Part 51

There are certain cases which a Chiropractor is powerless to aid and immediate recognition of such cases will save much trouble. In intestinal obstruction from intussusception or from strangulated hernia, for instance, it is best to advise the calling of a surgeon immediately, while in obstruction from volvulus or intestinal paralysis the adjustments 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 abscess, 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.

Frequency of Adjustments

The frequency of adjustments in practice should be determined entirely by the nature of the case and the circumstances 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, providing 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 reactive 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 lengthened 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 adjustment, even at first, and the demand on the body’s recuperative power may be greater than can be met.

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 “tolerance” 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 adjustment 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 involutionary change sets in before the next.

Specific vs. General Adjusting

By specific adjusting is meant the selection and adjustment 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 existing and recognized for every vertebra adjusted.

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 successive 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 considers only the condition of the spine and is given upon the principle that if the spine is right the man is right--a 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 Chiropractor 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 dangerous disease than the more pronounced. Specific adjusting tends to develop more discriminating and accurate palpation.

Specific adjusting weakens and shocks the weak or nervous patient less than general adjusting. It also concentrates 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.

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 discrepancy between theory and practice.

In favor of the practice of general adjusting it has been said that errors in diagnosis become unimportant if all subluxations be adjusted; 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 may be straightened completely. As a matter of fact this rarely, if ever, occurs. It is practically impossible ever to thoroughly “line up” a spine. The best that has been done as yet except in acute subluxations is to so modify subluxations 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 completely “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 examined 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 chiefest 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 determined corrective measure; and that guesswork will be largely eliminated.

Talking Points

The things which it is most important that the Chiropractor should set before his patient are the theories and facts peculiar to Chiropractic, perhaps adduced by Chiropractic investigations 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 convincing than the display of a wealth of knowledge of methods and theories used by other schools of practice. Chiropractic has been builded not by virtue of previously established truths but solely on the vitality of the new principles enunciated 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 intelligence 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. Reason 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.

Nevertheless in presenting Chiropractic we must be gently positive. Chiropractic is known and provable. Always able to fall back upon the clinical test as a final argument with supreme assurance that it will not fail to vindicate 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 Chiropractor an expression of his belief in his ability or inability to cure them. They will desire a statement as to the probable time required for a cure. They may even ask a guarantee of success.