Daniel David Palmer demonstrates his chiropractic method of spinal adjustments, designed to alleviate pressure on the nerves that he believed caused disease.
Time began on September 18, 1895. Or at least it seemed that way to magnetic healer Daniel David Palmer, who restored Harvey Lillard’s hearing with a touch. An African American janitor at Palmer’s Davenport, Iowa, office building, Lillard had lost his hearing seventeen years earlier while working in a cramped and stooped position. He told Palmer he suddenly felt something “give way in his back.” Suddenly, the world went mute, so much so that he “could not hear the racket of a wagon or the ticking of a watch.” Learning of Palmer’s healing skills, he came seeking help.
Palmer listened to Lillard’s story with interest. He’d been investigating the cause of disease and exploring drugless approaches to healing for several years. “One question was uppermost in my mind in my search for the cause of disease,” wrote Palmer. “I desired to know why one person was ailing, and his associate, eating at the same table, working in the same shop, at the same bench, was not. Why?” Examining Lillard, Palmer found a vertebra out of alignment—the possible source of that feeling of movement Lillard felt in his back. Intrigued by the possible connection, Palmer persuaded Lillard to let him try to knock the vertebra back into place. Palmer “racked it into position” with two adjustments, freeing the nerves that had “been paralyzed by the pressure.” Soon, Lillard could hear as well as before.1
That September day soon assumed legendary proportions in chiropractic lore. The “First Adjustment” became year zero, the point in time from which all else could be measured, according to the masthead of the chiropractic periodical Fountain Head News. From that moment on, each passing year gained one “A.C.,” the number of years “After Chiropractic.”2
Palmer was not alone in the late-nineteenth-century medical marketplace for manual manipulation. Osteopathy had emerged in the 1870s and offered patients another form of drugless therapy based on bodily adjustment. The similarity did not end there. Both systems began in the Midwest and found their most enthusiastic followers and practitioners in predominantly rural areas. Both pushed for legitimacy, not by fighting against laws and standards as the Thomsonians had before them, but by fighting for licensing laws and implementing guidelines to improve the quality of their schools and practitioners nearly from the start. Both were riven by internal disputes between those who remained true to their founders’ vision and those who saw the benefit of dabbling in many forms of healing. And perhaps most strangely of all, both systems were founded by haphazardly educated frontiersmen born in log cabins, who, as adults, were known for their scraggly beards and dynamic personalities, and who at one time practiced magnetic healing and claimed divine inspiration for their theories.
Osteopaths and chiropractors were not the first to notice the potential health benefits of the physical manipulation of the human body. In ancient Greece, Hippocrates described how to correct dislocated joints through pressure and adjustments, techniques that guided practitioners for centuries. The methods described in “On the Articulations” and “Instruments of Reduction” were not for the weak of stomach.3 For dislocated shoulders, Hippocrates first advised pulling the forearm back to the spine while simultaneously bending the arm upward at the elbow to snap it back into place. For particularly stubborn or chronic dislocations, he advised cauterizing the shoulder by passing red-hot irons through the skin of the armpit until it “burnt to the opposite side” while pushing them “forward with the hand.” The high heat was essential so the irons could pass through “as quickly as possible.”4 Hippocrates also described methods for reducing vertebra displacement on a treatment table fitted with various straps, wheels, and axles that bore a passing resemblance to the modern chiropractic adjustment table. Chiropractors clearly thought so, too, as many still claim Hippocrates as the true founder of the chiropractic technique. In the second century ce, Roman physician Galen won wide acclaim for reversing the paralysis in the right hand of the scholar Eudemus by adjusting the vertebrae in his neck. Galen’s writings include frequent mentions of Hippocrates’ manipulative techniques as well as his own recommendations for standing and walking on dysfunctional areas of the spine.5
This ancient and respected origin made manual manipulation an important treatment option for subsequent generations of European doctors. Tenth-century Persian polymath Avicenna included the Hippocratic manipulative methods in his influential five-volume al-Qanun fi al-Tibb, or The Canon of Medicine, published in numerous editions in Europe and used as a textbook in many medieval European medical schools. In the sixteenth century, French military surgeon Ambroise Paré practiced spinal manipulation and repeated many of Hippocrates’ techniques in his writings on the vertebrae. German surgeon Johannes Scultetus carried the tradition into the seventeenth century with the publication of The Surgeons Store-House.6
But despite this long lineage, by the eighteenth century regular medicine had largely abandoned the technique. The reasons are not completely clear, but tuberculosis epidemics likely had something to do with it. Force applied to the weakened joints of patients suffering from tuberculosis, a growing problem in overcrowded cities, could seriously harm and even disfigure patients. Bodily adjustment also required close contact with diseased bodies, so many doctors sought to limit their contact with contagious patients. But even as doctors grew more reluctant to use manipulation, public demand for these services persisted. So into the vacuum created by the absence of regular doctors stepped folk healers and amateur bonesetters like Sarah Mapp. Known as “Crazy Sally,” Mapp was a slovenly eighteenth-century Englishwoman perhaps as well known for her drunkenness as for her skill at setting bones. Mapp’s talent earned her mention in songs and even the theater, where a comedy called The Husband’s Relief, or The Female Bone-setter and the Worm Doctor was based on her life.7
Bonesetters weren’t new—nor were they all slightly loony drunks memorialized in verse—but they almost certainly found a larger patient base with the abdication of regulars from manual manipulation. Bonesetters did not just set broken or dislocated bones. They also helped with pains in the muscles, ligaments, and joints. These village bonesetters had undoubtedly passed on the tradition for centuries, long before formal recognition by the medical profession, but they now took a far more visible place in society for people of all classes. Many poor people had long relied on bonesetters for medical care. In England, Friar Thomas Moulton’s popular medical manual The Mirror, or Glass of Health included sections on bonesetting and went through at least seventeen editions in the sixteenth century alone. A century later, Robert Turner published a revised and enlarged edition in London, known as The Compleat Bone-setter, aimed at a general user.8 While some people learned from books, more still learned under the supervision of an accomplished master. Bonesetting skills often passed through families like other skilled trades. The homespun nature of bonesetting and its informally trained practitioners likely caused many regular doctors to associate the practice with the ignorant lower classes and to thus deem it beneath their dignity.9
But regular medical therapy offered few alternatives, so bonesetters found some success in adjusting deformities that doctors failed to treat. Nineteenth-century British surgeon James Paget suggested that doctors would do well to observe the techniques of the bonesetters, but he stopped far short of endorsing their methods, attributing the bonesetters’ success more to luck than actual medical skill.10 Manual manipulation soon fell out of the skill set of regular practitioners. American regulars tended to mirror the attitudes of their European counterparts, and lacking the long medical history of European medicine, the United States never developed a respected practice of manual medicine. From the beginning, American regulars lumped bonesetting together with a whole range of quackish folk practices.11
Everyday Americans did not seem to share their opinion, however. Bonesetters found a place in the United States just as they had in Europe, providing medical care to people who could not afford or did not have access to a regular doctor. Perhaps the most famous American bonesetters were the Sweet family of New England, who ministered to several generations of the sick in Rhode Island, Massachusetts, Connecticut, and New York in the late seventeenth century. Benoni Sweet, believing the skill an innate gift, passed on the practice to his sons. The family gained considerable fame after Benoni’s son Job Sweet set the broken or dislocated bones of French officers encamped in Newport, Rhode Island, during the American Revolution. After the war, Job reset the dislocated hip of Vice President Aaron Burr’s daughter, Theodosia, an achievement that won him a roster of patients and allowed him to practice bonesetting full-time. His was the rare case, though, as most bonesetters, including the other Sweets, worked other jobs and set bones on the side.12
Andrew Taylor Still first discovered the benefits of manual manipulation as a child. Born in a log cabin near the Cumberland Gap in Virginia on August 6, 1828, Still was the son of a Methodist minister who dabbled in medicine, the dual minister-physician role so common to early America, particularly on the frontier. One day, suffering from a terrible headache, Still tied a rope about ten inches off the ground between two trees. He wrapped a blanket around the rope as a kind of makeshift pillow, lay on the ground with his neck resting across the blanket-draped rope, and fell asleep. When he woke, the headache was gone. Still did not make much of it at the time, but years later the event took on historic proportions as Still’s first lesson in osteopathy.13
Still’s family was constantly on the move. Following the line of American settlement, the Stills moved first to Tennessee and then to Missouri and later Kansas as Still’s father rode the Methodist circuit and cared for the sick. Inspired by his father to enter medicine, Still studied medical books and opened his own practice in Missouri. In 1854, he joined his father in Kansas in an ill-fated attempt to escape rising tensions over the expansion of slavery in the West. The issue of slavery became unavoidable, though, following Still, an ardent abolitionist, to his new home.14
Working alongside his father, Still found himself growing increasingly frustrated over his inability to heal as he watched patient after patient succumb to disease. Standard medical therapy seemed to inflict more harm on patients than if he simply left them alone. Wondering if there was a better way, Still began digging up Indian graves to study human anatomy. He spent hundreds of hours examining and charting the placement and workings of each of the body’s bones. He also experimented with new treatments, including manual manipulation.15 His studies convinced him that “if Samson could slay the Philistines, or at least 3000 of them, with the jaw bone of an ass (one bone), . . . I could with over 200 bones of the human body, enter into combat and slay the greater part of the diseases to which the human race is subject.”16 Unsurprisingly, Still’s neighbors found his grave-digging a little strange, and his church eventually excommunicated him for emulating Christ by the laying on of hands.17
Still lost his confidence in medicine completely after the Civil War when three of his children died in an outbreak of spinal meningitis. Devastated by the loss and the doctor’s inability to save them through heroic methods, Still relinquished his faith in drugs and the doctors who administered them, vowing, like Thomson did before him in tragedy, to devote his life to finding a better way to treat disease. Still spent the next decade researching and experimenting. He maintained his medical license and continued to prescribe some drugs, but he turned more and more to various manual techniques for alleviating pain.18 Recalling his childhood experience with headache relief, Still slowly began to conceive of a theory of health based on a normally functioning musculoskeletal system. Undaunted by his excommunication, Still credited God with providing the inspiration for his theory and, thus, saw himself fulfilling a divine mission in working toward a drugless and nonsurgical approach to disease based on touch. Mesmerists, too, believed in the healing power of touch. A century earlier, Mesmer had witnessed the potential of the human spirit to heal as he passed his hands over the bodies of his patients. If there was any idea that would attract a spiritually inclined healer like Still, this was it, and he soon began advertising himself as a magnetic healer. Of course, the combination of magnetism and manual manipulation did little to win Still acceptance from the regular medical community or from many of his patients, who were bewildered by his change of methods. So in 1874, Still moved to Kirksville, Missouri, seeking a fresh start.19
At first, Kirksville proved scarcely kinder to Still’s brand of medicine. To win people over, Still became a medical circuit rider, traveling from town to town performing his manipulations on skeptical volunteers and advertising himself as “the Lightening Bone Setter.” His physical appearance likely gave a poor first impression. Tall and bearded, Still often arrived in town with a walking stick in hand, wearing a dowdy felt hat, a wrinkled suit, and baggy pants stuffed into the top of his boots. Flung over one shoulder was a bag of bones. It was a look that fairly shouted convention-flouting loony—or maybe macabre hobo.20 Still claimed that rumors about him in his early days made even children cross to the other side of the street to avoid the man called “an infidel, crank, crazy.”21 But any doubts about Still were soon overcome by his masterful ability to heal the sick.
To many observers, it seemed as though Still could see straight into the body and know just what bone to manipulate. In one town, Still freed a hard-drinking blacksmith from his taste for liquor by realigning his ribs. In another, Still relieved an Irish woman of nagging shoulder pain and asthma by resetting several ribs and an upper vertebra. As word of Still’s miraculous cures spread, people came from great distances to see him. Still’s demonstrations became like revivalist camp meetings. He denounced the evils of the regular medical profession and left people shouting in wonder at his startling treatments. In his wake, he left a trail of casts, crutches, and surgical devices no longer needed by patients.22 Even his rumpled appearance became an asset, representing to some admirers his lack of concern with material things. Still soon won over Kirksville and gave up his itinerancy to practice in town. Realizing he needed a more distinctive name for his form of therapy than bonesetting, Still coined the name “osteopathy” from os for bone and pathology, the study of the cause and effect of disease.23
Still conceived of the human body as an intricate, God-created machine that worked in harmony with nature. “Quit your pills and learn from Osteopathy the principle that governs you,” declared Still. “Learn that you are a machine, your heart an engine, your lungs a fanning machine and a sieve, your brain with its two lobes an electric battery.”24 He rejected drugs as unnecessary and potentially harmful and claimed that their use demonstrated a lack of faith in the powers of nature and “accus[ed] God of incapacity.” Still believed the body was chemically self-sufficient, a human drugstore designed and stocked by God with everything it needed to be healthy and happy. He claimed that his travels had confirmed to him that “all the remedies necessary to health are compounded within the human body.”25 Surely “the Architect of the universe was wise enough to construct man so he could travel from the Maine of birth to the California of the grave unaided by drugs,” asserted Still.26 The doctor’s job then was to serve as the body’s mechanic, tinkering with the machinery of the body to ensure the proper functioning of God’s perfect creation. In Still’s scheme, doctors were never directly responsible for the cure but simply acted as intermediaries between the patient’s self-healing mechanism and nature.
Still identified blood as the essential ingredient to health. The lubricant that kept the body running, blood ensured the well-being of its tissues and organs. The artery was the “father of the rivers of life, health and ease, and its muddy or impure water is first in all disease,” wrote Still of a concept that became known as the Law of the Artery.27 Misaligned bones exerted pressure on the blood vessels, diverting and even blocking their life-giving current to the organs and causing disease and deformity.28 He denied the existence of diseases as separate entities, seeing instead a collection of symptoms that pointed to a vascular blockage at a point known as the “osteopathic legion.” These lesions were small abnormalities that threw off the body’s whole system and caused patients to feel pain and other symptoms that they mistakenly associated with the disease itself. A similar idea underlay homeopathy, Thomsonism, and humoralism. “There is no such disease as fever—typhus, typhoid, or lung—rheumatism, sciatica, gout, colic, liver disease, nettle rash, or croup on to the end of the list,” wrote Still. “They do not exist as diseases, but separate or combined are only effects.”29 Still believed that the osteopathic lesion could account for all human complaints. Gout, for instance, resulted from lumbar displacements. Still based his conclusion, in part, on the high number of cases he found among merchants who frequently stretched their arms and backs to stock goods on high shelves, wrenching their lower backs out of alignment. Goiters, on the other hand, came from pressure on the blood vessels in the neck from vertebrae, ribs, or the clavicles.30
Blood was not the only cause of lesions; nerves, too, had to remain unobstructed. The nervous system fascinated and awed Still. While he was unsure of exactly what electrical force powered it, he was sure that the brain operated like an “electric battery” on the body. He suggested that the artery takes blood from the heart and deposits it in the cells of the nervous system, which “act to give life, motion and form to organs, muscles, and all parts of the body.”31 So interference with nerve functioning also produced an osteopathic lesion. The blood and nerves worked in close collaboration. The rope swing Still had constructed as a child, he now determined, had cured his headache by putting pressure on the soft tissues in the back of his neck, relaxing the nerves and lessening the dysfunction while giving “harmony to the flow of the arterial blood to and through the veins.”32 While any misplaced bone could cause an obstruction, the spinal column at the center of the nervous system seemed especially liable to lesions given all of the stress, pressure, twists, and falls it endured in the course of daily living. As a result, osteopathic treatment tended to focus on the vertebrae and ribs.33
Still located lesions by touch, but also by taking a standard patient history. Feeling the body for problems, osteopaths diagnosed the affected organ and deduced the vessels and nerves involved. Still needed no specialized equipment or devices to carry out his manipulations. He pressed patients against chairs, walls, tables, and doorframes.34
Still drew careful and firm distinctions between osteopathy and massage, which many of his critics assumed he practiced. Osteopaths did not knead, rub, or tap patients. They were “physicians,” asserted Still, who adjusted “bone, cartilage, ligament, tendon, muscle, or even . . . the fascia which enfolds all structures.”35 As evidence of the distinction, one only had to read his description of the treatment he gave an old woman suffering from a “crooked neck and a stitch in the muscles.” Still set one foot against the plank of a fence for leverage, while the woman rested against his knee. He placed one hand on her neck and the other on her head. He then gave her head a twist that reportedly corrected the lesion instantly.36 With the lesion removed, the blood and nerve energy could flow freely, and the body recovered its health automatically under the ancient principle of vis medicatrix naturae, or the healing power of nature.
Still’s original theory of disease was highly speculative, based only nominally in anatomy, but patients did not seem to care. Far more important was that it seemed to work. And trainloads of people flocked to his Kirksville infirmary seeking his help. Unable to treat all of the patients seeking his services, Still decided to open a school to teach others his system. He secured a charter from the state of Missouri and opened the American School of Osteopathy in Kirksville in October of 1892. Twenty-one students enrolled in the first class, six of them women. A state charter allowed Still to grant degrees of medical doctor, or MD, but seeking to visibly demonstrate osteopathy’s distance from regular medicine, Still decided to grant his own degree, the DO, or doctor of osteopathy. Students earned the degree by attending two five-month sessions of training in manipulation and anatomy. The addition of Dr. William Smith, a respected Scottish regular doctor trained at the University of Edinburgh, to the faculty as a professor of anatomy lent the school legitimacy and the imprimatur of regular medicine. Because osteopathic methods were difficult to explain in words, Still stressed the importance of observation and hands-on learning.37 Many students recalled afternoons in the infirmary with the “old doctor,” as Still was affectionately known, working on patients. “We would hold the patients in position while Dr. Still worked upon them, explaining to us as he treated why he gave this movement in one place, and a different movement in another,” wrote Arthur Grant Hildreth years later.38 Still took pride in making his system available to anyone who wanted to learn, including members of the lower classes, who often lacked a formal education and could not afford the tuition. Rather than turn them away, though, Still welcomed them as a way to demonstrate his system’s altruism and to spread the word about osteopathy.39
Women found a particularly warm welcome in the American School of Osteopathy, which advertised for female students and practitioners with blatant flattery. In 1895, the Journal of Osteopathy declared that “the science of osteopathy should particularly appeal to the intelligent and ambitious women who desire a noble life-work which will prepare them for a future free of pecuniary concern.”40 It was a message squarely in line with the tenor of the late-nineteenth-century women’s rights movement, which embraced women’s economic independence as a means to equality.41 Still’s passion for women’s rights was so strong and so genuine that he frequently suggested the US Constitution needed an equal rights amendment to grant and assure the rights and privileges women clearly deserved. Still held his female students to the same standards as the men. The school catalog clearly stated there would be “no distinction as to sex,” and Still assured any doubters that all his women graduates were “as well worthy diplomas as any gentlemen who ever entered.”42
Still welcomed women, in part, from a desire to reform obstetrical care, an oft-repeated rallying cry among nineteenth-century irregulars. He particularly wanted to remove forceps from the birthing room because he believed they lacerated women and caused “many fools and idiots among children to-day.”43 Still had performed osteopathic deliveries himself, placing the mother in a semi-upright position and using manipulations, particularly of the pelvic bones, to make the labor brief and as pain-free as possible, but he felt women might perform these duties more effectively and empathetically. One of Still’s early graduates, Alice Patterson, became head of the American School of Osteopathy’s Department of Obstetrics and Gynecology, which had its own infirmary. Patterson later moved to Washington, DC, and built a successful osteopathic practice of her own.44
Among the many who came to Kirksville to learn osteopathy was Daniel David Palmer, though he would later deny any contact with Still. The similarity of osteopathy and chiropractic led some to charge that Palmer’s system was simply a cheap imitation, an accusation that Palmer strenuously denied and that likely led him to refute any connection or exposure to Still. Osteopaths were only too happy to deny an association with Palmer as well, since if there was anything an osteopath hated more than a regular doctor, it was a chiropractor. Palmer recognized that the two systems shared similar features, but he rejected osteopathy’s focus on the blood. Instead, he believed the nerve force was essential to health.
Born in a log cabin in Port Perry, Ontario, Canada, on March 7, 1845, Palmer was the son of a man who worked variously as a shoemaker, grocer, teacher, and postmaster. When his father’s business failed in 1856, the family moved to the United States for a new start. Palmer and his brother Thomas dropped out of school and stayed behind in Canada to work, finally joining their family in Iowa in 1865. The young Palmer became a teacher in Muscatine, Iowa, and taught at several more schools before purchasing ten acres of land on a hillside above the Mississippi River just north of New Boston, Illinois. He raised bees, planted fruit trees, and began a new career as a horticulturalist, even developing a variety of raspberry known as “Sweet Home” that found a national market. Palmer’s bees perished in the harsh winter of 1881, so Palmer sold the land and rejoined his family, now living in the Iowa town of What Cheer. He opened a grocery store that also sold goldfish, but competition forced him out of the grocery business and back into the classroom.45
But teaching, while practical and nearly always in demand, did not fire Palmer’s passion. Spiritualism had first interested Palmer in the 1870s, but he soon shifted his attention to magnetism, the reverse course of many mesmerists, who subsequently became spiritualists earlier in the century. Palmer’s interest stemmed in large measure from local magnetic healer Paul Caster in Ottumwa, Iowa, who had impressed Palmer with his reputation, his bustling practice, and perhaps most important of all, his massive fortune. After Caster’s death, his son J. S. inherited the business and took the practice to Burlington, Iowa, in 1881. Palmer followed, hoping to ride the young Caster’s coattails to monetary gain. He read books on magnetic healing, fascinated by the idea of drugless cures, and he became convinced that he possessed the gift of healing—that he could literally pour his own “vital magnetism” or life force into diseased patients to effect a cure. He placed advertisements for his healing services in local newspapers. That Palmer lacked a formal education, not to mention actual training or experience in magnetism, was no barrier to medical practice. The competition in Burlington proved too intense, however, and Palmer moved to Davenport, Iowa, in 1887 to establish his own magnetic healing practice.46
Palmer opened his Magnetic Cure and Infirmary in the Ryan Building on the corner of Second and Brady streets with an aggressive advertising campaign. “Where can you get cured quicker and for less money, and without making a drugstore of yourself? It may not be popular to be cured without medication, [but] who cares so [long as] the sick will get well?” read Palmer’s ad in the 1888 Davenport Directory. His “vital healing” services cost one dollar but were offered free to the poor.47 Palmer treated everything from rheumatism and neuralgia to indigestion, sore throats, and toothaches using his hands to draw away the pain and disease from the problem area with a sweeping motion. He then stood aside and shook the illness from his hands and fingers, as if shaking off droplets of water.48 Palmer’s business flourished. His location by the Mississippi River allowed him to draw a client base from all over Illinois, Minnesota, Iowa, and Wisconsin. With his deep, penetrating eyes, feisty, self-assured manner, and scruffy bush of a beard just this side of menacing, he cut a commanding figure, as the original magnetist Franz Anton Mesmer had more than a century before. Palmer’s was a personality far larger than his short and stocky five-foot-four-inch frame.49 Many patients were lured to his office by his widely distributed ads touting miraculous cures: Jane Wilson of a decades-long sore throat; Ella Post of malaria.50 By the 1890s, Palmer was seeing ninety to one hundred patients daily, and in 1895 recorded profits of $4,669 at a time when the average regular doctor made less than $1,500 annually.51 His space had also grown from its original three rooms to forty-two by 1891, decorated with mounted animal heads and a glass-walled cage, home to four live alligators.52
Palmer’s success convinced him of the validity of drugless approaches to healing and the importance of the spine, nerve power, and the doctor’s touch to wellness, but he began to wonder about the relationship between the body’s structure and its physiological function. These questions all led up to his September 18, 1895, encounter with janitor Henry Lillard and the adjustment that changed everything for Palmer. It should be noted that Lillard remembered the events of that night a little differently than Palmer. Lillard recalled laughing with a friend in the hallway. The conversation, loud enough for Palmer to hear it, drew Palmer from his office to join in the banter. One joke struck Palmer as so funny that he slapped the janitor on the back with a book. A few days later, Lillard reported that he thought his hearing had improved. Only then did Palmer begin to explore manipulation as medicine.53 Whatever happened, that day proved pivotal to Palmer, who declared a connection between Lillard’s back and his deafness, and he soon shifted his attention from magnetism to manipulation.
Over the following months, Palmer experimented with what he called “hand treatments” on other patients with success. Realizing he needed a better name for his system, Palmer turned to Davenport minister and patient Samuel Weed for help. Weed suggested “chiropractic” from the Greek cheir meaning “hand” and praxis for “practice,” meaning roughly “done by hand.”54 With a name, he also needed a theory to explain what he had discovered through experimentation. What he came up with married the vitalism of magnetism to the mechanical aspects of bonesetting.55
Palmer reasoned that all diseases resulted from some kind of spinal “impingement, a pressure on the nerves” that enervates the organs. Normal nerve tension, which he called tone, produced a perfect state of health, but if some bone, most often in the spine, imposed on nerves passing through it, they became too slack or too tense, resulting in disease. This point of pressure was called a subluxation. The idea of disease resulting from nerve dysfunction would make sense even to regulars. In the eighteenth century, Scottish physician William Cullen, the same man who had inspired homeopath Samuel Hahnemann, had theorized that disease resulted from a decrease of “nervous energy.” Benjamin Rush modified Cullen’s theory, claiming that disease came from both an increase and a decrease in nervous energy, and popularized it among American regulars. It was Palmer’s interpretation of how that nerve dysfunction originated that made chiropractic unique.56
Using the magnetic idea of an internal physical force, Palmer explained that every living being possessed an eternal power known as “Innate Intelligence,” or just “Innate,” which animated every function of the body. This Innate circulated through the nerves, so a subluxation that caused impingement could disrupt its ability to govern the body and cause illness.57 Since the nerves branched out from the spine, Palmer focused much of his attention on the alignment of the vertebrae. Palmer came to believe that 95 percent of diseases originated in the spine, so it was the chiropractors’ job to facilitate the flow of nerve force, and the all-important Innate, through physical adjustments. Drugs were unnecessary because they did not solve the actual structural problem, and they might actually cause more problems with their harsh effects. Healing required nothing more than a resetting that, once accomplished, like osteopathy, allowed the body to restore itself.58 “The Chiropractor removes the obstacles to nature’s healing process,” Palmer proclaimed.59
It also did much more than just return people to health. Palmer believed that his system could usher in the dawning of a new age by answering age-old questions about the meaning of life, disease, and death. Crime, poverty, and suffering were all diseased conditions that could be cured through the free flow of Innate. Palmer frequently referred to how the impingement of nerves created a lack of ease or “dis-ease” that was the cause of all human problems. Sounding like the spiritualist he once was, Palmer believed that chiropractic would “give us a conscious connection with that unseen life which is believed in by all nations,” allowing humans to stop fearing death “because the life beyond the veil will be comprehended and known to us.”60 For a time, Palmer and his son, Bartlett Joshua Palmer, or B. J., as he was commonly known and who would eventually assume leadership of the profession, even considered classifying chiropractic as a religion rather than a new healing system due to its potential impact on humanity.61 In the end, they decided to stick with medicine, reflecting their belief that chiropractic stood on sensible middle ground between the spiritualism of religion and the materialism of science. At a time when American culture was uncertain about the appropriate relationship between science, which was on the rise, and religion, which appeared to many to be losing its authority, chiropractors argued that they alone had discovered the perfect balance between them in a philosophy that dealt with “manifestations of the spiritual through the material physical body.”62
Still, too, saw God in osteopathy. “God’s greatest gift is Osteopathy,” wrote Still. “God is the Father of Osteopathy and I am not ashamed of the child of his mind.”63 For the son of a Methodist minister who also practiced medicine, Still’s conflation of osteopathy and religion is, perhaps, none too surprising. Still saw the human body as worthy of awe and devotion, an intricate piece of machinery divinely designed. Adjusting the body became a form of devotion for him.64 “My highest and most profound worship is when I take up any part of the human body or any part of nature, and after examining it under the microscope, I give credit for all perfection to the great Architect,” proclaimed Still in a 1903 speech.65 Both Still and Palmer trusted in nature’s healing power because they saw the beauty and complexity of nature as something only God could have created. Each of their systems was an attempt to harmonize the spiritual with the physical.66
Chiropractors discovered subluxations in the same manner as their regular and osteopathic peers: with a patient history. Like osteopaths, chiropractors did not believe that the symptoms of the disease were the disease; they were, instead, secondary manifestations of the problem. After locating the afflicted area, Palmer instructed practitioners to consider the nerves connected to that area and to then trace those nerves back to the part of the spine from which they emanate. Confirmation of the subluxation came by touch.67 Specific ailments corresponded to individual vertebrae, so there would never be more than one impingement per disease. Smallpox, for instance, came from the fifth cervical vertebra, while heartburn emanated from the fifth thoracic.68
The removal of the subluxation through manipulation was officially known in chiropractic as an adjustment, a term osteopaths used as well, though not formally. Adjustments began with the patient lying face down on the adjusting table, a bench with a hole in the middle over which the chiropractor would position the blocked part of the body. The chiropractor would then stand on the side of the body where the vertebrae had been displaced. Resting the heel of his right hand against the vertebrae while wrapping his left hand around his right wrist, the chiropractor would apply enough pressure to move the vertebrae back into place. Palmer stressed that great force was not generally required, though it was up to each chiropractor to determine how much force was enough.69
At first, Palmer kept his system to himself, fearful of potential competitors and imitators. But a brush with death in a train accident in 1897 compelled him to share his system so that his great discovery did not die with him. He took on an apprentice and taught him enough of the basics of chiropractic technique that he could heal Palmer’s injuries from the accident. This informal apprenticeship system was quickly replaced with a formal school, the Palmer Chiropractic School and Cure in 1897. Like osteopathy, chiropractic adjustments were not easy to explain in words but better learned through observation and experience. That first year, the school graduated its first student, who also happened to be a homeopath. Enrollment tripled the next year and had increased to five by 1901. In 1902, Palmer’s own son B. J. enrolled. Many of these early students were regular doctors looking to add a new element to their practice. Women were also welcome, and many of the women who matriculated did so with their husbands, as Palmer offered a tuition break for spouses. Mae Parsons entered chiropractic with her husband not “seriously intending to practice,” but once she learned more, she “became greatly interested.”70 One of the first women to graduate was Minora Paxson, who went on to coauthor the first chiropractic textbook. Another, Julia C. Bowman, set up a “Chiropractic Cure” on Hennepin Avenue in Minneapolis in 1899. Palmer’s liberality only extended so far, however. Despite the importance of Henry Lillard, a black man, to the foundation of chiropractic, African Americans were not welcome at the Palmer School, or at most of the other chiropractic schools that soon opened, until the mid-twentieth century.71
And there were many more schools. The American School of Chiropractic was opened in Cedar Rapids, Iowa, in 1902 by two Palmer graduates. Schools also opened in Minnesota and Oklahoma, and in 1903, Palmer himself founded a school in Oregon. By the 1910s, schools conferring the degree of DC, doctor of chiropractic, had opened around the country, with particularly heavy concentrations in the Midwest and on the West Coast. Many were short-lived, closing after a few years or even a few months. Chiropractic’s leaders regularly acknowledged the poor quality of many of these schools. At a lecture in Oklahoma City, Palmer lamented that “I teach the science to one person and that person teaches it to another . . . until chiropractic is in the hands of the third or fourth person [and] is hardly recognizable as chiropractic.”72 Even Palmer’s own school was not safe from criticism. Oakley Smith recalled that the “first thing I learned was that there was no instruction to be given. There were no blackboards, no text books, no notes, not a single lecture. For six days I witnessed the giving of a number of treatments. That was the sum total of information that was transferred in exchange for tuition paid.” At the end of the week, Smith was told he had learned all that he needed and that he “should do the treating thereafter.”73 Rather than ignore or deny the problems, though, chiropractors took steps to eliminate the abuses at their educational institutions, particularly diploma mills that issued degrees to anyone who could pay.74
Smith’s negative review did little to hinder the growth of the Palmer School in Davenport, Iowa. The institution prospered under the charismatic and egotistical leadership of Palmer’s son B. J., who had purchased the struggling school from his father in 1906. B. J. paid off his father’s debts and purchased more land and buildings for the school. He then proceeded to shut his father out, even allegedly hitting his father with an automobile after Palmer refused to leave during the school’s 1913 homecoming parade. B. J. announced himself as the “Developer” of chiropractic and his Palmer school as the “Fountain Head” of the field. He also shifted the system’s focus from the divine to the more practical task of relieving daily pain through adjustments. Though he did not abandon the spiritual aspects completely, B. J.’s emphasis on the brain as the real seat of the body’s power rather than Innate Intelligence in the nerves angered and embittered Palmer, who accused his son of robbing him of credit and financial reward for chiropractic.75
Short of stature and filled with the same impetuous self-confidence as his father, B. J. possessed an administrative and business-oriented mind that allowed him to ably recruit both staff and students to the school and to expand the entire chiropractic field. Students learned not only the skills and theories of chiropractic but also how to be good businessmen, a skill B. J. believed essential to success and prosperity in medicine. It was a prescient move, as today more than sixty regular medical schools offer combined degree programs in medicine and business for much the same reason. At a chiropractic convention in Butte, Montana, B. J. explained that his school operated “on a business and not a professional basis. It is a business where we manufacture chiropractors. They have got to work just like machinery. A course of salesmanship goes along with their training. We teach them the idea and then we show them how to sell it,” B. J. proclaimed.76 Students developed their business acumen in a one-month “Salesmanship” course that intensively studied the topics of “Personal Magnetism,” “Business Relations,” “Advertising,” “Selling the Patient,” and “Keeping Yourself Sold.” To promote chiropractic, B. J. taught, lectured, and published constantly. He also saw the potential of commercial radio far in advance of other businessmen. In 1910, he established Davenport station WOC, whose call letters stood for “Wonders of Chiropractic,” one of the first and most powerful radio stations in the country. B. J. used the station, listened to by more than a million people, to promote the benefits of chiropractic care and to “establish Good Will for Chiropractic.” The station was not solely the marketing mouthpiece for chiropractors; it also broadcast news, sports, music, and farm reports. In the 1930s, the station hired a promising young Illinois sportscaster named Ronald Reagan. Under B. J.’s leadership, the Palmer School grew from twenty-one students in 1906 to more than two thousand in 1920. It was the largest medical school of any system of healing, regular or irregular, anywhere in the world.77
The osteopathic education system grew rapidly as well. The last five years of the nineteenth century saw schools opening in Anaheim, Minneapolis, Denver, San Francisco, Milwaukee, Boston, Des Moines, and Chicago. Graduates set up practices throughout the United States as well as abroad in Canada, Mexico, Britain, Ireland, and China. Not all of these schools were of the highest quality, as the rapid expansion of the field drew entrepreneurs out to make a buck from various educational schemes.78 Serious osteopaths worried about the damage these incompetent osteopaths might cause the fledgling field. Still was frequently moved to tears by stories of osteopathic charlatans preying on innocent patients or claiming osteopathic expertise. “They are drunken scoundrels, the very trash of your town,” raged Still, who “are no more fit [to practice] than a donkey is to go in a jewelry-shop.”79 And then there were, of course, the biggest imitators of them all, the chiropractors, who sullied the good name of manual manipulation. Regulars seized on osteopathy’s inferior schools as evidence of the profession’s mercenary rather than selfless motives to heal. They published articles ridiculing the incompetency of osteopaths and their education system. The fact that regular medicine had its fair share of diploma mills and poorly run schools did not seem to temper their criticism. Rather than refute these accusations, osteopathy’s leaders, like those in chiropractic, worked to upgrade and correct abuses.80
Many of the people who enrolled in osteopathic and chiropractic schools came from the lower classes. Too poor to afford regular medical school, which raised tuition in the late nineteenth century, many working-class Americans came to Palmer and Still seeking the promise of the American Dream, social mobility and economic independence. Osteopathic schools had historically maintained lower admission standards than regular medical schools, in part as a means of remaining accessible to poor students. In the 1920s, George Laughlin, president of the Kirksville College of Osteopathy, argued “that requiring two years of prior college work was hurting the underprivileged since they could least afford the additional schooling.”81 This commitment to accessibility had the unintended effect of creating an impression of osteopathy today as somewhat of a “back door” into medicine, a way for people who could not get into regular medical schools to become doctors.82 Both osteopathy and chiropractic also recruited practitioners from the ranks of satisfied patients, which Still and Palmer touted as the ultimate validation of their systems. Relief from what was for many a pain-filled life often prompted a powerful and dramatic conversion experience to a new way of life, just as it had for many of the founders and followers of other irregular health systems. Chiropractic, in particular, drew converts from those discontented with medicine or simply the course of their lives. Many had no medical experience save for a positive encounter with chiropractic adjustment. In other cases, teachers, lawyers, and ministers came to chiropractic seeking the fulfillment lacking in their current jobs. The maturity of these early chiropractors may have helped them withstand the persecution that a chiropractic career, particularly in the initial years, often entailed.83
Professional journals and associations followed the educational expansion of chiropractic and osteopathy. The Journal of Osteopathy began in 1894, and three years later, in 1897, the American Osteopathic Association (AOA) organized in Kirksville with the intention of improving educational standards, imposing sanctions on incompetent osteopaths, and raising the profile of osteopathy as a profession.84
Chiropractors embarked on a similar professionalizing course. The first chiropractic journal, the appropriately named Backbone, debuted in 1903. The Chiropractor, a Palmer publication, began the following year. In 1905, the American Chiropractic Association organized in Cedar Rapids, Iowa, and the following year B. J. Palmer started the Universal Chiropractors’ Association.85
These professionalizing tendencies differentiated chiropractic and osteopathy markedly from the irregular systems that had arisen before. American medicine, not to mention American culture, had changed. Experts and expertise increasingly mattered as people in every field banded together into professional organizations. While the democratic impulse still animated Americans toward common sense and resentment of elite knowledge and power, American culture in the late nineteenth century increasingly deferred authority in some fields, particularly science, to specialists. Irregulars could not rely on the populist sentiment that had sustained them in the past.86
But even as they recognized the realities of the new medical marketplace, osteopathy and chiropractic were not without internal dissensions that could potentially damage their growth. Osteopaths wrestled over the scope of their practice, particularly in regard to the range of therapies they should employ and the types of diseases and conditions they should treat. Two groups vied for support and control: those loyal to Still and his manipulative theory, known as “straights,” and those who doubted that manipulation could really cure everything and blended osteopathy with regular and other irregular medical therapies, known as “mixers.” Surgery presented the first challenge. Those who believed in manipulation alone saw no reason to add surgery to the osteopathic curriculum. Andrew Taylor Still, while disgusted by regular medicine’s overeagerness to reach for the knife, felt surgery had some place after all other options had been exhausted. It was the doctor, not the surgery, that was the problem, he reasoned.87 “We accept . . . surgery also as of great use and benefit to mankind,” wrote Still. “But when should the knife be used? Never, until all nerves, veins, and arteries have failed to restore a healthy condition of the body in all its parts and functions.”88 But if osteopathy was truly to compete with regular medicine and even other irregulars like homeopathy, the mixers argued, it had to provide the same range of services to patients. Still added surgery to the curriculum of his school in 1897, in part, out of hope that osteopathy could bring some reform to a field he thought too quick to send patients to the operating table. The conflict over inclusion of drugs was a far bigger and longer fight. Unlike surgery, Still saw no use for drugs, and he continued to attack them as an assault on the body’s natural healing power and an insult to the wisdom of God. He managed to keep most of his followers, who greatly respected his leadership even as they sought modifications of his theory, in line during his life. But the struggle between straights and mixers over drugs simmered beneath the surface and eventually transformed osteopathy into its modern form.89
Early chiropractors argued endlessly over adjustment techniques, equipment, and even aspects of Palmer’s theory itself. Many chiropractors developed their own way of manipulating subluxations. Others introduced a broad range of therapies to supplement physical adjustment, such as massage, electrical stimulation, and water therapy. Those methods that involved mechanical devices struck some pure chiropractors as particularly egregious, violating the meaning of a science whose name meant “done by hand.” B. J. Palmer discovered this himself in 1923 when he attempted to introduce the Neurocalometer, a device that could supposedly find subluxations by detecting changes in nerve transmission along the spine. The device deeply divided chiropractors and further fractured the movement.90 Many of the chiropractic schools, associations, and journals that formed operated as organs of these various splinter groups. The first chiropractic textbook was not published by Palmer but by some of his students who had set up a competing school in Cedar Rapids, Iowa. The authors not only neglected to credit Palmer, they also claimed the brain, not the nerves alone, was the source of all nerve function in the body, a position that Palmer’s son B. J. gradually adopted.91 B. J. himself also altered chiropractic theory and introduced new official chiropractic terms to maximize chiropractic’s differences from osteopathy. Instead of a diagnosis, chiropractors made an “analysis”; an “adjustment” instead of treatment; and never “manipulation,” the word most osteopaths used to describe their therapy.92 Some chiropractors felt their techniques were so different from Palmer’s as to be an entirely different medical system. One known as neuropathy blended chiropractic, osteopathy, and ophthalmology, while another called naprapathy was a form of manual medicine based on problems with the ligaments and connective tissues rather than nerves; both were started by Palmer graduates.93
Some chiropractors ignored the spiritual aspects of Palmer’s theory altogether, applying his system to the nagging back troubles for which regular medicine had little to offer. This frustrated and angered Palmer, who saw his system as a way to alleviate the world’s ills and illuminate life’s mysteries, and not simply a method of relieving chronic back pain. Those who thought so, declared Palmer, were “unprincipled shysters” and “kleptomaniac scavengers.”94 But for people suffering from lumbago and sciatica, the most common nineteenth-century back ailments, the mysteries of life took a backseat to the relief of debilitating pain.
People had searched for and tried various back remedies for centuries. For “An old Stubborn Pain in the Back,” John Wesley’s eighteenth-century Primitive Physick suggested steeping the “root of Water-Fern in Water” and rubbing it over the affected area. Rheumatism, the old word for musculoskeletal pain, could be helped in a variety of ways, from wrapping the back in molasses-smeared bandages to living on fresh “Milk Whey” and white bread for fourteen days.95 Many regular doctors prescribed opium for the pain, taken as laudanum or morphine or mixed in powders or elixirs. They also bled and made shallow cuts in the skin to reduce inflammation in the part of the body in pain. In the late nineteenth century, electrical devices became popular pain relievers. Dr. Scott’s Electric Flesh Brush was “WARRANTED TO CURE” a panoply of illnesses, from rheumatism and “Diseases of the Blood” to those “Back Aches peculiar to Ladies.” The brush produced an electromagnetic current through its bristles and came with a silver compass to test the potency of the charge.96 Electrical devices are still popular today. One, known as a TENS (transcutaneous electrical nerve stimulation) unit, stimulates the low back and other painful areas and is sometimes prescribed by regular doctors despite conflicting evidence of efficacy.97 As the range of these treatments suggests, no one had a clue how to relieve back ailments. That failure gave chiropractic an opportunity to fill a very real physical need. Palmer’s disapproval did little to dissuade some chiropractors from focusing entirely on the technical rather than spiritual aspects of the system. A Dr. Metzger in Anaconda, Montana, even predicted that one day instead of asking others how they were, the daily greeting would be replaced with “How’s your spine?” This focus helped chiropractic gain a devoted following.98
Part of the appeal of both osteopathy and chiropractic to many Americans was the simplicity of their theories. This was nothing new. Irregulars had long championed straightforward and accessible medicine. The idea of disease as an obstruction in need of correcting made intuitive sense to followers. But simplicity was also becoming increasingly anachronistic. Scientific discoveries in the late nineteenth century, most notably the germ theory of disease, convinced many medical researchers and regular doctors that disease could not be explained by one universal cause, especially one that accounted for both the body and the spirit as Palmer and Still believed their systems did. Manual manipulation also struck many regulars as too crude to address the wonders and intricacies discovered in the lens of a microscope. The regular medical profession had a vested interest in complexity, though. Medicine had to be beyond the comprehension and skill of the general public to command respect and prestige. Simple explanations undermined the authority and expertise of doctors.99
Osteopaths did not ignore or stand defiant in the face of new scientific discoveries. By the early twentieth century, most accepted that germs caused disease, though they interpreted the finding through an osteopathic lens. The health of the body’s structure determined the viability of germs in the body, reasoned osteopaths. Germs thrived where the blood pooled and slowed: at osteopathic lesions, in other words. Manipulation stimulated the body’s natural resistance by restoring the free flow of blood, which would overcome the infection.100 How to combat and prevent infection became the determined preoccupation of regular doctors in the first decade of the twentieth century. They searched for effective, germ-killing drugs, an investigation that only heightened tensions among osteopaths over the admissibility of drugs into osteopathic education and daily practice.
Chiropractors, on the other hand, had a more complicated relationship with the germ theory. While most did not outright reject the existence of germs, chiropractors believed that regular medicine overemphasized germs—just like drugs and surgery—and that the true cause of disease was not outside, where germs lived, but inside the body. This idea left germs in a rather nebulous place in chiropractic theory. “Chiropractors have found in every disease that is supposed to be contagious, a cause in the spine,” wrote B. J. Palmer. “There is no contagious disease. . . . There is no infection. . . . There is a cause internal to man that makes of his body in a certain spot, more or less a breeding ground [for microbes].”101 Chiropractors did believe that hygiene was important to health, just as regular medicine had come to believe thanks to the hydropaths by the late nineteenth century, though chiropractors likely saw it as a way to promote overall health rather than as a means of controlling and containing the spread of germs and thus disease.102 Because they emphasized nature and viewed disease as an internal process, chiropractors also tended to reject medical devices and gadgets like electric massagers because the introduction of these technologies suggested that nature was inadequate to the task of healing. Chiropractic ambivalence about the germ theory of disease continued well into the twentieth century, coming to a head in the 1940s with the introduction of antibiotics, which made germs harder to ignore. Although this led to a decline in chiropractic opposition, some chiropractors to this day do not accept that microbes can cause disease. The idea of disease caused and cured from inside or outside the body still constitutes a real philosophical difference between chiropractic and regular approaches to health care.103
While many Americans frequented chiropractors and osteopaths for philosophical reasons, many others went out of necessity; they were the only doctors in town. Since colonial times, regulars had been concentrated in more populous areas of the country, leaving rural and frontier communities to fend for themselves. By the early twentieth century, advances in medical science began dividing medical practice into subspecialties. Doctors no longer served as clinician and surgeon treating all diseases and all patients as they had for centuries. Many regulars moved to hospitals and medical institutions in urban areas to practice where the money and patient pool offered greater opportunities and benefits, often leaving rural communities without medical care. Both chiropractors and osteopaths benefited from this shift. They earned their first and most loyal followers in the rural Midwest and other small towns around the country, where they found a grateful clientele whose care absolutely depended on the survival of these systems. They also thrived in urban areas by offering a distinctive treatment that had no counterpart in regular medicine, creating a patient population dependent on their services.104 It certainly did not hurt that osteopathy and chiropractic tended to cost less than regular care as well.
Like most of the irregulars before them, osteopathy and chiropractic also legitimated all diseases as worthy of consideration and care, and they promised hope for all. Regular medicine often designated patients, particularly those suffering from chronic illnesses, as hopeless, or worse, as hypochondriacal. In osteopathy and chiropractic, nothing was impossible, nothing incurable. Each had a theory that provided a clear and coherent explanation for a range of sometimes confusing and conflicting symptoms that comforted patients in search of answers.105
And they did report great success in their treatments. Like those using hydropathy, most osteopathic and chiropractic patients were not generally acutely ill but suffered from chronic problems. These patients could generally get around, albeit painfully at times, and practitioners reported positive results with many patients who had given up on ever feeling better.
Regular medicine had plenty of biting criticism and ridicule for these new systems of manual medicine. Mark Twain rather precisely summed up the situation when he declared that asking a doctor what he thought about osteopathy was like “going to Satan to find out about the Christian religion.”106 Regulars disparaged not only the quality of osteopathic schools but also what they saw as its graduates’ blind subservience to a poorly educated, hopelessly vague, and mystical leader. Osteopaths were guilty of “claiming impossible things and doing harmful ones.” Any good that resulted from osteopathy was simply luck or the power of suggestion. “Happy is the charlatan who happens to be at hand when the triumph of the recuperative power takes place, and thrice happy is he when a reputable man who knows nothing about such things can be persuaded that mere coincidence is the brilliant demonstration of a new art of healing,” proclaimed a 1905 New York Times editorial.107 Regular physician Richard Newton declared osteopathy “a complete system of charlatanism, empiricism and quackery calculated and designed to impose on the credulous, superstitious and ignorant, and fraught with danger.”108
Most Americans were at least willing to give osteopathy a chance, and the system received mostly favorable reviews in popular magazines and newspapers. In 1895, John R. Musick wrote a history of osteopathy for Godey’s Magazine that included a record of its successes. He condemned regulars for dismissing it out of hand and suggested that they did so out of fear of new ideas. Still’s theory “has certainly achieved much success in the past, and is worthy of careful investigation before it is condemned,” Musick concluded.109 Among osteopathy’s most prominent supporters was Mark Twain, who after humorous run-ins and experiments with several other irregular health systems seemed to have found the system he’d been looking for and became an outspoken advocate of Still. Twain even testified at a hearing before the New York Assembly Committee on Public Health in 1901 in favor of a bill to license osteopaths. In trademark Twain fashion, he kept the room laughing with a speech that blended a plea for personal liberty with self-deprecation. “Now I am always wanting to try everything that comes along. It doesn’t matter much what it is, I want to try it. And so I went to [osteopath] Mr. Kelgrin, was treated by him in London, and later on in Switzerland, and he did me a lot of good,” said Twain, “although I must admit that my education doesn’t qualify me to say just when I am in good health. But I should like to have the right to experiment with my own body to my heart’s content. I don’t care whether it is to my own peril or anybody else’s.”110 Osteopathy also counted President Theodore Roosevelt, General Dwight Eisenhower, and businessman Howard Hughes among its supporters.111
Chiropractors mostly eluded the attention of regulars, at least at first. Perhaps they were too focused on osteopathy. But by the early twentieth century, reports of patient deaths due to “neck twisting,” vertebral “dislocations,” and other disfigurements were a regular feature in regular medical journals. B. J. Palmer’s pretensions and showmanship captivated followers and became fodder for critics. “Chiropractic is a religion, it is the worship of B. J. Palmer,” wrote Charles Warner. “Palmer encourages the idea by wearing his hair and beard to resemble Christ; and by having his pictures taken in a pose to imitate Christ in the painting ‘Christ Before Pilate.’”112 Regulars also delighted in sending barely literate letters requesting admission to chiropractic schools and publishing the results. In 1923, the Journal of the American Medical Association reprinted a letter supposedly from a young Texas widow seeking to enroll at the Carver Chiropractic College in Oklahoma City. “Sirs, Mister Kirpatic School, I want to rite letter an see if I can be kirpatic dr. if you can make a kirpatic dr. for how much money I got about 2 thousend dolers that my husband got wen he died.” The Carver school responded with condolences to the widow and commended her interest in chiropractic. They offered her immediate admission and praised her decision to spend her money on “a real life’s work.”113 Perhaps the most famous condemnation of chiropractic, though, came from Morris Fishbein, editor of the Journal of the American Medical Association and well known for his quack-busting crusades. Though no friend to osteopathy, Fishbein saw chiropractors as far worse, a “malignant tumor on the body of osteopathy. . . . Osteopathy is essentially a method of entering the practice of medicine by the back door. Chiropractic, by contrast, is an attempt to arrive through the cellar. The man who applies at the backdoor at least makes himself presentable. The one who comes through the cellar is besmirched with dust and grime: he carries a crowbar and he may wear a mask.”114
As much as regulars disparaged chiropractors, though, osteopaths might have hated them even more. They were certain that Palmer had simply copied Still’s ideas and methods. Rumors of Palmer having visited Still in Kirksville proliferated. As proof, osteopaths pointed to Palmer’s signature in Still’s guestbook. Palmer denied ever being in Kirksville and claimed the signature was a fraud.115
While many Americans found much to like in chiropractic, it struggled to receive praise in the press. Many magazines and newspapers took an extremely negative view toward chiropractors and their philosophy, sounding every bit like regular doctors. In Harper’s Weekly in 1915, journalist George Creel recalled visiting a chiropractor with a made-up problem needing treatment. The chiropractor cracked and popped Creel’s neck and spine to the point that Creel felt “he had done his worst.” Creel was wrong, though. “He turned me over on my face again, and in a few seconds I felt an awful pressure on my spine, first one spot, then another,” described Creel. When Creel got home, he looked at his back in the mirror and saw “a large black spot the size of a grape fruit. Only heaven knows what would have been my present state had I not been in perfect health and strength when I took the treatment.”116 These types of stories often appeared in newspapers that also featured ads for chiropractors promising free consultations or “no cure, no pay” policies as a measure of good faith. Some chiropractors boldly asked for patients who seemed incurable. A Dr. Offerman in St. Paul, Minnesota, advertised, “When others fail come to me . . . don’t give up. I will guarantee a cure. Remember that curing disease after all others have failed is my specialty.”117
More than words, regulars tried to use the law to destroy, or at the very least restrict, osteopathy and chiropractic. The primary issue hinged on whether either actually qualified as a form of medicine. Many states narrowly defined medicine as prescribing drugs, so drugless systems like chiropractic and osteopathy were not medicine and therefore could not be regulated or subject to laws for practicing “medicine.” But that did not stop regulars from claiming otherwise. Still’s own son, Charles, who had achieved success treating victims of a diphtheria outbreak in Minnesota, was the first osteopath to come to the attention of the state health authorities. In treating the disease, Charles likely followed his father’s instructions to “bring the clavicles and sternum far enough forward to take off any pressure that exists, in order to let venous blood and other fluids return to the heart” and to keep patients in a clean, well-ventilated room. As an infectious bacterial disease, diphtheria was likely little helped by Charles’s manipulations. His patients may have had mild cases, and they probably recovered on their own; most fatalities from the disease occur in children under five. Working in such close proximity to his patients, Charles was fortunate to escape without contracting diphtheria himself, though he could not escape the law. Charles was arrested and charged with practicing medicine without a license. The case against him was dropped, however, as the number of people seeking his care grew so large that it became hard for the state to deny his effectiveness. Not every osteopath was so lucky, and many others faced trials in the 1890s.118
Chiropractors had to watch out not only for regulars but for osteopaths, too. Some hid their DC diplomas and practiced behind closed shades and locked doors. Many chiropractors did go to court for practicing without a license, but few were convicted. Those who were usually went to jail willingly as a demonstration of their dedication to medical freedom. One of the first to be jailed was Palmer himself, who was arrested in Davenport in 1905 for violating medical practice laws. The case hinged, in part, on claims made by Palmer in his journal, the Chiropractor, in which the state claimed that Palmer professed to cure all kinds of diseases with his unlicensed healing method. The jury found him guilty, but Palmer’s refusal to pay the $350 fine led the Davenport Democrat & Leader to report, “He will stick with chiropractic to the end [and] offer himself as a martyr” by going to jail. In the end, Palmer only served twenty-three days of his 105-day sentence after his wife paid the fine.119 Following Palmer’s lead, the Federated Chiropractors of California launched a “Go to Jail for Chiropractic” campaign in the 1920s that helped to infuse chiropractors with a sense of martyrdom mixed with heroism. Arrests sometimes proved good for business. Publicly sacrificing oneself in defense of medical freedom against the tyranny of regular medicine was a winning storyline for many Americans.120
Although many received pardons and acquittals, osteopaths and chiropractors knew that depending on the favor of juries, particularly as regular medicine campaigned to have both prohibited by state legislatures, was a dangerous course. Besides legal action, regulars denied them membership in local medical societies and refused to allow them admission to university and public hospitals. Medical societies also prohibited regulars from any kind of professional cooperation, tactics they had previously employed against homeopaths, hydropaths, and other irregulars. Osteopaths and chiropractors responded with a very different course of action than their predecessors, though. Rather than fight the enactment and enforcement of licensing laws, as the Thomsonians had done in the 1830s, they fought to be licensed themselves.121
Osteopaths took a pragmatic course, fighting for full rights in some states and partial rights in others depending on their resources, support, and, of course, how much resistance they faced from regulars. In 1896, Vermont became the first state to license osteopaths, a move that led Dr. Robert T. Morris of the New York County Medical Society to label Vermont “the garbage ground of the profession.”122 Osteopaths often gave demonstrations and free manipulations to legislators to win support in key states. North Dakota and Missouri soon followed Vermont’s lead, and by 1901, fifteen states had granted osteopathy legal standing. A little more than a decade later, osteopaths could lawfully practice in forty states. Not every state was so easily won, however; Mississippi, the last holdout, finally consented to license osteopaths in 1973.
Osteopathy also expanded its college curriculum in the early twentieth century to include surgery, obstetrics, and even, most controversially, drug therapy.123 Many state legislatures insisted that if osteopaths were to be licensed to provide surgery, they should be required to study all of the same subjects as regular doctors, including drugs. Osteopathy yielded to the pressure, though not without considerable pain and torment to Still, who urged his supporters to not be “trampled in the mud” by regulars but to “hold up the pure and unadulterated osteopathic flag.”124
Chiropractors suffered far more arrests and abuse than osteopaths because winning licensure was a slower process. In 1913, Kansas became the first state to license chiropractors, and the total had climbed to twenty-two by the early 1920s. Twenty-five more states had passed licensing laws by the end of the 1920s, leading journalist H. L. Mencken to complain of “a chiropractor at every cross-roads, and in such sinks of imbecility as Los Angeles they are as thick as bootleggers.”125 It would be decades before the chiropractic battle for licensure ended, though.
After licensure, improving education was the priority for both osteopaths and chiropractors. Osteopaths concentrated on keeping pace with the requirements and standards of regular medical schools so that by the 1930s, the curriculum of regular and osteopathic schools looked nearly identical; by the 1950s, most osteopaths had become more or less the equals of regular medicine practitioners.126
At the same time, osteopaths insisted on maintaining a separate identity, something homeopathy had failed to do. They were not MDs, as homeopaths had considered themselves, even though osteopaths legally had the right to use that title; they were DOs. Osteopaths maintained their own schools, hospitals, professional journals, and associations and asserted that the quality and scope of their care was comparable if not superior to regular medicine. They resisted joining regulars as a therapeutic option within regular medicine, understanding, as other irregulars had not, that the allure of ostensible acceptance would likely lead to their demise as the actual distinctions between osteopathy and regular medicine blurred. Osteopathy became, in essence, a parallel profession to regular medicine with a similar range of institutions and periodicals.127 In fact, many doctors today wonder why osteopathy persists and question its reason for being. But many regulars are perhaps unaware of osteopathy’s history and its rise to prominence at a time when no medical system, regular or irregular, dominated. While manual manipulation plays a smaller role in osteopathy than it did at first, many osteopaths still use it in their practices, particularly those in solo practice. Proficiency in manipulation does require practice and time, things that osteopaths practicing in regular institutions often do not have due to the constraints of the modern medical system.128
Most critically, osteopaths survived by locating a medical need and defining their own niche. Many served small towns and rural areas where they were often the only doctors in town. The geographic scarcity of doctors in some regions led both federal and state governments to appropriate funds for the training of osteopaths as one strategy for solving the primary care shortage in rural areas. Osteopaths also did not actively pursue new medical research and subspecialties as quickly as regulars. This was, in part, because outside of the developing regular medical system, osteopathy lacked the resources for schools, equipment, and training. They focused, instead, on primary care and took advantage of the growing need for general practitioners in the 1940s as more regulars choose to specialize in fields like surgery and psychiatry. Barred from providing medical service and exempt from the draft in World War II, osteopaths who had not volunteered for other war duties provided much-needed medical care on the home front. With roughly forty-five thousand regular doctors in the military defense force, many Americans who might not otherwise have been exposed to osteopathy gave it a try. Many regulars returned from the war and found they had lost their patients. Osteopathy, in essence, gained legitimacy by stepping into the primary care vacuum left by regulars, even if many patients did not know the difference between the two forms of medicine (a problem that persists to this day). With these shifts, regular doctors found themselves dependent on an irregular system as a source of referrals for their own specialty practices, a seemingly unimaginable outcome of the more than century-long struggle between regular and irregular healers.129
Even so, osteopathy traded ideological purity for survival. In the 1930s, many osteopathic schools began referring to their practice as “osteopathic medicine,” with increasing emphasis on the word “medicine,” to gain more financial backing. They may also have hoped to “pass” as regular doctors without the necessary theoretical qualifiers to attract more clients. Rather than stress their differences from regular medicine as they had in Still’s time, osteopaths emphasized the quality of their care. They also relied less and less on manipulation as the primary mode of treatment. Today, many osteopathic medical schools still teach manual manipulation but regard it more as an option rather than as the only treatment. In deemphasizing manipulation, osteopaths tried to counter the accusations of regulars that osteopathy was a quackish cult. It seemed to work. In 1969, no longer able to easily justify their exclusion on the basis of education or quality of care, the AMA opened its membership as well as internships and residencies to osteopaths.130
Those patients who sought manipulative relief for chronic musculoskeletal problems continued to turn to chiropractic for help. Chiropractors’ devotion to low-technology adjustment as their therapeutic method kept them on the fringes of regular medicine at a time when medical care was growing increasingly complex and technological.131 Palmer’s belief that he had discovered a higher form of medicine, “the antithesis of medicine,” in B. J. Palmer’s words, significantly influenced the direction of the profession and its overall unwillingness to absorb the theories and therapies of regular medical science. Osteopaths, by contrast, tended to view themselves as reformers rather than crusaders of an entirely new health paradigm, so perhaps their accommodation and cooperation with regular medicine was more predictable.132 To function within regular medicine, chiropractors would have to gain patients through referrals from regular doctors rather than reaching out to patients directly. Chiropractors proved unwilling to relinquish their autonomy, a position strengthened by osteopathy’s move into primary care. Treatment of musculoskeletal conditions, particularly back pain, was left almost solely in their hands. While a far more diminished role than many chiropractors aspired to and that Palmer had envisioned for his science, this focus gave chiropractors authority in an arena where regular medicine had little to offer and allowed them to remain independent.133
In recent years, manual medicine has made some inroads into regular medicine, as regular doctors have recognized the benefits of osteopathic manipulation for specific cases. Some hospitals have even integrated it into overall patient management because it scores well in client satisfaction.134
Osteopaths themselves are osteopathy’s most significant and visible influence on regular medicine today. Many now practice and interact on equal terms with regular doctors. But the parallel profession path has its problems, as many patients cannot distinguish between the two types of medicine, and osteopathy has struggled to maintain and assert its identity. The time and bureaucratic constraints of the modern medical system make it challenging for osteopaths to practice manipulation and to take the detailed patient histories that Still required. Many regulars, too, continue to view osteopathy as inferior and see its schools as an easier and substandard path to becoming a doctor.
Chiropractors, on the other hand, have remained a marginal profession, not quite accepted but not as far to the fringe as holistic health movements like naturopathy and even homeopathy in its modern form. Unresolved conflicts and tensions between chiropractors and regulars continue to color relations between the two and perhaps bear the most resemblance to the strife that characterized nineteenth-century medicine. Some regulars still feel that chiropractic adjustments pose potentially serious health risks. Several reports have linked chiropractic manipulation of the neck to stroke.135 Many regulars would prefer that chiropractic-like adjustments be provided by physical therapists under their supervision or at least within the confines of a regular medical institution, a position chiropractors reject. Chiropractors today seem to have socially and psychologically accepted their outsider status, finding unity in a role as an extremely popular but “oppressed minority” within the dominant medical system.136
Perhaps that’s just the way the elder Palmer and his son wanted it. The two made much of the martyrdom of chiropractors who suffered at the hands of the law for their healing convictions. Conflict increased solidarity and gave chiropractic practitioners and their followers a sense of righteous indignation. Regular medicine “condemns every method, every procedure, every theory, idea or help to humanity that does not originate within and financially help to fill the pockets of its own ranks,” declared B. J. “It cares not what you, as a patient, think.”137