Part 48

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 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 expression, 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 intention, have a vertebral column for demonstration purposes. There are many times when it is necessary to show a subluxation as it would occur.

Beside the desk and within easy reach of your hand should be placed at least a single book-case section containing those reference works which you frequently consult. 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 consulted at once without your rising. I am not of the opinion that a pretension of unlimited knowledge is a valuable professional asset. It seems better frankly to seek authoritative information, even in the presence of the patient, than to allow an error to creep into your work, and your more intelligent 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 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 physiological 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 instance, 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 feelings of your visitors.

Adjusting Tables

For all purposes the best type of bench now on the market 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.

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 Lumbar 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 vertebra--the body--is to be moved most, this position of suspension 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 adjustable to an angle equal to that which would be secured with the roll.

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 adjustment.

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 remainder of the room will serve if no separate room is available 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, 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 movement 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 minutes 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 possible. Some prefer solid cots on rollers so that the cot may be noiselessly rolled beside the adjusting table after the adjustment, the patient may by one turn move himself upon it, and 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 directed 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 anticipated with eagerness.

A Complete Suite

The number of rooms in a perfectly convenient suite depends upon the approximate number of cases to be handled 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 adjusting rooms, and two rest rooms make probably the best number and employment of rooms. It is desirable if possible 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 adjusting table and a rest cot and each serving as the rest room after the adjustment. If a sufficient number be provided 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 Haliburton’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 Chiropractic 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 book is as necessary or useful as a good medical dictionary, preferably a large and complete one.