Chiropractic treatment was founded in 1895 by DD Palmer in Davenport, Iowa. As a magnetic healer (one who imparts energy to the body through the use of his hands to “effect cures”), Palmer was devoted to the study of health. He educated himself in all the current science, pseudo-science and fads of the day and built up a very successful practice (which tells you something about the state of health care in the mid-west in the 1800s).
In 1895 the janitor in his building related to Palmer how he had been deaf in one ear for 17 years after he had felt something “let go” at the top of his back. Curious, Palmer examined him and found “a bone out of place” at just that spot. After some convincing, Palmer was allowed to “put the bone back in place” through a carefully analyzed manipulation (Palmer was very well read in anatomy and possessed a large collection of human spines he had meticulously studied). After two such manipulations his patient could hear again and his hearing was normal for the rest of his life.
With this success Palmer went into six months of seclusion in his practice, carefully studying the effects of manipulations on a wide variety of his patients. Feeling he was on the edge of a great discovery he was fanatically secretive about what he was doing.
By 1900 he had proclaimed the profession of chiropractic and began to teach others his system of “adjustments” (manipulations). Soon new chiropractors were spreading across the mid-west opening their own schools of chiropractic and refining the techniques and the philosophy behind them.
Palmer promoted the idea that all disease was caused by an obstruction to the flow of “nerve energy” from the spine. By adjusting the spine and relieving the pressure on the nerves the body would then heal itself of whatever was ailing it. The idea of the “innate intelligence” of the body to heal itself was the fundamental principle of the new health science.
While all this was going on, the field of health care was rapidly evolving. In the late 1800’s there were three main schools of health care: the medical men (physicians) who worked with medicines and surgery, the eclectics who worked with natural botanicals as cures, and the manipulators, mainly in the form of osteopaths but soon joined by the chiropractors. There were other types of healers coming and going, homeopaths, hypnotics, elixir salesmen, etc, but these were the three most established fields.
By 1912 the physicians had become the pre-dominant field. With the discovery of “germs” (bacteria) by Pasteur and the development of vaccinations they had become successful in the prevention of disease. They were also the school most adept at using the scientific study of the human body and the research on disease carried out at the universities. By 1912 they were rapidly moving away from the heroic medicine techniques (bleeding, irritant emetics, etc), which were proving to be of no value. Accepted as “mainstream” health care by then, they had sidelined the eclectics (the profession was gone by the 1940s) and assimilated the osteopaths (by then you had to become an MD first then do further study to become an osteopath). As a result osteopathy became a dying profession, though they are still present in Canada today. Only the stubborn chiropractors, now the standard-bearers of the manipulative field remained, led by its obstinate discoverer and his dynamic and entrepreneurial son, BJ Palmer.
In 1912 the US government, in an effort to eliminate the weaker, profit based medical schools, commissioned the Flexner Report, describing the state of the schools in the US and making sweeping recommendations for reform. As a result many shady, profit motivated schools closed, and the remaining ones improved their course of study dramatically. The medical associations tried to use these recommendations to get the chiropractic schools closed too, thus eliminating the last significant alternative to their approach to health care. Many chiropractic schools did close, but some pulled up their socks and instituted the recommendations requiring more studies in basic sciences, a longer program and quality controls. Given the still rudimentary skills of much of medical care and the great success chiropractors had in the treatment of mechanical pain syndromes (low back pain and sciatica, neck pain and headaches), the chiropractors were able to weather the storm and continue to develop as a separate profession.
The Ontario government issued a similar report, the Hodgins Commission, in 1915, an investigation into the state of medical education in Ontario. This report noted “new avenues of healing which had not previously been dreamed of,” including “bonesetting”, “manipulation” and “mechanotherapy”. However, the three chiropractors that gave deputations to the commission, including the flamboyant BJ Palmer, espoused the fundamentalist philosophy that chiropractors, “have no use for diagnosis”, “do not believe in bacteria” and believe “the analysis of blood and urine … has no value”. The commission reacted as would be expected and recommended Ontario’s three chiropractic colleges be closed.
The commission did, however, recognize the value in “these new physical methods” recommending they be added to the medical curriculum. No action was taken by the medical schools, as evidenced by an Ontario government committee in 1970 (fully 55 years later!) chastising the medical profession for failing to incorporate manipulation into its curriculum. As further evidence of the distain medicine had for any form of physical therapy, Physiotherapists were not registered to practice in Ontario until 1933, 18 years after Hodgin’s recommendations.
Public support for chiropractic remained strong. Chiropractic still provided the most effective treatment for back pain available, and in 1925 the Ontario College of Physicians and Surgeons in an effort to limit the chiropractors’ role in health care, requested the government enact legislation to regulate the health practitioners out of their jurisdiction. The “Drugless Practitioners Act” of 1925 was enacted to regulate chiropractors, optometrists and other new professions. Chiropractic was now legal but strictly limited in scope.
During the next 30 years many chiropractic techniques still used in the mainstream today were developed. The obvious success they had with their approach to many musculoskeletal conditions created legions of loyal patients all across North America, in spite of medicine’s animosity. The lack of a successful alternative approach for these conditions from the physicians aided the chiropractor’s cause.
Over these 30 years the medical associations across the US, justifiably upset with the unscientific philosophy of the chiropractors, started a program of having them arrested for practicing medicine without a license. It became a badge of honour for a chiropractor to get arrested at least once in his career. The legal argument that no practice of medicine was going on, only the practice of chiropractic, actually stood up quite well in the courts but for 30 years there was a parade of chiropractors to local police stations. It was the unscientific assertion that all disease came from nerve interference in the spine that so offended the physicians who now understood bacteriology and many organic diseases like diabetes. It was an affront to the extensive modern fields of medical research that so many people flocked to these “unscientific” healers. The physicians, blinded by their perception of quackery, failed to appreciate that even though the philosophy was outdated and questionable, the techniques were modern and successful in treating mechanical joint and muscle problems, and that radiating nerve pain was significantly improved by these methods. The chiropractors, though, chose not to trumpet these successful results and instead continued to tenaciously assert their ideas of innate intelligence and spinal nerve compression as the cause of all disease.
A new chiropractic college, the Canadian Memorial Chiropractic College (CMCC) in Toronto, was founded in this atmosphere in 1945, catering to the mass of men returning from the war with government subsidies for education in their pockets. It was immediately successful and has over its first 60 years out-grown two new campuses.
By the 1940’s the physicians were emboldened by the discovery of the “wonder drug” penicillin and their newfound ability to contain deadly infections. Animosity towards chiropractors and other alternative healers heated up. It culminated in a final organized attack on chiropractic in the early 1960’s when the AMA instituted a secret policy declaring it “unethical” for an MD to associate with or refer patients to a chiropractor on pain of losing hospital privileges. The small inroad the chiropractors had gained with some open-minded MDs suddenly dried right up.
In Ontario the College of Physicians and Surgeons published “A report on Osteopathy and Chiropractic” in 1959, outlining “an all-out offensive policy… to give chiropractic in Ontario a ‘knock-out’ blow”. This triggered a series of Royal Commissions through the 60’s looking at the state of health care in Canada and chiropractic in particular. Chiropractic was found to be “a valid health service” by the Quebec Commission, an opinion accepted by the federal government’s Hall Royal Commission on Health Services in 1961. As a result, in 1970 chiropractic services were added to OHIP in Ontario with the government picking up 80% of the treatment fees. This OHIP legislation stated, “the potential therapeutic benefits of manipulation have been neglected by the medical profession.” It was a scolding for the medical associations, and a backfiring of their plan.
The United States followed a much different path to acceptance of chiropractic. In 1961 an internal AMA memo fell into the hands of the chiropractic profession. It stated that the goal of the AMA was to “contain and eliminate” the chiropractic profession. That triggered an anti-trust lawsuit filed by 5 chiropractors against the AMA and several related organizations. Essentially the suit claimed the AMA was trying to create a monopoly on health care in the United States.
The lawsuit moved up through the courts of appeal following many convoluted legal arguments until it finally ended 20 years later in 1989 at the Supreme Court of the State of Minnesota. The court found in favour of the chiropractors, in effect agreeing the AMA had embarked on a malicious campaign to establish a health care monopoly. The AMA did not appeal.
There was no financial penalty requested or imposed, but the AMA did have to publish a formal statement declaring relationships between chiropractors and MDs were, in fact, ethical. Hospital privileges had to be made available to chiropractors as well. The attitude towards chiropractic as a profession began to change almost immediately. In fact, many MDs had already been ignoring the AMA policy for years and the AMA did not enforce it after the 1970s while the lawsuit was winding its way through the courts.
Why did the courts find in favour of the chiropractors? The strongest evidence came in the form of independent inquiries, like the royal commissions in Canada, which had found evidence of the chiropractic profession’s far superior outcomes with back and neck pain than anything the medical profession had to offer, including surgery. The most powerful report came from the New Zealand government’s massive inquiry in1978, which agreed the substantial evidence put forward by the chiropractors was convincing, especially in the face of medicine’s obstreperousness.
None of these outcomes could have been possible had not the chiropractic profession, beginning in the 1950s, put forth a concerted effort and significant money, raised entirely from donations within the profession, to devote itself to scientific study on the effects of chiropractic adjustments and care (chiropractors had been frozen out of government research money by the medical association’s overarching lobby). By 1980 there was a considerable body of evidence demonstrating the effectiveness of the chiropractic approach to low back and neck pain. The evidence for improvement in organic disease, chiropractic’s founding principle, was weak, though not absent. In the 1960’s, with the advent of serious scientific research, the profession slowly began the difficult road away from the original Palmer philosophies. Most chiropractors were sincerely surprised how weak the evidence was for the compressed nerve causing organic disease theory. Anecdotal evidence of “miraculous cures” in chiropractic offices had long been a mainstay of the profession.
Since 1989 the chiropractic profession has made great strides towards widespread support within society and within the mainstream health science community. There are now chiropractic research positions at universities all across Canada getting government grants to support their work. While it takes a long time to overcome embedded biases in any profession, there are many, many MDs who now welcome referral and research relationships with chiropractors. Significantly, Worker’s Compensation Boards became supporters of chiropractic care, based on their own research into the cost effectiveness of the chiropractic approach to the treatment of back and neck injuries. Some of the greatest successes in chiropractic have been with high performance athletes who have proven to be very sensitive to the significant gains chiropractic techniques can offer them.
The final piece of legislation affecting the chiropractic profession was passed here in Ontario in 1991 as the “Regulated Health Professions Act”. This replaced the Drugless Practitioners Act of 1925 in regulating chiropractors. This new statute authorized the use of the title “doctor” and provided for the right to diagnose, granted only four other professions: optometry, dentistry, medicine and psychology (podiatry was later added). A new regulating body, the College of Chiropractors of Ontario, was established giving the profession the right of self-regulation under the same legal parameters as the College of Physicians and Surgeons.
Today there are over 5,000 chiropractors across Canada, with government legislation overseeing and guaranteeing the profession’s rights in every province.
The chiropractic profession has really been the steward of the art of manipulation as a healing art. Labeling chiropractors, and everything they did, as quacks and quackery, the medical profession ignored the technique of manipulation for musculoskeletal ailments. Had the chiropractic profession withered, so too would have this helpful therapeutic technique. It is now our responsibility to bring it back into the mainstream, available to any person suffering low back pain, sciatica, headaches and a host of other musculoskeletal ailments.
For all information referring to the American experience:
Peterson, D. and Wiese, M.A. Chiropractic, An Illustrated History. 1995. Mosby Year-book Inc. St Louis, Missouri.
For all information referring to the Canadian experience:
Sutherland, D.C. The Development of Chiropractic in the Canadian Health Care System. Journal of the Canadian Chiropractic Association. September, 1993. re-print published in 1995 by the Canadian Chiropractic Association.