume that
the disease caused the subluxation.

The development of germ life is accompanied by the

excretion of toxins of greater or less virulence which
circulate through the blood and affect the entire body. This
poison, irritating sensor nerves, brings about motor reac-
tions in the segments irritated and, since the normal opera-
tion of the laws of reflex action is interrupted somewhat by
subluxation, and since the muscles immediately around a

subluxated vertebra tend to pull upon it with unequal lever-

age, this motor reaction is likely to increase already existing

malalignments, especially in the same body segment in which

the poison is generated and in which the irritation is con-
sequently greatest. Thus subluxation is most pronounced
during the activity of the disease caused by it and reacting
upon it and thus a disease which began as a localized

destructive process may manifest systemic effects through

its action upon other abnormal spinal segments.
192 Technic and Practice of Chiropractic

DIET
The internal chemistry of the body varies so greatly
under changing conditions, the operation of any two dif-

ferent organisms is so hard to compare accurately, that it

is impossible to set down any rule for diet which will apply

properly to all patients or to all with the same disease or

habit of body. In fact, only experiment with an individual
can determine the exactly proper diet for him.
Through lack of judgment or of observation of the ef-

fects of certain foods upon us we often eat that which our

bodies cannot properly digest and assimilate. Sometimes
through accident or negligence we partake of food which
is proper in kind for us but improper in quality, perhaps
partially decomposed. Improper food, when taken into the
body, tends to exert a deleterious effect upon health. This
fact should not lead us to confine ourselves to reasoning

superficially that improper foods cause disease or that diet-

ary measures will cure disease.

Some Chiropractors have held that the hunger of in-
dividuals for certain foods is a safe guide to a proper diet.
This is manifestly untrue in some cases ; the voracious ap-

petite of the convalescent typhoid patient is an example.

But it would probably be true if all men zvcre normal. Close
observation of a few exceptionally well-developed and nor-
mal individuals has disclosed an interesting fact. If a man
has no subluxation in that portion of the spine which con-
trols the stomach, the ingestion of decomposing food, even
 The Cause of Disease 193

though the alteration be so sHght as to escape notice on

casual examination, induces immediate vomiting followed

by no untoward consequences. Only occasionally does one

find persons without subluxations in some way affecting the

stomach; in such cases the body promptly rejects and expels

injurious material.
This carries us to the rather surprising conclusion that
the norma! person is not susceptible to the influence of had

food. In the majority of individuals, some degree of ab-

normality existing, improper food has a decidedly bad effect.

Passing through the alimentary canal it is improperly

digested ; toxins are developed ; these chemically affect the

entire body, perhaps leading only to a congestion and in-

flammation of some part of the lining of the alimentary

tract, perhaps producing a general fever, malaise, diarrhea,
and the other effects of a general poisoning.

It has been found that proper adjustment is followed by

quick relief in such cases, the commonest effect being the

rapid expulsion of the deleterious matter by vomiting and
diarrhea with breaking of the fever and lessening of all

symptoms.
It has also been observed that during the suffering from
dietetic error the subluxation controlling the stomach or
some part of the small intestines is often found increased in

degree with tension of the adjacent muscles. With adjust-

ment and relief of the other symptoms the muscular tension

tends to disappear. This motor reaction from the irritation

of food poison undoubtedly serves to increase subluxation

13
194 Technic and Practice of Chiropractic

already existing, thus intensifying effects. But for its pri-

mary effect food poison requires a previous subluxation

lowering the natural protective power of the body. Food
poisoning is often a secondary cause of disease.
When it is found in any specific case that certain foods

exert a bad influence upon the progress of the case, that the
symptoms are aggravated by the taking of these foods, they

must be abandoned. Yet no rigid diet need be prescribed

in any case. Every patient will require a different diet, nor
is it possible to understand the intimate chemical relations

within the body sufficiently to fix a proper diet except by

experiment.
A word here about fasting. If improper food were a
primary cause of disease, fasting would be an effective,

though somewhat radical, removal of the cause of disease

and a logical procedure. Since improper food is not a pri-

mary cause of disease and since nature requires food for
the repair work made possible through adjustments, it would
seem unwise for Chiropractors to prescribe fasting. Also it

is well to remember that fasting and starvation are synony-

mous and their symptoms identical.

POISONS
Any substance taken into the body and not usable as

food may be considered poison. Most drugs administered

as medicine or used habitually are either directly poisonous

and commonly so considered or are poisonous in the sense

that they do not build but rather tend to injure the body. In-
 —

The Cause of Disease 195

jurious substances accidentally taken into the body; cer-

tain products included in the preparation of otherwise nutri-

tious foods, alcohol, tobacco, etc., affect the body in varying

degrees but in accordance with the same laws. Poisons may
be internally generated through the action of pathogenic
germs or through the failure of the body to digest food and
to prevent injurious chemical changes in it. It has even
been said by some that abnormal mental states so affect
metabolism as to cause the formation of certain auto-toxins
which injuriously affect the entire body.

However poison may make its appearance in the body

its presence is associated with certain bad effects. Poison
may be corrosive, destroying tissue wherever it touches ; it

may be stimulating, affecting the nerves so as to increase

their activity, following which waste of energy there is a
weakening reaction ; it may be narcotic, lowering some
physiologic process below normal.
If a man without subluxation —and therefore normal
have poison introduced into his body one of two effects will

follow. Either the poison will be sufficient to produce death

in a short time, and will do so, or the poison will be ejected
from the body and the patient recover naturally and without
treatment, and recover fully.
This is the statement of the ideal, not the real. The
fact is that no person has yet been found without subluxa-
tion in some part of the spinal column. Occasional cases
have been reported but always by Chiropractors whose state-

ments are open to question on account of imperfect training

 —

196 Technic and Practice of Chiropractic

in vertebral palpation or a known habit of unconsidered

statement. And in the weakened body, whose natural pro-

tective power has been lowered, the effect is different.

The body fails to throw off all the poison normally and
some of it remains in the circulation and tends to cause pro-

gressively increasing damage. In addition to the direct

effect of the poison upon the tissues, the irritation of sensory

nerves gives rise to a motor reaction which increases sub-

luxation generally throughout the spine but especially in
the segment in which the sensory irritation is greatest. If

the poison be taken into the stomach the vertebrae affecting

that organ are most affected in the resulting motor distur-

bances. When vaccine virus is introduced into the arm

the greatest influence is upon the last two Cervicals and
first Dorsal, causing increased weakening of the nerves to
the arm'. If the vaccination does not "take" it is because
the body is so normal as to be able to take up and rapidly
excrete the poison or to neutralize it with an internally
generated antitoxin.
This tendency of poisons to increase subluxations al-

ready existing has caused many to conclude that nezu sub-

luxations could be produced by the motor reactions from
poison. The laws governing reflex action make this im-
possible. If a mild stimulus be applied in the segment oc-
cupied by a given, and normally aligned, vertebra, the result-
ing contraction will tend to appear on the same side as the
irritation and would — if sufficient to subluxate the vertebra
draw it tozvard the irritated side. If a stronger stimulus
 ;

The Cause of Disease 197

were applied the resulting reaction would appear on both

sides and with sufficient intensity on the opposite side to the

irritation so that the difference between the contractions on

the two sides would never be sufficient to overcome the
fixity and inertia of the vertebra. If this bit of theorizing

be doubted, let me add that if poisons could cause subluxa-

tion they would undoubtedly cause drawing of the vertebra
tozcard the irritated side —which is not the way we find

them in poisoning cases. Almost without variation, the

subluxation is an'ay from the afifected side. Such a subluxa-

tion produces most impingement on the side of the irritation

the only kind which could follow poisons would produce its

effects on the opposite side.

In acute poisoning cases which may possibly proceed to

a rapidly fatal termination, while immediate adjustment

may be sufficient to cause the expulsion of the poison and
the recovery of the patient it is probably wisest to administer
an antidote or to call a physician with a stomach pump.

Just so, the pulmotor should be summoned for gas asphyxia-

tion ; but at least one case was recently encountered in which

an adjustment started the heart and artificial respiration

movements restored consciousness before the pulmotor could

arrive. There are few, if any, acute poisoning cases in

which an adjustment will not aid. Sometimes it should be

assisted by other measures not strictly within the province
of Chiropractic.
Chronic poisoning, such as lead poisoning from paint
work, yields well to adjustments providing the secondary
198 Technic and Practice of Chiropractic

cause, the persistent inhalation of lead fumes, be dis-

continued.
Poisons may wound or injure the body whether or not
it be normal; in such case they might properly be classed
with trauma. But no poison causes disease except through
the medium of vertebral subluxation previously produced.
Some subluxation which has never been sufficient to pro-
duce active disease may be so increased by the action of
poisons as to be of serious effect even though the poison
has long since been eradicated from the body — for the sub-
luxation is permanent until affected by force outside itself.

In considering the etiology of any disease the possibility of

its being augmented by medicines, drug habits, or dietetic
errors should be weighed with other evidence.

EXPOSURE
By this term is especially meant exposure to sudden tem-
perature changes. The body may sustain a very high or a

very low outside temperature providing the change is grad-

ual enough so that the heat-regulating mechanism may
adapt itself properly to protect the body and maintain an
even temperature within. A sudden change from a very
warm room to a very cold atmosphere ; a quick transporta-

tion from cold air to a superheated apartment ; or a sudden

draft of air whose temperature is sharply at variance with

surrounding air and therefore with the condition of the
body surface may have a very bad effect.

The skin and mucous membranes of the body have be-

 a

The Cause of Disease 199

come accustomed to a certain temperature ; the change irri-

tates them. And the immediate result is a motor reaction

increasing subkixation in the same body segment in which
the irritation is greatest and probably producing first an
irritation of the nerves at the spine and then an inflammation
of the exposed surface. Thus a ''cold" is produced. One
who has no subluxation affecting the respiratory tract —
rare degree of normality —may escape coryza, bronchitis,
or pneumonia, the most common effects, but may suffer a

congestion of the stomach walls or of other parts of the body.

It is said that the cold "settled on the stomach." The fact

is that the motor reaction takes advantage of the weak parts

of the spine and affects them most, like the pernicious habit

of spine-stretching which used to prevail among Chiroprac-

tors. This explains why "cold in the head" is so very

frequent. The fourth Cervical vertebra is situated at the

middle point of the neck and is very freely movable and

easily subluxated and, in fact, more often displaced than
other Cervicals.
Noxious or poisonous vapors may have an effect identical

with that of sudden temperature change. Sleeping in an

improperly ventilated room often appears to cause "cold."

Careful study of the part of the body exposed to draft, and

of spino-organic connection, will show that in most instances
the effect of such exposure is first felt in the same body
segment.
It is a well-known fact that not all people are "subject

to colds." One may be "subject to lung colds," another to

200 Technic and Practice of Chiropractic

"cold in the head." The susceptibiHty is entirely governed

by the condition of the spine, the person having no middle
Cervical subluxation being immune from coryza even though
subjected to the same exposure which will produce it in

others. The pollen of plants produces hay fever in the

susceptible in much the same manner that draft produces

coryza, both acting as secondary causes.

BODILY EXCESSES
In this division of secondary causes may be mentioned
overwork, continuous loss of sleep, overeating, venereal
excesses, etc.
They act in this manner. Wasting and overusing the
bodily resources they lower the general vitality. Now,
though there be subluxations at various points in the spine

there is still transmitted through each impinged nerve a

certain amount of Vital Force which to a certain extent

maintains the functions of the body and keeps it in a state of

activity sufficient for ordinary demands. When the entire

stock of vitality is lowered through excess the amount of

energy passing through each nerve in the body is lessened,

but the effect of such lessening is felt most where there is

subluxation. At the high tide of vitality the subluxations

are not sufficient, perhaps, to produce serious disease. At

low ebb, every organ whose nerve is interfered with suffers

keenly. Under such conditions the body is much more sub-

ject to adverse influences, to shocks and jars, to contagion

or infection, to the action of cold or exposure. Thus
bodily excess acts as a secondary cause of disease.
 The Cause of Disease 201

ABNORMAL MENTAL STATES

There are many who believe that fear, worry, hate, grief,
etc., are in themselves sufficient to produce disease in a
normal organism. "vShock" following the demise of a loved
one or some deep disgrace is occasionally alleged as a cause

of death or of a rapid decline in health which terminates

fatally.

The failure of Suggestive Therapeutics to cure disease

except when it is largely imaginary rather argues against

this theory. It is also true that proper Chiropractic ad-

justments not only lead to the cure of disease apparently

caused by abnormal mental states but also, restoring proper

blood-supply and nutrition to the brain, induce a happier

mental state in the patient. Even insanity has been cured in

a number of cases by Chiropractic.

We hold that worry, fear, etc., are abnormal ; that they

arise from the improper expression of Mind through dis-

ordered brain-cells. ''Diseases of the Mind," in the strictest

sense, cannot occur, but only diseases of the physical medium

through which mind is expressed and translated to the
physical plane of being —the brain.
A condition of abnormal mental expression or activity,

especially worry, fear or anger, probably has a two-fold

effect : it rapidly wastes the body energy and, like bodily ex-

cess, renders every subluxation more effective ; it is possible

that it may also really produce auto-toxins, generated by

abnormal brain-action and aft'ecting the body metabolism
202 Technic and Practice of Chiropractic

adversely. In this way disease appears through the action

of abnormal mental states as secondary causes.

They themselves are the result of subluxation of the
first or second, sometimes third, Cervical, impinging the
nerves which control the blood-supply to the brain and
hence its nutrition. Correction of the subluxation causes
them to disappear.

INFLAMMATION
Inflammation is a morbid process characterized by the
presence of increased temperature and one or more of the
symptoms, pain, redness, and swelling. It is distinguished
from fever by being confined locally, while fever is a general
functional disturbance showing elevation of temperature,
increased katabolism, decreased secretion, etc.

Our clinical experience with fevers leads us to accept

Metchnikoff's conclusion that the essential phenomenon of
inflammation is hyperaemia. Upon the hyperaemia depend
the swelling, pain, and local increase in heat-production.
Hyperaemia in turn depends upon disturbance of the vaso-
motor nerves either as a direct result of some local sub-

luxation or as an indirect consequence of local irritation.

A newly acquired subluxation produces an acute irrita-

tion of the pre-ganglionic axons which connect the spinal

nerves with the sympathetic ganglia. If these ganglia send

out post-ganglionic axons which are vaso-motor in function,

an inflammation may be produced without the intervention
of any secondary cause. On the other hand, there may be a
 ;

The Cause of Disease 203

subluxation producing weakness of some part ; through in-

jury to that part or the introduction of poisons or irritants

such as germ infection, sensory end-organs are affected and
the motor reaction which fohows increases the subkixation
this sHght increase produces acute irritation of the nerve
and hyperaemia, with its resultant phenomena, follows.

Stated briefly, irritants produce inflammation only by acting

through the medium of the spine. If the spine be normal
these irritants are insufficient to produce morbid process.
Local inflammation tends to develop toxins, especially if it

be of bacterial origin, which may in turn affect the entire

organism —an effect which will be discussed presently. Ex-

ception must be made in those traumatic cases in which
hyperaemia is essential to the reparatory process, and which
are attended by what may be termed a normally increased
heat-production. This beneficent and reparatory condition
cannot be termed disease or morbid process.
The normal temperature of the body depends upon the
balance maintained between heat-production and heat-

expenditure. This balance is maintained through a com-

plicated nerve mechanism consisting of various nidi in

thalamus, medulla, spinal cord and sympathetic ganglia, and

a network of communicating axons of both the cerebro-
spinal and sympathetic systems, controlling the amount of
blood passing through any given body area at a given time,
the- secretion of the perspiratory glands, the internal meta-
bolic processes, etc. Most important are the vaso-motor
nerves, directly, but not originally, derived from the sym-
204 Technic and Practice of Chiropractic

pathetic, and governing the size and cahber of all blood-

vessels so as to control the amount of blood flowing to and

through the surface capillaries on the one hand, or the deep-
seated, heat-making organs on the other. More than seventy
per cent of the body's heat expenditure is through the skin
by evaporation, radiation, and direct conduction. The major
portion of the heat production is in the muscles and the

parenchymatous viscera, such as liver, spleen, etc., w^here

metabolism is active.

This mechanism is so deHcately adjusted that when the

outside temperature is lowered the amount of blood passing

to the skin is reflexly lessened while internal heat produc-

tion is increased and the bodily temperature retained at nor-

mal. Conversely, the body perspires freely and the surface
is flushed with blood in a high temperature, so that heat
production is lessened and its discharge accelerated, again
tending to maintain an even and normal temperature.
The nervous mechanism is responsive to many and va-

rious forms of stimuli —thermic, emotional, mechanical, phy-

siologic need, toxic. Poisons in circulation may affect the

bulbar center and produce general fever. A number of cen-

ters in the spinal gray may be stimulated with like result.

Or there may be purely local irritation which results in

local hyperaemia and inflammation.
It will always be found that the primary cause of any
permanent derangement of the mechanism lies in vertebral

subluxation impinging some of the nerves and thus throwing

the mechanism out of its natural balance and poise. Other
 The Cause of Disease 205

forms of disturbance are transient and the very nature of

the mechanism makes it normally capable of adjusting itself

to thermic, mechanic, or emotional stimuli in a short time.

Only the subluxation produces permanent elevation of tem-

perature. When such elevation does occur there are many
associated changes, increased katabolism, lessening of secre-
tions, anorexia, sometimes mental changes, such as delirium
or coma. Fevers vary according to the part of the nerve
mechanism affected and the action of any secondary causes.

Fever due to vertebral subluxation alone without any

secondary cause operating is very rare. Ordinarily fevers
come about in this way. A subluxation occurs which weakens
tissue and permits germ invasion; toxins enter the circula-
tion from the germ action and motor reaction increases the
original subluxation and causes local inflammation; germ
activity is favored by the increasing degree of abnormality
and toxins from rapid tissue destruction are added to those
already present. The poison-loaded blood then affects the

general centers for heat regulation, blood becomes internally

engorged, and a chill (internal fever) followed by general
increase of temperature occurs. At this juncture any sub-
luxation previously existing is likely to be increased and to

add its quota of harm to the rapidly developing picture.

Our problem is to find the original subluxation which
controls the site of the original pathologic change and to

correct that. In nearly all cases where this is done, even

partially, the body is enabled to care for the remainder of
the damage and to throw off the accumulated toxins. It is
206 Tfxhnic and Practice of Chiropractic

not uncommon that the temperature falls two degrees in

five or ten minutes after a proper adjustment. We expect

always to abort or check a fe^er in twenty-four hours or
less.

There are cases in which the temperature drops after

adjustment but presently rises again. This indicates the

virulence of the autointoxication or that some other area of
poison production is operating than the one our first adjust-
ment would control. A correct diagnosis will enable one to
give specific adjustment and check practically any fever
except a chronic one with much tissue destruction already

accomplished ; even some of these yield.

The commonest cause of fever is at the fifth or sixth

Dorsal vertebra, long known as Center Place, or Fever

Center. Here emerge many pre-ganglionic fibres which dis-

tribute their impulses through lower neurons in the sym-

pathetic system to the coeliac plexus and thence to the blood-
vessels supplying the major portion of the abdominal viscera.

Adjustment here causes a sudden contraction of these ab-

dominal vessels and a forcing of the blood to the surface
with rapid cooling.
Often, however, this adjustment is followed by a re-
crudescence which indicates that some other vertebra must
be adjusted. Many fevers, such as typhoid, pneumonia,
tonsilitis, etc., yield to specific local adjustment without any
involvement of the so-called Center Place.
I have said that we expect to check or abort a fever with
spinal adjustments. The facts that we do so and that the
 The Cause of Disease 207

more rapidly we accomplish the result the more rapid the

convalescence and the less likely are complications and

sequelae argue loudly against the correctness of any theory

which supposes fever to be a beneficial and cleansing pro-

cess. According to such theory it would be totally wrong
and dangerous to abort a fever but wiser to encourage it in

taking its course. The exact opposite proves true under

Chiropractic. The very fact that fevers do diminish and

disappear under proper adjustments is a proof that they are

abnormal, since adjustment does not in any case tend to

lessen normal processes, but only to restore normality no
matter in what way the functions of the body have departed

from that condition.

All the clinical evidence gathered by Chiropractors in

regard to inflammations and fevers tends to prove the cor-

rectness of the theories herein set down. Fever plays a
part in so many diseases that it has been considered advisa-
ble to consider the subject under a special head.

IN CONCLUSION
The vertebral subluxation is the primary cause of all

truly pathological conditions. Through its existence the

action of a large number of secondary causes becomes pos-

sible. Upon no other hypothesis can we explain the re-

markable percentage of cures of all known classes of dis-

ease through the specific vertebral adjustment.

 THE PROCESS OF CURE
Nature is the only real curative agent. Neither sug-
gestion, manipulation, adjustment, nor any other known
method applied by Man for the eradication of disease has in

itself any power to heal. No man possesses power to do

more than so arouse the vital energies of thhe patient that the

body heals itself.

We contain within our own bodies the possibilities of per-

fect normality. Unless interfered with by powerful out-
side force we should continue normal from birth to death
and death itself would only occur through the simultaneous
wearing out of all the parts of the human mechanism. The
Chiropractor, insofar as his work succeeds in its purpose,

assists the body by adjusting displaced structure and afford-

ing the body a free and unhindered opportunity for the
exercise of its own self-healing powers. It may be interesting
and instructive to analyze the process of cure and to study

the exact effects of vertebral adjustment as we have studied

the exact effects of vertebral subluxation.

Cure of Simple Subluxation Disease

An acute subluxation —that is, one resulting entirely

from concussion of forces within twenty-four or forty-eight
hours prior to the moment of adjustment —rarely produces
a condition which could be named as any particular disease.

208
 The Process of Cure 209

The symptoms are those of "wrenched back," if any. A

single adjustment usually suffices to correct such subluxation

just as a single movement might correct a dislocated hu-

merus within the same period, and any symptoms promptly
disappear. This is probably the maximum benefit to be

derived from adjustment and the best time for its adminis-
tration, because it leaves the spinal column in an exactly
normal condition and no more susceptible to further jars or
shocks than before the injury. All disease which might
have resulted from that subluxation has been fully prevented.
Older subluxations must be dealt with differently be-
cause they present a different condition. Adaptative changes
have taken place in the shape of the vertebra itself and of
every surrounding tissue as they prepare to make the best
of their situation. But a vertebra once displaced has lost

its poise and broken or modified the reflex arcs through its

nerves so that it becomes more likely to respond to further

forces applied, or to muscular contractions within the body,
by further change of position. Such changes are always fol-

lowed by further adaptation of the surrounding parts.

The degree of nerve impingement must change to keep

pace with the developing malposition and thus, by gradually
successive steps, disease develops in the area of peripheral
distribution of the nerves. The nerve is under a thumb-
screw gradually tightening.
To adjust such a vertebra many successive movements
are required. An apparently full and free movement of a
subluxation meets the elastic resistance of the solidly packed

14
 —

210 Technic and Practice of Chiropractic

tissues and the pull of the modified intervertebral disk

strains at these tissues —and rebounds so as to settle almost,

but not quite, in its old abnormal position. The amount

gained in a single adjustment can rarely be appreciated by
palpation. To the touch it would appear that no change had
been made, except occasionally in the Cervical region. But
with repeated adjustments the vertebra will be found to
have approached its normal position. Sometimes in a few
weeks, sometimes in a few months, the gain becomes pal-
pable and then perhaps visible to the eye in thin subjects.
The relief of impingement then is not usually an in-
stantaneous process, but proceeds by gradual steps. Each
movement of the vertebra is accompanied by a shock to the

nerve against some part of which the bone is pressing, which

may produce some disturbance in the diseased organs and
may even appear to have aggravated disease for a time.
Some pain and soreness around the vertebra may accompany
the necessary adaptative changes of shape which readapt
the tissues to their proper shape and relation.
As the impingement of the nerve is gradually relieved
the disease is gradually modified and finally disappears.
As the course of adjustments nears its conclusion and the
impingement has been reduced to a comparatively slight one
there may appear a stage of irritation of the nerve which
is a reduplication of the first steps which appeared in the

development of the disease. As most subluxations appear

not all at once but by a series of changes, so disease develops
synchronously, passing from stage to stage with the changes
 The Process of Cure 211

in the impingement. Often it passes through first an acute

and active stage due to irritation and then a chronic and
comparatively passive stage due to heavier, inhibiting im-
pingement.
Under adjustment these successive stages tend to reap-
pear in reverse order, the most alarming sometimes ap-
pearing last and just before the cure is completed. It must
be remembered that from the moment one practitioner ad-

ministers medicine or other remedy and the other adjusts a

vertebra, the clinical courses diflfer widely. No text-book
on medical practice has as yet described the clinical course
of the various diseases under Chiropractic adjustment.
In chronic diseases where the nerves are paralyzed there
may be a period under adjustment during which no change
is apparent. This is followed by a period of rapid gain
leading to complete recovery. This may be accounted for by
the fact that the nerves are degenerated and must be re-

paired all along their course before communication is re-

established between nerve centers and peripheral organs.

When this repair is sufficiently completed to allow communi-
cation, the cure is really well advanced, although evidence

of it then first appears. This has been noted especially in

locomotor ataxia.

Cure of a Germ Disease

First, under adjustment, the acute or acutely increased

impingement is relieved. The caliber of the blood-vessels

is at once regulated and the destructive action of fever

212 Technic and Practice of Chiropractic

checked. At the same time the vitality of the local tissue

in which the germs are active is suddenly increased and

there ensues a struggle between the body, as represented by

its phagocytes and auto-protective chemicals, and the germs,

which if adjustments be continued results in the rapid de-

struction of the germ colony. Also the elimination of the

toxins already in the body proceeds so rapidly that if the

fever can be held in check it takes only a short time for the
body completely to overcome and eradicate the germs.

Cure of Mental Disease

Mental diseases —so-called—usually depend upon dis-

turbance of the blood-supply to the brain, controlled by the

Cervical sympathetic. Adjustments, relieving the pressure
on the sympathetic ganglia or cord and perhaps the direct
impingement from the vertebral arteries, restore a normal
circulation to the brain. The time required by Nature to
effect a cure depends upon the rapidity with which the im-
pingement is removed and the amount and character of the
damage to brain tissue which must be repaired. The cure
often requires time for a change of materials in brain cells
or fibre tracts, by which they are reconstructed and again
become capable of expressing normal function.

Cure of Dietetic Disease

When the subluxation is corrected, or partially so, the

appetite changes and the craving for food becomes more

normal. Adjustments may lessen a voracious appetite, in-
 The Process of Cure 213

crease a too capricious one, or abolish a perverted. At the

same time the stomach is enabled to digest its contents more
properly, the intestines to take it up and continue it, and
the tissues to assimilate that which is brought to them. The
body eliminates its waste with less effort and in some ex-
treme cases the first effect of the adjustment may be to
cause vomiting and diarrhea and thus purge the alimentary
tract of materials which have become unusable.
If injurious diet be persisted in the effects of the ad-
justments will be partly counteracted, the tendency of the
poisons generated within the body being to increase sub-
luxation while the tendency of the adjustments is to correct

them.

Cure of Poisoning Cases

In acute poisoning by way of the alimentary canal and

sometimes when poison has been injected hypodermically,
the body rids itself of the menace to its integrity by means
of vomiting, diarrhea, and increased secretion of urine.
Chronic cases tend rather toward the gradual absorption and
removal from the body of the poisons and their cure depends
upon the cessation of the poisoning; i. e., it is useless to try

to cure a morphine case while the patient is still using the

drug.
In acute poisoning the muscular contraction often in-
creases subluxation and counteracts the effect of the ad-
justments, so that it becomes necessary to give very fre-

quent adjustments until relief is had.

214 Technic and Practice of Chiropractic

Cure of Exposure Disease

After the acute irritation of nerves arising from the

exposure and causing irritation has been removed, perhaps
by the first adjustment, if the exposure is not repeated the

body heals itself with great rapidity, repairing with compar-

ative ease the damage done.

Cure of Bodily Excess Disease

This depends upon the nature of the excess. If it be

overeating, perhaps a more moderate diet will of itself and
without adjustments enable the body to rid itself of the bad
effects and restore general equiUbrium. Adjustments will

aid and accelerate this process. Venereal excess is most

often engendered by an improper state of mind, perhaps

demanding attention as a mental disorder, or by an irritation

of the genital organs which demands local adjustment for

its relief. Normality of the reproductive tract leads to
sane forgetfulness and libidinous habits always suggest
sexual weakness or disease. Often where a cure would be
possible with right habits, no cure can be effected without
their correction. A little good sound advice which will

arouse the will of the patient to co-operation may aid. Boys

with the masturbation habit offer small chance for favorable
results in enuresis or nervous disorders unless the secondary

cause be understood and overcome.

 The Process of Cure '
215

ADJUNCTS
In this connection the author cannot forbear a reference

to the use of other methods to relieve disease in combination

with the Chiropractic adjustment. From the foregoing

study of the laws governing the cause and cure of disease

it will be seen that therapeutical methods have little direct

bearing upon the removal of disease. The logical method

of effecting the cure is the removal of the cause. The sub-

luxation being always the primary cause, its correction is

always the logical method of effecting a cure. Not some-

times but ahi'ays.

We know that when the subluxation is corrected the

body naturally heals itself. Can we accelerate and aid that

healing with stimulant or narcotic? Logic says no; expe-
rience says no: the use of any method which strikes at the

disease beyond its primary cause and operates upon some of

the effects of that cause without touching the cause itself is

inconsistent with behef in Chiropractic.

Administration of poisonous drugs to the well body is

considered poisoning; their administration to the sick body

is also poisoning, whose symptoms combine with the dis-

ease to produce different outward signs. Fasting is starva-

tion. Massage is stimulation or inhibition. Spondylotherapy

means exhaustion of the spinal nerve centers in riotous
expenditure of their stored-up energy.
It would require a wisdom beyond the human to im-

prove upon the natural healing processes with which the

 ;

216 Technic and Practice of Chiropractic

body has been provided. It should be our entire business

to remove the obstructions which hinder the full exercise of

that healing power —the subluxations —to remove them

dexterously and decisively and to interfere in no other way.
Other methods may and do serve to scatter or modify
disease but not to cure it—unless they affect subluxations, as

they sometimes do without intent. This accidental adjust-

ment factor is valueless in the presence of a scientific and

intelligent adjustment.

Let Medicine, Osteopathy, Spondylotherapy, Christian

Science, Massage, and Electricity have their field. It is not

ours. Nor can any of these methods be rationally combined

with Chiropractic. Their basic principles contradict ours
their application interferes with the results of adjustment.

If you claim to remove the cause of disease, do so, and do

not mar your work by treatment of effects.
 SPINO-ORGANIC CONNECTION

It has been said in a previous section that when sub-

kixation and disease are associated the subluxation always
precedes the disease and that the former is the cause, the
latter the effect. So clearly do we understand this law that
we are able to say what subluxation would cause a certain

disease and err by only so many cases per centum as there

are variations from the usual structure of the spinal column

and the nervous system.
But merely to state that a second Dorsal subluxation
causes heart disease is not enough. We must know why and
how it causes heart disease and whether, perchance, some
other subluxation may sometimes have a Hke effect. We
must map out the sphere of malign influence of each pos-
sible subluxation so that when our fingers encounter it it at

once and inevitably suggests its possible effects, from which,

by diagnostic methods, we may choose the one toward
which most symptoms point. And we must know the
relation of every nerve in the body to peripheral organs and
their functions so that when we encounter indubitable evi-
dence of some functional or organic disease we may know
exactly where, in the spinal column, to seek for its cause.

We have learned how to discover a subluxation, how to

adjust it, and how that adjustment permits a natural cure of

its abnormal effects. We must now learn exactly ivhere to

217
218 Technic and Practice of Chiropractic

apply adjustment for any given organ in the body or for

any disease. It must be understood in interpreting this

statement and all those which follow in this section that it

is never proper to adjust a vertebra merely because it is

stated to be the cause of a disease believed to exist in a

patient. No vertebra should be moved unless palpation de-

termines it to be subluxated. Rather let it be known that

as a rule the statements of spino-organic connection here

made will prove to be verifiable by palpation. There is no

rule in Chiropractic without some exceptions, and mere
diagnosis of disease is too notoriously unreliable to serve as
a guide to adjustment without the verification of the trained
touch.

The Field of Study

We wish to know the relation existing between each

part of the Nerve System and other parts and between each
part and the other organs of the body. Especially we wish
to understand the relation between each part of the Nerve
System and the spinal column, by which permanent subluxa-
tions of the latter interfere with the former's action and
therefore with the peripheral organs.
This requires a general knowledge of anatomy, physi-
ology, and pathology which we shall presuppose the reader
to possesses so that we may present only facts to which his
attention should be particularly called. Let us begin with
the relation of nerve tissue to other tissues where this rela-
tion can be most clearly comprehended, namely, with the
development of the human embryo.
 Spino-organic Connection 219

Segmentation

The complete human organism represents the snarled

fusion of a series of similar, yet specialized, somatic seg-

ments, each presenting most of the attributes of a simple
animal, though the association and co-ordination of all are

required for the production of higher animal phenomena.

The embryo is composed of such segments placed with
their centers in the same axial line. Each segment contains
in association which is morphologic, physiologic, and ana-
tomical, a segment of nerve matter and a somatic (body)
segment. The neural segments are arranged end to end so

as to form the rudimentary beginning of the complete cen-

tral nerve axis of the adult human body ; the somatic seg-
ments blend together with somewhat indefinite lines of

cleavage which are to become much more indefinite and

obscure by changes in relative form due to differences in the
growth rate of different parts or to involuntionary changes

following functional inutility at various periods. Gray says,

"The intrinsically segmental nature of the spinal cord is

expressed by the association of each definite segment with

the somatic segment supplied by its nerve."

Within each segment there may be observed at an early

period cell migrations from the walls of the primitive neural
tube and amoeboid projection of axonic and dendritic pro-
cesses from these cells, which serve to bring the other
tissues of the segment under the control of the nerve ele-

ments ; there is an assumption of command, as it were, by

220 Tech NIC and Practice of Chiropractic

the nervous system, so that the epithelial, connective, and

muscular tissues of each segment are linked in sensomotor
and vegetative co-ordination by the contact association of
the nerves w^hich ramify them —sensomotor because the
nerves are presently to carry the only force capable of incit-

ing activity of any kind in other tissues, vegetative because

the functions of growth, nutrition, and repair, in each
somatic cell, depend upon the continuity of communication
between it and the lowest nerve cell in the nerve pathway
which connects it with the higher motor and sensor centers.

Development of the Nerve System

Already may be noted a hint and a prophecy of that

future segmental organization by which it becomes possible
for some spinal vertebra to become displaced and thus begin
a morbid process which may diffuse itself throughout an en-

tire body segment, involving neural and somatic elements

together. Already the simple organization begins to be-
come rapidly complex and difficult to trace.

Cell masses begin to migrate from the walls of the primi-

tive neural tube to a position laterad to become the spinal

ganglia ; these send out long dendritic processes which mar-

vellously thread their way to a predetermined peripheral
connection which is to bring some cutaneous, or muscular,

or joint tissue into sensor relation with the dorsal, or sensor,

portion of the cord and through it with the brain; at the
same time they send their axonic processes inward to mingle
with and communicate with the dendrites of other sensor
 Spino-organic Connection 221

cells remaining in the central axis to form the gray matter

of the cord, and thus, migrating, keep up communication

both with the central axis and the periphery. Other cell

masses migrate ventrolaterad to form the sympathetic

ganglia and they also send out afferent and efferent pro-
cesses which make a connection on the one hand with the
periphery and on the other with the source from which the
cells developed, the situation to be occupied by the cord.

From this view it is seen that the sympathetic system is

merely an offshoot from the same source with all the rest of

the peripheral nerve system, merely a mechanism for the

proper distribution of nerve impulses from the central organs,

and that it retains its connection in all its parts with those

organs. Its ganglia, like those of the cord, are always and
from the beginning under the domination of the upper or
cephalic end of the neural tube.

This cephalic end rapidly expands. Its growth is faster

than the rest of the neural tube and from its walls, by pro-
liferation, develop the structures of the cerebrum, mid-brain,
and hind-brain. It also gives off ganglionic masses from

which grow sensor processes to form the afferent elements

of the cranial nerves and contains, like the cord, motor
nuclei, or nidi, from which motor axons grow toward the
periphery to come into relation with definitely predetermined

organs.
222 Tfxhnic and Practice of Chiropractic

The Spinal Column and Cranium

Now appear the primitive cartilaginous and membranous
elements from which a bony wall is to be built around the
central nerve axis, primitive vertebrae, the upper known as
cranial and numbering four, and the lower, or spinal, num-

bering usually thirty-three. These bone structures develop

around the brain and spinal cord. Later the cephalic verte-
brae fuse into a solid vault, the cranium, completely en-
closed except for various foramina for the passage of spinal
cord, nerves, and blood-vessels. The succeeding twenty-
four vertebrae remain separate and movable upon each other
and leave between them the openings for the emergence of
the spinal nerves. The last nine segments fuse eventually
into two immovable or false vertebrae called Sacrum and
Coccyx. These latter also contain foramina from which
nerves issue.

The Adult Nerve System

When this development and growth of new parts is

completed the Nerve System appears as a set of complex

organs made of a central axis, brain and spinal cord, and
peripheral connections made up of forty-three pairs of di-
rectly attached nerves (12 cranial and 31 spinal) with two
great gangliated cords and numerous other sympathetic
ganglia and communicating cords situated outside the
skeletal axis but communicating with it intimately by means
of interchange of fibre bundles between the sympathetic and
the cerebro-spinal nerves.
 ScV.cmdtic Ji4<^»dm oj Spinal nerve dnd I^4m I.

fl: Spinal nerve. -B: Spmdl 34n^lion. C: Posterior Tierve toot.

Ante y] Of ner^e faot-E.White.Mrrws CoiT»mut\i6itV--T G^v
J):

Vdmus Cammunicins.'G S^mpjthefic gang/icri. H SijrnVi^heiic Cord

Fig. 31. Interchange of fibre bundles between spinal and sym-

pathetic nerves.
 ;

Spino-organic Connection 223

But we who have viewed the embryonic development

even briefly and sketchily, understand that all these complex
organs are merely an aggregation of neurons, each neuron
made up of a cell body, one or more axons, and dendrites
that the nerve cells are the controlling elements and the
axons the centrifugal carriers of nerve energy, while the
dendrites are the centripetal processes through which each
nerve cell receives communications.

The Body Axis

The skull and spinal column, taken together, constitute
the bony axis of the body, the center of organization of the
skeleton ; to these parts are attached other skeletal structures,

mandible, ribs and sternum, extremities, classified as the

appendicular portion of the skeleton. Likewise are attached,
directly or indirectly, the voluntary muscles which move
the skeleton, and the vessels and viscera. Any given struc-
ture in the body can be traced to a supporting connection
with this bony axis.
The bony axis contains the neural axis. Its strength and
solidity are such as to preserve the integrity of the most
vitally important tissue of the body from every form of in-

jury if such protection be possible. Through openings in

the bony axis — foramina—the central nerve organs give of¥

or receive the nerve bundles which bring them into com-

munication with every other structure of the body. And the

body has been so arranged that every single part of it is

partly or wholly under control of nerves emerging through

224 Technic and Practice of Chiropractic

these foramina. Even the brain and spinal cord themselves

respond to changes in the blood-vessels which are controlled
by nerve impulses which have emerged through the inter-

vertebral or cranial foramina and returned by other routes

to supply the muscular coats of the vessels.

Concussion of Forces Affects Spinal Column

Reverting for a moment to the primitive segmental ar-

rangement which is none the less persistent and important
because in the completed human the regularity of contour of

the segments has been wholly lost and aberrant organs have
moved from their original positions carrying their nerve

supply with them, let us first state and then illustrate a gen-
eral law.

Any violence applied to the body tends to affect the spinal

column. Such violence does or does not produce permanent
displacement of a spinal segment according as it does or does
not succeed in overcoming the internal resistance. But what-
ever effect upon the spine is accomplished will occur most
noticeably in the same body segment to which violence was
applied. That is, force applied to any body segment tends

to subluxate the vertebra which would impinge the nerves

contolling that segment. Thus diseases are primarily seg-

mental and later general just as the body is primarily

segmental and later co-ordinated into complicated functional

systems, all more or less interdependent.

If a man falls so that he strikes first on the point of his

shoulder the force will be transmitted almost directly across
 Spino-organic Connection 225

the line of the spine, at right angles, and may subluxate the
sixth or seventh Cervical or first Dorsal. If subluxation

occurs it is because the law of gravity causes the remainder

of the body to keep moving downward after the shoulder

strikes and until it too comes to rest. The subluxation

which results is a right one if the left shoulder be struck and
vice versa. Now the brachial plexus is chiefly controlled by
these three vertebrae and a right subluxation tends to im-
pinge most the nerves on the left side, so that if any per-
manent effect of the fall follow it will be a permanent weak-
ness or disease of the left shoulder or arm, with possible
slight extensions along other branches of the same plexus,
as to the latissimus dorsi. Also by the internal sympathetic
communications from this same region the larynx, trachea,
or large bronchi may be affected, occasionally the heart, all

structures segmentally associated with the arm.

This law applies throughout the body and can be fully

demonstrated by any one having a complete knowledge of
nerve connections and body segmentation upon being fur-
nished with a complete and accurate history of any injury to
the body. It goes further than this. Toxins or other
secondary causes operating within the body tend always to
produce their motor reactions and consequent effect upon
any subluxated vertebrae in the same body segment with the
peripheral irritation, so that if the stomach contain a poison
which affects the spine the sixth or seventh Dorsal vertebrae

will be most affected and the stomach itself the organ to

suffer most.

15
 —

226 Technic and Practice of Chiropractic

The spinal column is peculiarly adapted, with its strong

ligaments, its cartilage cushions, its perfect flexibility and
flexuousness, to withstand jars and shocks. Yet the spine
is the door by which disease enters the organism. Con-
cussion of forces, the energy from the environment en-
countering the bodily reistance, is of no serious effect upon
the organism —of no permanent or irreparable effect —unless
it affects the spine and brings about vertebral subluxation,
disturbance of the normal alignment between vertebrae, and
thereby interrupts the perfect healing and controlling in-
fluence exerted by the vital part of the segment, the central
nerve portion.
When a concussion of forces does produce subluxations,

does disturb the perfect poise and balance of that center of

structure of the body, its consequences affect an entire body
segment, producing, or tending to produce, disturbances
through the entire segment.
Disease is the indirect consequence of the contact of man
with his environment and is natural but not normal.
The spinal column is a center or a series of centers for
disease. In this column will be found the primary cause
the introductory element —by which disease first makes its

appearance in a previously healthy body.

Comparative Anatomy

The study of Comparative Anatomy is necessary to a

complete understanding of the human organism. We may
trace in the simplest forms of animal life the beginnings and
 Spino-organic Connection 227

foreshadowings of the same plan of organization. We may

follow it through the ascending scale and watch its com-
plexity develop, and by viewing each step in the process we
may come fully to realize that the original plan has been
preserved throughout, though often in such form that by
study of the single species we should fail to recognize it.

We lack space for complete consideration of this sub-

ject and shall merely suggest certain facts and phases. No

clear analogy can be drawn until we reach the worm, with
its rudimentary spinal column and nerves. Roughly speak-
ing, dissection of one spinal segment with its nerves and
their controlled area — if this were possible —would separate
from the rest a fairly regular layer similar to all the other
layers. This is the primitive segmentation.

It is shown much more clearly in the fish but the segments

have begun to curve with their periphery directed slightly
caudad and some have already shown a preponderating
growth over other segments and a change of shape from the
original symmetry.

The reptiles and birds show still more complicated seg-

mentation. It is notable that in these lower animals the

purely reflex portion of the nervous system is highly de-
veloped while the volitional and sensory portions, the cere-
bral hemispheres, are yet rudimentary. In birds, particularly,

the cerebellum is very highly developed because its function

of co-ordination of muscles for the maintainence of equili-

brium is required in a high degree for flying.
Those land animals which walk on all fours approach still
228 Technic and Practice of Chiropractic

closer but their arrangement is much more readily compre-

hensible than in man. As the animal stands on all fours

with head extended, a gigantic cleaver slicing out each

vertebra and pair of nerves and slicing straight tov^ard the

base of support might be said to divide the body approxi-

mately according to the structural and functional arrange-
ment in segments. Yet no segment so separated would
exactly correspond to the nerve distribution; there would

be enlargement of some organs with extension into the zone

previously occupied by their neighbors; enlargement here

and atrophy there; invagination of one organ by another

and overlapping and intermingling of parts. Even the

relation between the spinal cord segments and the vertebrae

has departed much from the primitive so that the growth
of the vertebrae has exceeded that of the cord and the
cord terminates opposite the Lumbar region instead of at the
end of the Sacral canal. It may here be remarked that in
the human embryo the cord at first occupies the entire length
of the neural canal formed within the vertebrae ; that in the

adult it terminates opposite the lower border of the body of

the first Lumbar vertebra and that the nerves, still retaining

their original foramina of exit and their relation to the

somatic segments, pass downward within the canal to their

respective openings and collectively form a brush like mass

called "cauda equina."
 Spino-organic Connection 229

Causes of Segmental Changes

The causes of the change in the shape, form, and relation

of the different segments are functional : the body changes

to meet the changing needs of its environment and the steady

progressive functional development from one species to

another.

When the animal at last assumes the erect position, doing

more intricately and intelligently the bidding of a de-

veloping and improving central nervous system, the change

of position and the force of gravity bring about a gradual

downward, or caudad, tendency of the parts of the somatic

segments most remote from the spine and of the nerves
which supply them.
The nerves, muscles, and bones of the lower extremities

change from almost a right angle to an extremely obtuse

angle, less obtuse during infancy and more so in the adult.

The forelegs become arms and hang at the sides, extending

downward from the part of the spine which controls them.

The ribs tend more obliquely downward and outward from

the spine and the tendency of all the nerves is downward
from their attachment to the spinal cord to their emergence
from the intervertebral foramina. In the neck and head

alone is this rule varied, the tendency of the nerves and

some other structures there being to run from the spine
either at right angles or upward.
It seems almost symbolic and indicative of the purpose
of creation that the body, which is less strong and vigorous
280 Technic and Practice of Chiropractic

in Man than in the lower animals, should tend more and

more obliquely downward from its central axis, while the

cranium, containing a highly specialized mass of cells and

fibres, the organ of Mind, which marks Man's supremacy in
the animal kingdom and is his crowning glory, is reared
above the body it dominates.
In all the form changes which mark the growth of the
body the organs are arranged to afford the greatest possible

economy of space and convenience for use. This perfect

and matchless mechanism adapts itself to the changing habits

and environments and to the quality and needs of the Mind

which inhabits it.

Necessity for Table of Spino-Organic Connection

To the practitioner who is fully equipped with an in-

stantly available knowledge of all the nerve connections in

the body and to whom palpation of a subluxation at once

suggests its somatic sphere of influence as a weakened or
diseased area, or to whom mention of a disease immediately
calls to mind the organ, or segment, which is primarily
affected and its nerve connection with the spine, any tabula-
tion of spino-organic connection or of diseases and adjust-
ments, for reference, is unnecessary. But the ordinary prac-
titioner finds it difficult to acquire and retain such an array
of information and much more convenient to refer to reliable

and easily read tables which will supply at once any such
information desired.
No specific adjustment is possible without knowledge of
 Spino-organic Connection 231

the vertebra which controls the part diseased and toward

the heahng of which the nerve energy should be directed.

Specific adjustment without correct diagnosis is of course

impossible. And whenever correct diagnosis has been made

it is essential that the mind of the Chiropractor should

revert to one certain vertebra which he expects to find

subluxated as the primary cause of the disease.
Diagnosis is essential in order to find out H'hat organ is

the site of the disease, for all disease is primarily segmental.

The location of the disease having been determined, a quick

reference to a table showing the spinal connection with

that location makes specific adjustment possible. The value
of specific, as against general, adjustments will be considered
under ''Practice."

Method of Investigation

One who wishes to determine for himself the proper

specific adjustment for a certain disease must, in order to
be able to attach any weight to his conclusions or to announce
them with any hope of credence by the scientific world,

much
proceed very after the following method, which sets

down what may be termed "standard test conditions" for

research into the spino-organic connection.

He must make a correct diagnosis which serves to
determine the nature and location of the disease process.
In this he may be greatly aided by vertebral palpation and
nerve-tracing, especially in diflferential diagnosis. Any case

which afifords less than a quite positively correct diagnosis

232 Technic and Practice of Chjropractic

should be excluded from the test list because any conclusion

based on a doubtful diagnosis must itself be doubtful and
may be seriously misleading.
He must then ascertain as far as possible the known
anatomical nerve connection between the spine and the dis-
eased part. If several connections are known he must
decide according to nervous physiology, by recognizing the
morbid functions which constitute the disease and learning
which nerves control these functions and which must there-
fore be deranged in order that the disease may exist. I may
say right here that to attempt to answer the problems of
Chiropractic on the assumption that standard anatomies are
incorrect in their statement of nerve connections is as hope-

less as the wail of the schoolboy that the answers in his

arithmetic are wrong because his sums fail to come out that

way.
The investigator must next be accurate in Palpation,

selecting the subluxation which would, from his knowledge

of the body segmentation, seem most likely to influence the
nerves involved, and positively ascertaining the number of
the subluxated vertebra. No one who cannot count verte-
brae accurately can positively say which vertebra he has
adjusted. More than that, no one who has not counted the
vertebrae in the special case in question can say which
vertebra he has adjusted. No mere regional localization will
suffice for scientific investigation.

Correct and accurate adjustment must follow selection

of the single vertebra and the adjuster must know that he
 Spino-organic Connection 233

has used the one special movement, or form of adjustment,

which is mechanically right for that kind of subluxation and
has so moved the vertebra as to release impingement. Mere
movement of a vertebra is not necessarily an adjustment or
even a maladjustment ; it may be movement without perma-
nent change of relation or release of impingement. (See
"Preferable Adjustments," p. 155.)

There follows the observation of the progress of the

case and this must be so careful and accurate that the
observer knows to a certainty whether the disease is pro-
gressing unfavorably, or favorably, or whether it has been
entirely eradicated. He must know the value of every chang-
ing symptom, the real meaning of each new development.
Every diagnostic method should be at his command for

this work. Constant vigilance and constant thought should

mark each step of his work.

Finally he must be so cautious and careful in his state-

ments that no doubtful conclusion is allowed to escape from
his own mind. We may believe or suspect or hope for proof
of our theories but we have no right to state as a fact any-

thing except that which has been proven under the most
rigidly guarded scientific test conditions.

Failure to observe any of the precautions mentioned

renders worthless the results of investigation. Nothing
further than a mere presumption can be based upon re-

search which fails to observe all these rules. It will be

readily understood that there are few Chiropractors whose

training has been sufficient to enable them successfully to
 —

234 Tech NIC and Practice of Chiropractic

accomplish such research. There are thus many things

connected with the spino-organic connections which are
commonly held as facts but which should be classed as pre-

sumptions. And the prevalence of the habit of general ad-

justment rather than specific makes the future final solution

of all these problems remote.

Kinds of Evidence Acceptable

It will be seen that of the three kinds of evidence

Anatomical, Physiological, and Clinical —^which are admis-

sible in reasoning upon the connection between the spine

and disease, only one form — clinical evidence —has been ad-
duced by Chiropractic. For anatomical and physiological
corroboration of our apparent clinical findings we are obliged

to turn to standard works on these subjects; fortunately we

find it in abundance.
Anatomy, fortified now by research in the morphologic
relations of the parts studied and by physiological and path-
ological experiment which has thrown much light on the
proper viewpoints from which to describe structure, contains
sufficient data on the nervous system to enable us to explain
practically every fact observable in a Chiropractic clinic.

It is true that there are a few statements in the ensuing

outlines for which we cannot as yet find the anatomical or

physiological proof. But it must be remembered that anat-

omists and physiologists have never studied the body with
a knowledge of the subluxation theory to aid them in gain-

ing perfective and that Chiropractors, as a class, have not

 Spino-organic Connection 235

yet delved deeply enough into anatomy and physiology to

extract all the available and illuminating information from

them. Ofttimes the facts we value most are most obscure
in the texts because to others they seem least important.
But they are there. Armed with information concerning
Chiropractic facts it is probable that the scientist of the
future will corroborate all of our clinical findings of today
and emphasize the rational explanations of them.

In the following tables it has been found best to insert

in parentheses the capital letter (P) to call attention to any
statement in support of which we have gathered less than
all three forms of admissible evidence and which is there-

fore as yet presumptive. It is well, howe^^er, for the prac-

titioner to be careful lest he regard too lightly such presump-
tive statements. Unless there is very strong and reasonable
ground for such presumption or a general belief in its cor-

rectness all mention of it is omitted. Those labelled pre-

sumptive are merely so indicated because they have not yet

been proven and not because they have failed to serve as a
convenient and useful guide to adjustment. For each pre-
sumption ofifered there is either clinical or anatomical justi-

fication but not both.

SPECIAL NERVE CONNECTIONS

This section does not purport to state with any degree of
completeness the various nerve-paths by which spinal verte-
brae come into relation with all, or nearly all, the peripheral
organs of the body. It merely points out some of the more
236 Technic and Practice of Chiropractic

interesting and important connections, some of the paths

which serve to explain the common effects of vertebral ad-

justment. It is not expected that this resume of the sub-

ject will be more than suggestive to the student; certainly

it cannot, in so brief a space, be a complete exposition.

Outline of Nerve System

Let us begin with the observation that almost every

organ of the body, including the central nerve organs them-
selves, may be adversely affected by spinal subluxation im-
pinging spinal nerve axons at their exit from, or entrance
through, intervertebral foramina, or by spinal subluxation
producing direct impingement upon some part of the
sympathetic system and similarly interfering with its power
to functionate.

The Nerve System may be divided into two great divi-

sions, the central axis and the peripheral system which
distributes nerve energy from, and brings stimuli to, the

central axis. The central axis consists of the brain and

spinal cord ; the peripheral system of 12 pairs of nerves at-

tached to the brain and having exit (except the eighth)

through foramina in the base of the cranium, 31 pairs of

spinal nerves emerging through intervertebral foramina

whose parts are movable upon each other (except the for-

amina for sacral and coccygeal nerves), and an intricate

system of sympathetic fibres and ganglia arranged in a

double chain of ganglia in front and at the sides of the

vertebral column, three great prevertebral plexuses, the
 Spino-organic Connection 237

cardiac, coeliac, and hypogastric, and numerous scattered

ganglia and communicating cords which bind the gangUa
together and connect them with spinal or cranial nerves
and with the periphery.
The peripheral system is somewhat complex and numer-
ous intercommunications are established by which nerve im-
pulses originating in the central axis and leaving by one

part of the peripheral system may exercise a controlling in-

fluence over another part. Plexuses, or intertwinings of

nerve axons, are so numerous and complicated that it is

difficult to follow each set of nerve stimuli from their origin

to their final destination and effect without considerable
study.

Direct Distribution of Spinal Axons

The spinal nerve axons, taken as a whole, establish paths

between the motor gray of the ventral horn of the spinal

cord and all voluntary muscles of the body below the head
except the trapezius and sternomastoid, partially innervated
by the eleventh cranial, and between the sensor cells of the

dorsal spinal gray and gracile and cuneate nuclei of the

medulla on the one hand and the sensor end organs in skin
and mucuous membrane, muscles, tendons, and joints on
the other. The ventral cornu receives impulses from the
cortico-spinal axons of the direct pyramidal, crossed pyrami-

dal, rubrospinal, and other smaller tracts which bring the

spinal gray under the direct voluntary domination of the

volitional centers in the brain or of the indirectly voluntary
338 Technic and Practice of Chiropractic

pathway through the cerebellum. The spinal nerves are

the direct media for motion of the body or its parts in rela-
tion to its environment. The sensor gray of the cord is

similarly in communication with the conscious sensation

area in the cerebrum and with the cerebellum by way of the
dorsal tracts of the cord, the lemnisci, and the cerebellar

peduncles.
In the main these nerves of motion and sensation are
arranged as follows:
The Cervical plexus is composed of the intertwining of
axons from the anterior primary divisions of the four upper
Cervical nerves. Its branches pass to and innervate many
voluntary muscles of the neck and side and back of head,
and supply sensor fibres to the adjacent cutaneous areas.
Branches also communicate with the last three cranial nerves
and one long branch, the Phrenic, or Internal Respiratory
Nerve of Bell, passes through the neck and thorax to the
diaphragm, as its motor nerve.
The Brachial plexus is made up of the anterior primary
divisions of the four lower Cervical nerves and the greater
part of the first Thoracic. It is distributed chiefly to the
voluntary muscles and integument of the shoulder and arm,
forearm, and hand, but sends branches to some muscles of
the neck and upper back as well. It, like the Cervical plexus,

receives branches from, but gives none to, the Cervical sym-

pathetic.

The Thoracic nerves are not arranged in plexiform

fashion like those above but pass separately, for the most
 Spino-organic Connection 239

part, to their destinations. They are distributed to the walls

of the thorax and abdomen following the curve of the ribs in
direction. The last Thoracic sends one division downward
as far as the outer aspect of the ilium.

The Lumbar, Sacral, and Pudendal plexuses are formed

of the ventral divisions of the Lumbar, Sacral, and Coc-
cygeal nerves and distribute branches to the integument
and voluntary muscles of the lower abdomen, pelvis, and
lower extremities. From two of the sacral nerves branches
known as "Visceral" pass through the plexus to terminate in

the walls of the uterus and rectum.

All of the thoracic nerves and the first and second, some-
times the third and fourth, lumbar give off branches to the
sympathetic ganglia, known as white rami communicantes.

Direct Distribution of Cranial Nerves

The distribution of the 12 pairs of cranial nerves is not

so definitely to voluntary muscles and to areas from which
conscious sensation is to be derived as is the case with the

spinal, although the cranial nerves present many analogies

with the spinal and there is abundant reason for considering
them as in one series of 43 pairs. There is direct distribu-

tion of some cranial nerve fibres to secreting glands, but

these fibres are probably merely derived from sympathetic

trunks and carried in company with the axons of cranial
origin. There is also some direct distribution of cranial

nerve axons to visceral walls made of non-striated muscle,

as in the case of the vagus distribution to the respiratory and
240 Technic and Practice of Chiropractic

alimentary tracts and that of the spinal accessory to the

heart. This is a resemblance to the sympathetic.
The cranial nerves carry afferent impressions from the
special sense organs, except those of the sense of touch,

which function is divided with the spinal nerves.

Various intercommunications exist between the cranial
and sympathetic divisions of the peripheral system, by means
of which axons starting with one division may be finally

distributed with another, or by which an axon of the sym-

pathetic may pass to one of the sensor ganglia of the cranial
system and influence its nutrition and condition, and there-
fore its power to act. There is a limited intermingling of

spinal fibres with the lower cranial.

Distribution of Sympathetic

The sympathetic system directly innervates most of the

nutritive or vegetative system, the alimentary tract and its

accessory organs, the vascular systems, the genito-urinary

system, and the ductless glands. To a limited degree it

shares this control with the cerebro-spinal and to a much

greater degree it brings the central axis into indirect con-
nection with these viscera.

Gray says, 'The distinction of the sympathetic system

from the cerebrospinal system is made merely for reasons of

convenience. The two systems are intimately connected

and the sympathetic is morphologically a derivative of the
central axis disseminated in connection with the nutritive
 Spino-organic Connection 241

apparatus and establishing relationships among the vegeta-

tive organs."

Structure of Nerve Pathv^ays

Most pathways which carry nerve impulses from their

origin or inception to the organ in which they are finally

expressed as action of some sort or translated into sensation

or into stimuli which pass out reflexly over a connected
neuron, are composed of more than one neuron. The neurons
of a nerve pathway are arranged end to end with the axons
all pointing in one general direction so that the nerve
energy travels always in the same direction over the entire

nerve path. Impulses are transferred from the first neuron

in the chain to the second, and from second to third, etc.,

by contact of the telodendria of the one neuron with the

dendrites or receptive processes of the next. Part of the
nerve pathway may be within the central axis and part
within the trunk of a peripheral nerve.
Several peripheral pathways for afferent impulses may
be joined to an efferent pathway so as to complete reflex arcs
and the efferent cell be under the controlling influence of
some upper neuron coming down from the central axis with

the power either to permit or to ihibit the reflex acts which

would otherwise take place as a result of peripheral stimuli.

Several such lower cells may be under the domination of one

upper neuron.
In some instances the nutrition of ganglia or nerve
trunks, or of parts of the central axis itself, is under the

16
242 Technic and Practice of Chiropractic

control of sympathetic neurons terminating in connection

therewith, so that interruption of the normal action of the

sympathetic neuron may be followed by effects manifested

through some distant part of the cerebrospinal system. In
the following pages we shall discuss nerve pathways with
reference to the explanation of diseases caused by vertebral
subluxation impinging nerves either by tension or constric-
tion, and therefore our grouping of parts will differ some-
what from any anatomical or physiological grouping with
another object in view.

Important Nerve Pathways

To brain: C 2, 3, or 4 to superior cervical gangHon by

direct impingement, through internal carotid nerve to sym-
pathetic plexuses following branch arteries from Circle of

Willis. The blood-supply of the brain is under control of

the cervical sympathetic and most brain lesions or diseases

are due to vascular changes leading to anaemia, hyperaemia,

inflammation, or hemorrhage.
To meninges: Loop between first and second cervical
nerves to trunk ganglion of vagus and through meningeal
branches of vagus (P), or by way of internal carotid nerve
to pial sympathetic plexuses. (P) The connection of the
first, second, or third cervical with cerebral meningitis is

established clinically but there is still doubt as to the ex-

planation.

Eye and Muscles, Retina, Optic Nerve: The external

muscles of the eye, the four recti and two oblique with the
 Spino-organic Connection 243

levator palpebrae superioris, are innervated by the Oculo-

motor, or third cranial, and the fourth and sixth cranial,
which receive branches from the cavernous plexus of the
sympathetic derived from the internal carotid branch of the
superior cervdcal ganglion. As the ganglion lies in front

of the transverse processes of the second, third, and fourth

cervical vertebrae, direct impingement upon it by subluxa-
tion of one of these vertebrae may cause strabismus or
other affection of the external ocular muscles.
The eye-ball receives filaments from the ciliary or

ophthalmic ganglion, which in turn is connected with the

cervical ganglion by way of cavernous plexus and internal
carotid nerve. This pathway controls the radial fibres of

the iris and dilates the pupil as a part of the light accom-
modation reflex mechanism. Loss of pupillary reaction,
especially with small pupils, suggests upper cervical sub-

luxation.

The retina, containing the cells of origin of the optic

nerve axons and being the special end-organ of the sense of

sight has no direct spinal or sympathetic connections but its

blood-supply, and therefore its nutrition, is influenced by

branches from the sympathetic which enter with the central

artery of the retina. Retinal hemorrhage has been cured by
cervical adjustment, C 2, 3, or 4.

The conjunctiva is innervated by the sympathetic and

by the fifth cranial, or trigeminal.

Olfactory Nerve: Nerve of smell, distributed to the

Schneiderian membrane over the upper portion of the nasal

244 Technic and Practice of Chiropractic

septum and over the upper lateral wall. There is no known

connection by which the trunk of the olfactory nerve can
be reached by adjustment but the condition of the special
end organs in the membrane and their ability to functionate

depend not only upon the integrity of their axons but also
upon the nutrition and moisture of the membrane in which
they are embedded. This is under the control of the Vidian
nerve and of branches from the spheno-palatine, or Meckel's
ganglion, both connected with the carotid plexus of the
sympathetic and therefore responsive to adjustment of C 2,

3, or 4. This is also the route by which epistaxis is usually

checked.
The external nasal muscles, like those of the rest of
the face except some of the muscles of mastication, get
their supply from the facial nerve, which connects with the
sympathetic plexus on the middle meningeal artery. It may
be said parenthetically here that peripheral facial paralysis
(Bell's palsy) yields to adjustment and proves the value of
this connection. The nasal integument is under the sensor
control of the trigeminal and trophic disturbances may re-

sult from its involvement.

Trigeminal Nerve: This is the great sensor nerve of

the face and carries a motor division, the inferior maxillary,

to some of the muscles of mastication, as the temporal,

masseter, and buccinator. It has connected with it four
ganglia, which also receive sympathetic roots, and the
ganglion of origin of its sensor axons, the Gasserian or
semilunar, also receives direct sympathetic communications.
 Spino-organic Connection 245

The importance of this communication is shown by the

powerful effect of adjustment of third or fourth Cervical
for tic dolouroux.

Ear: The external ear receives branches from the

vagus and from the first and second cervical nerves. The
middle ear and Eustachian tube are supplied by the tympanic
plexus made up of branches from the glosso-pharyngeal,
otic ganglion, facial nerve and the small deep petrosal from
the sympathetic on the carotid artery. By all these routes
communication from the third and fourth cervicals is possi-

ble but especially is the latter important. The fourth cervi-

cal is the especially frequent subluxation with middle ear
disease. To the internal ear and auditory or acoustic nerve
there appears to be no direct route from the spine. It has not
yet been conclusively established within the writer's knowl-

edge that adjustments will affect auditory deafness but

Meniere's Disease, inflammation of the semicircular canals,
has been cured repeatedly by adjustments of Atlas or Axis,
by what route I am unable to state.

Teeth and Gums: It is probable that the only connection

between the vertebrae and the teeth is an afferent one by way
of the trigeminal. Toothache may be stopped by adjustment
of C 3, or C 4, but no evidence is at hand to show that the

condition of the teeth is improved or that more than a tem-

porary effect can be had. Trophic changes in the gums may
be due to vascular disturbances controlled by the sym-
pathetic.

Tongue: The hypoglossal, motor nerve to both the in-

246 Technic and Practice of Chiropractic

trinsic and extrinsic muscles of the tongue, receives direct

axons from the loop between the first and second Cervical
nerves. Sympathetic fibres pass to the blood-vessels and
secreting glands of the tongue.
Tonsils: Receive fibres from the spheno-palatine gang-
lion and by this means are brought under the domination of
C 2, 3, and 4. Abundant clinical evidence in tonsilitis,

simple, follicular, and suppurative, proves this to be the

practically, as well as anatomically, correct nerve connection.

Salivary Glands: The parotid receives branches from

the great auricular nerve from the second and third cervical,

and from the sympathetic on the external carotid artery,

branches from the superior cervical ganglion. The sub-

maxillary and sublingual glands are connected with the
submaxillary gangHon, which receives a sympathetic root
and which, with the chorda tympani also carrying fibres

derived from the sympathetic, controls the secretions of

these glands.
Pharynx: The pharyngeal plexus is a mixture of sen-
sory axons from the glosso-pharyngeal, motor components
from the vagus and probably sensor from the same nerve,
and sympathetic branches from the superior cervical gan-

glion. All of these may be influenced by the upper cervical

adjustment.
Larynx: According to anatomy the larynx is innervated
by the superior and inferior, or recurrent, branches of the
vagus and by sympathetic branches from the superior cervi-
cal ganglion. Clinically the sixth cervical adjustment cures
 Spino-organic Connection 24-7

laryngitis and aphonia. The explanation probably lies in

the fact that the thyroid branches of the middle cervical gan-
glion, lying in front of the transverses of the sixth, com-
municate within the thyroid gland with the recurrent laryn-
geal and with the external laryngeal branch of the superior
laryngeal.

Thyroid Gland: "The nerves to the thyroid are amye-

linic and are derived from the middle and inferior ganglia
of the sympathetic." (Gray.) The middle cervical ganglia

are situated in front of the transverse processes of the sixth

cervical vertebra. Clinically, the sixth cervical reaches

goitre. •' -"^^^

Muscles of Keck: The platysma is supplied by the
facial nerve ; the sternomastoid by the spinal accessory and
cervical plexus ; the infrahyoid region by the first three

cervical nerves ; the suprahyoid region by the facial and

the ansa cervicalis ; the anterior and lateral vertebral mus-

cles by the cervical nerves from second to seventh inclusive,

but especially the second, third, and fourth. It will be seen

that muscular disturbance in the neck may result from any
cervical subluxation. Torticollis, which usually involves the

sternomastoid, yields to the second cervical most frequently.

Lymph Nodes of Head and Face: These lymph nodes
are controlled by the cervical sympathetic. Pathological

changes in one or more nodes requires careful cervical pal-

pation to determine the presence of a subluxation away from
the aflfected side.

Muscles of Back: The trapezius is innervated by the

 ;

248 Technic and Practice of Chiropractic

spinal accessory and by the third and fourth cervical nerves

the latissimus dorsi by the sixth, seventh, and eighth cervi-
cal through the middle or long subscapular. Occasionally
a tender nerve, traceable from the lower reaches of the lat-

issimus to the cervical region has mislead the practitioner

into imagining a cervical connection over the back with in-

ternal viscera.

The second layer of the back is supplied by the third,

fourth, and fifth cervical nerves. The third layer is inner-

vated by the middle and lower cervical and upper three

thoracic nerves except the serratus posticus inferior which

is supplied by the ninth, tenth, and eleventh thoracic. The

fourth and fifth layer are supplied by the posterior primary

divisions of the spinal nerves and any given section of these

layers may be traced to a vertebra directly above, or

cephalad.
Thoracic Walls: The parietal muscles of the thorax are

innervated by the intercostal nerves and a very definite

segmental association with the spine is traceable.

Diaphragm: Phrenic nerve, which arises from fourth

cervical chiefly; lower intercostals, especially eighth and
ninth; and phrenic plexus of the sympathetic which may
sometimes be reached from the fourth or fifth dorsal verte-

brae through the gangliated cord. For motor disturbances

of the diaphragm adjust fourth cervical.
Abdominal Muscles: These are supplied by the lower
intercostals and the^ transversalis and internal oblique make
connection with L 1 by the iliohypogastric. Cremaster is
 Spino-organic Connection 249

supplied by L 1 and 2 by way of the genital branch of the

genitofemoral.
Perineal Muscles: The anterior perineal group are sup-

plied by the perineal branch of the internal pudic which

traces to the second, third, and fourth sacral nerves. The
posterior perineal and ischiorectal region is also supplied by
the sacral and coccygeal nerves.

Trachea and Bronchi: Vagus and sympathetic filaments

from first and second thoracic ganglia. The latter receive

preganglionic fibres from first dorsal nerve in all probability,

as this adjustment reaches the bronchi.

Lungs: The third thoracic ganglia connect with the

pulmonary plexus and establish a connection from third

dorsal vertebra direct to the lung parenchyma. The Pleurae
have a similar connection or may sometimes be reached by
the first dorsal.

Heart and Pericardium: In 55% of all heart disease or

improper action the second dorsal is responsible; in 40%
the first dorsal, and perhaps in the remaining 5% the atlas

or axis. The former nerves (T 1 and 2) furnish pre-gan-

glionic fibres which stream upward through the gangliated
'cord to terminate in the three cervical ganglia in relation

with the dendrites of new neurons (amyelinic) which form

the superior, middle, and inferior cardiac nerves and pass

into the thorax to mingle with vagal fibres to form the su-
perficial and deep cardiac plexuses, controlling the heart.

Probably the upper cervicals occasionally affect the vagus

through the loop between the first and second cervical
nerves.
250 Technic and Practice of Chiropractic

Thoracic Aorta: Controlled by sympathetic from first

thoracic ganglion or last cervical ganglion, and thus by

seventh cervical or first dorsal vertebra.

Abdominal aorta — Coeliac Axis: The upper portion of

the abdominal aorta is innervated by the coeliac or solar
plexus of the sympathetic. Sub-plexuses from the coeliac
accompany the various branches of the aorta and are widely
distributed to the blood-vessels and to the glands and non-
striated muscle of the abdominal organs. The coeliac plexus

receives fibres from the right vagus and from the greater,,

lesser, and least splanchnic nerves, by the latter route mak-

ing connection with the thoracic ganglia of the sympathetic
from fifth to last. These ganglia receive pre-ganglionic
fibres from the thoracic spinal nerves in the form of white
rami communicantes, so that it is not incorrect to say that
the coeliac plexus and its branches are largely controlled by
the condition of the last eight thoracic nerves.
Through this intricate plexus it is difficult to trace the
relations of each abdominal organ with the particular verte-
brae of which subluxation would produce disease in said
organ. By the aid of clinical experimentation covering a
period of years and by diligent search among anatomies and
physiologies, we have arrived at the conclusions indicated
in succeeding statements.
The most important spinal connection with the abdominal

blood-vessels is that of the fifth dorsal vertebra, for the

fifth dorsal nerve, by its rami, seems greatly to influence

the caliber of the aorta and coeliac axis.

 '/i-Cortjco spinal nerve. ^Br-^pino Qdn^liomc ricrv*.
-C-Qdii^ho Qin^honic nerve.-)}-(j4n^|to "Peripheric ttery^c,

-£rB/ooa Vessel Wall.

Fig. 32. Schematic representation of nerve pathway from brain

to periphery by way of sympathetic.
 Spino-organic Connection 251

Liver: Fourth thoracic nerves (especially the right) to

gangliated cord, via great splanchnic nerve to coeliac plexus,

by hepatic plexus to interior of liver. The hepatic plexus

gives off the cystic plexus which controls the gall-bladder.

Stomach: Sixth and seventh dorsal nerves by white
rami to and through the ganglia of the gangliated cord to
coeliac plexus. The gastric plexus is an offshoot of the
coeliac and gives off Auerbach's plexus to the muscular
coat, and Meissner's plexus to the submucous and mucous
coats of the stomach. The nutrition of the stomach walls,

their peristaltic action, and the secretory action of the stom-

ach glands are thus brought under the direct influence of the
sixth or the seventh dorsal subluxation.
Pancreas: Eighth dorsal nerve by great splanchnic to

coeliac plexus, to hepatic and superior mesenteric plexuses,

and by the pancreatico-duodenal branches of the former and
pancreatic branches of the latter to the pancreas.

Spleen: The coeliac plexus, the left semilunar gan-

glion, and the left vagus and right phrenic nerves give off

branches which form the splenic plexus. Spinal connection

by way of ninth dorsal nerve, by rami communicantes to

ganghated cord to great splanchnic nerve to coeliac plexus

to splenic plexus. Many nerve pathways like this one are

less indirect than they sound ; various names have been given

to different parts of the same pathway through which, often,

the axons pass without interruption. On the way from the

cerebral cortex to one of the abdominal viscera there may

be only three, sometimes four or five, neurons connected
end to end.
252 Technic and Practice of Chiropractic

Duodenum: Coeliac plexus by way of duodenal branches

of hepatic plexus and branches from the superior mesenteric

plexus. Spinal connection from eighth dorsal nerve and
possibly branches from the upper lumbar ganglia of the
sympathetic may join the superior mesenteric plexus, as

results in duodenal disease are occasionally reported fol-

lowing specific adjustment of L 1 or 2.

Jejunum and Ileum: Connection same as for duodenum,

by superior mesenteric plexus. Adjustment of L 2 in typhoid

fever is undoubtedly correct so that it is probable that the

lumbar ganglia send branches to this vicinity.

Peritoneum: Nerve supply to the peritoneum is rather

general owing to its great extent. It is supplied by the

sympathetic from both the lower thoracic and lumbar por-
tions of the gangliated cord through the various abdominal
plexuses and in general it may be said that any localized
peritoneal disease will yield to the same adjustment as would
be made for disease in the immediately subjacent organ.

Suprarenal Capsules: These important glands are sup-

plied by amyelinic fibres derived from the gangliated cord
by the lesser splanchnic nerve and connecting with pre-
ganglionic fibres from the tenth dorsal nerve. The suprarenal
plexus is an oflfshoot of the coeliac.

Kidneys: Tenth, eleventh, and twelfth dorsal nerves by

way of lesser and least splanchnic nerves to renal plexus,
an offshoot of the coeliac. McConnell's experiments and the
frequently duplicated clinical feats of Chiropractors prove
this to be a vital and dominant nerve pathway in kidney
disease.
 Spinoorganic Connection 253

Ureters: Nerves derived from inferior mesenteric, pel-

vic, and spermatic plexuses. Most important connection

seems to be from first lumbar nerve by lumber ganglia to
inferior mesenteric plexus.

Caecum and Vermiform Appendix: The inferior me-

senteric plexus, which supplies these organs probably carries
to them chiefly fibres derived from the lumber ganglia whicH
complete a connection with the second lumbar vertebra,
especially on the right side.

Colon: Third and fourth lumbar vertebrae, influencing

lumbar ganglia and thus inferior mesenteric plexus.
Rectum: Lower lumbar ganglia by inferior mesenteric

and plevic plexuses, through superior and inferior hemor-

rhoidal plexus to rectum. Adjustment L 4 or 5. Visceral
branches from the third and fourth sacral nerves also pass
directly to the rectal wall and sacral adjustment may affect

rectum or anus.
Bladder: The urinary bladder is innervated by the
vesical plexus from the pelvic, and by sacral nerve fibres

direct. It is said that the vesical plexus contains many

spinal nerve fibres which are derived from the second and
fourth lumbar nerves especially. Clinically the second or

the fourth lumbar will control the bladder much oftener

than the sacrum.
Prostate Gland, Seminal Vesicles, Penis, and Urethra:
By the vesical and prostatic plexuses derived from the pel-

vic plexuses, divisions of the hypogastric plexus, which is

formed of the abdominal aortic plexus and filaments from

254 Technic and Practice of Chiropractic

the lumbar ganglia. The latter receive filaments from the

second and third lumbar nerves. There is a connection with

the sacral nerves also by the pelvic plexus, though the

lumbar adjustment appears the more potent.
Testes and Scrotum: Ilioinguinal from second lum-
bar, genital branch of genito-femoral from second and
third lumbar nerves, internal pudic nerve from the pudendal
plexus, and spermatic and pelvic plexuses. The most ef-

fective adjustment for scrotal or testicular diseases is L 3.

Uterus and Vagina: Uterovaginal plexus from the pel-

vic and containing spinal nerve fibres from L 4, L 5, and
sacrum.
Ovaries and Fallopian Tubes: The ovarian plexus re-

ceives fibres from the abdominal aortic and through it from

the lumbar ganglia, influenced by second lumbar adjust-
ment.
Brachial Plexus: The brachial plexus of spinal nerves
arises from the nerves from the fifth cervical to the first

thoracic inclusive and controls the voluntary muscles of the

upper extremity, with its integument. Muscle groups,
rather than single muscles, are representated for the most
part in the spinal segments giving ofif these nerves, and
the ramification of the nerves within the plexus is such that
almost any given muscle might be affected by more than
one spinal subluxation. Below are given the principal con-

nections :

Pectoralis Major and Minor Muscles: Sixth or seventh

cervical through internal anterior thoracic nerve and first

dorsal through external anterior thoracic.

 Spino-organic Connection 255

Shoulder Joint: The joint, muscles covering the joint,

and integument of this region are innervated by the cir-

cumflex nerve which traces through the plexus to fifth and

sixth cervical nerves. Sixth cervical adjustment usually
affects this joint.

Serratus Magnus Muscle: Sixth cervical by long thor-

acic, or External Respiratory Nerve of Bell.
Elbozv Joint: Sixth cervical vertebra by musculocu-
taneous nerve.
Anterior Arm Muscles: Sixth cerv^ical.
Posterior Arm Muscles: Seventh cervical and first

dorsal.

Lumbosacral Plexus: This plexus, derived from the an-

terior primary divisions of the lumbar, sacral, and coccygeal
nerves, supplies the muscles and integument of the lower
extremity, taking with it axons derived from the sympathetic
by the lumbar ganglia to supply the blood vessels, perspira-

tory glands and sebaceous glands of this region. The latter

are responsive to adjustments of the first or second lumbar

vertebrae.

Hip-Joint: Third and fourth lumbar nerves by femoral

and obturator or accessory obturator nerves and fifth lum-
bar or first sacral by the nerve to the quadratus femoris or

the great sciatic. Fourth lumbar seems the most potent

connection and is usually adjusted for hip-joint disease.

Psoas Magnus Muscles: Anterior branches of the sec-

ond and third lumbar nerves.
Anterior Thigh Muscles: Supplied mostly through the
femoral nerve from the second and third lumbar nerves.
256 Technic and Practice of Chiropractic

Internal Thigh Muscles: Second and third lumbar

nerves (chiefly but not wholly) through the obturator, ac-
cessory obturator and femoral nerves.
Gluteus Maximus: From the fifth lumbar and first and
second sacral nerves through the inferior gluteal branch of
the sacral plexus.
Obturator Extentus: Second, third, and fourth lumbar
nerves through the obturator nerve.
Posterior Thigh Muscles: Fourth and fifth lumbar and
sacral nerves through the great sciatic.

Great Sciatic Nerve: This great nerve, direct con-

tinuation of the sacral plexus, arises from the fourth and
fifth lumbar and first three or four sacral nerves and is

widely distributed to muscles and integument of the lower

extremity. Sciatica, or sciatic rheumatism, is most com-
monly relieved by adjustment of fourth or fifth lumbar
vertebra; but there is a condition commonly diagnosed as

sciatica which is really a sciatic neuritis and due to vaso-

motor disturbance afifecting the blood-supply to the nerve

trunk. This responds to adjustment of first or second lum-

bar because the amyelinic fibres which control these blood-

vessels are derived from lumbar ganglia of the sympathetic.
Anterior Leg Muscles: Fourth and fifth lumbar and
first sacral nerves through the anterior tibial.

Posterior Leg Region: Fourth and fifth lumbar and

first and second sacral through the internal popliteal and
posterior tibial.

Knee-joint: This joint receives branches from the

 Spino-organic Connection 257

great sciatic through both internal and external popliteal,

and from the femoral and obturator. It is therefore con-
nected with the lower lumbar and sacrum and with the
second lumbar. The latter connection seems oftenest in-
volved in knee joint inflammations.
Foot: Fourth and fifth lumbar and sacral nerves
through the great sciatic and its branches.
Sensor Areas of Longer Extremity: In general, any
given cutaneous area receives sensor branches from the
nerve which supplies the subjacent muscle area. For ac-
curate diagnostic purposes a good chart of sensor distribu-
tion may be consulted.

DISEASES AND ADJUSTMENTS

The appended list includes the diseases with which the
profession has had experience but is not in any sense a
complete list of diseases. It is merely intended for quick
and handy reference. In obscure cases or diseases not
mentioned it is suggested that the practitioner carefully
diagnose the case with reference to the location of the mor-
bid process and then refer to Special Nerve Connections
to find the nerve pathway between the spine and the organ
indicated as the seat of the disease. Standard works on
anatomy and physiology will explain more fully the paths

and functions of the nerves but information gleaned from

them must be sought out and pieced together from scattered

statements and discussions.

17
258 Technic and Practice of Chiropractic

A
Disease Adjustment.
Abscess According to location.

Accommodative iridoplegia C 3 or 4.

Acid stomach D 6 or 7.

Acne D 11 or 12.

Acoria D 6 or 7.

Acromegaly C 1 or 2, D 10, 11, or 12.

Addison's disease D 10.

Adenitis According to location.

Adenoids of pharynx C 2 or 3.

Adiposis dolorosa D 8 and D 11 or 12.

Adrenals, tuberculosis of D 10.

Ageusia C 1 or 2.

Ague D 4, D 9, D 11 or 12.

Albuminuria D 10, 11, or 12.

Albumosuria D 8, D 10, 11 or 12.

Alcoholism C 1, D 10, 11 or 12.

Amenorrhoea L 4 or 5.

Amnesia C 1 or 2.

Amyosthenia General.
Amyloid liver D 4.

Amyloid kidney D 10, 11 or 12.

Anachlorhydria D 6 or 7.

Anaemia D 4, D 9 and D 11 or 12. Some-

times L 4.

Anaesthesia, general C 1 or 2.

Anasarca D 10, 11 or 12.

Aneurism D 1 or according to location.

Angina pectoris D 2.

Aniscoria C 4.

Anorexia nervosa C 1, D 6 or 7.

Anosmia C 1 or 2, C 4.
 Spino-organic Connection 259

Disease Adjustment.

Anthracosis D 3.

Anterior poliomyelitis C 3 or 4. local zones for perma-

nent paralyses following.
Anuria D 10, 11 or 12. Or L 2 or 4.

Aortic stenosis D 2.

Aphasia C 1 or 2.

Aphonia C 6.

Aphthous stomatitis C 2.

Apoplexy C 2, 3.

Appendicitis L 2.

Apraxia C 1 or 2.

Argyll-Robertson pupil C 1 or 2.

Arrhythmia C 2 or D 2.

Arteriosclerosis D 10, 11 or 12 and local.

Arteritis According to location.

Arthritis According to location.

Arthritis deformans D 10, 11 or 12 and according to

location.

Ascarides L 2 or 3.

Ascites D 4.

Asphyxia, gas D 2 or 3, Atlas (First aid only).

Asthenia To correct disease producing
same.
Asthenopia C 4.

Asthma D 1.

Ataxia, cerebellar C 1 or 2.

Ataxia, locomotor General adjustment.

Athetosis C 1 or 2.

Atrophic cirrhosis of liver D 4.

Atrophy According to location.

Aural discharges C 1, 2, 3 or 4.
260 Technic and Practice of Chiropractic

B
Disease Adjustment.

Back, pain in According to location.

Barber's itch C 5, D 10, 11 or 12.

Bell's palsy C 2, 3 or 4.

Biliousness D 4.

Blepharitis C 3 or 4.

Blepharospasm C 3 or 4.

Blindness C 1, 2, 3 or 4.

"Blood poisoning" D 10, 11 or 12 and local.

Boils D 10, 11 or 12 and according to
location.

Bradycardia D 1 or 2, possibly C 2.

Bright's disease D 10, 11 or 12.

Bronchitis D 1.

Bronchiectasis D 1.

Broncho-pneumonia D 1, D 3,

C
Caked breast D 3.

Calculi, cystic L 2 or 4.

Calculi, hepatic D 4.

Calculi, renal D 10, 11 or 12.

Cancer No cure.

Cancrum oris C 2 or 3, D 11 or 12.

Canker (mouth) C 2.

Carbuncle According to location.

Carcinoma No cure.

Caries of spine According to location. See "Prog-

nosis."

Cataract C 2, 3, or 4.

Catarrh, nasal C 4.

Catarrhal gastritis D 6 or 7.
 /

SpI NO-ORGANIC CONNECTION 261

Disease Adjustment.

Catarrhal stomatitis C 2 or 3.
Cerebral abscess C 1 or 2.
Cerebrospinal meningitis C 2.
Cervical glands, enlargement of.. Any cervical.

Cervico-brachial neuralgia C 6. '

Cerv'iconoccipital neuraligia C 1 or 2.
Chickenpox C 5, D 10, 11 or 12.

Chills D 5.

Chlorosis D 4, D 9, D 11 or 12.

Cholangitis D 4.

Cholecystitis D 4.

Cholelithiasis D 4.

Cholera infantum D 5 or 6. D 10, 11 or 12, L 2.

Chorea C 1 or 2.

Chyluria D 8, D 11 or 12.

Cirrhosis of liver D 4.

Claw hand C 6 or 7 or D 1.

Clubfoot L 4 or 5.

Colic, hepatic D 4.

Colic, renal D 10, 11 or 12.

Colitis L 2 or 3.

Collapse C 1, D 2, and according to asso-

ciated condition.

Coma According to cause.

Conjunctivitis C 3 or 4.

Constipation D 4, D 10, or L 3, 4 or 5.

Contractures According to location.

Coryza C 4.

Coxalgia L 4.

Cramp According to location.

Croup C 2 or C 6.
 .

262 Technic and Practice of Chiropractic

Disease Adjustment.

Cutaneous eruptions D 10, 11 or 12.

Cyanosis D 2, D 3 or C 2.

Cystitis L 2 or L 4.

D
Deafness, catarrhal C 4.

Deafness, central C 1 or 2 ( P)
Delirium C 1 ,or 2.

Dementia C 1.

Dengue D 5, D 10, 11 or 12 (P).

Dentition, disorders of D 6 or 7.

Diabetes insipidus D 10, 11 or 12.

Diabetes mellitus D 4, D 8, D 11 or 12.

Diarrhoea D 10, 11 or L 2, 3.

Dilatation of heart D 2.

Diphtheria C 2, C 6 and D 11 or 12.

Dipsomania C 1 or 2, D 11 or 12.

Dropsy, abdominal D 4.

Dropsy, cardiac D 2.

Dropsy, renal D 10, 11 or 12.

Duodenal ulcer D 8 or 9.

Duodenitis D 8 or 9.

Dysentery L 2, 3, or 4 and D 11 or 12.

Dysmenorrhoea L 4.

Dyspepsia D 7.

Dysphagia C 2 or D 6 or 7 (P).

Dyspnea D 1 or D 2 or D 3.

Dysuria L 2 or L 4 or sacrum.

E
Earache C 2 or C 4,

Ecchymoses D 11 or 12.
 Spino-organic Connection 263

Disease Adjustment.
Eczema D 11 or 12 and according to loca-
tion.

Embolism, cerebral C 2 or 3.

Emphysema D 3,

Encephalitis C 1, 2 or 3.

Endocarditis D 2.

Enlarged glands According to location.

Enlarged heart D 2.

Enlarged liver D 4.

Enlarged tonsils C 2 or 3.

Enteralgia D 9 or 10, or L 1 or 2.

Enteritis D 9 or 10, or L 1 or 2.

Enterocolitis D 9 or 10, L 1, 2 or 3.

Enteroptosis D 9, 10, 11 or L 1, 2, 3.
Enterospasm D 9 or 10, or L 1 or 2.
Enuresis L 2 or 4.

Epilepsy C 1 or 2, sometimes L 3.

Epistaxis C 4.

Epithelioma No cure.

Eructations D 6 or 7.

Eruptions, cutaneous D 11 or 12.

Erysipelas C 5 and D 11 or 12.

Exophthalmic goitre C 6 or 7.

F
Facial hemiatrophy C 1 or 2.

Facial paralysis C 1 or 2.

Faecal obstruction L 2, 3 or 4.

Fainting D 2.

False angina C 1 or 2.

Fatty degeneration of heart D 2.

Fatty degeneration of liver D 4.

264 Technic and Practice of Chiropractic

Disease Adjustment.

Fatty infiltration of heart D 2.

Fatty infiltration ,of liver D 4.

Felon C 6 or 7 or D 1.

Fever D 5. Locate organ of origin.

Fibroid tumor According to location.

Follicular tonsilitis C 2 or 3.

G
Gallstones D 4,

Gangrene According to location.

Gastralgia D 6 or 7.

Gastrectasia D 6 or 7.

Gastric neuroses D 6 or 7.

Gastric ulcer D 6 or 7.

Gastritis D 6 ,or 7.

Gastro-duodenitis D 7 or 8.

Gastroptosis D 6 or 7.

Gland, mammary D 3.

Glaucoma C 2 or 3.

Gleet L 3 and D 11 or 12.

Glossitis C 2 or 3.

Glycosuria D 4 and D 11 or 12.

Goitre C 6.

Gonorrhoea L 3.

Gonnorrhoeal rheumatism D 11 or 12 and L 3.

Gout D 11 or 12 and L 4.

Granulated lids C 4 and D 11 or 12.

H
Hay fever C 3 or 4.
Headache, anaemia To correct anaemia.
Headache, bilious D 4.
 Spino-organic Connection 265

Disease Adjustment.

Headache, neuralgic C 1.

Headache, neurasthenic C 1 or 2.

Headache, ocular C 2 or C 4.

Headache, of constipation D 4 or D 9 or 10, or L 4 or 5.

Headache, toxic Locate toxin-forming organ.

Headache, uterine L 4 or 5 or sacrum.

Hematemesis D 6 or 7.

Hematuria D 10, 11 or 12.

Hemicrania C 1, 2 or 3.

Hemiplegia C 2 or 3.

Hemoptysis D 3.

Hemorrhoids L 4 or 5 or sacrum.

Hepatic hyperemia D 4.

Hepatoptosis D 4.

Hernia, diaphragmatic C 4 (P).

Hernia, femoral L 4.

Hernia, inguinal L 2 or 3.

Hernia, umbilical D 8.

Herpes facialis C 4.

Herpes zoster (shingles) Vertebra above nerve involved.

Hiccough C 4.

Hodgkins' disease General adjustment.

Hydrocele D 10, 11 or 12 and L 4.

Hydrocephalus C 2 and D 2.

Hydronephrosis D 10, 11 or 12.

Hydropericardium D 2.

Hydrothorax D 3.

Hyperaemia According to location.

Hyperaesthesia, general C 1 or 2.

Hyperchlorhydria D 6 or 7.
266 Technic and Practice of Chiropractic

Disease Adjustment.
Hypertrophy According to location.

Hysteria C 2.

Hystero-epilepsy C 2.

Icterus D 4.

Icterus neonatorum D 4.

Ileocolitis L 2, 3 or 4.

Impacted gallstones in ducts . . . . D 4.

Impotence L 3 or sacrum.
Incontinence of urine L 2 or L 4.

Incompetency, aortic D 1 or 2.

Incompetency, mitral D 1 or 2.

Incompetency, pulmonary D 1 or 2.

Incompetency, pyloric D 6 or 7.

Incompetency, tricuspid D 1 or 2.

Infantile paralysis C 3 or 4 and according to loca-

tion.

Inflammation, general D 5.

Inflammation of appendix L 2.
Inflammation of bladder L 2 or 4.

Inflammation of bowels D 9 or 10, L 2, 3 or 4.

Inflammation of bronchi D 1.

Inflammation of kidneys D 11 or 12.

Inflammation of larynx C 6.

Inflammation of lungs D 3.

InflammatixDn of meninges C 1 or 2.

Inflammation of ovaries L 2 or 3.

Inflammation of pharynx C 2.

Inflammation of pleurae D 3.

Inflammation of stomach D 6 or 7.

Inflammation of vertebrae Next above inflamed one.

 Spino-organic Connection 267

Disease Adjustment.
Inflammation of uterus L 4 or 5.

Influenza C 4, D 1, D 11 or 12.

Intestinal neuralgia D 9 or 10, L 1 or 2.

Intestinal neuroses D 9 or 10, L 1 or 2.

Intestinal obstruction See "Practice."

Intussusception See "Practice."
Insanity C 1 ,or 2, sometimes L 4.

Insomnia C 2,

Iritis C 3 or 4.

J
Jaundice D 4.

K
Keratitis C 3 or 4.

Kyphosis See 'Curvatures."

L
Lactation, disorders of D 8.

Lacunar tonsilitis C 2 or 3.

La grippe C 4, D 1, D 11 or 12.

Laryngeal paralysis C 6.

Laryngismus stridulus C 6.

Laryngitis C 6.

Lateral spinal sclerosis According to location.

Lead poisoning D 4, D 11 or 12.

Leucaemia D 9 and D 11 or 12.

Leucorrhoea L 4.

Lipoma According to location.

Lobar pneumonia D 3.

Lockj aw C 1, 2, or 3.

Locomotor ataxia General adjustment.

268 Technic and Practice of Chiropractic

Disease Adjustment.

Lordosis See "Curvatures."

Lumbago L 3, 4 or 5.

Lumbo-abdominal neuralgia Any Lumbar.

M
Malaria D 4, D 9, and D 11 or 12.

Malignant endocarditis D 2 and D 5 or 6.

Mastoiditis C 1 or 2.

Measles C 5, D 11 or 12.

Memory, disorders of C 1 or 2.

Meniere's disease C 1 or 2.

Meningitis C 1 or 2.

Menorrhagia L 4.

Metrorrhagia L 4.

Migraine C 1, 2, or 3. ,

Mitral incompetency D 2.

Mitral stenosis D 2.

Monoplegia According to location.

Mouth breathing C 4 ,or 5.

Movable kidney D 11 or 12.

Mucous colic D 10 or L 3.

Mumps C 4.

Mutism C 1 or 2 or C 6.

Myelitis According to location.

Myocarditis D 2.

Myopia C 4.

Myositis ossificans According to location, also D 11

or 12.

Myxoedema C 6.
 Spino-organic Connection 269

N
Disease Adjustment.
Nephritis D 10, 11 or 12.

Nephrolithiasis D 10, 11 or 12.

Nephroptosis D 10, 11 or 12.

Neuralgia, trigeminal C 3 or 4.

Neuralgia, brachial C 6 or 7 or D 1.

Neuralgia, intercostal According to location.

Neuralgia, of feet L 4, L 5 or sacrum.

Neurasthenia C 2.

Neuritis According to location.

Nodding spasm C 1 or 2.

Nystagmus C 1, 2, 3 or 4 (P).

O
Obesity, pathological D 8 and D 11 or 12.

Obstructi£)n, intestinal See "Practice."

Oculomotor paralysis C 2 or 3.

Oedema According to location.

Optic atrophy C 3 or 4.

Optic neuritis C 3 or 4,

Orchitis L 3.

Otitis media C 4.

Ovarian disease L 2.

P
Pachymeningitis C 2,

Pallor D 2 or to correct anaemia.

Palpitation D 2 or C 2.

Pancreatic calculi D 8.

Pancreatic hemorrhage D 8.

Pancreatitis D 8.

Paralysis agitans C 1 or 2.
270 Tech NIC and Practice of Chiropractic

Disease Adjustment.

Paralysis, brachial C 6 or 7 or D 1.

Paralysis, crural L 4 lOr L 5.

Paralysis, facial C 1 or 2.

Paralysis, diplegic C 1 or 2.

Paralysis, hemiplegic C 1 or 2.

Paralysis, monoplegic According to location.

Paralysis, sensory According to location.

Parageusia C 1 or 2.

Paratyphoid fever L 2.

Parosmia C 2 or 3.

Parotitis C 4.

Pericarditis D 2.

Perihepatitis D 4.

Perinephric abscess D 10, 11 or 12.

Peritonitis D 9, 10 and L 2, 3 or 4.

Pertussis C 6, D 1.

Pharyngitis C 2 or 3.

Photophobia C 1 or 2 or C 4.

Plantar neuralgia L 4 or 5.

Pleurisy D 3.

Pleurodynia D 3.

Pneumonia D 3.

Priapism L 3 or sacrum.

Proctitis L 4 or 5.

Prolapsed kidney D 11 or 12.

Prolapsed uterus L 4 or 5.

Prostatic disease L 4 or 5 or sacrum.

Ptosis C 4.

Puerperal fever L 4, D 5, and D 11 or 12.

Pulmonary incompetence D 2.

Pulmonary phthisis D 3.
 Spino-organic Connection 271

Disease Adjustment.
Pulmonary stenosis D 2.

Pyelitis D 11 or 12.

Pyelonephrosis D 11 or 12.

Pyaemia D 5 or 6 and D 10, 11 or 12.

Q
Quinsy C 2 or 3.

R
Rabies C 1 or 2. D 10, 11 or 12.

Rachitis See "Adjustment of Curvatures."

Raynaud's disease C 6 or 7 or D 1, or L 4 or 5.

Rectal fistula L 4 or 5.

Rectal neuralgia L 4 or 5.

Relapsing fever D 5, D 9 and D 11 or 12.

Renal colic D 10, 11 or 12.

Retinal hemorrhage C 4.

Retinitis C 4.

Retropharyngeal abscess C 2 or 3.

Rheumatic fever D 5 or 6, D 11 or 12.

Rheumatism D 11 or 12 and according to loca-

tion.

Rhinitis C 4,

Roseola D 10, 11 or 12.

Rubella C 5, D 6, D 11 or 12.

Rubeola See "Measles."

S
Salivation C 2, 3 or 4.

Salpingitis (Eustachian) C 4.
Salpingitis (Fallopian) L 2.
Sarcoma No cure.
272 Technic and Practice of Chiropractic

Disease Adjustment.
Scarlatina C 5, D 6, D 11 or 12.

Scarlet fever C 5, D 6, D 11 or 12.

Sciatica L 4 or 5, ,or sacrum.

Sclerosis According to location.

Scoliosis See "Curvatures."

Scrofula D 11 or 12 and locally.

Seminal emissions L 3.

Septicaemia D 5, D 11 ,or 12, and for site of

entrance of toxins.
Smallpox C 5, D 5, D 10, 11 or 12.

Sneezing C 4.

Softening of brain C 2.

Spasm According to location.

Spermatorrhoea L 3.

Splanchnoptosis Caudad of D 5 according to pal-

pation.

Splenic enlargement D 9.

Splenitis D 9.

Splenoptosis D 9.

Spondylitis Deformans General adjustment.

Stenosis According to location.

Stomatitis C 2, 3 lOr 4.

Strabismus C 3 or 4.

Sudamina D 10, 11 or 12.

Sunstroke C 2, D 2, D 11 or 12.

Suppression of urine D 11 or 12.

Syncope D 2.

Syphilis, primary According to location of ulcer.

Syphilis, secondary D 5 or 6, D 11 or 12.

Syphilis, tertiary No cure.

 Spino-organic Connection 273

T
Disease Adjustment
Tabes dorsalis General adjustment.
Tapeworm D 8, 9 or 10, L 2 or 3.

Tenesmus L 4 or 5.

Tension, high arterial D 5.

Testicles, pendulous L 3.

Tetanus C 4, D 5, D 10, 11 or 12.

Thrush C 2 or 3.

Tic dolouroux C 3 or 4.

Tinnitus aurium C 1 or 2.

Tonsilitis C 2 or 3.

Toothache C 4.

Torticollis C 2, 3 or 4.

Toxaemia D 11 or 12 and local according to

indications.

Toxic gastritis D 6 or 7.

Tricuspid incompetency D 2.

Tricuspid stenosis D 2.

Trigeminal neuralgia C 3 or 4.

Tuberculosis of any organ See "Special Nerve Connections"

to organ diseased.
Tuberculosis, general D 5 or 6, D 11 or 12.

Tuberculosis, pulmonary D 3.

Tumor According to location.

Typhoid fever L 2.

Typhus fever D 5 and L 2 (P).

U
Ulceration According to location.
Ulnar neuritis D 1.

Ununited fracture According to location.

Uraemia D 10, 11 or 12.

18
274 Technic and Practice of Chiropractic

Disease Adjustment.
Urethritis L 3.

Urticaria D 10, 11 or 12.

Uterine catarrh L 4.

Uteroversion L 4.

V
Vaccinia D 5, D 10, 11 or 12 and for site of

inoculation.

Vaginitis L 3.

Valvular lesions D 2.
"
Varicella D 5 or 6, D 10, 11 or 12.

Varicocele L 3.

Varicose veins of lower extremi-

ties L 2, 3 or 4.

Variola Same as Smallpox.

Varioloid Same as Smallpox.

Vertigo C 1 or 2. Locally for toxic ver-

tigo.

Vomiting, pernicious D 6 or 7 or C 1.

W
Whooping-cough C 6, D 1.

Writer's Cramp C 6 or 7 or D 1.

Worms, stomach D 6 or 7.

Worms, intestinal Any Lumbar.

Wryneck C 2, 3 or 4.

X
Xerostomia C 2.

Y
Yellow fever D 4, D 6, D 10, 11 or 12 (P).
 Spino-organic Connection 275

CONCLUSION
The correct use of the foregoing table depends entirely

upon correct diagnosis. Knowledge of the vertebra to be

adjusted for the correction of any disease is useless unless

the disease be recognized when met. Diagnosis may be, and

usually is, aided by Palpation and Nerve-Tracing, which
may be considered as divisions of diagnosis since the sub-
luxation and the tender nerve are evidences (symptoms) of
disease. But these two divisions can never wholly take the
place of a complete diagnosis which calls to the aid of the
examiner every harmless method of ascertaining the patient's

condition. The part may not suffice for the whole.

The Chiropractor has an opportunity to become the best

of diagnosticians because he has at his command all the

usually taught methods and in addition Palpation and Nerve-

Tracing, which are especially useful in differential diagnosis.

(See ''Schedule of Examination.") The profession is at

present lamentably weak in diagnosis and as long as they

remain so they will fail to achieve the possible maximum of

results from the application of a theory which, per se, is

applicable to all disease but which is often imperfectly ap-

plied in practice.
 PRACTICE
Introduction

The ensuing section is intended rather more for the use

of the practitioner than for the guidance of the student but
may furnish the student a preconception which will prepare
him somewhat, before leaving college, to meet the problems
of practice.
Just as too frequently the young Chiropractor overlooks
the fundamental logic of Chiropractic which may be epitom-
ized with the terse command, ''Adjust the cause," and con-
siders his practice as requiring him to dabble in every sug-

gested or discovered method of treating effects, so, too fre-

quently, the young Chiropractor is prone to consider that

his practice consists solely of the adjustment of vertebrae,

that he practices a mechanic art rather than a profession too ;

frequently he overlooks the thousand details which lead to

and surround the adjustment and are essential to its success.

The practice of Chiropractic involves more than correct

technic. It includes the use of a vast fund of knowledge;
the constant study of diseases and of patients; the art of
controlling and directing others sometimes in their very
trivial acts. Successful practice requires a proper setting,
proper business methods, and a knowledge of psychology.
Anyone entering upon a profession assumes a great
moral responsibility and the greatest responsibility of all

276
 Practice 277

falls upon the doctor, of whatever school. He enters the

stricken home at a time when all members of the household

are off guard, as it were, at a time when all turn to him as
to one of higher knowledge and of greater power for their

guidance and often for their strength in affliction ; he becomes

the repository of their most sacred confidences. He who is

unable to meet this responsibility, to realize his influence and

his power and to prepare himself with care and conscienti-
ous training to acquit himself well, has mistaken his calHng.
He is unfit for his ministry.

The thorough student wrestles not alone with the technic

and the text-book branches necessary in practice but also

studies his profession from every possible standpoint, broad-

ening his field of usefulness wherever possible.
This section does not by any means contain all the infor-

mation not found elsewhere in this book but necessary to

the Chiropractor in his practice. It is intended merely to

suggest some of the many sides and phases of our work and
to open the way for a life study of humanity and of pro-
fessional life as a Chiropractor.

OFFICE EQUIPMENT
Value of First Appearance
The patient, upon first entering an office, consciously or

unconsciously forms an estimate of the personality and

standing in his profession of the occupant of that office.

This impression is gathered from the kind and arrangement

278 Tech NIC and Practice of Chiropractic

of the furniture and visible equipment, from the neatness or

disorder of the room, from countless little things which play

each their part in making up the whole appearance. This
first estimate is sometimes the only one, for an unfavorable
first impression may lead to the loss of a prospective patient.

In any case it will play a part in all subsequent judgments

which the patient may form concerning the Chiropractor and
his work.
Many patients entering our offices have no previous

knowledge of our profession ; their minds are open and

curious, alert for new impressions of some sort. We may
impress them as we choose. Every good business or pro-
fessional man realizes the value of the first impression and
strives for a good one. Therefore, upon entering practice,

choose for yourself every article which shall have a place in

your office. Your surroundings will then truly reflect your
personality and will attract those upon whom that personality
can work in harmony and understanding. It is of no avail

to attract the type of patients you cannot hold, to draw

through the borrowed judgment or taste of another sur-
roundings alien to yourself and thus to attract people who
will at once sense the incongruity and be repelled by it.

Yet one may aspire. And if you are able to perceive and
appreciate truly professional surroundings you may hope
to school yourself by association and study to harmonize with
them.
 Practice 279

Choice of Articles
In choosing the contents of your office keep in mind
good taste, utility, and the psychological effect upon all

visitors. Remember that you expect to spend many hours

each day in the company of your furniture, and select such
things as will contribute to a proper professional state of
mind in yourself. A Chiropractor's profession is in many
ways like, yet in many ways unlike, any other. Therefore
his office equipment, while following in general the equip-

ment of other professional offices, must be selected with an

eye to the special and particular needs of the Chiropractor
and his patients. Too little attention has been paid thus far

by the profession to the selection of office equipment.

Furniture in General

The furnishing of an office depends upon the amount

and disposition of the room at your command. One must
have at least a waiting room and a private office even if a

single rented room must be cheaply partitioned to make the

division. A larger suite is a better investment when pos-

sible. In the waiting-room should be found easy chairs,

library table, hall-rack, mirror, and an easy divan or couch.
The floor should be covered with a good rug or carpet and
the walls properly and cleanly decorated and hung with
restful, pleasant pictures. A book-case filled with carefully
selected books is a good addition.

On entering your private office the patient should see

your diploma, which hangs in full view of the entrance and
280 Technic and Practice of Chiropractic

which bespeaks with no weak voice your fitness to practice,

your professional ability. The importance of this point

cannot be overestimated. The intelligent visitor expects
you to have had careful training and to possess thorough
knowledge of your work. If he notes the diploma as evidence
of it and of your pride in your college he is assured.
If only two rooms are at your command the second must
be at once consulting room, adjusting room, dressing room.
As such it should contain your desk, desk chair, chairs for
the patient or patients, adjusting table or tables, towel
cabinet, lavatory, and a curtained recess for a dressing-table,
chair, and hooks for hanging clothing. On the wall hang
those charts from which it is at times necessary to explain

a part of the human mechanism to the inquirer.

This room should convey a two-fold impression —busi-
ness and professional. It should contain the special para-

phenalia of your profession and some of the suggestive con-

tents of the ordinary business office, such as desk, card-index

file typewriter, etc.

Let us consider these points more in detail.

Waiting Room
In your waiting room new patients wait and form their

estimate of you before your appearance. They are tired

patients, worn perhaps with years of disease, and their com-
fort must be considered. Some time is theirs for use in

some way and the use of their minds during the waiting in-

terval must be studied.

 Practice 281

For these reasons first of all the waiting room should

be furnished quietly, in perfect taste, but zvell furnished.

A good dark rug for the floor rather than matting or lino-

leum with their suggestion of bareness, a tinted or papered

wall done in a soothing shade, upholstered furniture pleasing

to the eye and comfortable for tired, weak bodies, and a
library table with proper literature for the occupation of

the mind — ^these are the proper furnishings for a waiting

room.
Let the table contain chiefly Chiropractic literature and
select that literature with care. Be sure that it reflects the

view-point toward your profession with which you wish

your patients to be impressed. It must be scientific, well

written, not sensational, not dealing coarsely or vulgarly

with the revolting diseases or features of disease, but quietly

convincing. Your literature must impress with the great-
ness of Chiropractic without setting forth extravagant claims
which your patients will expect you to vindicate. Your
selection of books for the book-case must convince all ob-
servers of your proper literary taste or the book-case had

better be omitted. Likewise the pictures on the walls must

suggest pleasant things, restful things, good to contem-
plate.

When possible secure a high-'ceilinged room with good

ventilation, plenty of fresh air without drafts. And then let

all the articles in the room harmonise. One jarring note in

form or color may mar the entire effect, which should be

that of comfortable simplicity.
283 Technic and Practice of Chiropractic

Private Office

Even more important than the contents of the waiting

room is the equipment of your private office. It is in this

room that your work is done. There your patients confide

to you their weaknesses there they determine
; finally whether
to trust themselves to your knowledge and skill ; in that

room they form their judgment as to your cleanHness, your

use of system; there they meet you.

Arrangement of Furniture

Every bit of furniture for the private office having been

carefully selected its arrangement should be studied.
When the patient first enters the private office he should

be able to see your diploma. He should also sit where he

can notice it as he consults you and every other object within
his vision during the consultation should be picked so as to

avoid attracting his attention to anything foreign to his

visit and its purpose.
Two chairs are placed near the desk, one an easy
chair for yourself, a revolving chair being preferable, and

a straight-backed leather-upholstered chair for the patient.

In placing these chairs be careful of two things: let the
strongest light shine over your own shoulder and bring the
face of the patient out in clear detail ; and let your own
chair be higher than the patient's so that he looks slightly

upward to meet your direct gaze. For the last mentioned

point there is a sound psychological reason ; to control any
dialogue with another person place yourself on a higher
 ;

Practice 283

level than he and unconsciously he will obey the suggestion

and lift his thought to meet yours, offering it rather than

commanding with it. The light is arranged for its value in

observing, as a matter of diagnosis, every indication in ex-
pression, gesture, and skin coloring.
Hanging back of the desk where it may be easily reached
but where its gruesome suggestion will not obtrude itself

upon the nerves of the sensitive without your deliberate in-

tention, have a vertebral column for demonstration purposes.

There are many times when it is necessary to show a sub-
luxation as it would occur.
Beside the desk and within easy reach of your hand
should be placed at least a single book-case section con-
taining those reference works which you frequently con-
sult. The contents of this section will be considered later
suffice now to say that they should be well bound and should
be so placed that if a doubtful point arise they can be con-
sulted at once without your rising. I am not of the opinion
that a pretension of unlimited knowledge is a valuable pro-

fessional asset. It seems better frankly to seek authorita-

tive information, even in the presence of the patient, than to

allow an error to creep into your work, and your more in-
telligent patients will appreciate your care. Furthermore,
this placing of your books is convenient when you are alone

and considering the cases which have passed before you

during the day. It tempts to study.
The desk should hold a typewriter, significant of business

methods, and a card file for case records. Incidentally, you

284 Tech NIC and Practice of Chiropractic

should have neat bill-heads and printed stationery for all

correspondence, though blank white paper is better than

over-ornate design or profuse coloring.

On the wall hang a few good anatomical and physiologi-
cal charts upon which may be pointed out certain facts for

the instruction of patients. It may be suggested that these

hang on racks so that the surface charts may be easily
changeable and that those ordinarily exposed to view be such
as will avoid unpleasant suggestion of any kind. For in-

stance, an X-Ray chart of the body showing the skeleton is

but one degree less repugnant to the average person than

the bones themselves. Though your college training has

robbed the subject of all emotion, for you, take thought for
the feeHngs of your visitors.

Adjusting Tables

For all purposes the best type of bench now on the mar-
ket is probably that composed of two sections, one fixed
and the other —the rear one — sliding on a track. Both
sections should be adjustable at various angles to the plane

of the base and some of the best tables are made so as to

permit changes in the distance from the floor to the entire
top or to any part of the top, a great advantage in that the
table height may thus be made to suit the height of the
adjuster.

An abdominal support is now indispensable but must be

so elastic as not to interfere with the adjustment. Leather
upholstery is more sanitary than plush and has come into
general use.
 Practice 285

An opening in the front section such that the face may

look downward through it and straighten the cervical and
upper dorsal spine for palpation and adjustment has been
proven a disadvantage instead of a help and will be entirely
unnecessary to one who follows the technic laid down in

this book.

The Roll

A desirable addition to this table is an upholstered roll

of quite solid material and about eight inches in diameter.

This can be placed under the patient's thighs on the rear
section, thus elevating the thighs and straightening the
Lumbar region so as to separate the spinous processes. The
roll is especially useful for the adjustment of posterior Lum-
bar subluxations, being inadvisable with rotation.
With a patient lying on the bifid bench in the ordinary

adjusting position the Lumbar spinous processes are crowded

together and the bodies separated. In rotation, since the
adjustment works by using a short power arm against a
long weight arm (distance from contact point to center of
rotation against distance from center of rotation to anterior
margin of body), and since the heaviest portion of the ver-
tebra —the body— is to be moved most, this position of sus-

pension secures the easiest adjustment. But if the vertebra

be posterior and a spinous process contact is used the best

adjustment can be secured over the roll or with a table ad-

justable to an angle equal to that which would be secured

with the roll.
286 Technic and Practice of Chiropractic

Cleanliness

Everything in the office should be kept scrupulously

clean. A lavatory with towel racks well filled with clean
towels is an absolute necessity. If no lavatory is inbuilt in

the office a portable one may be secured which will answer

every purpose. It will be well if the patient observes that
you carefully cleanse your hands before giving an adjust-
ment.
The office should contain a towel cabinet with a stack
of clean towels and a compartment for used towels. Or
tissue towels may be used to save laundry bills. Before
each adjustment a clean towel should be unfolded and placed
upon the front section of the bench so that the patient rests

head and face upon a perfectly clean surface. When the

adjustment is completed toss the towel into the used-towel

compartment. This use of towels minimizes the risk of
contagion or infection from a germ-infested upholstery,
suggests care and cleanliness to your patient, and gives the
patient greater trust in you.

Dressing-room

A curtained recess separated by a screen from the re-

mainder of the room will serve if no separate room is avail-

able for a dressing-room. It is better, if possible, to have a

separate dressing-room and better still to have separate

dressing-rooms for men and women. If extra rooms are

not at your command and you use a curtained recess be
sure that it contains good light, a dressing-table with mirror,
 Practice 287

a small chair, and hooks for clothing. Provide also a few

dressing-sacks for women though most of them will prefer

to furnish their own.

The Rest Room

It is a known fact that the patient who can be kept in a
quiet, restful, and relaxed state for some time following the
adjustment derives the greatest benefit therefrom. Having
loosened subluxated vertebrae by adjustment their tendency
is to settle in their old abnormal position and every move-
ment of the patient for a time aids this tendency. Quiet
permits adaptation of surrounding tissues to the changed
position of the vertebra; action facilitates the re-adaptation

of the vertebra to the state of surrounding tissues.

If possible a special room should be provided in which

patients may lie down in comfort for twenty or thirty min-
utes following an adjustment. If more than one patient at

a time is to rest, separate rooms should be provided for

men and women. The rest rooms should have high ceilings

and excellent ventilation without drafts. The floors should

be carpeted so as to soften footfalls and suggest quiet and

rest. Potted plants adorn such a room very well and always
afford a pleasant suggestion.
The patients lie on cots, foldable for convenience when
not in use, and should lie on their backs as quietly as possi-
ble. Some prefer solid cots on rollers so that the cot may be
noiselessly rolled beside the adjusting table after the adjust-

ment, the patient may by one turn move himself upon it, and
288 Technic and Practice of Chiropractic

it may then be gently rolled into the rest room. This is a

more finished, if more expensive, handling of the problem.
It may be well to furnish some occupation for the mind
and to this end, since reading in such a position is injurious

to the eyes, a good phonograph is a valuable addition. Equip

it with a soft parlor needle and select only soothing, restful
music. Just as you would avoid doing the walls of the rest
room in striking or garish colors, exciting to a diseased
mind, so avoid exciting or harsh music. The object of this
room is rest for mind and body. Let every thought be di-

rected to that end. With some patients the use of the

phonograph or other amusement must be avoided. Study

your cases with care.
The trip to the Chiropractor's office is too often regarded
in the light of an unpleasant necessity. If proper care be

used in equipping an office and if such means as have been

suggested for the rest room be employed, these in addition
to the pleasing personality of the Chiropractor may make
of the visit a pleasant thing, a part of the day to be antici-
pated with eagerness.

A Complete Suite

The number of rooms in a perfectly convenient suite

depends upon the approximate number of cases to be han-
dled daily. If it is needful to economize the practitioner's
time a greater number of rooms will be required than would
be desirable with a small practice.
A waiting room, a consulting room, two or more adjust-
 Practice 289

ing rooms, and two rest rooms make probably the best
number and employment of rooms. It is desirable if possi-

ble that the adjusting room be used for that purpose only

and that there be separate rooms for men and women. Each
adjusting room can then have its own dressing room or
recess. Or in addition to the other rooms named above
there may be many small rooms each containing an ad-
justing table and a rest cot and each serving as the rest
room after the adjustment. If a sufficient number be pro-
vided as many patients can be handled in this way as time

permits, the practitioner need lose no time at all, and each

patient may have a room entirely to himself throughout
his visit.

Reference Library

This should consist of those standard works to which

you will necessarily refer most often. Gray, Morris, or
other standard anatomical authority, Brubaker's or Halibur-
ton's physiology, Butler or Osier on diagnosis, Delafield
and Prudden on pathology, Morat on the physiology of the
nervous system, Bing on regional diagnosis of nerve lesions,

one or two good works on psychology, gynecology, histology,

etc., a good medical dictionary, and any books on Chiro-
practic in which you have confidence make up an excellent
list. Any standard works will suffice and this list is merely
suggested for those who may be uncertain as to their own
tastes. Always examine a book before buying it, even those
named above. Next to works on Chiropractic no single

19
290 Technic and Practice of Chiropractic

book is as necessary or useful as a good medical dictionary,

preferably a large and complete one.

Door Sign
Your door should bear a sign in gold or black, setting
forth your name and business and perhaps your office hours.
It may read, "W. R. Jones, Chiropractor," or, ''J^^^s &
Jones, Chiropractors," with office hours appended. Avoid
repetitions such as "Dr. W. R. Jones, Chiropractor," or
"W. R. Jones, D. C, Chiropractor."

Advertising

The word of a satisfied patient to his friend is the best

advertisement. Beyond this, considerable diversity of opin-
ion exists as to what constitutes proper, ethical, and wise

advertising. I shall make no attempt to settle this question

but shall simply suggest that while it is undoubtedly neces-
sary often to explain to the public through various avenues
what Chiropractic is and what it can do it is wise to be as
reserved and dignified as possible and to avoid offense to
any. Thus it is clearly unwise to advertise that your com-
petitor is a fraud, much wiser to convince your readers by
the logic and strength of your statements that you are not.
Consider good taste and avoid unpleasant references to
loathsome or vulgar diseases. Such advertising is associated
in the public mind with quackery, with patent medicines
and medical institutes, and no matter how sincere and right
your motives may be it will be misinterpreted by those you
wish to reach.
 Practice ^1
Consider also the legal side of advertising. Study the
laws of your state and avoid any statement which will con-

flict with the law. In some states it is illegal to advertise

with the term "Dr." unless you hold a medical license. In

others to advertise to "treat," "cure," or "heal" disease is

to jM-actice medicine technically. Such statements miss the

truth, in any case, because the Chiropractor administers an
adjustment and not a treatment and because Nature alone
can cure or heal.

Collection Cards

Different communities respond to different collection

methods. With one class of patients it may be better nerver
to mention fees except to answer inquiry and simply to sub-
mit monthly statements of account to all patients. With
another it is necessary to charge in advance. More Chiro-
practors use this method than any other and many use cards
for the purpose.

These cards are best printed with name, address, tele-

phone number, etc., on one side and on the other six or

twelve spaces ruled off at one end for punching to indicate

adjustments given, and the words, "Good for six (or twelve)
Chiropractic adjustments at (office) (residence) when
properly countersigned." A line should be left below for
your signature and at the bottom the price of the card

should be printed plainly. If desired a space may be left

for the patient's name so that the card may be made non-
transferable.
292 Technic and Practice of Chiropractic

The card is issued at the beginning of a course of ad-

justments and a dupHcate is kept on file. Each time the
patient is adjusted he presents his card before leaving and
one space is punched out. By this system both the patient
and the adjuster may know exactly the number of adjust-
ments given and accounts may be easily kept. Without it,

a book entry of some sort must be made for every adjust-

ment.
The best thing about this system is that it reminds the
patient that you expect to be paid in advance without the
necessity of your saying so, since the words "in advance"
follow the statement of price on the card. At the time of
payment you give him, as a receipt, a card entitling him to a
certain amount of your service at a stipulated place.

Schedule of Examination

This method of procedure for the investigation of new

cases is offered as a suggestion to be followed as far as the
education of the Chiropractor will permit. If every prac-

titioner adopts some such method of making his own diag-

noses he will advance in ability much more rapidly than by

accepting the diagnoses given his patients by physicians or

others. We should remember, though without arrogance,
that our special ability to discover subluxations and our
knowledge of their significance as the primary causes of dis-

ease renders us better prepared for correct diagnosis than

our medical friends, other education being equal.
It should be quite obvious that in attempting the ac-
 :

Practice 393

complishment of any object it is necessary first to have in

mind a clear preconception of the things to be accomplished,

and second, to have a clear and concise, yet complete, outUne

of the steps to be taken, their order or sequence, and their
relative importance in the accomplishment. These two
needs, as regards a Chiropractic diagnosis, we shall endeavor
to supply in this section.

Chiropractic Diagnosis properly consists of three parts.

Vertebral Palpation, Nerve-Tracing, and Symptomatology,
together with the reasoning necessary to properly weigh and
summarize the facts ascertained. Of these three divisions

two fall properly under the head of Physical Diagnosis and

the third, symptomatology, should consist principally of
physical diagnosis.
Everywhere the physical or objective sign is given pref-
erence over the subjective symptom. Before a single ques-
tion is asked of the patient relative to the case or its history,

every other means of obtaining information properly coming

under the head of a Chiropractic diagnosis should be utilized.

The questions should come last and be very few and direct.

They should serve only to illuminate the few remaining

doubtful points in the mind of the examiner, points which

perhaps exist only because of some fault or weakness in his

methods of examination.
The proper order of examination is as follows

1. General Observation.
2. Vertebral Palpation.
3. Nerve Tracing.
294 Technic and Practice of Chiropractic

4. Special Examination.
5. History of Case.
6. Summary.

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 tem-
perament, 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 examina-
tion 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
 Practice 295

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 obser-

vation and all other considerations for the time in favor of

Vertebral Palpation.

Vertebral Palpation

The primary object of Vertebral Palpation is the loca-

tion of subluxations, or partial displacements, and the de-

termination 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 seg-

ments you may safely eliminate those segments from con-

sideration and confine your further attention to the remain-
der. (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 posi-

296 Technic and Practice of Chiropractic

tive 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 tracea-

ble 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.
 Practice 297

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 con-

dition 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 dififerential diagnosis. Each
step in the process of examination helps to explain and
clarify the facts elicited by other steps until the facts mar-
shal 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 sub-
jective symptoms." If this be necessary, the examiner should
298 Technic and Practice of Chiropractic

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 defi-

nite 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 examina-

tion 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 distur-

bance, and the probable duration and outcome of the case

either with or without Chiropractic adjustments. In this
broader sense we use the term hereafter.
 Practice 299

The object of diagnosis is correct adjustment. Includ-

ing 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 con-

stantly 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 phys-

ical or objective signs throughout the body —the examina-
tion of the body for the discovery of all the changes in the

size, shape, position, etc., of organs which indicate dis-

ease. 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

300 Technic and Practice of Chiropractic

future should become, and probably will become, par ex-

cellence a physical diagnostician.

For many reasons we should be able to rely upon our

own diagnoses. Capability in diagnosis renders us inde-
pendent of the errors or false beliefs of others. Since it

includes a knowledge of subluxations, not included in med-

ical training but still vital to correct interpretation of mor-
bid 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 phy-
sician 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 re-

garding 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.,
 Practice 301

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 power-

less to aid and immediate recognition of such cases will save

much trouble. In intestinal obstruction from intussuscep-

tion or from strangulated hernia, for instance, it is best to

advise the calling of a surgeon immediately, while in ob-

struction from volvulus or intestinal paralysis the adjust-

ments 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 ab-
scess, 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.
302 Technic and Practice of Chiropractic

Frequency of Adjustments
The frequency of adjustments in practice should be
determined entirely by the nature of the case and the cir-

cumstances 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, pro-
viding 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 reac-
tive 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 length-

ened 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 adjust-

ment, even at first, and the demand on the body's recupera-
tive power may be greater than can be met.
 Practice 303

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 ''tol-

erance" 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 adjust-
ment 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 invol-

utionary change sets in before the next.

Specific vs. General Adjusting

By specific adjusting is meant the selection and adjust-

ment 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 exist-

ing and recognized for every vertebra adjusted.
 a

304 Tech NIC and Practice of Chiropractic

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 suc-
cessive 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 con-
siders only the condition of the spine and is given upon the
principle that if the spine is right the man is right —
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 Chiro-

practor 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 dan-
gerous disease than the more pronounced. Specific adjust-

ing tends to develop more discriminating and accurate

palpation.

Specific adjusting weakens and shocks the weak or

nervous patient less than general adjusting. It also con-

centrates 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.

 Practice 305

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 discrep-

ancy between theory and practice.

In favor of the practice of general adjusting it has been

said that errors in diagnosis become unimportant if all sub-
luxations be adjustted; 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 inay be
straightened completely. As a matter of fact this rarely,

if ever, occurs. It is practically impossible ever to thor-

oughly ''line up" a spine. The best that has been done as

yet except in acute subluxations is to so modify subluxa-

tions 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 com-

20
306 Technic and Practice of Chiropractic

pletely "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 exam-
ined 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 chief est 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 de-

termined corrective measure; and that guesswork will be

largely eliminated.

Talking Points

The things which it is most important that the Chiro-

practor should set before his patient are the theories and
 Practice 307

facts peculiar to Chiropractic, perhaps adduced by Chiro-

practic investig^ations 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 convinc-

ing than the display of a wealth of knowledge of methods
and theories used by other schools of practice. Chiroprac-
tic has been builded not by virtue of previously established
truths but solely on the vitality of the new principles enun-

ciated 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 intelli-

gence 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. Rea-

son 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.
308 Tech NIC and Practice of Chiropractic

Nevertheless in presenting Chiropractic we must be

gently positive. Chiropractic is known and provable. Al-
ways able to fall back upon the clinical test as a final argu-

ment with supreme assurance that it will not fail to vindi-

cate 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 Chiro-

practor an expression of his belief in his ability or inability
to cure them. They will desire a statement as to the prob-

able time required for a cure. They may even ask a guar-

antee of success.
These questions are hard to meet truthfully and convinc-
ingly, for the truth is that every Chiropractor fails some-
times 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 verte-

brae, 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 bear-
ing. You may assure him of the excellent results you have
obtained in other cases similar to his, or even cite indi-

vidual cases if to do so does not violate a professional con-

 Practice 309

fidence. But you had best avoid a promise to cure or an

exact statement of thie 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 Chiro-
practor 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 dis-

ease with which the patient usually approaches the Chiro-

practor 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 irrita-

tion 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 adjust-
ments making slight and gradual changes from the abnor-
mal back to normal.
310 Technic and Practice of Chiropractic

Thus it is that the subluxation passes back in reverse

order through the successive stages of its development, fol-

lowing a process which may be called the involution of the

subluxation. At the same time the morbid process result-

ing 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 unaccount-
ably return under the reawakening of the long dormant
nerves. Headache, long absent but once a prominent feat-

ure 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 pres-
ent, although in many cases they occur so rapidly or are
modified so much by changed environment as to be unrec-
ognizable. Inmany cases it is possible by securing an ac-
curate 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 dis-
ease. 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 de-

gree of subluxation, the fever may reappear during adjust-

ments, last a day or two, and disappear forever, having
been corrected beyond that stage.
If explained in advance to patients with chronic dis-

eases, the facts of retracing may not cause the patient to

 Practice 311

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. Chiro-
practors have used it to cover a multitude of errors in prac-
tice. 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 atten-
tion 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 unfav-
orable development always to examine our own work thor-
oughly 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.
313 Technic and Practice of Chiropractic

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 hav-
ing 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 adjust-
ment 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 vari-
 Practice 313

ous states should be modified to permit Chiropractors, with

precautions required of physicians to safeguard the pubHc

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.

S^-philis 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 correctible 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 Chiro-

practic 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 super-

ficial resemblance to Chropractic which leads many to
believe them closely related. Such methods are Spondylo-
therapy, Osteopathy, etc. There is a system called Napravit

or Naprapathy which may be dismissed with the statement

that it is Chiropractic, renamed.

Spondylothreapy, on the other hand, is a system of treat-

314 Tech NIC and Practice of Chiropractic

ing disease which takes no account of the vertebral sub-

luxation 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 intro-

duced 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 counter-

feiting 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 some-
times 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 medi-

cine 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
 ;

Practice 315

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 Chi-

ropractic? Or shall we adhere to the principle that the

treatment of desease 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 mas-
sage, 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 Chiro-

practic, 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 harm-

ful 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

^ /
316 Technic and Practice of Chiropractic

always unnecessary and always tend to lessen the good effect

of adjustments. The latter alone is beneficial but in combi-

nation 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 pre-
dicted. 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 free-
ing 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. now broader than the mere
Medicine is

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 demon-
 :

Practice 317

strated 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 resasons

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 Chiroprac-
tic 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 dis-
ease. 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. Fur-
thermore, the Chiropractor who knows that he can rely upon
318 Technic and Practice of Chiropractic

various other methods if his adjustment fails does not feel

impelled to study his Chiropractic as he should. He weak-

ens 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.
 Practice 319

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 w^hich his educa-

tion 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 responsibil-

ity 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
320 Technic and Practice of Chiropractic

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 pros-
perity.

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 stead-

iness 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 cheer-
ful 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

 Practice 321

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 bene-

fited, 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 competi-

tion 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 con-

tact 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, zvork at it not alone for the
acquisition of ever-increasing knowledge but for the unfold-
ment of a powerful and winning personality.
21
 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 Chiro-
practic 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 prog-
nosis 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 adjust-
ments, 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 accept-
ing the observations of others one must be sure that
they are sufficiently trained and sufficiently careful and
veracious to render their statements reliable.

322
 Chiropractic Prognosis 323

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. Xo statement is made without the gathering of

reliable evidence.

GENERAL PROGNOSIS
Abscesses. —Those abscesses which would tend to dis-
charge externally may be adjusted for with success and
will rapidly develop, point, and discharge, with quick
recovery. Those which might break internally abso-
lutely 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 con-
traindicate 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 par-
ticular. No final report received.
Alcoholism. —Adjustments greatly aid a cure if alcohol
324 Technic and Practice of Chiropractic

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 tu-

berculosis or other v^asting disease, disappears only w^ith
the occasion.

Anaemia. — If primary, yields slowly but surely. Sec-

ondary 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 adjust-

ment. 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 adjust-
ment and those are usually broken in time.

Anterior Poliomyelitis. — Chiropractic experience with

 Chiropractic Prognosis 325

''infantile paralysis" has been very extensive and grati-

fying. 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 restora-
tion of the motor function and trophic tone of the par-

alyzed 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 improve-
ment progresses to a complete cure.
Aphonia. — Prognosis excellent. No failures reported.

Apoplexy. —The occasional case in which a premoni-

tory partial paralysis precedes real hemorrhage responds
remarkably to adjustment so that with care the hemor-
rhage may be averted. After hemorrhage the absorp-
tion 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 im-
mediate 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.
326 Tfxhnic and Practice of Chiropractic

Ascites. — Fair prognosis, depending upon the nature

of the portal obstruction. Cirrhotic ascites does not yield
well.

Asthma. — Spasmodic bronchial asthma is almost al-

ways curable except in the very aged, but the usual

posterior curvature in lower cervicals and upper dorsals
requires time and persistent heavy adjustments for its

correction. The asthmatic paroxysm may be relieved

instantaneously, but will recur at intervals for a long
period before the cure is fully established. The cardiac
form of asthma depends upon restoration of compensa-
tion for a leaking valve, and yields by irregularly
progressive diminution.
Blindness. —As a condition, without qualifying terms,
blindness offers a bad prognosis. Most cases fail to
develop sight under adjustments. Yet some individual
cures in optic atrophy, in detached retina, and in other
conditions, attest the possibility. Cataract blindness per-
haps yields best.
Bradycardia. — If symptomatic, yields as does the dis-

ease. If primary, a few adjustments are usually suffi-

cient. In one case the first adjustment increased to 90

a pulse which had been at 60 for fifteen years. In twenty-
four hours^ without further adjustment, the rate had
settled at 69 and there remained.
Bright's Disease. — Prognosis good, but some cases
terminate abruptly with intercurrent disease, such as
pneumonia. There is danger until the albuminuria has
 Chiropractic Prognosis 327

ceased and the strength of the patient markedly im-

proved. Probably the diseased kidney area is simply
walled off from the healthy tissue, which then hyper-
trophies and takes on the work of the entire organ, or
pair of organs. If too much damage has been done, the
case will terminate fatally in time, even though its

progress is checked by adjustments.

Bronchitis. —Acute bronchitis is quickly checked as
a rule. Chronic bronchitis may prove intractable, or
may require many months for a cure. There are excep-
tional quick cures of the most chronic cases.

Caked Breast —Mammary Inflammations. — Rapid and

positive cure follows proper adjustments.
Cerebral Softening. — Prognosis bad.
Cerebrospinal Meningitis. — Serious always, but no
fatalities reported in adjusted cases. Failure to modify
fever and cervical retraction wdthin two or three hours,
and w^ith one to ten adjustments, is alarming.
Chickenpox. — Like smallpox and the other exanthe-
mata, chickenpox should be modified at once by adjust-
ment and all cases should be light, eruption hastened,
and fever quickly broken. Sometimes the rash may be
strongly marked and the disease run its usual course in
all particulars except fever and prostration, being a
febrile w^ith absence of all the consequences of fever.
Cholangitis.— Recovers quickly under adjustment.
Cholecystitis. — Prognosis excellent.
Chorea. — Prognosis excellent acute and subacute
in
328 Technic and Practice of Chiropractic

cases, less favorable in chronic. No figures are available,

but many chronic cases fail to respond at all.

Cirrhosis of Liver. —Doubtful. No statistics have

been compiled, but it seems probable that most cases are
unmodified by adjustment.
Congestion of Liver. — Prognosis good.
Conjunctivitis. — Readily curable, unless part of a more
general infection.
Constipation. — Prognosis usually good, but some cases
which have paralyzed the intestines w^ith drugs, or in
which atony of the intestinal muscles exists from any
cause, are very stubborn. One is led to believe that any
case of chronic constipation would respond to proper
adjustments in time, but sometimes the time is prolonged
more than seems reasonable.
Coryza. —Some cases respond instantly, others persist
and run their usual course. Chronic nasal catarrh re-

covers in favorable climates, and in unfavorable tends to

become permanent, though less severe and annoying
under adjustment.
Croup. —Always dangerous, but no fatalities reported
under adjustments, which are powerfully effective. Croup
requires constant attention until all symptoms subside,
usually within an hour or two.
Cystitis. —Usually curable, but some chronic cases
prove intractable for an unknown reason. There is no
way of recognizing the curability of a case before the

attempt.
 —

Chiropractic Prognosis 329

Deafness. —Variable outlook. Deafness due to catar-

rhal occlusion of the Eustachian tubes is usually curable.
That due to middle ear disease sometimes yields. That
due to nerve disease is possibly —though not certainly
incurable.
Diabetes Insipidus. — Prognosis excellent. Few cases
fail of cure, and no fatalities are reported.

Diabetes Mellitus. —Always necessitating grave and

careful consideration, this metabolic disease is marvel-
lously controlled by Chiropractic adjustment. Probably
90 per cent of all cases are curable, and only those pre-
senting impossible problems of adjustment, or those in
the very last stages, are hopeless.
Diarrhoea. — Prognosis depends largely upon sec-

ondary causes. Adjustments sometimes produce diar-

rhoea to cleanse the intestinal tract of waste or poisons.

Such a diarrhoea, if instituted by Nature without aid,

does not cease with adjustments until its purpose is ac-

complished. Nervous and infective diarrhoeas usually

respond well.
Dilatation of Heart. — Compensatory hypertrophy and
strengthening of the muscle usually follows adjustment.
Diphtheria. —Under adjustment the false membrane
tends to exfoliate and to be coughed out entire within a
few hours, with rapid recovery. In children, watch for
possible strangulation from loosened membrane. Con-
stant bedside attention is imperative until fever and mem-
brane have disappeared. Convalescence, unless antitoxin
330 Technic and Practice of Chiropractic

has been used, is very rapid, and physicians Watching the

cHnical course of diphtheria under adjustment customarily
doubt the diagnosis unless culture is made. Antitoxin
modifies the prognosis toward gravity, and in spite of
adjustments persistent sequelae often follow its use.

Dropsy. — Cardiac or renal dropsy disappears with

improvement in the diseased organ.

Dysentery. — In temperate climates death is extremely

unlikely. Recovery is often quick and easy, but some
cases persist. The tropical amoebic dysentery seems
hardest to master and may not improve at all.

Dyspepsia. — Prognosis good.

Endocarditis. — primary, recovery
If is the rule. Oc-
curring in the course of some other disease, as rheumatic
fever, it renders the prognosis less certain and may termi-

nate fatally. Likely to leave chronic valve weakness or

contraction.
Enteritis. — Prognosis generally fair. No figures

available.

Enuresis. —^The majority recover within a few weeks

or months, with occasional exceptions. Failure to get
results within a few weeks suggests a change of

adjustment.
Epilepsy. — Doubtful. Less than half of all cases re-
cover, and no case can be pronounced cured until all

symptoms have been absent for a year. Cases with an-

terior cervicals of¥er the poorest chance. It is usually
possible to restore consciousness and muscular control
 Chiropractic Prognosis 331

by an adjustment during the grande mal, in the instant

between the tonic and clonic spasms, but such immediate

response does not —unfortunately—always mean that a
cure will eventually be effected.
Epistaxis. — Nose-bleed usually stops at once follow-
ing proper adjustment.
Erysipelas. — Cases adjusted early show little spread-
ing of the eruption with but slight constitutional symp-
toms. After eruption is fully developed it is more diffi-

cult to keep down the fever and recovery is slower, but

none the less certain unless cardiac or other grave
weakness is present.
Exophthalmic Goitre. — Like other forms of goitre this
may be reduced, and with its reduction all other symp-
toms disappear. Many cures are on record.
Friedrich's Ataxia. —In hereditary cerebellar ataxia
(which is probably congenital, rather) cures are limited
to 40 per cent or less. History of instrumental delivery,
with marked upper cervical subluxation, argue for the
natal origin of the disease and increase the probability
of cure.
Gallstones. — Prognosis excellent. The calculi absorb
under adjustment by a reversal of the chemical process
by which their deposit was induced. When small they
may pass through the ducts and escape, with slight pain.
Adjustment during the painful passage of a gallstone may
act upon the duct so as to lessen greatly the pain and
hasten the passage.
332 Technic and Practice of Chiropractic

Gastralgia. — Like other gastric neuroses, is easily

curable but may sometimes require correction of a

neurotic diathesis, which means time.
Gastric Ulcer. —Usually recovers, but occasionally
leaves a fibrous cicatrix which cannot be affected by ad-
justment and which, if located at the pylorus, may pro-
duce stenosis, with consequent incurable dilatation of the
stomach. Operation is required for such a condition,
but the diagnosis is difficult, and it may be best to test
with adjustments for some time.
Gastritis. — Prognosis good. To prevent recurrence
adjustments should continue after symptoms subside.
Goitre. — Prognosis good. One large goitre under the
author's observation was reduced in one week so that the
neck measurement decreased one inch. Most cases re-

quire several months for complete reduction.

Gonorrhoea! Rheumatism. — More stubborn than other
forms of rheumatism and sometimes defies adjustment.
No percentages are available. It is probable that nothing
but a general cleansing of the system will prevent
recurrence.
Hay Fever. — Perhaps one-half of all adjusted cases
recover fully, some at once and some after several months.
By recovery is meant failure of the annual appearance of
the attack with no symptoms at any time. No case can
be pronounced cured in less than a year. The remaining
half are modified little or not at all.

Headache. — Nervous, bilious, ocular, and reflex head-

 Chiropractic Prognosis 33.')

aches yield well. Toxic headaches, or those accompany-

ing systemic infections, give way slowly with the cleansing
of the system.
Hemorrhoids. — Excellent, except when lower lumbars
are anterior and defy adjustment.
Hernia. —In all sites and forms of hernia, excepting

strangulated hernia, prognosis is good. Strangulation

requires immediate surgical interference. Prognosis is

better if a truss be used.

Hodgkins' Disease. — Prognosis theoretically good,
but the few cases under adjustment, while benefited, seem
to have died of intercurrent disease, so that it is well to

suspend judgment.
Hydrocele. —Theoretically hydrocele should respond
well, but in practice the author has seen several failures,

and no cures.
Hydrocephalus. — If due to cervical twisting at birth,

the prognosis is fair; otherwise bad.

Hypertrophy. —Adaptative hypertrophies, those due
to overstrain upon an organ, do not and should not dis-
appear until the strain has been relieved. Hypertrophy
is sometimes accelerated by adjustment, as in the case of

defective heart valves, when thickening of the wall re-

stores and maintains compensation. Other hypertrophies
tend to disappear under adjustment.
Hysteria. — Good, but slow. Some extreme cases re-

fuse to respond. Instant recovery from hysterical coma

is the rule following adjustment, but the coma tends to
recur.
334 Technic and Practice of Chiropractic

Immunity. —There is no doubt that adjustments often

confer immunity from infection and contagion, but it is

so difficult to strengthen every part of the body against

every possible infection or contagion, and so uncertain
that immunity really exists in a given case, that it is best

always to assume the possibility of contagion and act

accordingly. Adjustments following exposure to known
contagion are always wise, but one may never know, if

they succeed, that the patient might not have escaped

without them.
Impotence. —Variable outlook, according to secondary
causes and pathology. Previous venereal disease renders
the prognosis most doubtful. Nervous or vascular im-
potence is likely to respond well. If due to cord disease,
the prognosis is to be made on the original disease.
Influenza. — Mortality not more than 2 per cent, and
that in the very aged and infirm. Duration varies greatly.
May yield at once, first adjustment being followed by dis-

appearance of fever, profuse perspiration, and completed

convalescence in from twenty-four to forty-eight hours;
or may require several adjustments at frequent intervals
to break fever.
Insanity. — No accurate tabulation of results in dif-

ferent forms of insanity has been made. Numerous

successes, interspersed with fewer failures, have been re-
ported. The author has both succeeded and failed with
acute dementia, but the failure was a twenty-four-hour
trial only, and included but three adjustments.
 Chiropractic Prognosis 335

Intestinal Obstruction. —The prognosis of intestinal

obstruction from intussusception or strangulated hernia
is, under Chiropractic, bad. Such cases are almost surely
fatal unless operated. Faecal obstructions or masses of
worms, also volvulus, respond quickly and prognosis is

good. Careful diagnosis is required before taking a case

of apparent complete obstruction.
Irritable Heart. — If purely nervous, recovery is quick
and easy. If there is a drug diathesis or organic disease,
slow and doubtful.
Jaundice. —Yields readily, but if of the obstructive

form the obstruction must first be reduced or removed by

adjustments.
Laryngitis. —A few adjustments suffice for simple
acute cases. Specific laryngeal infections are more diffi-

cult. Laryngitis with ulceration, which is either syphi-

litic or tubercular, may not recover or may recover after

a protracted struggle. Chronic laryngitis of other forms
is curable, but requires more time than acute.

Leucorrhoea. — Fair prognosis only.

—
Lumbago. Good, unless pain prevents proper adjust-
ment. True lumbago is quick to respond.
Malaria. —Tenacity varies according to climatic con-
ditions. Malarial cachexia always yields slowly, some-
times defies adjustment altogether. No reports are to be
had on pernicious malaria. Other forms recover though
paroxysms tend to recur several times before checked, but
of shorter duration than if no adjustment is given.
 —

336 Technic and Practice of Chiropractic

Mastoiditis. — Good results in the few cases observed.

Measles. — Excellent. Recovers quickly. Eruption
hastened by early adjustment, runs very mild course with
little or no fever, catarrhal symptoms disappear early.

No sequelae.
Meniere's Disease. — Labyrinthine disease of this char-
acter has been cured, without reported failures, but data
is meagre, not more than three or four cases having come
under the author's notice.
Menorrhagia — Metrorrhagia.— Results excellent, and
usually quick. One fifty-two-hour intermenstrual hemor-
rhage from uterus was stopped in one hour by adjustment,
with no recurrence.
Migraine. — Migraine, or hemicrania, gives a fair prog-
nosis only. Most cases require a long course of adjust-
ments.
Movable Kidney. —Prognosis good, but change of posi-
tion and complete fixation slow. No treatment required
merely adjustment.
Myelitis. —Transverse myelitis, if adjusted in the acute
stage, may be checked as any other inflammation, and
the damage and resulting paralysis will be greatly
lessened or altogether prevented. The paralyses which
follow myelitis require time for the rebuilding of the
degenerated axons whose course is interrupted at the
diseased area, but tend to recover.
Myocarditis. — Reports conflict. It is well to con-
sider this a grave condition and one open to investigation.
 Chiropractic Prognosis 337

Myxoedema. —Only one case known to have been

under adjustment, and this after several years v^as
markedly improved, but not yet quite cured.
Nephritis. — Prognosis good. Acute cases show rapid,

chronic cases slow, improvement.

Neuralgia. — Prognosis excellent in any form. Trophic
neuralgias, such as herpes zoster, are slowest as a rule,
but occasional cases of tic doloureux will require several
months. One may always expect a cure unless the
patient, in long cases, becomes discouraged and stops
adjustments.
Neurasthenia. — Good, but will be slow unless mental
aid be given in the form of freedom from worry or strain.

Neuritis. — Good, but very uncertain as to time ; some

cases show quick disappearance of all pain and some
drag interminably.
Optic Atrophy. — Complete atrophy with total blind-
ness is rarely cured, though occasional partial or com-
plete cures have been reported. Partial atrophy may
slowly recover, or recovery may cease at some point short
of completion and case remain stationary thereafter.

Ovaritis. — Good, except in suppurative forms. When

adhesions have been formed, results are doubtful.
Pancreatitis. — Obscure, hard to recognize, and hard to
cure. Prognosis probably bad.
Paralysis Agitans. — Probably in the earliest stages
this is curable. Cure of a fully developed case is exceed-
ingly doubtful and the writer has yet to see marked benefit

in such a case.
22
338 Technic and Practice of Chiropractic

Paralyses. — Prognosis decidedly variable. Apoplectic

hemorrhage recovers in about 50 per cent of all cases.

Paralyses from central lesions require much more time

than peripheral palsies because of the necessity for re-

building degenerated nerve cells as well as fibres. The

paralyses following anterior poliomyelitis are almost cer-
tain to be cured if sufficient time is allowed. Most
peripheral palsies, except in the very aged, are curable.
Any other paralysis but a purely functional one recovers
slowly, but this form may yield almost in a day.
Parotitis. — Mumps respond immediately and may be
checked at any stage.
Pericarditis. —Usually recovers. Effusions are stub-
born and may become purulent, in which case the
prognosis is grave.
Peritonitis. — Prognosis grave, but some cases have
been reported as cured under adjustment. These are
probably localized rather than diffuse inflammations,
usually pelvic.
Pertussis, or Whooping-Cough. —Tends to run its

course despite adjustments, though some aborted cases

are reported. All cases mild under adjustment, with
small liability of complications. A nervous cough is

likely to persist for months after the infection has passed.

Adjustments seem seldom to prevent contagion.

Pharyngitis. —Acute form yields readily. Chronic
pharyngitis is more stubborn, but usually curable.
Pleurisy. — Pleurisy, unless purulent or tubercular,
 Chiropractic Prognosis 339

yields well in varying periods. Purulent and tubercular

pleurisy are stubborn and may not recover.
Pneumonia. —The author has had a wide and grati-
fying experience with pneumonia. At every stage it

seems amenable to adjustment, and the usual effect of

the first adjustment is a drop of from one to two degrees

in the temperature with immediate softening of the con-
solidated area. Specific adjustments get best and quickest
results. Pneumonia should always recover, unless it

occurs as an intercurrent event in some chronic and

wasting disease, as Bright's Disease,
Potts' Disease. —Tubercular caries of the bodies of the
vertebrae is curable, within limits. Occasional cases are
seen in which Nature has stopped the spread of the dis-
ease by walling off the morbid area with exostosis. Such
cases should not be adjusted, and the disease may remain
latent through a long life. When active the disease
proves fatal unless checked, which is possible in the
earlier stages, and becomes impossible when the vertebral
bodies are too fragile to stand strong adjustments. Dis-
cernment in case-taking will avoid any fatalities under
adjustment, but by no means all cases of Potts' Disease
are curable.
Pregnancy. —We may correct by adjustment any
pathological conditions arising during pregnancy which
would be amenable to adjustment under other conditions.
A course of adjustments during a normal pregnancy will
render delivery easier and lessen, but not abolish, the
340 Technic and Practice of Chiropractic

pains. Great care must be exercised in the manner of

adjustment.
Prostatic Enlargement. —Varies according to age and
recuperative power. Prognosis is bad in the very aged
and infirm, but in more vigorous subjects quite good for

steady reduction of the hypertrophied gland, with sub-

sidence of attendant symptoms. Venereal history is

unfavorable.
Pulmonary Tuberculosis. — In the early stages, where
little damage has been done to lung tissue, recovery is

rapid and quite certain. In fully developed cases, with

characteristic symptoms and marked damage to tissue,
prognosis is very grave, and it is usually wisest to advise
a trip to the Southwest in preference to adjustments.
Tubercular cases should be studied with a view to esti-

mating the exact condition and recuperative power of the

patient before taking.

Rachitis. — Prognosis excellent. In a period varying
from six months in the best to five to seven years in the
slowest cases, all show complete or nearly complete cures.
All deformity may be checked in a short time and proper
bone nourishment established. Correction of deformities
existing prior to adjustment is a growth process. Too
many cases become discouraged at the slowness of the
work and stop adjustments.
Retinal Hemorrhage. — Prognosis fair. Undoubted
cures have been recorded, as well as a few failures. At
least one case of hemorrhages followed by partially de-
tached retina has been cured, or nearly so, by adjustments.
 Chiropractic Prognosis 341

Rheumatic Fever. —Hard to adjust because of its pain-

ful nature. Results of proper adjustment usually, but not
always, good.
Rheumatism. — Muscular rheumatism yields more
rapidly than articular. Acute tends to quick recovery,

chronic to more or less lengthened and slow improvement.

Rheumatic diathesis may require many months of careful

adjustment.
Rubella. —Simply and easily checked. Rash slight,

and no prostration at all.

Scarlet Fever. — Data on quarantinable cases is meagre,

but scarlet fever, od scarlatina, seems to be quickly
modified by adjustment. One may expect a drop of from
one to two degrees in temperature after first adjust-
ment, followed by steady rise, which will again be checked
by the next adjustment. Rash appears early, and all

symptoms are mild, but several days are often required

to put the patient at ease. Occasional sequelae, such as
endocarditis, otitis media, or other inflammations, occur
unless case be watched with great care. No fatal termi-

nations under adjustment except in cases which were at

first misdiagnosed.
Seminal Emissions. — Prognosis excellent in cases un-
complicated by masturbation or excessive venery in such ;

cases bad until habits are changed.

Simple Continued Fever. —Always recovers. Usually
drops one to two degrees shortly following correct ad-
justment, with amelioration of all symptoms.
 —

342 Technic and Practice of Chiropractic

Smallpox. — Infections vary in virulence. In tem-

perate climates all phases are hastened by adjustment and
tend to recover without sequelae. The milder smallpox
due to infection by vaccination is also amenable to ad-

justment, and prompt handling will often prevent serious

poisoning.
Splanchnoptosis. — Partial or marked relief is usual
and slow. Complete natural replacement of all viscera is

the exception rather than the rule.

Splenic Enlargement. —Variable prognosis according
to cause. Secondary enlargements due to systematic
infection yield with the disappearance of the infection.
Primary enlargements yield more readily as a rule, with
exceptions. Malarial spleen is slow to reduce.
Splenitis. — Prognosis presumably good, but few au-
thentic cases reported.

Spondylitis Deformans. — Prognosis favorable for slow,

slight improvement, but not for complete cure.
Strabismus. — Excellent in young subjects, less than
fair in patients over thirty.
Sunstroke. — Theoretically curable, but no experience.
Syphilis. — The primary sore frequently dries under
adjustment without the development of any secondary
or tertiary stage. If first adjusted during the secondary
manifestations symptoms may readily disappear and no
tertiary stage ever appear. There are some authenticated
cures eight and ten years past without recurrence of any
sign. In the tertiary stage the organic lesions do not
 Chiropractic Prognosis 343

respond. Prognosis is so hopeless in this stage that it

seems useless to apply Chiropractic at all.

Tabes Dorsalis. — Posterior spinal sclerosis, commonly

called from its chief symptom "locomotor ataxia," re-

covers in 40 to 50 per cent of cases adjusted. No accu-

rate pre-judgment can be formed as to the probabilities
in any particular case without experiment, nor has any
adequate explanation been offered as to why some cases
recover and others do not. Those cases w^hich improve
at all are likely to recover fully. In any instance, time
is required for the regeneration of the dorsal column
axons, and while this is going on no improvement may
be apparent at all.

Tachycardia. — If symptomatic, as of exophthalmic

goitre, tachycardia yields as the disease does. If primary,
a few adjustments usually establish a proper pulse rate.
Tetanus. —Only one undoubted case has been brought
to the writer's attention and this one a marvellous cure.
Adjustments were given as often as every ten minutes
for a time.

Thoracic Aneurism. — Cure exceedingly doubtful, and

fatal termination possible at any time. Little informa-
tion is at hand.

Tonsilitis — Quinsy. — Simple or follicular tonsilitis

aborts under adjustment in from a few hours to two or

three days. Quinsy, or suppurative tonsilitis, runs its

regular course as to duration, but is frequently a febrile

after the first day. Spontaneous rupture of the tonsil
344 Technic and Practice of Chiropractic

will usually occur and sometimes two or three such rup-

tures will lengthen the case slightly. Sequalae are want-
ing, but all forms of tonsilar inflammation tend to recur
unless a long course of corrective adjustments is applied
to the cervical region.
Torticollis. —Acute spastic or rheumatic torticollis in
which permanent contractures have not yet set in may
be cured almost invariably in a period varying from a
few days to several weeks. Chronic cases with perma-
nent contractures yield very slowly, but prognosis is good
for a fairly accurate straightening of the neck. Such
cases often leave slight abnormalities even in the most
competent hands.
Tuberculosis, Pulmonary. — See Pulmonary Tubercu-
losis.

Tumors, Benign. —Unlike malignant growths, benign

tumors, fatty, fibroid, etc., tend to gradual absorption
under adjustment. Perhaps 75 per cent or more may be
completely cured. Age is a factor, tumors in young sub-
jects being more readily curable than in the aged or
infirm.

Tunlors, Malignant. — Prognosis bad. If cancer in

any form can be cured proof has escaped the author's
diligent search. It is wisest to refuse all cancerous cases.
Typhoid Fever. — Prognosis excellent if adjustments
are commenced during first week of fever, in which case
the fever should be aborted at once, followed by one or
two mild exacerbations, then permanently checked.
 Chiropractic Prognosis 345

Doubtful prognosis after first week, because of liability

to perforation during adjustment. After second week of

fever very grave prognosis under adjustment, and better
with nursing alone.
Uteroversion —Prolapsus.—Uteroversions and pro-

lapses are corrected, sometimes rapidly but more often

slowly and gradually. Favoring circumstances are free-

dom from overwork or overlifting. Some extreme cases

result in failure.

Valvular Diseases. —These may be grouped for prog-

nosis. No percentages have been compiled, but it may
be said that the prognosis is generally good as to relief
and restoration of compensation, but poor as to rebuild-
ing of the valves. Many cases of apparent permanent
and complete recovery are probably simply cases of ex-

cellent compensation. Death occasionally occurs despite

adjustments.
Varicocele. — Outlook good for a slow, certain re-

covery.
Varicose Veins. — Probability favors cure in subjects
not beyond middle life, providing they are not greatly
overweight or too much on their feet. Cure always slow.
 INDEX
A Page Page
Abdominal muscles 248 Aorta, abdominal 250
Abscesses 323 thoracic 250
Acne 323 Aphonia 325
Adenoids of phamyx 323 Apoplexy 325
Addison's disease 323 Appendicitis 325
Adiposis dolorosa 323 Appendix, vermiform 253
Adjuncts 215 Approximation, vertebral 82
Adjuncts, use of 315 Arm, anterior muscles of 255
Adjusting, contact in 94 posterior muscles of 255
89 Arteria centralis retinae 243
definition of
general 303 Arthritis deformans 325
Ascites 326
how to learn 164
principles of 89 Asthma 326
rapid movement in 93 Atlanto-occipital move 106
specific 303 Atlas 18
special technic of 99 Atlas move 106
speed in 131 Atlas palpation 35
technic of 89 Axis 19
Adjusting position, rules for. 127
.
Axis of body 223
Adjusting tables 284
Adjustment, effect of 186, 189
B
object of 90 Back, muscles of 247
specific 230 Bag punching 97
vertebral 89 Bent process 59
Adjustment of curvatures ... 153 Blindness 326
Adjustments, coccygeal 152 Bodily excesses 200
frequency of 302 Body axis 223
iliac 150 Brachial plexus 225, 236
sacral 150 Bradycardia 326
table of for any subluxa- Brain 242
tion 156 Break move, the 107, 109, 110
Bright's disease 326
Advertising 290
Bronchi 249
Age of subluxations 84
Bronchitis 327
Alcoholism 323
Bladder 253
Amenorrhoea 324
Anatomy, comparative 226
nervous 234 C
Anchor move 116, 118 Caecum 253
Angina pectoris 324 Caked Breast 327
Anidroses 324 Cards for collection 291
Ankylosis 58, 88, 324 Caries of spine 56, 154
Anosmia 324 Case history 297
Anterior cervical move 102, 103 Causes, accessory chains of... 177
pisiform 100 direct chain of 177
Anterior fifth lumbar 150 Cause of disease 165, 167
Anterior poliomyelitis 324 Cause of disease, primary 207
Anterior subluxations 84 Cause of disease, secondary . 185

346
 Index 347

Page Page
Cell, effect of impingement Diarrhoea 329
upon 183 Diet 192, 193
Center place 206 Dietetics 315
Cerebrospinal meningitis 327 Dilatation of heart 329
Cervical move, double contact 120 Diphtheria 187, 190, 329
Cervical move, posterior 119 Direction of subluxation 25
Cervical plexus 238 Disease, cause of 165
Chassaignac's tubercle 61 functional 166
Chickenpox 327 organic 166
Chiropractice hypothesis 172 Diseases and adjustments.... 257
Chiropractic, limitations of 312 table of 258
Choice of furnishings 178 Displacements 84
Cholangitis 327 Door sign 290
Cholecystitis 327 Double contact move 120
Chorea 327 Double transverse moves
Christian Science 216, 315 135, 138, 139, 148
Cirrhosis of liver 328 Dressing room 286
Cleanliness 286 Dropsy 330
Coccyx 17, 19, 45, 152 Drugs 315
Coeliac axis 250 Duodenum 252
Collection cards 291 Dysentery 330
Colon 253 Dyspepsia 330
Comparative anatomy 226
Concussion of forces.. 178, 224, 226
Congestion of liver 328
Conjunctiva 243 E
Conjunctivitis 328 Ear 245
Contact, close 94 Edge contact, the 144
Contact point 129 Effect of adjustment 188, 189
Constipation 328 Effect of subluxations 79
Coryza 328 Elbow joint 255
Count 30, 33 Electricity 216, 315
difficulties in 34 Enuresis 330
verifying 33 Epidemics 189
Cranial nerves, distribution of 240 Epilepsy 330
Croup 328 Epiphysis, absent 60
Cure of bodily excess disease 214 Epistaxis 331
dietetic disease 212 Erysipelas 331
germ disease 211 Eustachian tube 245
exposure disease 214 Evidence, kinds of acceptable 234
mental disease 212 Examination, schedule of 292
poisoning cases 213 special 296
simple subluxation disease 208
Excesses, bodily 200
process of 208 Excitation *
162
Curvatures 153 Exposure 198
causes of 55
Eye 242
compensatory 57
description of 54
record of 56
rotatory 55
F
Curves and curvatures 53 Fallopian tubes 254
Fasting 215
Fear 201
D Fees 291
Deafness 329 Fever 205
Diabetes insipidus 329 Fever center 206
mellitus 329 Fibrocartilages, intervertebral 83
Diagnosis 231, 275, 298 First appearance, value of 277
Diaphragm 248 Foods 194
348 Index

Page Page
Foot 257 Hypertrophy 333
Force in adjusting 98 Hypothesis, chiropractic 172
Freidrich's ataxia 331 Hysteria 333
Frequency of adjustments 302
Furniture, arrangement of 282
office 278 Ileum 252
Iliac adjustments 150
G Ilium 150
Gallstones 331 Immunity 334
Ganglion, ciliary 243 Impingement of nerves 180, 209
Gasserian 244 Impotence 334
middle cervical 247 Individual subluxation 40
sphenopalatine 244, 246 Infection 186
superior cervical 244, 246 Inflammation 202
Gastralgia 332 Influenza 334
Gastric ulcer 332 Inhibition 169, 182, 189
Gastritis 332 Insanity 201, 334
General adjusting 303 Interiliac line 34, 62
Germ diseases 185 Intervertebral disks 83
Germs 185 Intervertebral foramina 18
pathogenic 185 Intestinal obstruction 335
Gland, thyroid 247 Iris 243
prostate 253 Irritable heart 335
Glands, salivary 246 Irritability 169
suprarenal 252
Gluteus maximus muscle 256 J
Goitre 332 Jaundice 335
Gonorrhoeal rheumatism 332 Jejunum 252
Group method, the 37
example of 39 K
Gums 245 Key 39
Kidneys 252
H Klebs-Loeffler bacillus 187
Habits 15 Knee joint 256
Hay fever 332 Knife move 144
Headache 332 Kyphosis 54
Heart 249
Heat-regulating mechanism.. 203 L
Heel contact, the 133 Landmarks 61
Hemorrhoids 333 Laryngitis 335
Hernia 333 Larynx 246
Hip joint 255 Last finger contact 102
History of case 297 Lateral cervical move 107, 109, 110
Hodgkins' disease 333 Lateral displacements 84
Hook support 105 Law of momentum 98
Hydrocephalus 333 Leg, anterior muscles of 256
Hydrotherapy 315 posterior muscles of 256
Hyperaemia 202 Leucorrhoea 335
 Index 349

Page Page
Library, reference 289 Nerve, auditory 245
Limitations of Chiropractic... 212 chorda tympani 246
Liver 251 great sciatic 256
Location of subluxations 78 hypoglossal 245
Lordosis 54, 85 inferior maxillary 244
Lumbago 335 internal carotid 242
Lumbar, anterior 150 olfactory 243
Lumbar plexus 239 phrenic 248
Lungs 249 recurrent laryngeal 246
trigeminal (trifacial) 244
M Vidian 244
Maladjustment 89 Nerve connections, special 235
Malaria 335 Nerve impingement. .180, 182,
. 209
Major subluxations 39 Nerve paths 70
Massage 215, 315 Nerve pathways, important... 242
Mastoiditis 336 structure of 241
Measles 336 Nerves, cranial 240
Meckel's ganglion 244 optic 242
Mechano-therapy 315 spinal 237
splanchnic 250
Medicine 315, 316
Meniere's disease 336 sympathetic 240
traceable 64
Meninges 242
Menorrhagia 336 Nerve system 171, 222
Mental attitude 63 development of 219, 220
outline of 235
Mental states, abnormal 201
sympathetic 171
Metrorrhagia 836
Migraine 336 Nerve-tracing 64, 296
errors in 73
Minor subluxations 39
Mixing 315 place of in diagnosis 67

Morikubo move 99 suggestion in 67

Motor reaction 193, 196, 199

technic of 68

Movable kidney 336 Neuralgia 337

Movement for correction 27 Neurasthenia 337
Neuritis 337
Muscles of abdomen 244
of back 247 Neurology 234
of neck 247 Neuron 220
of perineum 249
Muscular control 97
O
Muscular suggestion 96 Observation of patient 294
Myelitis 336 Occipital subluxations 66
Myocarditis 336 Occipito-atlantal move 106
Myxoedema 337 Occlusion of foramina 180
Ofhce equipment 277
N Optic atrophy 337
Naprapathy 313 Optic nerve 242
Napravit 313 Oral suggestion 95
Neck, muscles of 247 Organs, effect of impingement
Nephritis 337 upon 183
350 Index

Page Page
Organ-tracing 64 Plexus, gastric 251
Osteopathy 216, 313, 314, 315 hemorrhoidal 253
Ovaries 254 hepatic 251. 252
Ovaritis 337 h^Togastric 253
Overadjustment 303 inferior mesenteric 253
lumbar 239
lumbosacral 255
Meissner's 251
ovarian 254
pelvic 253
Palpation, atlas 35
pharyngeal 246
cervical 42, 47,48
phrenic 248
coccygeal 45
prostatic 253
difficulties in 59
pudendal 239, 254
dorsal 43, 46
pulmonary 249
habits of 15
renal 252
lumbar 44, 46
sacral 239, 254
pelvic 44
44 solar 250
sacral
spermatic 253, 254
transverse 49
splenic 251
vertebral 15, 295
Pancreas 251 superior mesenteric. .. .251, 252

Paralysis agitans 337 suprarenal 252

Parotitis 338 uterovaginal 254
Pectoralis muscles 254 vesical 253
Penis 253 Pneumonia 339
Pericarditis 338 Point 2 contact 144
Pericardium 249 Poisons 197
Perineal muscles 249
Position A 22
Peritoneum 252
Position B 23
Peritonitis 338
Position C 23
Personality 319
Positions for palpation 30
Pertussis 338
Pharyngitis 338 Posterior cervical move 119

Pharynx 246 Posterior subluxations 85

Pisiform anterior cervical Potts' disease 56, 154, 339

move 100 Practice 276

Pisiform contact Preferable adjustments 155
125, 135, 139, 141. 146 Pregnancy 339
Pleurisy 338 Preparation of patient 22
Plexus, abdominal aortic. 253, 254 Presumptive statements 235
Auerbach's 251 Private office 282
brachial 238. 254 Process, bent spinous 59
cardiac 249
Processes, spinous 20
carotid 244
transverse 21
cavernous 243
cervical 238 Prognosis 322
coelic 250, 252 general 323
cystic 251 Prolapsus 345
 Index 351

Page Page
Promises to patients 306 Scoliosis 55
Prostate gland 253 Scrotum 254
Prostatic enlargement 340 Second metacarpal contact 103
Psychoses 201 Segmentation 219, 229
Pudendal plexus 239 Selecting movement 156
Pulmonary tuberculosis 340 Seminal emissions 341
Seminal vesicles 258
Q Sensor areas of lower extrem-
Quinsy 343 ity 257
Serratus magnus muscle 255
R Serum-therapy 186, 315
Rachitis 340 Shoulder joint 255
Rami communicantes 172 Signs 290
white 250 Simple continued fever 341
Recoil, name of 132, 133 Single transverse moves
the 125 141, 142, 146
uses of 131 Smallpox 342
Record, the 23 Smell 243
the complete 29 Special cases 301
sample of 29 Special nerve connections 235
use of 30 Specific adjustment 230, 303
Rectum 253 Spinal column 16, 222
Reference library 289
Spinal nerves, distribution of. 237
.

Reflex arcs 241

Spine 16
Relaxation 95
Spino-organic connection 217
Rest room 287
Spinous, bent 59
Retina 242
central artery of 243
Spinous process 20

Retinal hemorrhage 340 Splanchnoptosis 342

Retracing of disease 211, 309 Spleen 251
Rheumatic fever 341 Splenic enlargement 342
Rheumatism 341 Splenitis 342
Roll, the 285 Spondylitis deformans 342
Rotary move, the Ill, 115, 116 Spondylotherapy 215, 313, 315
Rotation, axis of 80 Spread move 148
vertebral 80 Stimulation 169, 189
Rubella 341 Stomach 251
Rules for adjusting positions. 127
. Strabismus 342
Subluxation 217
direction of 25
S
effect of 179
Sacrum 17, 19, 149
the individual 40
Sacral adjustments 149
Sacral plexus 239
theory 172
Salivary glands 246 Subluxations, age of 87
Sample record 29 anterior 84
Scarlet fever 341 contiguous 37
Schedule of examination 292 effect of 79
Schneiderian membrane 243 increase of 191, 193, 196, 199
352 Index

Page Page
Subluxations, inferior 83 Tongue 245
lateral 84 Tonsilitis 343
law governing location of.. 78 Tonsils 246
major 39 Torticollis 344
minor 39 Trachea 249
occipital 86 Transmitted shock 91
posterior 85 Transverse adjusting
production of 76 ..135, 138, 139, 141, 143, 146, 148
secondary causes of 77 Transverses 21
superior 83 Trauma, effect of 174, 178
varieties of 80 Tube, eustachian 245
Suggestion, muscular 96 fallopian 254
oral 95 Tuberculosis, pulmonary 344
Suggestive therapeutics 315 Tumors, benign 344
Sunstroke 342 malignant 344
Supporting head in adjusting. . 105 Typhoid fever 189, 344
Suprarenal capsules 252
Susceptibility 186 U
Sympathetic, cervical 242 Underscoring 26
Sympathetic nerves, distribu- Ureters 253
tion of 240 Urethra 253
Sympathetic nerve system 171 Use of adjuncts 315
Syphilis 342 Uterus 254
Uteroversion 345

T V
Tabes dorsalis 343
Vagina 254
Table of diseases and adjust-
Valvular disease 345
ments 257
Variations in number of verte-
Table of subluxations and
brae 60
moves 155
Varieties of subluxation 80
Tachycardia 343
Varicocele 345
Talking points 306
Varicose veins 345
Teeth 245
Vermiform appendix 253
Tenderness 69, 71
Vertebrae 16
Tension 181
cervical 16
Testes 254
dorsal 16
Tetanus 343
lumbar 16
Theory of Chiropractic 172
variations in number of. .16, 60
Theory, subluxation 172
Vertebral palpation 15, 295
Thigh 255, 256
Vertebra prominens 17, 19
Thoracic aneurism 343
Vital energy 169
Thoracic nerves 238
Visceral nerves 239, 253
Thrust 91
Thumb move 121. 123
Thyroid gland 247 W
Tipping, vertebral 82 Waiting room 280
T. M 121, 123 Worry 201
 University of California Library
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