Part 50

Vertebral Palpation

The primary object of Vertebral Palpation is the location of subluxations, or partial displacements, and the determination 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 segments you may safely eliminate those segments from consideration and confine your further attention to the remainder. (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 positive 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 traceable 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.

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 condition 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 differential diagnosis. Each step in the process of examination helps to explain and clarify the facts elicited by other steps until the facts marshal 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 subjective symptoms. If this be necessary, the examiner should 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 definite 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 examination 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 disturbance, and the probable duration and outcome of the case either with or without Chiropractic adjustments. In this broader sense we use the term hereafter.

The object of diagnosis is correct adjustment. Including 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 constantly 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 physical or objective signs throughout the body--the examination of the body for the discovery of all the changes in the size, shape, position, etc., of organs which indicate disease. 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 future should become, and probably will become, par excellence a physical diagnostician.

For many reasons we should be able to rely upon our own diagnoses. Capability in diagnosis renders us independent of the errors or false beliefs of others. Since it includes a knowledge of subluxations, not included in medical training but still vital to correct interpretation of morbid 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 physician 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 regarding 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., 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