,transcriber's ,note3 ,boldface text is enclosed in equals signs2 italics text is enclosed in underscores4 ,,technic ,,and ,,practice ,,of ,,chiropractic ,,by ,,joy ,m4 ,,loban1 ,d4 ,c41 ,,ph4 ,c4 ,professor of ,anatomy and of ,theory and ,practice of ,chiropractic at the ,universal ,chiropractic ,college4 ,formerly ,professor of ,chiropractic ,analysis at the ,palmer ,school of ,chiropractic ,,second ,,edition ,revised and ,enlarged ,,published ,,by ,,universal ,,chiropractic ,,college ,,davenport1 ,,iowa #aiae ,,copyright #aiae ,,by ,,joy ,m4 ,,loban ,,hammond ,,press ,w4 ,b4 ,,conkey ,,company ,,chicago ,,this ,,book ,,is ,dedicated ,,to ,,the ,,girl ,,who ,,has ,,been ,,my ,,staff ,,and ,,lantern1 ,,aiding ,,and ,,lighting ,,me ,,on ,,my ,,way ,,in ,,this ,,new ,,field ,my ,wife ,,table ,,of ,,contents ,,page ,preface to ,first ,edition #i ,preface to ,second ,edition #aa ,introduction #ac ,vertebral ,palpation #ae ,definition #ae ,general ,propositions #ae ,habits of ,palpation #ae ,facts ,concerning the ,spine #af ,preparation of ,patient #bb ,position of ,patient #bb ,the ,record #bc ,the ,count #bi ,atlas ,palpation #ce ,the ,group ,method #cg ,the ,individual ,subluxation #dj ,palpation in ,position ,b #df ,palpation in ,position ,c #dh ,transverse ,palpation #di ,curves and ,curvatures #ec ,difficulties in ,palpation #ei ,landmarks #fa ,mental ,attitude #fc ,nerve ,tracing #fd ,organ ,tracing #fd ,what ,nerves are ,traceable #fd ,suggestion #fg ,place in ,diagnosis #fg ,technic of ,nerve ,tracing #fh ,subluxations #gf ,definition--,how ,produced #gf ,law ,governing ,location of #gh ,varieties of ,subluxations #hj ,technic of ,adjusting #hi ,general ,principles of ,adjusting #hi ,special ,technic 7,thirty-two ,moves7 #ii ,preferable ,adjustments #aee ,the ,cause of ,disease #afe ,simple ,subluxation ,disease #ahd ,secondary ,causes #ahe ,germ ,diseases #ahe ,diet #aib ,poisons #aid ,exposure #aih ,bodily ,excesses #bja ,inflammation #bjb ,the ,process of ,cure #bjh ,adjuncts #bae ,spino-,organic ,connection #bag ,general ,discussion #bag ,special ,nerve ,connections #bce ,table of ,diseases and ,adjustments #beg ,practice #bgf ,office ,equipment #bgg ,schedule of ,examination #bib ,necessity for ,correct ,diagnosis #bih ,frequency of ,adjustments #cjb ,specific vs4 ,general ,adjusting #cjc ,talking ,points #cjf ,promises to ,patients #cjh ,retracing of ,disease #cji ,limitations of ,chiropractic #cab ,the ,use of ,adjuncts #cae ,personality #cai ,chiropractic ,prognosis #cbb ,general ,discussion #cbb ,practical ,prognosis #cbc ,preface to ,first ,edition ,this little work is offered to the profession without apology for its brevity or its form4 ,it has been prepared because of an immediate and pressing need for such a guide in our colleges1 and is offered abroad under the impression that many practicing ,chiropractors feel the same need4 ,it is intended for handy reference and clinical use and is arranged as systematically as possible1 style being everywhere sacrificed to utility4 ,the author lays no claim to the origination of any of the subject matter of this book nor to having invented any of the movements described under ,technic of ,adjusting4 ,the arrangement and phraseology are in the main original4 ,the intention has been merely to condense into practical and convenient form for students and practitioners certain knowledge now held and utilized in our profession4 ,the author feels himself indebted to the entire profession for the information embodied in this work1 and to scientists of all time upon the results of whose infinite and painstaking research are based our present day advancement2 to the many friends and co-workers whose valuable criticisms and suggestions have aided in this labor2 and to his students1 past and present1 who have furnished the necessary encouragement and inspiration for the achievement of this1 the author's first text-book4 ,the chief merit of this effort--if merit there be--is its honesty4 ,the author has endeavored to set forth fairly and simply the facts and hypotheses with which we have to deal4 ,its chief offense1 in the eyes of many1 will lie in its being just what it purports to be--a book on ,chiropractic4 ,constructive criticism and suggestion are invited from all sources1 for by our interchange of thoughts we grow4 ,j4 ,m4 ,l4 ,preface to ,second ,edition ,the republication of this book has been made possible by the sustained friendship of the profession for it1 and the author's thanks are due its many buyers and readers who1 by their recommendation1 have made it both possible and necessary that this book should live and grow4 ,the new edition has been somewhat enlarged by the introduction of additional matter into each section and by the addition of two entire new chapters on 8,preferable ,adjustments0 and 8,chiropractic ,prognosis40 ,new plates have been added and old errors corrected4 ,in every way an attempt has been made to express with conservatism the real advance made by ,chiropractic since the first edition was put on the press4 ,j4 ,m4 ,l4 ,,introduction ,no two students1 approaching for the first time the study of ,chiropractic1 approach from the same angle4 ,their viewpoints differ4 ,in order that all may gain as nearly as possible the same viewpoint from which to consider in turn the sections of this book1 it will be well if each student reads the entire book before beginning to memorize its parts and convert them into practical working knowledge4 ,an effort should be made1 abandoning all other1 to acquire the ,chiropractic viewpoint4 ,this accomplished1 the rest of the task requires time and patience alone1 without waste labor4 ,the section on ,vertebral ,palpation should be studied step by step1 the study of each step being combined with practice in it4 ,likewise the section on ,nerve-,tracing1 theory preceding practice4 ,the study of the ,technic of ,adjusting should occupy those months immediately preceding the commencement of actual adjusting practice and continue during such practice4 ,the chapters on ,practice are intended for the student about to enter the field4 ,the table of ,spino-,organic ,connection can be best understood by those who have studied or are studying the anatomy and physiology of the nervous system4 ,let every page be studied with a good medical dictionary open at the elbow of the reader4 ,pass no word without comprehension1 no detail without mastery4 ,he who would seek to modify the life processes of the human body must fortify himself against fatal error with every bit of knowledge he can acquire4 ,,vertebral ,,palpation ,definition ,vertebral ,palpation consists in the use of the tactile sense to determine the position1 relation1 size1 shape1 and as far as possible the condition1 of the segments of the spinal column1 in order thus to discover the primary causes indicative of disease4 ,or1 ,vertebral ,palpation is the name given the manual examination of spinal vertebrae4 ,general ,propositions ,every palpation should be made with the adjustment of the vertebrae in mind4 ,the record of palpation should be a correct guide as to direction of adjustment4 ,no subluxation impossible of adjustment should be recorded4 ,the two essentials of correct palpation are accurate perception and correct reasoning4 ,to secure the first1 a certain approved manner of using the hands is herein laid down and a considerable amount of tactile sense development by practice is required4 ,correct reasoning depends upon knowledge of all the important facts concerning the spine and of the rules governing palpation4 ,absolute concentration is required and to this end many of the following rules are directed4 ,habits of ,palpation ,every palpater unconsciously forms habits of thought and action4 ,these habits may be good or bad4 ,we deliberately form a habit of holding the first three fingers closely together or the habit of using a downward glide1 but we should avoid the habit of finding certain subluxations because they are usual and expected rather than because they are actually there4 ,for instance1 one may easily form a habit of listing every other vertebra in the spine1 his whole record thus depending upon his first choice4 ,because of this perfectly natural tendency to establish a routine of thought and action and to follow it precisely1 it is best not to attempt palpation without the aid of an experienced teacher until after correct habits have been formed4 ,once formed1 a palpation habit1 right or wrong1 is very hard to break4 ,many a teacher has expended himself uselessly in the effort to undo some technical fault acquired by the student in a blundering undirected trial4 ,facts ,concerning the ,spine ,the spinal column is composed of twenty-six segments called vertebrae1 twenty-four movable and two fixed4 ,the movable vertebrae are divided for convenience in study into three sections4 ,there are seven ,cervical vertebrae1 twelve ,dorsal1 and five ,lumbar in the normal individual4 ,the number of ,dorsals or ,lumbars may vary by one in a rare case4 ,these variations occur in about one spinal column in each five hundred and are usually in the ,lumbar region1 which may contain four or six vertebrae4 ,a prominent first sacral spinous process may be mistaken for an extra ,lumbar4 ,five vertebrae have special names4 ,the first ,cervical is called ,atlas2 the second ,cervical1 ,axis2 the seventh ,cervical is commonly known as ,vertebra ,prominens on account of its long and large spinous process1 although this long process belongs to the sixth ,cervical or first ,dorsal instead in #ce of all cases2 the large1 irregularly fusiform vertebra just below the ,lumbars and between the ilia is called the ,sacrum2 and the smaller one below it1 the ,coccyx4 ,the latter is occasionally missing4 ,each vertebra except the ,atlas is composed of a body and an arch2 the arch is made up of two pedicles1 short1 thick plates of bone extending outward and backward from the postero-lateral surface of the body nearer its upper than its lower border1 two laminae1 thin plates of bone extending backward and inward from their union with the pedicles and joining behind to form the spinous process1 and has projecting from it seven processes1 two transverse1 one spinous1 and four articular1 two of which are superior and two inferior4 ,the foramen enclosed by the body1 pedicles1 and laminae is called the neural or vertebral foramen and the canal formed by the connection of these foramina and completed by the ligaments which unite the arches is called the neural1 vertebral1 or spinal canal4 ,it contains the spinal cord with its membranes and the roots of the spinal nerves4 ,by means of the four articular processes each true vertebra except the first articulates with its fellows above and below4 ,the body of the vertebra is its largest portion and is joined to its fellows by fibrocartilaginous disks which are sufficiently elastic to permit some torsion and compression4 ,nine sets of ligaments1 including the intervertebral substance just mentioned1 bind the vertebrae firmly together4 ,many muscles are attached to the spinal column4 ,the intervertebral foramina are openings at the sides of the vertebrae1 formed by the notching of apposed pedicles4 ,these openings are surrounded by bone1 cartilage1 and ligaments and vary in shape in different sections of the spine4 ,they permit the exit of the spinal nerves and their sheaths1 the re-entrance of some nerve fibres into the neural canal1 and the passage of blood-vessels to and from the cord4 ,the entire philosophy of ,chiropractic focuses at the intervertebral foramen because there we find the primary cause of all pathological changes in the body4 ,the spinous and transverse processes merit particular description since they are the levers by which vertebrae are adjusted and nerve impingements at the intervertebral foramina corrected4 ,but it will be found easiest to describe these processes separately in different sections of the spine and before proceeding to this description1 a brief picture of the peculiar vertebrae will be presented4 ,the ,atlas is a bony ring composed of two arches1 an anterior and a posterior1 separated in the recent state by a transverse ligament4 ,its body is detached and appears as a tooth-like projection upward from the body of the ,axis1 the odontoid process1 which articulates with the anterior arch of the ,atlas and around which the ,atlas rotates1 a ring around a pivot4 ,the ,atlas supports the head upon its lateral masses1 two wedge shaped bodies between the anterior and posterior arches1 thinner internally than externally4 ,it has no spinous process but merely a tubercle where the laminae join1 so that it can be palpated only from the sides upon the tips of its long transverses4 ,the first ,cervical1 or suboccipital1 nerves emerge by a groove above the pedicles instead of through a foramen4 ,the ,axis1 or second ,cervical1 is distinguished by its large1 strong spinous process1 which is bifid at its tip1 by its superior articular processes which rest upon body1 pedicles1 and transverses1 and by its odontoid process1 upreared from the body4 ,the ,seventh ,cervical1 or ,vertebral ,prominens1 usually has a large spinous process1 presents no foramina in its transverse processes1 or only one1 the left1 and shows no facets on body or transverse for the rib articulation1 as do the ,dorsals4 ,the ,sacrum is the largest vertebra2 is curved with its convexity backward2 is commonly made up of five fused segments2 has only rudimentary spinous and transverse processes except the first2 and shows sixteen openings1 eight anterior and eight posterior1 or four on either side of the median line in front and the same number and arrangement behind4 ,these openings permit the exit of the anterior and posterior primary divisions of the sacral nerves separately4 ,the ,coccyx1 usually composed of four fused segments1 is a triangular bone which articulates with the ,sacrum above and is free at its distal extremity4 ,its portion of the neural canal is open posteriorly and contains merely the thread-like termination of the cord membranes4 ,it is frequently ankylosed to the ,sacrum1 sometimes in an abnormal position so as to impinge the single pair of coccygeal nerves4 ,the different regions of the spine show decided differences in structure1 though all resemble each other4 ,the ,cervicals are smallest1 the ,dorsals next in size1 and the ,lumbars largest and strongest of the movable vertebrae4 ,the ,dorsals have facets and demi-facets for the articulation of the twelve pairs of ribs with their bodies and intervertebral substance1 as well as oval facets upon the anterior aspect of their transverses for articulation with the tubercles of the ribs4 ,the spinous processes are smallest and usually bifurcated down to and including the fifth4 ,the sixth may show a plain bifurcation1 or on any ,cervical the bifurcation may be so small as to be imperceptible to touch4 ,the spinous process of the second overlies that of the third so as to make the latter very difficult of detection4 ,indeed1 all cervical spinous processes down to the sixth are harder to palpate than those in other regions1 owing to the anterior cervical curve4 ,the processes lie in a groove between prominent muscle ridges4 ,dorsal spinous processes are usually single1 although the last four1 three1 two1 or one may show plain bifurcation in certain individuals4 ,they are somewhat pointed and overlap1 except the lower ones1 the obliquity being greatest in the mid-dorsal region and least at the first and last dorsals4 ,lumbar vertebrae have broad1 flat-tipped spinous processes much larger than the others4 ,the last ,dorsal may sometimes appear like a ,lumbar in shape1 so that the change in shape commonly supposed to mark a division between ,dorsals and ,lumbars is not always an infallible guide4 ,the transverse processes in the cervical region are very short and lie close in front of the articular processes4 ,they are pierced by foramina for the vertebral artery and vein1 except the seventh1 which may have one foramen or none4 ,they are difficult of access for palpation because of their shortness and the amount of overlying muscle1 but may be reached from the front and side by drawing back the sternomastoid4 ,they increase in length from the second to the seventh4 ,in the dorsal region the transverses are larger and stronger and more constant in size1 shape1 and direction1 serving to support rib articulations4 ,they extend in a curved direction outward1 backward1 and slightly upward from the union of laminae and pedicles and terminate in a large subcutaneous club-shaped extremity which may be readily palpated4 ,the eleventh and twelfth dorsal transverses do not articulate with the ribs and must therefore be used with caution or not at all as levers for adjustment4 ,the dorsal transverses are located on a higher level than the spinous processes4 ,in the case of the upper three dorsals the transverse lies in a plane which would cross the mid-spinal line between its own and the next superior spinous4 ,in the mid-dorsal region the transverse is even with the spinous of the vertebra above1 though the relation may vary slightly4 ,the lower dorsals return to the same relation as the upper4 ,the transverse processes of the ,lumbars are relatively light compared with the general structure of the vertebrae and are found just even with the interspace between their own and the adjacent superior spinous process4 ,they vary greatly in size1 length and strength and may be used as levers for adjustment only when they are large enough to be clearly palpable through the muscle mass which separates them from the body surface4 ,preparation of ,patient ,in all cases where a complete spinal examination is intended the preparation is essentially the same4 ,have patient arrange clothing so that the spine is exposed to the touch throughout4 ,avoid bands of cloth across the spine1 as these interfere with the necessary continuous gliding movement of the fingers4 ,advise the patient1 if a female1 to wear waist or dressing sack1 reversed1 and have skirts loosened at the waist4 ,if a man1 he should strip to the waist and wear coat or coat shirt reversed4 ,position of ,patient ,this varies widely according to circumstances but for general purposes use position3 7,a7 ,place patient on stool1 feet even on floor and body in an easy1 relaxed position4 ,this may be modified by asking him to lean forward and rest elbows on knees1 evenly1 to facilitate ,lumbar palpation4 ,patient's head may be erect or flexed forward or backward but should never be rotated or laterally flexed during ,cervical palpation except for the purpose of locating some particular transverse process4 7,b7 ,in emergency cases1 where haste is urgent or patient is unable to assume a sitting posture1 or as a means of re-verifying previous palpation1 place the patient on adjusting table prone1 face down4 7,see ,fig4 #b47 ,remember that with the head lying upon its side the upper dorsal vertebrae will assume a curve with its convexity away from the face4 ,palpation in position 7,b7 should precede every adjustment and1 to guard against error1 should be considered as a necessary preliminary to the movement of any vertebra4 7,c7 ,for palpation preparatory to using the ,rotary1 the ,break1 and other moves1 have patient lying on his back with his head projecting beyond upper end of bench and resting on the hands and wrists of the palpater1 or have the patient's head rest on the bench1 a less accessible position4 ,general ,observation ,each spinal examination should begin with a general survey by which curvatures1 marked prominences1 etc41 may be appreciated4 ,frequently some very important fact may be noted which would escape attention upon minute examination4 ,,the ,,record ,the record of spinal palpation1 when completed1 should be an accurate history of the irregularities found in the spine and an accurate guide to adjustment4 ,it must be brief and concise as well as readily comprehensible4 ,one should be able to see at a glance any desired point on the record1 so that it may be used during the adjustment without undue loss of time or attention4 ,obviously the introduction of any useless mark or sign1 such as the inclusion of a number and blank space for each vertebra of the spine1 or all possible subluxations with indications as to which do or do not exist in the given case1 is a mistake4 ,the record should contain three parallel columns4 ,in the first column place the number of the vertebra chosen for adjustment4 ,in the second1 place the direction of subluxation4 ,in the third1 place the word or sign which stands for the indicated movement for correction4 ,number of ,vertebra ,the letter ,c is used to indicate ,cervical1 ,d ,dorsal1 ,l ,lumbar1 and ,s ,sacrum in the record4 ,immediately following the letter which designates the region1 place the number which shows the position in that region occupied by the vertebra in question1 the relation of that vertebra to its fellows4 ,for instance1 the third ,cervical vertebra is ,c #c1 the eleventh ,dorsal ,d #aa4 ,to the ,s for ,sacrum append ,b or ,a to indicate that the ,base or ,apex is described as to position4 ,this locates the subluxation4 ,for a record of full spine palpation it is unnecessary to use the letters ,c1 ,d1 or ,l more than once1 as subluxations are recorded in the order of their occurrence from above downward4 ,a dash should always follow the number of the vertebra to separate it from the letters in the second column for convenience in reading4 ,direction of ,subluxation ,the directions considered in palpating or recording subluxations are six in number1 namely3 ,name ,abbreviation ,meaning ,posterior ,p ,toward the rear 7,dorsad7 ,anterior ,a ,toward the front 7,ventrad7 ,right ,r ,toward the right hand ,left ,l ,toward the left hand ,superior ,s ,toward the head 7,cephalad7 ,inferior ,i ,toward the feet 7,caudad7 ,as the fingers glide down the spine the posterior vertebra is the one which interposes itself in the path of the fingers1 forcing them to describe an outward curve4 ,it is the hill on the automobile road which forces the surmounting of a curved departure from the evenness of the road4 ,it is relatively posterior to its fellows above and below4 ,the anterior vertebra1 to the gliding fingers1 means a depression1 a valley4 ,it causes the fingers to dip inward from the level of their course4 ,the right or the left subluxation is appreciated by running the tips of the fingers down the sides of the spinous processes4 ,it really indicates rotation of the whole vertebra more often than any other malposition4 ,we say that a vertebra is superior when its spinous process is nearer the one above than the one below4 ,it requires a measuring of relative distances4 ,the degree to which a vertebra is superior is measured1 not by its actual closeness to its fellow1 but by the relation between the space above and the space below4 ,likewise a vertebra is inferior when it is closer to its fellow below than to its fellow above4 ,anterior subluxations are rarely recorded as such1 except of the ,cervicals or the last ,lumbar1 because no means of properly adjusting them is known to ,chiropractic4 ,order of ,letters ,in the second column1 that devoted to direction of subluxation1 the letter ,p or ,a should appear1 if at all1 as this antero-posterior relation is the first thing to be determined concerning any individual subluxation chosen except the ,atlas4 ,with the ,atlas the first letter will be ,r or ,l4 ,next the laterality or rotation is indicated by ,r or ,l in every case except ,atlas subluxation4 ,finally the ,s or ,i indicates the last point to be determined1 the approximation of the vertebra to its fellows4 ,this last letter usually shows thinning of intervertebral fibrocartilage1 which will be discussed elsewhere4 ,if you desire to emphasize any direction as being more important than another1 underscore the letter which stands for that direction with a single line4 ,if two directions are to be emphasized1 one more than another1 underscore the one with two lines and the other with one4 ,for example1 if a vertebra is found to be quite decidedly posterior1 more plainly to the right1 and slightly superior1 the record will show it thus3 ,p ,r ,s4 ,movement for ,correction ,this is indicated in the third column1 separated from the second by a dash1 by means of some brief word or words which describe a certain movement used in adjusting4 ,the descriptive words and terms used in this work are all given and explained under ,technic of ,adjusting4 7,see p4 #hi47 ,each word or term stands for a definite method of procedure4 ,the best movement for the correction of any subluxation of any vertebra may be found by reference to the section on ,preferable ,adjustments1 p4 #aee4 ,if other terms are more familiar to the student1 or in time replace those which are now common usage in the profession1 they will be brief and clear and may be easily substituted for those given4 ,palpation1 fixing in the mind of the palpater the manner and direction of the subluxation1 should also suggest as the obvious correction a movement calculated to reverse the procedure by which the subluxation was first produced4 ,in other words1 a certain kind of subluxation stands as the effect of a certain application of force along definite lines determinable by examination4 ,its correction should be made in a reverse direction along the same lines4 ,by recording with the record of subluxation the desired correction1 the adjuster may be reminded daily without new palpation of the movement best fitted to the case4 ,if on trial it is decided that some other movement than the one first indicated will better overcome the abnormality1 the record should be changed to correspond to the decision1 and thereafter followed4 ,complete ,record ,the completed record in three columns separated by dashes can be conveniently read4 ,it contains no superfluous mark of any kind4 ,it conveys all the necessary information leading to adjustment except diagnosis and case history4 ,this palpation record should be a part of a more comprehensive record concerning the case in full and is best kept on a card1 the reverse side of which carries case history4 ,if kept in an indexed card file it may be referred to daily without loss of time and an accurate handling of each case be assured4 ,have card perfectly blank on palpation record side4 ,for convenience in reading draw a heavy line beneath the last ,cervical subluxation recorded and another beneath the last ,dorsal1 thus dividing the record as the spine is divided1 into three divisions4 ,below follows a sample palpation record4 ,it will be seen that here in a very small space may be recorded a great deal of information1 for this record contains an accurate list of the primary causes of every disease1 weakness1 or tendency to disease with which the patient is afflicted1 together with the methods for their removal4 ,sample ,record ,c #a ,r ,break #d ,p ,l ,s ,double ,contact #g ,l ,i ,rotary ---------------------------------------- ---------------------------------------- ------------ ,d #c ,p ,r ,recoil #g ,l ,s ,pisiform ,single ,transverse #aj ,p ,s ,heel ,contact ---------------------------------------- ---------------------------------------- ------------ ,l #a ,p ,l ,i ,recoil #d ,r ,lumbar ,single ,transverse ,use of ,record ,the above record is made with patient sitting4 ,it is to be used while patient is lying upon the adjusting bench4 ,the most convenient way is to begin palpation in the ,dorsal region after patient has been placed for adjustment1 in this way4 ,if first subluxation recorded is ,d #b--,p ,r ,i1 find the vertebra in the region of ,d #b which appears ,p ,r ,i to the touch4 ,to avoid error1 let the fingers then glide downward to the next recorded subluxation4 ,if this be found to agree in number and direction with the record1 it is safe to assume that the first one found was correctly numbered in the palpater's mind2 if not1 that an error was made4 ,this can be quickly done4 ,before each adjustment the vertebra adjusted should be found to agree with the record2 by doing this constant accuracy may be assured4 ,,the ,,count ,having described the preparation of the patient and the different positions in which he may be palpated1 noted that all records should be made in position ,a1 mentioned that general observation which should immediately precede actual palpation1 and interpolated a description of the record to be made during the palpation1 with its use afterward1 we are now ready to consider the technic of the palpation itself4 ,this should begin with a count of the vertebrae and continue with ,atlas palpation1 general examination of a group of vertebrae1 and special examination of individual subluxations in the group4 ,each of these tasks will be considered in turn4 ,position of ,palpater ,this depends upon the position of the patient4 ,the letters which follow correspond to the letters describing the position of the patient4 q4 v4 7,a7 ,if you desire to palpate with the right hand stand at patient's left and face toward him with left hand resting on his shoulder or supporting his forehead as you palpate ,dorsals or ,cervicals respectively4 ,to use left hand stand similarly at patient's right4 ,have palpating arm relaxed and easy1 extending as nearly as possible so that the forearm and hand make a right angle with the patient's spine4 ,let the arm and hand remain close to the patient's body at all times4 ,keep the elbow close to your own body and avoid flexion of wrist on forearm1 or of forearm on arm at more than a right angle1 since such flexion would bring about too great muscular tension for close appreciation of tactile impressions4 ,if necessary lean sidewise and elevate shoulder and palpating arm in order to preserve the proper relation between hand and arm when hand must be elevated as in palpating upper ,cervicals4 7,b7 ,as above1 if you desire to use right hand stand on left side of patient and if left hand stand on right4 ,if the patient lies on a bench so constructed that the head lies on one side1 his face must be toward the palpater in order that the same hand may be used in ,cervical as in other regions4 ,it is inadvisable to change hands except when absolutely unavoidable4 ,if the patient's head must be turned from you palpate the ,cervicals by standing with feet pointed away from patient and turn your body with one hand resting on patient's head to hold it steady and the other palpating as if you were standing on the other side4 ,this is difficult and it is rarely necessary to count ,cervicals in position ,b if the record be used as advised on page #bi4 7,c7 ,palpation preparatory to the ,cervical adjustment will be made in this position or in position ,a1 according as you intend adjusting the ,cervicals in the prone or the sitting posture4 ,for the prone position have the patient's head supported by either hand1 while the other hand is applied with the tips of the first three fingers resting on the tips of the spinous processes1 from which position they may glide smoothly down1 noting deviations from normal in position as well as mentally numbering the vertebrae4 ,while this method of palpation is not so accurate as those given elsewhere1 and should be used only as an additional means after record has been made1 it will always be necessary to make a count before adjusting any ,cervical4 ,use of ,hands ,in general it may be stated that the first three fingers of one hand are used with an easy downward gliding movement in which only the tips of the three fingers1 evenly placed1 are in contact with the patient's body4 ,this concentrates the attention upon a very small tactile surface which may become extremely sensitive by the concentration4 ,indeed1 it may be said that vertebral palpation only became an art through the application of the principle of concentration in practice4 ,the gliding movement is always downward1 because to palpate upward will mass the superficial tissues under the fingers and confuse the palpater4 ,if there is uncertainty in the mind of the palpater1 as he proceeds1 as to the identity of any vertebra he should go back to the second ,cervical1 or to any certainly recognizable vertebra previously fixed in mind1 and recount4 ,the use of the hands for ,atlas palpation differs from their use elsewhere and will be described under separate head4 ,the use of the hands with the patient lying face upward is also different4 ,if the patient be lying prone1 the same three fingers are used and the same downward glide as with patient sitting4 ,illustration3 ,fig4 #a4 ,position of hands in palpation for record4 ,with patient sitting1 the palpater should step from side to side1 changing hands frequently and usually palpating each vertebra with each hand before reaching a conclusion4 ,there are three reasons for this4 ,more accurate records may be made by combining two different impressions on each vertebra2 with frequent change of hands one may prevent tiring and consequent loss of sensibility of fingers2 this practice develops the tactile organs of both hands equally so that if occasion demand the use of either hand alone it is fitted for the task4 ,to be ambidexterous in all departments of ,chiropractic is an invaluable attainment1 too often neglected4 ,the ,count ,commence at the second ,cervical1 the first spinous process below the occiput1 and let the fingers glide smoothly downward over the tips or along the sides of the spinous processes1 without interruption of motion1 until they reach the ,sacrum4 ,the palpater notes each vertebra passed and its number--mentally--so that when he reaches the ,sacrum he knows that he has passed every intervening vertebra and received a touch impression from each4 ,the ,sacrum itself may usually be recognized by its peculiar shape and also by its articulations with the ilia4 ,if the fingers are raised from their contact during the count1 the palpater must recommence at the second ,cervical4 ,it is impossible to be accurate in replacing the hand1 once removed1 until the count has been established and the peculiarities of certain vertebrae remembered1 together with their numbers4 ,to determine the location of the fourth ,lumbar where1 on account of obesity1 lipoma1 ,cervical lordosis1 etc41 the count of ,cervicals or ,sacral palpation is difficult1 drop on heels behind the patient and place the second finger of each hand on the crest of the ileum4 ,then let the thumbs meet in the mid-spinal line in the same horizontal plane as the two second fingers1 which spot should correspond to the interspace between third and fourth ,lumbars4 ,this measurement is accurate in about #ih of all cases1 when patient sits erect2 when it varies it will vary by about half the width of a ,lumbar spinous process4 ,the count should be repeated until the palpater is certain that he is able to palpate every spinous process distinctly or to locate accurately any impalpable one4 ,in making the count1 palpater may note the number of some very prominent and easily recognizable ,dorsal or ,lumbar vertebra to be referred to as a starting point for a recount if confusion arises later4 ,this recounting from some prominent vertebra is permissible only after the first accurate count has been made1 but then will save the full count1 especially when the patient is in an unfavorable position1 as lying on table during adjustment4 ,difficulties in ,counting ,the commonest difficulties met with in counting are the following3 ,inaccessibility of third ,cervical1 which lies closely beneath the spinous process of the second and1 unless unusually large or somewhat out of its proper position1 cannot be readily felt4 ,an occasional anterior fourth or fifth ,cervical which may escape notice unless the head is flexed far toward or the transverse processes examined4 ,lipoma or other adipose tissue covering part of the spine4 ,a missing epiphyseal plate resulting from fracture and absorption1 which absence may simulate a wide interspace and be overlooked without careful and detailed observation4 ,cervical or ,lumbar lordosis4 ,this difficulty may be at least partially overcome by having head bent far forward or body leaning forward with elbows resting on knees and a deliberate attempt on the patient's part to render the dorsolumbar spine convex backward4 ,an anterior fifth ,lumbar4 ,the occasional extra vertebra which confuses the palpater4 ,finally1 the greatest of all difficulties is the imperfect touch of the untrained palpater or the imperfect concentration of the trained4 ,and this is always remediable4 ,,atlas ,,palpation ,with patient in position ,a stand behind him and place the tips of the second fingers on the tips of the transverse processes of the ,atlas1 or first ,cervical4 ,it can be felt on each side just anterior and inferior to the mastoid process of the temporal bone4 ,let the first and third fingers rest respectively above and below the transverses and determine whether the ,atlas is subluxated as a whole to the ,right or to the ,left4 ,another convenient method is3 ,place first fingers on mastoid processes1 second on ,atlas transverses1 and third on angle of jaw4 ,the three fingers of each hand then constitute the points of a triangle4 ,imagine the base line between the first and third fingers and measure the altitude as a line at right angles to this base line and reaching to the tip of the second finger as the apex of the triangle4 ,the relation of the two altitudes determines the laterality of the ,atlas4 ,thus1 if the altitude of the right triangle is less than that of the left1 the ,atlas is laterally displaced to the ,right4 ,the second matter to determine is the rotation of the ,atlas4 ,this is done by using the first and third fingers as probes to determine the amount of space between the transverse and the mandible in front or the mastoid behind4 ,the intention is to compare the laterally prominent side with the other so that the letter ,a or ,p on the record will indicate the position of the prominent transverse compared with its fellow4 ,next decide as to tipping4 ,still comparing the prominent transverse with the other1 decide whether it is above or below the level of the other by the following method4 ,placing first three fingers one above the other with the second finger on the tip of the process1 note which transverse is highest in the space beneath the ear4 ,list the prominent side as ,s or ,superior1 ,i or ,inferior4 ,atlas palpation is rendered especially difficult by the special technic and by the interposing tendons of the sterno-cleido-mastoid muscle4 ,position of ,head ,there are three head positions for ,atlas palpation4 ,head erect1 face forward2 head flexed forward on chest2 head flexed backward4 ,sometimes it is necessary to test in all three positions in order to reach a decision1 but ordinarily the first is sufficient4 ,,the ,,group ,,method ,in general palpation of the spine the author has had the greatest success and attained the greatest accuracy through which is called the ,group ,method4 ,this consists in dividing the spine mentally into five groups or sections1 each of which overlaps its fellows except the end groups4 ,this is of advantage for several reasons4 ,it limits somewhat the attention of the palpater so that he may examine thoroughly and in detail the various vertebrae without holding his attention so closely to one that he fails to perceive its relation to its surroundings4 ,it furnishes five or six vertebrae at a time for comparison so that one may determine which is most subluxated1 and therefore most in need of adjustment1 and then allows one to reason upon the remainder of the group with this major subluxation in mind4 ,the use of the ,group ,method may best be understood by the study of certain didactic instructions1 which follow3 ,never record or adjust two subluxations of contiguous vertebrae except in those unusual cases where they are equally subluxated and in the same direction2 even then it is wisest to adjust them on alternate days4 ,let it be understood that only in exceptional circumstances should two adjacent vertebrae be listed4 ,the ,group ,method is chiefly valuable because of this rule1 to prevent the overlooking of the most important subluxation by selecting that one first4 ,consider the spine as divisible into five groups2 in the first group belong the ,cervicals below the ,atlas2 in the second1 the seventh ,cervical and first five ,dorsals2 in the third1 the vertebrae from the fourth to the eighth ,dorsals inclusive2 in the fourth1 the last five ,dorsals and sometimes first ,lumbar2 and in the last group1 all of the ,lumbars and the base of the ,sacrum4 ,consider the first ,sacral spinous process here rather than the whole ,sacrum and remember that this process should seem to complete the regular ,lumbar curve4 ,this grouping may be modified somewhat by the exigencies of palpation in any given case1 but the group considered should always include from four to seven vertebrae4 ,in each group proceed in the same manner to select subluxations4 ,let the fingers glide over the group1 first on the tips and then along the sides of the spinous processes1 and note that some one vertebra stands out as the sharpest1 most abrupt deviation in the group1 thus indicating its selection4 ,remember that neither the one above this nor the one directly below may be adjusted4 ,this narrows your field of observation for this group to two1 three1 or four remaining vertebrae4 ,select then such others in the group as need to be listed yet do not conflict with the rule against adjacent subluxations4 ,proceed to discover and record the exact direction of each4 ,when this is done examine the next lower group in the same way and continue until the whole spine has been palpated4 ,the ,atlas must be considered alone and not as a part of any of the above mentioned groups and its position is judged rather by its relation to the head than to other vertebrae2 the ,sacrum also requires individual attention1 being compared with the ,lumbar curve and with the ilia4 ,the one most pronounced subluxation in a group is often mentioned as the 8key0 to the group1 since its correction would effectually loosen the entire group and sometimes partially correct the apparent abnormalities of the rest4 ,it has also been called 8major subluxation0 to distinguish it from 8minor subluxations0 which are the others of less importance in the group4 ,this term is not a good one because it suggests what is not always true1 namely1 that the mechanically greatest subluxation is more potent than any other4 ,occasionally a slighter subluxation irritates nerves so as to produce a disease more serious and immediately alarming than the condition following the greater displacement4 ,example of ,group ,method ,if1 in the ,cervicals1 it is noticed upon gliding downward over the spinous processes that the fifth is badly subluxated and must be adjusted1 this fact is held in mind for a moment while the palpater remembers that he cannot adjust and must not list the sixth or fourth4 ,this leaves only the second1 third and seventh for consideration1 the ,atlas having been separately examined4 ,the seventh may best be included in the next group when such a selection is made1 so that the palpater need only decide between the second and third ,cervical1 providing ,atlas has not been chosen1 as to which1 if either1 most requires attention4 ,if ,atlas has been listed1 then there remains instead only the question as to whether the third is or is not subluxated4 ,in using the ,group ,method no preference is given to subluxation in any particular direction1 save only that below the ,cervicals we discriminate against the anteriors1 because we cannot adjust them4 ,the ,group ,method has to do with determining the points of greatest pressure on nerves and this depends upon one's impression as to the interrelations between all the members of the group4 7,see p4 #hj under ,subluxations47 ,,the ,,individual ,,subluxation ,having prepared our patient1 surveyed the entire spine1 carefully counted the vertebrae to secure a proper orientation1 and specially examined the ,atlas1 then divided the spine into groups and selected the vertebrae to be adjusted with regard to their degree of malposition1 let us confine our attention definitely for the first time to the single vertebra below the ,atlas4 ,reread 8,direction of ,subluxation0 under 8,the ,record10 p4 #be4 ,also read article on 8,subluxations10 p4 #gf4 ,bear in mind that each subluxation recorded is intended for adjustment and indicate nothing impossible on your record4 ,for instance1 an anterior subluxation in the ,dorsal region cannot be corrected and should not be recorded for correction4 ,remember the six capital letters used in describing a subluxation4 ,use only the downward gliding movement of the three palpating fingers4 ,keep in mind the count as you have established it for that particular spine1 recalling one or two very prominent and noticeable vertebrae whose numbers you have noted4 ,use a light touch4 ,if necessary1 change the patient's position to make the vertebra more accessible instead of pressing with more force4 ,when in doubt as to direction1 change sides and use the other hand4 ,if still in doubt1 take a longer glide1 covering six vertebrae instead of three or four4 ,keep your mind on your work1 forgetful of everything else4 ,and picture to yourself the entire vertebra and its surroundings2 its body1 pedicles1 and laminae1 its transverse processes and all articulations2 above all1 mentally visualize the foramina and nerves4 ,estimate from the position of each vertebra the pressure at each foramen4 ,decide whether the vertebra is rotated1 tipped1 laterally displaced1 anterior or posterior1 or whether the subluxation partakes of several of these directions4 ,decide in what direction movement of the vertebra would release most pressure and list accordingly4 ,never hesitate to change your opinion if you discover evidence that you have made a mistake4 ,keep at all times an open mind in palpation4 ,cervical ,palpation ,the third ,cervical1 lying under the projecting spinous process of the larger second1 may be hard to find1 and therefore the full count is always required before listing any vertebra4 ,by requiring the patient1 who is in position ,a1 to drop his head forward and rest its weight in the hand which is not palpating1 the ,cervicals may be more easily palpated4 ,remember that this posture widens the interspaces and also makes the spinous processes appear more posterior than they really are1 this difference being most noticeable at the fourth4 ,one bifurcation of a ,cervical spinous process may be longer than the other and prove confusing unless care be taken always to palpate both bifurcations and note their form4 ,this can almost always be successfully accomplished4 ,sometimes the posterior neck muscles and ligaments will be rigid so that they interfere with palpation and at the same time make it impossible for the patient to flex his head forward4 ,having found that this is due to real contracture and is therefore not susceptible of voluntary relaxation by the patient1 support the head in front and push aside the muscles with the fingers1 gliding underneath the muscle layers as much as possible and close to the spinous processes4 ,transverse palpation in the ,cervicals is used to verify findings from the spinous processes or to differentiate between rotated and laterally displaced vertebrae and bent spinous processes when the spinous swerves to right or left4 ,dorsal ,palpation ,the ,dorsals are usually considered in three groups4 ,it must be remembered that the form and obliquity of spinous processes vary considerably in this region4 ,the upper processes are very slightly oblique1 slanting downward1 the middle ,dorsals very oblique1 and the inferior ones again only slightly so4 ,there is a form change1 most commonly at the eighth ,dorsal1 which may be mistaken for a posterior subluxation4 ,the process here becomes more horizontal and more blunt4 ,among the first four ,dorsals a bad lateral or rotated vertebra may be listed as well as a posterior one1 since we can readily adjust it4 ,in the middle group either the posterior or rotated vertebra is chosen according to the estimate as to which causes greatest nerve impingement1 either being adjustable4 ,in the lower group1 however1 preference is usually given the posterior vertebra when possible1 because rotary subluxations indicate transverse adjustments and it is somewhat dangerous in this region to use the transverses as levers4 ,lumbar ,palpation ,the ,lumbars and ,sacrum are considered in one group4 ,the ,lumbars1 with patient erect1 should curve anteriorly and the first ,sacral spinous process should complete the regular curve4 ,this is rarely found1 however2 the normal is the exception in any part of the spine4 ,in the ,lumbars we usually choose the rotated rather than the posterior vertebra1 but solely because rotation here produces the greatest degree of impingement4 ,the laterality of spinous processes1 indicating rotation of the whole vertebra around an axis lying in the transverse line between the articular processes1 can best be perceived1 as a rule1 with patient sitting quite erect4 ,if in doubt1 have patient lean forward and rest elbows on knees1 which posture separates the ,lumbars1 rendering the individual spinous process easier to discover but the relative position more difficult of determination4 ,the fifth ,lumbar1 if anterior1 may be so listed1 forming an exception to the general rule4 ,sacral ,palpation--,pelvis ,first palpate ,sacrum as if part of ,lumbar region4 ,note whether the base 7upper portion7 is posterior or not4 ,then stand behind the patient and use both hands to examine the sacroiliac articulations4 ,use palmar surfaces with the flat hand toward patient's body1 and carefully compare the two sides to detect inequalities1 which indicate iliac subluxation1 or rotation of ,sacrum between the ilia on a transversely disposed axis passing through the two articulations1 in which case the ,sacrum is to be adjusted4 ,do not mistake a dislocated hip with compensatory tilting of the whole pelvis1 or faulty sitting posture with only one tuber ischii supporting the body1 for pelvic subluxation4 ,be not in undue haste to record pelvic subluxations lest your haste bring its immediate reward in the difficulty of adjustment4 ,the ,coccyx ,the ,coccyx may be detached from the ,sacrum by various accidents and later re-ankylosed thereto in an abnormal position so as to impinge upon the rectum or other structures4 ,impingement of the coccygeal nerves is usually unimportant4 ,chronic and intractable rectal constipation1 with its attendant train of evils1 may result from coccygeal displacement with ankylosis4 ,in spite of numerous treatises to the contrary1 the writer avers that other symptoms are extremely rare4 ,to examine the ,coccyx use a rubber covering on the second finger4 ,place patient face down and insert second finger per rectum with the palmar surface upward4 ,if subluxated ,coccyx be found1 it must usually be fractured with a sharp jerk1 in order to relieve the condition4 ,after fracture1 it may be absorbed or may re-ankylose to the ,sacrum in a better position1 or it may remain freely movable4 ,,palpation ,,in ,,position ,b ,this is the position for the majority of adjustments1 and as the palpation of each vertebra to be adjusted is a necessary preliminary to the adjustment1 this method1 though not so accurate as the one already described1 must also be used4 ,the use of the first three fingers of each hand and the relation of hands to patient's body is the same as in ,position ,a1 except for palpating ,cervicals when the patient's face is turned away4 ,it will be found very difficult to make a correct full count1 especially to count ,cervicals1 in this position1 and is better to use a record already prepared4 ,dorsals ,begin at1 or near1 the first ,dorsal to palpate in this position4 ,find the vertebra which agrees in direction with the first ,dorsal subluxation recorded2 let the fingers glide downward until they reach the vertebra which1 according to the first decision1 would correspond in number with the next subluxation on the record4 ,if this also agrees in direction with the record it may safely be assumed that you are accurate in your numbering4 ,thereafter1 during that adjustment1 the count can be made or repeated from any prominent vertebra the number and identity of which are easily recognized4 ,illustration3 ,fig4 #b4 ,palpation in ,position ,b1 preparatory to adjustment4 ,lumbars ,it may be difficult to count or otherwise to palpate the ,lumbars in this position because of the increase in the normal anterior curve when patient is suspended between the two sections of the bench4 ,this will be obviated if a roll be placed under the thighs or if the bench has an adjustable rear section4 ,cervicals ,if a solid front bench is used remember the spiral turn in the ,cervicals1 which occurs because of the resting of the head on one side4 ,the curve due to this rotation of the head is compounded with the ever present anterior curve to make a spiral4 ,do not expect the vertebrae in this position to agree in apparent direction with a record made with the head straight4 ,it is better to make all decisions as to direction of ,cervicals in position ,a and merely to count them in other positions4 ,in position ,b1 if the patient's face be away from the palpater it will be necessary to stand with back toward patient and body twisted1 and to change hands for counting1 resting the free hand on patient's head to insure its steadiness4 ,disagreements ,if there be any apparent disagreement between findings in positions ,b and ,a1 re-examine carefully in both positions1 whereupon that which seemed a disagreement will probably prove to have been an error in one or the other palpation4 ,if apparent disagreement persists after searching examination1 position ,a furnishes the safest guide to adjustment because the patient is in his most usual attitude as regards the spinal curves1 muscle tension1 etc4 ,but it is usually wisest when in grave doubt not to adjust the doubtful vertebra at all4 ,,palpation ,,in ,,position ,c ,since palpation in this position1 patient lying on his back with head supported by palpater's hands1 cannot be so reliable as that done in position ,a1 the chief point to be observed is an accurate count4 ,only the ,cervicals below the first can be properly palpated in this position4 ,induce the patient to relax the neck muscles as much as may be1 and use in palpation the first three fingers of one hand if the count alone is desired or the first three fingers of both hands if you desire to ascertain the direction of any vertebra4 ,in the former case let the fingers press aside the muscles and glide downward from the second ,cervical1 being careful to lift the head high enough so that the third ,cervical is not overlooked beneath the overlapping second4 ,in the latter case let the fingers of both hands glide gently downward while the patient's head rests upon the palpater's wrists or knee4 ,palpate the transverses in much the same manner1 paying special attention to their laterality1 felt as a prominence on one side lateral to a transverse process and a corresponding depression on the opposite side4 ,do not be deceived by exceptionally long transverses where both project outward to an equal degree4 ,illustration3 ,fig4 #c4 ,locative palpation of ,cervical spinous processes in ,position ,c1 preparatory to ,rotary or ,break4 ,since the greater mass of the vertebra is divided with fair equality by the intertransverse line1 laterality of transverses indicates laterality of the whole vertebra with the possible exception of the anterior portion of the body4 ,laterality of a ,cervical spinous process may indicate laterality of the entire vertebra or merely rotation around its vertical axis1 in which the one articular process is separated from its fellow of the adjacent vertebra while the other remains in partial apposition4 ,disagreements ,if disagreements appear between palpation made in positions ,a and ,c1 re-palpate in both positions4 ,if still uncertain call a consultation or follow finding in position ,a4 ,the ,rotary adjustment may sometimes aid in deciding difficult questions if gently attempted and free movement secured4 ,with this adjustment a vertebra will not usually move without rather extreme force unless the articular process on the side sought to be moved has lost its apposition with its fellow of the adjacent vertebra4 ,in any case of disagreement nerve-tracing1 the discovery of sensitive nerves on one side only may aid in decision4 ,a knowledge of probabilities1 previous experience1 and the diagnosis may also serve as partial guides4 ,,transverse ,,palpation ,palpation of the transverse processes is easiest in the ,cervical and mid-dorsal regions and most difficult in upper ,dorsal and ,lumbar regions4 ,it has two uses3 first1 to assist in making a record by verifying the work done on the spinous processes2 second1 to locate a given transverse process in order to use it as a lever for the adjustment of the vertebra4 ,it will be seen that fulfillment of the first purpose requires careful examination of the direction and position of the transverses as compared with each other and with the spinous process of the same vertebra1 while the second requires only the discovery of the exact location of some particular transverse4 ,it will be best to consider the three divisions of the spine separately1 excluding from the present chapter ,atlas palpation1 which has been thoroughly described4 ,cervicals ,these can be best palpated in the position for ,atlas palpation2 that is1 standing behind the patient and using the palmar surfaces of the fingers of both hands4 ,from the ,atlas transverses follow the anterior border of the sternomastoid muscle downward1 and opposite each spinous process draw the muscles backward and inward until the tips of the transverses are found with the middle fingers4 ,their position on the two sides may then be easily compared as well as their relation to those above and below them4 ,illustration3 ,fig4 #d4 ,locative palpation of ,dorsal transverse processes4 ,the transverses of the second ,cervical may sometimes be so prominent laterally that they are1 or one of them is1 mistaken for an ,atlas transverse4 ,as a rule1 however1 the width of the ,cervicals increases from the second downward1 the second being narrowest4 ,chassaignac's tubercle1 on the transverse process of the sixth ,cervical and opposite the lower border of the cricoid cartilage1 is a prominent point easily felt as a rule4 ,the transverses of the fourth are usually opposite the upper border of the thyroid cartilage4 ,the ,cervical transverses lie very close to the articular processes and the determination of their relation is a better guide to the condition of the articulation than is spinous process palpation4 ,it is also more difficult4 ,palpation of ,cervical transverses to determine laterality of the vertebra as a whole or its rotation is possible in position ,c and has been described under that head4 ,dorsals ,palpation for direction can be done best in position ,b4 ,use three fingers with a gliding movement along the line of the transverses1 passing over several to determine which is most posterior4 ,then repeat the glide on the other side of the spine to determine whether the transverse corresponding to the anterior one is posterior or vice versa1 showing that the entire vertebra is merely rotated or is displaced backward4 ,some palpaters prefer using both hands and palpating both transverses at once and there is no serious objection to this method1 if confined to palpation in position ,b4 ,in many cases1 however1 it leads to similar palpation of spinous processes1 a most execrable habit4 ,it should be remembered that with the first two ,dorsals the transverse will be found in a transverse plane which would pass between its own spinous process and that above4 ,this is also true of the last three ,dorsals1 while in the middle ,dorsals the transverse is usually 7not always7 level with the tip of the spinous process of the next superior vertebra4 ,before adjusting1 to determine the location of a transverse process in order to direct an adjustment against it1 first palpate spinous process and hold it with the tip of the middle finger4 ,then approximate with the first finger a point even with the tip of the spinous process above and about one inch from the spine--this of course in mid-dorsal4 ,then let second and third fingers follow the first so that all three rest on or near the transverse to be palpated4 ,pressing gently1 but firmly1 move the three fingers until the process can be felt beneath them4 ,hold the process with the middle finger so as to direct with it the contact of the adjusting hand to a point exactly over the transverse process4 ,lumbars ,the transverses of a ,lumbar vertebra lie just even with the interspace between their own and the adjacent superior spinous process4 ,they are deeply embedded in muscle tissue and very hard to palpate4 ,they may vary considerably in size or length and the last one or two may be absolutely impalpable4 ,it is sometimes advisable to adjust a rotated ,lumbar by using the transverse as a lever1 but this should never be attempted unless the process can be distinctly felt4 ,the method of locating in ,lumbar is practically the same as in the ,dorsal region4 ,transverse ,palpation with ,patient ,sitting ,palpation of ,cervical transverses in position ,a has been described and is frequently done4 ,palpation of ,dorsal or ,lumbar transverses in the same position may sometimes be desirable4 ,it can be done with the same movement as spinous process palpation1 and may serve to detect a bent spinous process4 ,if it is necessary to palpate both transverses at the same time1 stand in front of the patient and lean over his shoulder1 letting his shoulders rest against your body4 ,use palmar surface of fingers of both hands and note which transverse is posterior to its fellow1 if either1 or whether both are posterior to the line of the others above and below them4 ,it is rarely possible to find if a transverse process be superior or inferior to its normal position1 except the ,atlas transverses1 although this may occasionally be detected4 ,fortunately this is a rare form of subluxation1 or appears rare1 although it must be said that this apparent rarity may be due to our comparative inability to detect it in the living subject4 ,,curves ,,and ,,curvatures ,for convenience1 curve is used to denote the normal curvilinear deviation from a straight line naturally present in the normal spine or naturally assumed in response to the need for equilibrium during the erect position of the body3 ,curvature means either the abnormal increase of any normal curve or the appearance of any abnormal curvilinear deviation of vertebrae from their normal position4 ,deviations from normal must contain at least three vertebrae to be considered curvatures4 ,visual ,examination ,the general inspection of the spine which precedes the count should bring to light1 in addition to prominent subluxations1 and general symptoms observable by inspection of the back1 any marked curvatures4 ,their general locality and direction will be noted by this observation and their details left to be discovered by closer examination4 ,during palpation with a long and rapid glide one may also note these general points with respect to any curvature4 ,do not mistake the four normal curves1 the anterior ,cervical and ,lumbar and the posterior ,dorsal and ,sacral1 for curvatures4 ,the normal ,lumbar curve is so unusual in practice that a novice has been known to name it a lordosis4 ,description of ,curvatures ,four varieties of curvature are commonly described4 ,kyphosis is a curvature with its convexity directed backward1 usually1 but not always1 found in the ,dorsal region4 ,lordosis1 the opposite of ,kyphosis1 is an anterior curvature1 usually in the ,lumbar in which case it is an accentuation of the normal curve4 ,scoliosis has its convexity directed laterally either to the right or the left4 ,it is commonly also ,rotatory1 having its vertebrae rotated around their vertical axes so as to make the outer or the inner transverses more prominent than those on the other side4 ,in a ,scoliosis the rotation may swing either the bodies or the spinous processes toward the convex side of the curvature2 the latter is much the easier of adjustment while the former furnishes one of the most intricate problems of adjustment4 ,cause of ,curvatures ,without entering here into a discussion of those disturbed metabolic processes--themselves the result of subluxation--which result in curvature by general softening of the bone1 as in rachitis or spondylitis deformans1 we will simply state the general proposition that almost all curvatures which are in any degree angular result from a single subluxation to be found at the point of the angle4 ,it has been demonstrated in such cases that adjustment at that point will correct the curvature in time but it is usually wiser to hasten matters by selecting other points of attack by a method to be presently suggested4 ,long1 regular1 but not pronounced1 ,scoliosis1 usually in the ,dorsal1 may be an example of occupation curvature1 following the continued use of muscles in a fixed position and not due to subluxation4 ,another example is the mailman's ,lordosis4 ,these in themselves are not detrimental to health and are negligible unless some special point of impingement through individual subluxation exists within them4 ,the sharp1 angular kyphosis of ,pott's ,disease1 tubercular caries of the vertebrae1 the curvature involving three or four vertebrae which are extremely tender to palpation1 should warn against adjustment unless one can be very certain that the vertebrae are sufficiently intact4 ,fracture of a decayed vertebra is easily possible under adjustment4 ,the cause of ,pott's ,disease is usually at the angle point1 most frequently the tenth ,dorsal but possibly any ,dorsal from fifth to twelfth4 ,record on ,curvatures ,if it is the purpose of the examiner to straighten the curvature he should choose for adjustment a series of non-adjacent vertebrae which are most prominent in the direction of the curvature2 thus in a right scoliosis he should choose only those vertebrae most prominently out to the right1 and in a kyphosis only posterior ones4 ,a lordosis as such cannot be properly adjusted except in the ,cervicals1 but lordosis is usually a compensating curvature 7see below7 and can be otherwise corrected4 ,if the patient suffers from some disease which assumes more importance than the curvature and demands attention1 select the one vertebra which is causing the disease1 without reference to its position in the curvature1 and adjust that vertebra into a proper relation with the adjacent ones1 even though you adjust directly toward the convexity of the curvature4 ,disease may often be relieved by making a curvature regular more quickly than by eliminating the entire curvature4 ,sometimes both considerations may influence the selection of vertebrae4 ,in a curvature there is not necessarily pressure on nerves at every foramen4 ,in fact1 such pressure is the exception rather than the rule in curvature and a careful study of the spine must be made in order that adjustments may be accomplished without causing temporary impingement here and there4 ,a foot-note describing curvature may be appended to the record of palpation4 ,it should contain the special name of the curvature1 whether simple or compound1 and the numbers of the first and last vertebrae in it4 ,for instance1 note may read3 8,right rotary scoliosis from ,d #c to ,l #a inclusive40 ,compensatory ,curvatures ,when a primary curvature is present one or two secondary curvatures usually appear to preserve the equilibrium of the body4 ,with a ,dorsal kyphosis there is often a ,lumbar lordosis and sometimes less marked lordosis in both ,cervical and ,lumbar4 ,with a primary right scoliosis in the ,lumbar there will be a secondary left scoliosis above4 ,the secondary curvature is called compensatory4 ,in selecting vertebrae for adjustment it is well to neglect the compensatory curvature as much as possible1 leaving it to right itself as the primary one is corrected4 ,if1 however1 the primary curvature be a lordosis1 and not adjustable1 work on the secondary curvature may gradually aid in reducing the primary1 to a certain extent at least4 ,ankylosis ,this topic is discussed here partly because it is so often associated with curvature4 ,ankylosis can be appreciated only by detecting the lack of normal movement between adjacent vertebrae4 ,place a finger in the interspace between suspected vertebrae and ask the patient to perform the movement calculated to separate the spinous processes in a normally movable spine4 ,if in the ,dorsals1 ask him to drop the head and shoulders as far forward as possible without bending at the hips4 ,alternate repetitions of this movement with straightening and the spinous processes should alternately separate and approach each other4 ,test several successive vertebrae so as to note that all change their position except two4 ,in the ,lumbars have the patient repeatedly bend the body forward from the hips striving to make his spine convex backward4 ,in the ,cervicals forward flexion of the head will serve4 ,occasionally general ankylosis is found with curvature1 as in ,spondylitis ,deformans4 ,many ,chiropractors mistake failure to move a vertebra with an attempted adjustment for evidence of ankylosis4 ,in nine cases out of ten such failure is due to other reasons1 ankylosis being very infrequent4 ,it is a much abused excuse for incapability4 ,free movement between spinous processes is absolute proof that the vertebrae are not ankylosed4 ,,difficulties ,,in ,,palpation ,the chief difficulty arises from failure to observe some of the rules herein laid down4 ,carelessness or inattention precludes accuracy4 ,pain may cause the patient to assume an unnatural or cramped attitude simulating curvature1 especially of the ,cervicals4 ,more errors occur from this cause in judging the laterality of ,c #b than with any other vertebra4 ,the occasional bent spinous process in ,cervical or ,dorsal regions may deceive the palpater unless transverse palpation is employed4 ,but the frequency of slightly bent processes in dry spines and a superficiality of reasoning upon the subject have led to great overestimation of their importance4 ,as a matter of fact only a very few maladjustments arise from deception of the palpater in this way1 though the profession contains few practitioners who make a routine method of verifying by the transverses4 ,the reason is simple4 ,bent processes are caused by direct violence applied before the union of shaft and epiphysis is complete4 ,sufficient force to produce a change of direction usually produces subluxation in the same direction4 ,adjustment continued until the offending process was quite aligned with its fellows would constitute overadjustment1 but adjustment is not usually continued after all symptoms have subsided1 so that actually small harm occurs through failure to detect bending4 ,an epiphyseal plate may be absent1 having been broken off by trauma and absorbed4 ,this can be discovered by noting the too-wide space between apparently adjacent vertebrae1 and careful palpation will disclose the apparently much anterior vertebra1 an appearance not borne out by the position of the transverses4 ,when an epiphysis is absent a patient has a somewhat weak back from lack of muscular attachment4 ,lipoma1 or the heavy cicatrix following a burn or carbuncle1 may render palpation of two or three vertebrae impossible4 ,in such a case only the palpater's experience and his knowledge of the characteristics of various vertebrae will enable him accurately to number the remainder4 ,patients with much adipose tissue may require palpating in several positions in order to permit certainty4 ,a deep third ,cervical which is absolutely impalpable may mislead one1 but a careful count which shows one vertebra overlooked indicates the necessity for a careful re-examination of the ,cervicals1 by which the gap at the third at least may be appreciated4 ,if the ,axis is very much inferior the third is especially likely to be overlooked4 ,anomalous cases have been found in which there were more or less than the usual number of movable vertebrae1 the usual deviation being the presence of twenty-five1 and the extra one being most commonly a ,lumbar4 ,in one case under my observation there were twenty-five movable vertebrae1 apparently thirteen ,dorsals according to shape1 and only eleven pairs of ribs posteriorly1 two pairs being dichotomous so that there appeared thirteen pairs anteriorly4 ,deviations in number occur1 in my experience1 about once in five hundred cases4 ,,landmarks ,the regional location of vertebrae by means of certain landmarks 7so called7 in or near the spine1 is a much discussed question in the profession4 ,without discussing the various arguments in favor of this method1 chief of which is the inability of the untrained to count vertebrae1 let us set forth the principal landmarks used and the facts in regard to them4 ,the seventh ,cervical1 called ,vertebra ,prominens1 is usually considered a guide to the count4 ,in over three hundred cases examined for that purpose the seventh ,cervical was found to be ,vertebra ,prominens in about #fe1 the other #ce showing the sixth ,cervical or first ,dorsal to be the prominent one4 ,this method is two-thirds as accurate as counting4 ,the tubercle 7,chassaignac's7 of the sixth ,cervical transverse is said to be directly opposite the lower border of the cricoid cartilage and this is a better guide than the above4 ,the third ,dorsal spinous process is said to be on a level with the root of the spine of the scapula1 and with arms hanging at sides1 the upper angle of the scapula to be on a line between first and second ,dorsal spinous process4 ,this is not at all constant4 ,the inferior angle of the scapula is said by some writers to be on a line with the tip of the seventh ,dorsal spine4 ,others locate it opposite the interspace between seventh and eighth ,dorsals4 ,still others give it as opposite the eighth ,dorsal spine4 ,all are correct--sometimes4 ,in truth1 the inferior angle may be opposite any part of the spine between the sixth and ninth ,dorsals4 ,there is nothing constant about it4 ,the twelfth rib may be followed to its articulation with the twelfth ,dorsal vertebra4 ,this is a good guide1 providing that the rib can be palpated4 ,the lower margin of the last rib is usually even with the spinous process of ,d #ab about one inch and a half from the mid-spinal line4 ,the humor lies in the fact that the patient upon whom the count is so difficult as to require this verification is usually obese and obesity renders the rib impalpable4 ,the line drawn between the iliac crests falls between the third and fourth ,lumbar spinous processes in about #ih of all cases4 ,this is our most reliable landmark4 ,it is used as described under the ,count4 ,all landmarks except the last two show such variance in different individuals as to be quite unreliable4 ,the correct method of numbering spinous processes is the obvious and logical method--count them4 ,the skill and accuracy of touch required for successful counting is invaluable in determining direction of subluxations4 ,,mental ,,attitude ,in order to secure that absolute concentration without which it is impossible to appreciate properly those tactile impressions for the very reception of which such continued practice is necessary1 the hands should leave the spine as little as possible during palpation2 a second person should record subluxations found so that the palpater need only state1 and not write1 his conclusions2 light pressure on the spine should always be used1 as a heavy pressure desensitizes nerve-endings in the fingers2 and silence should be maintained except for the necessary statement of points to be recorded4 ,palpate as rapidly as is consistent with good work4 ,the more rapid the palpation1 if concentration is absolute1 the more accurate the impressions received4 ,the end and aim of palpation is to determine the means by which impingement of nerves may be removed with the greatest rapidity and success4 ,palpation includes such a study of the vertebral column as will fix in your mind a clear thought-picture of the impinged nerves throughout its length4 ,,finally ,if you would achieve success in ,vertebral ,palpation1 be persistent4 ,spare no labor to acquire that accuracy of detail which distinguishes the expert from the amateur4 ,you can make of yourself what you will4 ,there is no limit to the ability which may be acquired4 ,another may guide your hands but with you lies your success4 ,,nerve-,,tracing ,definition ,nerve-tracing is that branch of palpation by which the tenderness of irritated spinal nerves is discovered and their paths demonstrated4 ,organ-,tracing ,organ-tracing is that branch of palpation which deals with the outlining of the boundaries and surface markings of a tender organ or part4 ,palpaters frequently confuse tenderness of one of the parenchymatous viscera for the tenderness of interlaced and branching nerve filaments1 especially in the abdominal region4 ,the fact that the tender area takes on the characteristic shape of one of the viscera is conclusive evidence that an organ1 and not nerves1 have been traced4 ,what ,nerves ,traceable ,any spinal nerve may be traceable for at least a part of its course4 ,the cranial nerves are made inaccessible to palpation by their location1 except the spinal portion of the spinal accessory and the terminal portions of the nerves to the face4 ,likewise the sympathetic trunks1 except perhaps in the neck1 are untraceable4 ,nerve-tracing is comparatively easy in the upper and lower extremities1 neck and back4 ,the superficial nerves of the scalp are hard to follow on account of the hair4 ,the superficial nerves of thorax1 abdomen1 and pelvis are accessible under the conditions mentioned below2 the deep or visceral branches1 never4 ,of those nerves mentioned as traceable1 only such as are irritated and consequently swollen and tender1 can be followed4 ,if a nerve is very heavily impinged1 especially if the impingement be chronic1 it is partially or wholly paralyzed and not traceable4 ,if the heavy impingement be acute1 or if there be a light impingement serving as a mechanical irritant1 nerve-tracing is a real aid to diagnosis4 ,proportion of ,cases with ,traceable ,nerves ,about one-half of all the cases which visit ,chiropractors for adjustment are susceptible of nerve-tracing4 ,in the remaining half it is absolutely impossible to acquire any information in this way4 ,of the half who are at all susceptible1 it is possible in perhaps four-fifths of all cases to secure some accurate or reliable information4 ,the patient in whom all accessible nerves seem tender to light palpation is hyperesthetic and unavailable for tracing4 ,in the usual case one or two nerves will be found easily traceable1 while the rest exhibit no tenderness on pressure4 ,such a case furnishes the most reliable information securable by this method and the tender nerves may be considered as lightly or acutely impinged4 ,preconception of ,nerves ,essential ,knowledge of the anatomy of the nervous system is a part of the necessary equipment of the ,chiropractor who would trace nerves and this knowledge should be so thorough as to enable the palpater to recognize each tender line found as an anatomically described nerve-path or an error on his part4 ,the examiner must know the paths of all nerves and be able to predict from the first tender points discovered the probable course which the tenderness will follow1 so as to direct his search along that probable path4 ,he must be able to detect unconscious deception on the part of the patient through his knowledge of the anatomical impossibility of the apparent tracing4 ,for instance1 if for any reason he may appear to have traced a nerve upward beside the spinal column from ,d #aj to the eye by way of the vertex1 he must know that this is an illusion--because such nerves do not exist and cannot be anatomically demonstrated--or accept the well merited ridicule of any educated person who discovers his absurdity4 ,because of the difficulty of determining whether the tender structure found be muscle1 nerve1 or viscus1 and because of the natural suggestibility of both palpater and patient1 nerve-tracing cannot be so reliable a guide to nerve-paths as is dissection4 ,it should not be necessary to state this obvious truth but the calm acceptance1 by many1 of the weird conclusions based upon a belief in the infallibility of nerve-tracing testifies that it is necessary4 ,nerve-tracing is valuable only where the nerve-path outlined as being tender corresponds to the known path of some nerve4 ,suggestion ,paradoxically1 knowledge of nerve-paths may lead to error4 ,by the law of expectancy1 we are prone to find what we look for and if we hold too strongly to the belief that because we have found one or two points of tenderness we must find a series of points extending along a mentally pictured nerve-path1 we may search until we falsely believe that we have found this series4 ,likewise the patient1 having been carefully informed as to the manner of procedure and knowing what we expect to discover1 may unconsciously deceive us by feeling tenderness in response to suggestion1 where no real impingement exists4 ,place in ,diagnosis ,the value of nerve-tracing in diagnosis has been much overestimated by many1 though the tendency of the profession seems to be toward rationalism along that line4 ,whereas1 in palpation of the spine every real subluxation gives evidence of disease1 or tendency to disease1 while every normally aligned pair of vertebrae furnish proof that no disease can exist in the area of distribution of the nerve emerging between them1 nerve-tracing is much less reliable4 ,if the tender nerve be traceable to a vertebral subluxation it may be taken as additional evidence that the effect of that subluxation is disease1 rather than tendency to disease1 truly an important distinction1 but scarcely broad enough to support a diagnosis without aid4 ,the absence of tenderness from nerves does not negative a disease in any instance1 whereas the absence of subluxation does4 ,like all other expedients for the selection of vertebrae for adjustment without admitting the necessity for first acquiring much skill by much labor1 nerve-tracing has a great weakness4 ,only irritated nerves are tender and the effects of subluxation may be either irritation or paralysis4 ,if accurately done1 sources of error carefully eliminated1 and the results of nerve-tracing found to correspond with the condition of the spine and the other symptoms1 this method of demonstrating to the patient the connection between the vertebrae and the diseased region of his body is valuable4 ,it aids in convincing him of the validity of the ,chiropractic theory4 ,,technic ,,of ,,nerve ,,tracing ,where to ,begin ,the palpater1 having made his vertebral palpation1 may begin at some point in the body indicated by the symptoms as diseased and1 finding tenderness1 follow the path of a nerve back to the spinal column where the nerve may be fairly presumed to enter the intervertebral foramen4 ,or he may use his palpation record as a guide and follow the tender nerves outward to their periphery4 ,this is the better method4 ,illustration3 ,fig4 #e4 ,technic of nerve tracing1 showing position of fingers and marking of tender points4 ,palpation as ,guide ,when palpation has been made1 remember that the impinged nerve is usually found on the side opposite to the direction of the spinous process in its departure from the median line4 ,with a left subluxation the tenderness is usually1 though not always1 on the right side4 ,if in the ,lumbar1 and the subluxation a rotation1 the impinged nerve will be found below the transverse process of the subluxated vertebra4 ,in the ,cervical and ,dorsal regions the tender nerve is usually below1 but may be either above or below1 the transverse of the subluxated one4 ,examine the nerves having exit from the foramina of each subluxated vertebra in turn from above downward4 ,when a tender point is found about an inch from the mid-spinal line1 attempt to follow the nerve and palpate until it has been traced as completely as possible4 ,where to ,expect ,tenderness ,the region immediately surrounding the spinous process of the subluxated vertebra may be tender because of impingement of the axons of the posterior primary division of that spinal nerve which emerges below the vertebra4 ,such tenderness is more common with anterior subluxations than with others4 ,it is not to be confused with the soreness which often appears after adjustment and is due to bruising or straining of the tissues4 ,nerve tenderness may be discovered at a little distance from the mid-spinal line and at a level slightly lower than the emergence of the nerve4 ,if a nerve is irritated1 the finger inserted between the ribs near their articulation with the transverse processes will elicit tenderness4 ,the discovery of tender points along the spine is the most important part of nerve-tracing4 ,nerve-,paths ,detailed description of the paths of all the spinal nerves may be studied from any standard work on anatomy and will not be included here1 but it may be well to remind the reader of certain general tendencies4 ,the spinal nerves do not cross the median line in front except perhaps fine interlacing fibres4 ,in the ,dorsal region the nerves are usually found following the interspaces until the lower ones debauch upon the abdominal wall anteriorly4 ,there are1 however1 some ,dorsal and lower ,cervical nerve bundles which pass obliquely downward and outward to innervate back muscles4 ,reference to the section on ,spino-,organic ,connection will make clear the tissues supplied by each nerve4 ,slight deviations from the usual course of nerves are common2 marked deviations very infrequent4 ,use of ,fingers ,use second finger of either hand for the palpating finger1 choosing the hand which can be most conveniently used as determined by the position of patient and the part of the body to be examined4 ,there is no set rule4 ,reinforce this second finger by the pressure upon it of the first and third and1 if desired1 by pressing thumb against it4 7,see ,fig4 #e47 ,apply the tip of the palpating finger to the nerve with a motion such that it crosses the path of the nerve at right angles back and forth4 ,meanwhile the probable path of the nerve must be kept in mind4 ,as the finger crosses the nerve-path it makes steady and even pressure upon any structures passing beneath it4 ,the motion of the hand is almost a rolling motion1 the finger tip probing1 as it were1 for a tender spot4 ,tenderness--,how ,recognized ,the irritated condition of the nerve which has thus been rolled beneath the finger may be recognized in one of three ways2 the patient may involuntarily flinch1 betraying the hurt2 or he may inform the palpater of the hurt2 or the swollen1 cord-like nerve may be felt4 ,the two former are the reliable guides1 while the latter is only occasionally possible4 ,in children and in feeble-minded1 insane1 or mute adults1 the first mentioned method must be relied upon entirely4 ,muscular contraction is the unconscious or reflex response to pain and often occurs independently of the intelligence or state of mind of the subject4 ,of all the three methods the one most commonly relied upon is the second--the statements of the patient4 ,instruction to ,patient ,the patient should be informed of your intentions when palpation is begun and should be asked to answer every time you apply your finger1 saying1 8,yes10 if the spot is tender and1 8,no10 if not4 ,he should speak promptly each time so as to avoid self-deception which might come with reasoning upon his sensations4 ,occasionally vary the steady rhythm of your movements by omitting one and note if the patient responds mechanically when you do not press4 ,at times during the tracing1 it is well to depart from the probable nerve-path and to touch again a point marked as tender1 to see if the patient's information may be relied upon4 ,whenever you leave the nerve-path his answer should be1 8,no10 immediately changing to1 8,yes10 when you re-cross the tender line4 ,marking ,tender ,points ,at each tender point noted a small mark should be made with an eye-brow pencil or other grease-paint1 which leaves a distinct but easily removable mark4 ,these tender points should be noted and marked at intervals of about an inch4 ,connecting ,line ,when the entire nerve-path has been traversed in this way1 draw a line with the eye-brow pencil1 passing through all the marks indicating points of tenderness4 ,this line should be a sufficiently accurate rough outline of the nerve-path to make clear the spinal connection with the diseased area4 ,the significance of this connection will be better understood when the section on ,spino-,organic ,connection has been studied4 ,illustration3 ,fig4 #f4 ,anterior half of completed nerve tracing4 ,common ,findings ,in muscular rheumatism1 neuralgia1 neuritis1 or in case of a local boil or abscess indicating local disturbance of the trophic influence of nerves1 clear and definite tracings are common4 ,muscular spasm1 such as wry-neck1 usually has a very tender nerve associated4 ,localized painful disease of any kind is likely to be associated with a very definite nerve tenderness1 as is the case frequently with appendicitis1 ovaritis1 hepatic colic1 etc4 ,the painless disorders1 or various disorders of spleen1 diaphragm1 heart1 lungs1 etc41 though they be of a very serious nature1 seldom are discoverable by nerve-tracing unless their serous membranes are involved4 ,tracings may be made from ,d #b or #c to anterior thoracic walls in heart or lung disease but are not common4 ,any spinal nerve may be traceable at times through at least a part of its course4 ,sources of ,error ,several of these have been mentioned1 such as the natural suggestibility of both examiner and patient4 ,among others are3 failure in the back1 thigh1 or leg to reach the really tender nerve because of the interposition of several muscle layers between it and the finger1 ignorance of nerve-paths1 failure to apply equal pressure to all parts of a nerve1 application of such heavy pressure that muscle tissue is bruised and hurt1 and failure of full co-operation on the part of the patient4 ,let us consider these in turn4 ,if several muscle layers interpose themselves between the searching finger and the nerve1 it is proper to push aside the intervening layers1 using a twisting and rolling movement until the finger feels underneath the muscles4 ,this done1 and a tender nerve found underneath several muscle layers1 the same amount of overlying tissue must be pushed aside each time the finger searches for the nerve4 ,only exhaustive study of the anatomy of the typical nervous system will enable the examiner to know exactly at what point a nerve will become more or less superficial4 ,unless he does know this it is best to follow the neutral rule that nerves tend to follow the long axes of ribs and limbs and to maintain their depth beneath the surface throughout their course4 ,this statement is too general for accuracy4 ,care should be taken that equal pressure be made on all points palpated on one nerve4 ,if the nerve pass over a bone1 less force is needed to exert the same pressure than if it overlie muscle or other soft structure4 ,the force used varies constantly as the hand moves from place to place1 according to the density and hardness of the structures overlying and underlying a nerve4 ,sufficiently heavy pressure will elicit tenderness in all except anaesthetic patients4 ,but if a nerve be irritated it will be tender without heavy pressure1 when the finger really makes a close contact with it4 ,if the patient willfully attempts to deceive the palpater1 nerve-tracing might as well be abandoned except in those extreme cases where the patient will flinch against his will on account of extreme sensitiveness4 ,use of ,second ,hand ,as far as possible1 the second hand is placed opposite the tracing hand and steadily supports the body2 its position changes with changes in the position of the first4 ,if the arm is to be examined it had best be held away from the body1 and the part to be examined held between the two hands4 ,position of ,patient ,for tracing nerves in the neck1 back1 and upper extremities1 the patient should sit easily4 ,for lumbar1 abdominal1 or pelvic tracing1 or for tracing in the lower extremities1 have patient lie on side or back4 ,do not hesitate to change the position of the patient as often as is necessary to secure easy access to the part to be examined and relaxation of the patient's muscles4 ,never allow the assumption of a strained position during tracing2 the sensation of cramped muscles may be confused with sensations of nerve tenderness4 ,,subluxations ,definition ,a vertebral subluxation is a displacement1 less than a dislocation1 in which the chief element is the partial loss of normal apposition of the articular surfaces of the subluxated vertebra with those of the vertebra above or below1 or both4 ,or1 ,vertebral subluxation is a permanent partial dislocation4 ,how ,produced ,subluxations are primarily caused by trauma--falls1 blows1 strains1 etc41 being the chief factors4 ,hereditary weakness in structure of some part predisposes by rendering that portion more easily displaced4 ,subluxations are never hereditary but may be congenital through violent or instrumental delivery into the world or may appear hereditary because they occur shortly after birth through the effect of light jars upon the hereditarily weakened segments of the spinal column4 ,they are always the result of concussions of forces2 never of forces acting entirely within the organism4 ,they result from the contact of the body with its environment4 ,it has been said that muscular action in response to peripheral irritation may produce subluxation4 ,the laws of reflex action render this impossible4 ,given a normally aligned vertebra1 and consequently normal nerves and a normal reflex arc in that segment1 the ventral horn cells respond to a slight peripheral stimulus by exciting muscular contraction on the same side with the irritation4 ,if the irritation be sufficiently increased1 the response occurs on both sides but most strongly on the side from which the irritation comes4 ,greater irritation merely serves to cause greater distribution of the responsive action4 7,see any standard physiology on reflex action47 ,in no case will the difference between the contractions of muscles on the two sides be sufficient to displace a normally aligned vertebra4 ,nature has provided against that contingency4 ,given a subluxated vertebra causing nerve impingement and thus interruption of the normal action of the reflex arc1 irritation may result in greater contraction upon the opposite side than upon the side of the irritation4 ,this is an abnormal condition and accounts for the increase of previously existing subluxations under pain or peripheral irritation4 ,but in every instance trauma must and does precede and cause subluxation4 ,reaction of ,secondary ,causes ,once produced1 however1 a subluxation may not cause noticeable effect until it has been increased in degree by the reaction of forces within the body such as poisons1 general fever1 etc4 ,thus germs1 dietetic errors1 exposure to sudden temperature changes1 waste of energy through abnormal mental activities1 as hate1 fear1 worry1 etc41 or through physical excess--in fact1 all the secondary causes of disease may appear to have produced a subluxation4 ,in fact1 they have merely accentuated that which already existed and have done so through the muscular contractions which they induced4 ,general thinning of intervertebral substance through a condition of disturbed metabolism itself produced through the agency of some one serious subluxation1 may narrow all the foramina and increase impingement of nerves at any point where a slight subluxation previously existed4 ,an irritated nerve may become swollen and the nerve impinged at the foramen4 ,law ,governing ,location ,so definite is the law governing the effect of force applied to a given portion of the body upon an associated vertebral segment that the skilled ,chiropractor who has studied vertebrate segmentation thoroughly may determine1 from the history of a fall or injury1 the vertebra which would tend to be subluxated by that injury and the tissues controlled from that part4 ,the rule is this3 ,force applied to any body segment tends to subluxate the segmentally associated vertebra4 ,this subluxation tends to produce disease throughout the area of distribution of the subjacent pair of spinal nerves4 ,the task of explaining this law seems hopeless unless the student is familiar with human embryology and the life history of the vertebrata1 as well all the details of human anatomy4 ,to such a student the law will be self-evident1 so interwoven with the threads of higher organization as practically to form its pattern4 ,in simple terms we might offer this general statement4 ,any force applied to the body with sufficient violence will produce subluxation of the vertebra above the spinal nerves supplying the injured area4 ,thus1 the brachial plexus controls the arm and shoulder and connects with the spine by way of the #e1 #f1 #g1 #h1 ,cervical and #a ,dorsal nerves4 ,any force striking the arm or shoulder tends to produce subluxation of the sixth or seventh ,cervical or first ,dorsal vertebra so that all permanent disease conditions resulting will be found in the arm or shoulder or nearby tissues of the neck4 ,this theme presents a magnificent field for individual study and research but is1 per se1 beyond the limitations set for this work4 ,effect of ,subluxations ,slight subluxations may exist1 because of the adaptation of surrounding parts and the slight play within the intervertebral foramen1 without producing noticeable effect4 ,they always1 however1 evidence a tendency to disease4 ,the majority of subluxations do produce disease1 to some degree1 and do so by impinging nerves4 ,impingement may be either by pressure against a nerve or ganglion or by constriction of a nerve where it passes through an intervertebral foramen2 the former occurs in the case of the ,cervical sympathetic1 the sub-occipital nerves1 and the sacral nerves2 the latter is the commoner form in ,dorsal and ,lumbar regions of the spine4 ,probably the most positive constriction of a nerve which can occur within the body is to be found in rotation of ,lumbar vertebrae2 the body of the rotated vertebra encroaches upon the inferior nerve on the side opposite to the direction taken by the spinous process4 ,either variety of impingement produces disease1 morbid structure or function1 by irritation of the nerve3 light impingement irritates1 heavy impingement partially or completely paralyzes1 the nerve4 ,,varieties ,,of ,,subluxation ,according to the abnormal relations between vertebrae subluxations may be variously described as rotated1 tipped1 anteriorly1 posteriorly1 or laterally displaced4 ,they commonly combine two or more of these forms1 so that the purely rotary or the entirely lateral subluxation is uncommon4 ,rotation ,every vertebra has a vertical axis around which it tends to rotate4 ,this axis is not always the center of mass but depends upon the arrangement of mass1 the fixity of cartilages1 ligaments1 and muscles1 which tend to hold some parts of the vertebra more fixed than others1 and the apposition of articular processes1 which tends to prevent movement in certain directions4 ,the axis of rotation of the first ,cervical is the center of the odontoid process of the second ,cervical1 which articulates with the transverse ligament and anterior arch of the first4 ,a frequent subluxation of the ,atlas is a rotation around this process so that the one transverse is permanently posterior to its normal position and the other correspondingly anterior4 ,the axis of rotation of the ,cervicals below the ,atlas is in the extreme anterior portion of their bodies4 ,this part remains relatively fixed in rotatory subluxation while the tip of the spinous process describes the greatest arc4 ,in the ,dorsals the axis of rotation lies in the posterior portion of the centrum near the neural canal4 ,when the spinous process appears laterally displaced in rotation the anterior portion of the body is slightly displaced in the opposite direction1 twisting and straining the fibres of the intervertebral disk4 ,in the ,lumbar region rotation is the commonest form of subluxation1 the axis of rotation being laterally movable upon a transverse line between the articular processes in the beginning and shifting1 as soon as the vertebra leaves its normal relations1 to the junction of the articular process with that of the adjacent vertebra on the side toward which the spinous process is moving4 ,thus1 in rotation of the vertebra so that the spinous is to the right1 the axis will be found on the right side1 the superior articular process of the next vertebra serving as a support on which the inferior articular process of the rotating vertebra may turn4 ,the processes are so firmly locked that unless the whole vertebra be quite posterior little lateral movement of the spinous process is possible without marked rotation4 ,the body describes the greatest arc because it is further removed from the center of rotation than is the tip of the spinous4 ,tipping ,this is a subluxation in which the one transverse process is1 or appears to be1 superior or inferior to the other4 ,it occurs frequently to the ,atlas in combination with lateral subluxation4 ,in fact1 the shape of the occipito-atlantal articulations is such that1 if the remaining ,cervicals maintain their proper relation to each other1 the ,atlas cannot be laterally displaced without a certain amount of tipping4 ,it will be relatively superior on the prominent side and the head will be tipped toward that side2 that is toward the side of the lateral displacement4 ,thus1 on account of the wedge-shaped lateral masses1 if the whole ,atlas be to the right of its normal position the right side will be superior and the head tipped toward the right4 ,this is only true when the vertebrae below maintain a normal interrelation4 ,approximation ,this is a name applied to that condition in which1 on account of changes in the intervertebral disks due to subluxation interfering with metabolic processes1 the bodies or spinous processes of vertebrae are crowded too closely together4 ,occasionally a spine is found in which1 on palpation1 the spinous processes are found to be crowded together in groups1 sometimes of two or three1 sometimes of five or six2 no two interspaces appear equal1 a very wide one being succeeded by one or two which are almost inappreciable2 the variation in width of the interspaces does not correspond to the known normal variation in those regions where the changing obliquity of spinous processes should modify the relative width of successive spaces4 ,we expect1 for instance1 to find a wider space between third and fourth ,dorsals than between second and third2 if we do not find this difference it is doubtless due to cartilage change and the vertebrae are approximated4 ,in case of general thinning of intervertebral substance unequally divided between different sections of the spine the record will show that almost every vertebra is listed either ,s or ,i1 and if a system of underscoring is used that these two directions are frequently indicated as most noticeable4 ,a study of the spine will make clear the fact that if the cartilage between any two ,dorsal vertebrae be thinned in front the bodies of the vertebrae will be closer together and the spinous processes more widely separated2 the spinous process of the upper vertebra will be crowded against the one superior to it and that of the lower against the one inferior to it4 ,these spinous processes are said to be approximated4 ,the correction of ,s or ,i subluxations1 then1 depends upon correction of disturbed nutritive processes4 ,lateral ,displacements ,according to the usage of earlier writers on subluxations this term 7lateral displacement7 included rotation of the vertebra as well as those changes in position in which the whole or nearly all of the vertebra deviates sidewise from its normal position4 ,since the introduction of the term 8rotation0 into the description of subluxations1 the meaning of the term 8lateral displacement0 is much more restricted4 ,it refers now to a condition which probably occurs in the strictest sense only in the ,cervical region1 most frequently with the first and second ,cervical1 the two being subluxated together4 ,we have already stated that the most important fact to be determined regarding the ,atlas is its lateral displacement1 since this produces the greatest impingement of nerves4 ,lateral displacement of any other ,cervical can best be judged by examination of the transverse processes1 since by palpation of the spinous process alone it is quite impossible to distinguish between lateral and rotary subluxation4 ,in the ,dorsal and ,lumbar regions the ,r or ,l used to describe the position of the spinous process most often indicates rotation of the vertebra4 ,while it is perfectly proper thus to describe the subluxation on a record1 in the determining of the form of adjustment to be used the position of the whole vertebra must be considered4 ,anterior ,subluxations ,forward displacements may occur anywhere in the spine4 ,in the case of the first ,cervical they are usually1 though not always1 forward displacements of only one side--rotation--though the whole ,atlas may be anterior if the ,axis has moved with it or is tipped so that the spinous process is much superior4 ,this is rare4 ,any ,cervical may be anterior2 usually a series are anterior 7if any7 amounting to an increase in the ,cervical curve--a lordosis4 ,this condition may be corrected by transverse adjustments given from the front and side4 ,a ,dorsal vertebra is only relatively anterior1 the adjacent ones being relatively posterior1 and the only possible correction at present is the adjustment of the posterior ones4 ,a ,lumbar cannot be anterior unless those below it are also anterior1 on account of the locking of articulations4 ,discovery of anterior ,lumbars is quite common4 ,the fifth ,lumbar may be subluxated anteriorly by slipping forward on the ,sacrum2 it must be superior at the same time1 on account of the shape of the articulating surfaces which face downward and forward4 ,the spinous process is crowded closely against the fourth while the body of the fifth is too widely separated from that of the fourth4 ,posterior ,subluxations ,there are many ,chiropractors who have always considered the posterior subluxation more than any other1 not because it produces greater nerve impingement than others but because it is easiest to detect2 it intrudes itself upon the attention of the unskilled examiner most persistently4 ,nor should its importance be underestimated1 though we now realize that in some instances a rotated or anterior vertebra may cause more nerve impingement than a posterior one4 ,the posterior subluxation in the lower ,dorsals and ,lumbars is the easiest variety to adjust2 in this region a posterior displacement of one vertebra tends to bring with that one the next adjacent superior one1 the sharpest deviation occurring between the posterior one and the one below it4 ,any vertebra may be posterior3 the ,atlas is rarely so as a whole1 and never unless the ,axis is also displaced backward2 the ,cervical and ,dorsal regions present frequent variations of this sort1 which must not1 however1 be confused with long1 prominent1 or overdeveloped spinous processes2 the ,sacrum may be posterior to the ilium on one side1 or to both ilia4 ,occipital ,subluxations ,mention should be made here of a form of subluxation not strictly vertebral--displacement between the condyles of the occipital bone and the lateral masses of the ,atlas4 ,this occurs when the head has been moved too violently upon the ,atlas so as to cause an immediate nerve irritation and muscle tension sufficient to hold it in its abnormal position4 ,the ,cervicals may be quite normal below the ,atlas though this1 of course1 is not the rule4 ,correction of occipital subluxations is made by applying force to the ,atlas and to the skull1 sometimes by holding ,atlas and rotating the skull4 ,age of ,subluxations ,the relative age of subluxations may be determined1 within rather wide limits1 it is true1 by a study of the form of the spinous process4 ,newly acquired subluxations are sharply defined1 having noticeable edges on the spinous process4 ,in time they tend to become rounded and blunt and appear to cover more surface1 just as the mountain range which1 when first upheaved1 is sharp and rugged1 gradually rounds into regular curves through the work of the elements4 ,in this way ,nature protects the subluxated vertebra from further contact with the environment surrounding man1 the rounded process offering less opportunity for a blow or shock to affect it4 ,changes in ,shape ,bone diseases such as rachitis osteomalacia1 etc41 and especially ,potts' ,disease1 or spinal caries1 make marked changes in the shape of vertebrae4 ,also a subluxated vertebra may gradually assume a shape suited to the abnormal position it occupies1 the commonest change being the assumption of a wedge shape by the centrum4 ,this is a great obstacle to adjustment1 as the abnormal shape of the vertebra makes it tend to settle after each movement into the old abnormal position4 ,there are few spines without some more or less misshapen vertebrae4 ,ankylosis also makes great changes in the shape of vertebrae4 ,there are two kinds of ankylosis--true and false4 ,the first is a deposit of bone cells upon bone1 often the formation of a bridgelike structure to hold contiguous vertebrae together4 ,this may bind any portions of the vertebrae but most commonly holds the bodies1 in which case it can only be appreciated by detecting the lack of movement between normally separable vertebrae4 ,false ankylosis occurs with fever in bone and consists in an exudation of bone substance which sometimes produces remarkable distortions of shape4 ,,technic ,,of ,,adjusting ,definitions ,vertebral ,adjusting is the art of correcting by hand the malpositions of subluxated vertebrae4 ,a ,vertebral ,adjustment1 strictly speaking1 should mean the complete restoration of normal relation between previously subluxated vertebrae4 ,as used in ,chiropractic1 it means either a partial or complete restoration of such normal relation4 ,maladjustment1 as used in the profession1 designates any movement of vertebrae by hand which produces or increases subluxation4 ,,general ,,principles ,,of ,,adjusting ,it will be well for the student to master first the general rules and principles which govern vertebral adjustment and then to proceed to a detailed investigation of each movement1 in turn1 before practicing it4 ,the art of adjusting can only be acquired by practice1 and a high degree of excellence in it only by long-continued practice4 ,however1 the rapidity with which it can be mastered depends largely upon the formation of a clear pre-conception of the work to be done and the manner of its doing4 ,as the student progresses in the art he finds himself occasionally guilty of errors which mar1 in some degree1 the efficiency of his work4 ,these may arise from unconscious modification of the technic first learned or from unconscious repetition of some necessary modification demanded by a special peculiarity in one or more cases4 ,this section is intended to furnish the proper pre-conception and also to serve as a monitor to adjusters who1 by reference to the precepts herein set down1 may discover and remedy their own errors4 ,it is not intended to furnish sufficient education to warrant practice without clinical instruction1 which is unwarrantable1 but rather to accelerate the education which practice alone can furnish4 ,object of ,adjustment ,the vertebral subluxation being an abnormality of relation between vertebrae1 it is obvious that its correction must be a return of normal relation4 ,this can only be accomplished by bringing about a change of relative position4 ,movement of a section of the spine composed of several vertebrae is not1 in the true sense1 an ,adjustment4 ,it is the single vertebra which must be moved4 ,the movement should be one calculated to bring the vertebra to its normal position in the most direct manner possible4 ,such a movement should be used as will reverse the direction of the forces which subluxated the vertebra4 ,it should be applied to the transverse or spinous processes1 or to the lamina1 as is sometimes done in the case of the ,atlas1 according to the kind of subluxation4 ,different subluxations require different handling4 ,cases vary4 ,select the move best suited to the case4 ,this can be determined most properly by correct palpation which fixes in the mind of the adjuster the position of every part of the vertebra1 its relation to its fellows1 the points of greatest nerve impingement1 etc41 all of which should suggest the best method for correction4 ,the prime object of adjustment is the removal of impingement from nerves4 ,transmitted ,shock vs4 ,thrust ,the movement used in adjusting has been variously described4 ,many writers and teachers have used the term 8thrust0 to describe the movement of the hands1 and the term is correctly applied to the movement used by many ,chiropractors4 ,but a careful study of the methods of applying force in use among the most successful adjusters1 those who have attained the greatest results with the slightest percentage of failures and a minimum of pain to the patient1 discloses the fact that the chief element of their adjustment is transmitted shock4 ,the hand is held in close contact with the vertebra to be adjusted and the arms and shoulders describe such movements as to deliver the required amount of force with the slightest possible change in the position of the hands4 ,the vertebra bounds away from the contact hand4 ,in the delivery of a thrust the hand would follow the vertebra1 forcing each portion of the movement4 ,the real effect of a thrusting motion1 since the hand cannot enter the body as a sharp instrument would1 is that of pushing4 ,pushing neither subluxates nor adjusts vertebrae so readily as does a rapidly applied shock4 ,let us illustrate with a common experiment in physics4 ,suspend a number of ivory balls by cords of equal length in such a manner that each is in contact with its fellow and all are in a straight line4 ,when the balls are properly adjusted a straight line should connect their centers4 ,hold one end ball firmly in the hand or with an instrument which renders it absolutely fixed4 ,then strike sharply with a light hammer4 ,the balls will all remain stationary except the one on the opposite end which will fly off to a distance exactly measurable according to the force of the blow4 ,how does this occur8 ,a shock is transmitted through the molecules of the ivory until it reaches the end ball1 which is not held back by another4 ,here the transmitted force is expended in molar motion1 the ball leaping away from its fellows as if it had been hung alone and had been struck with the same force4 ,it is well known that by placing an elbow firmly against a man's jaw and then sharply striking the closed fist with the other hand1 open1 a very heavy blow can be given2 yet the forearm1 through which the shock is transmitted1 does not move4 ,now ivory is very like human bone4 ,further1 it has been demonstrated that the law illustrated by the above experiment is equally applicable to the movement of vertebrae4 ,the pushing or thrusting movement may move a specific vertebra1 but it is probable that the chief factor in so doing is the element of transmitted shock contained in the movement and delivered at the instant of release of the hand from the spine at the end of the movement4 ,on the other hand it is obvious that a pushing or thrusting movement may move several vertebrae in addition to the one directly in contact with the adjusting hand1 in consequence of the way in which the spinal segments are closely bound together4 ,if a steady strain is used1 in which muscles and ligaments have time to act1 one of three results may occur3 7a7 the specific adjustment2 7b7 the movement of several vertebrae at one time1 which does not constitute an adjustment2 7c7 the giving way of the spine at its weakest point1 which may be some distance from the point of contact with the adjusting hand1 the ligaments and muscles having communicated and diffused the strain throughout a large area4 ,in the latter contingency the result is usually a new subluxation or the increase of an old one1 instead of an adjustment4 ,the ,rapid ,movement ,thus ,speed becomes an important factor in correct adjustment4 ,a good illustration of the value of speed may be taken from a pile of stakes bound together by a cord4 ,if a man with a hammer desires to remove the center stake of the group1 and attempts to do so with a slow pushing movement1 the result is a change of position of many stakes1 which adhere to the center stake and to each other4 ,if1 on the contrary1 he strikes a sharp1 quick blow with his hammer1 meeting squarely the center of balance of the one stake1 it will fly straight from its position leaving the others unmoved4 ,this is exactly what we desire to accomplish with an adjustment4 ,by the speed of the movement we expect to move one vertebra before adhesion or the contraction of muscles or inelasticity of ligaments can diffuse the force4 ,close ,contact ,in order to accomplish the transmitted shock it would seem wisest1 at first thought1 to draw back the hand and strike the vertebra sharply4 ,on the contrary1 it has been found advisable to place the hand carefully in close and immediate contact with the vertebra to be adjusted4 ,nature herself shows us the way in the delicate shock-transmitting mechanism of the tympanum4 ,also the hand of the adjuster will cover much more than merely the spinous or transverse process which is used as a lever and to which it is desired to transmit the shock1 unless carefully placed so that only a small portion is in contact2 by such a contact diffusion of the shock is prevented and its efficiency within a limited area is increased4 ,a carpenter wishing to countersink a nail places in contact with the nail head a small instrument called a countersink1 which he then strikes sharply with a hammer4 ,the contact hand of the adjuster represents the countersink and is used by the two arms as a passive instrument for transmitting shock4 ,the close contact of the hand1 which remains passive1 renders the adjustment much less painful to the patient than it would otherwise be1 and one of the prime objects in the mind of the adjuster should be the minimizing of pain inflicted1 by any means which does not lessen the resulting benefit4 ,also any drawing back of the hand before the movement warns the patient and tends to induce involuntary muscular contraction which interferes with adjustment4 ,relaxation ,in an adjustment it is necessary to overcome two kinds of resistance--the passive resistance of inertia1 of ligaments1 or of superincumbent weight1 and the active resistance of muscular contraction4 ,it is important that both forms be minimized4 ,the first may be lessened through the position of the patient's body2 he is placed so that the vertebra to be adjusted is in the freest possible position4 ,the second is reduced to the least possible quantity1 amounting to no more than muscle tonus1 by using two methods3 7a7 ,oral ,suggestion1 and 7b7 ,muscular ,suggestion4 ,oral ,suggestion ,explain to the patient the need for relaxation4 ,make it clear to him that less force will be required if his muscles are passive4 ,remind him frequently of this and assume that he desires to relax4 ,a word immediately before the adjustment often induces a temporary relaxation during which the adjustment is given4 ,anything which detracts the attention from the coming shock is an aid4 ,sometimes asking the patient to inhale and exhale slowly and deeply will sufficiently take his attention from the adjustment4 ,experience will teach him that he suffers less pain when relaxed and presently relaxation becomes a habit4 ,instructing patients to think of sleep1 turning the eyeballs upward1 has been effective with some4 ,muscular ,suggestion ,this can only be given by maintaining a state of relaxation in one's own muscles1 which in itself is desirable in most cases1 for reasons to be presently explained4 ,in handling ,cervical vertebrae move the head gently from side to side with your own hands relaxed as much as possible4 ,the lazy motion suggests relaxation4 ,then when it is felt that the neck is thoroughly relaxed1 vary the motion with a quick adjusting movement4 ,in ,dorsal and ,lumbar regions after the hands are in correct position the adjuster should pause a moment both to be sure that the direction of movement and his purpose to move are clearly fixed in his mind and to be certain that both himself and the patient are relaxed4 ,the adjustment is given instantly and from a perfectly lax muscle1 as a boxer strikes4 ,an added advantage is the greater amount of speed and control which may be commanded in this way4 ,the lax arm1 being in a neutral state as regards motion1 can be contracted in any desired direction without loss of force or of time1 whereas a taut muscle cannot further effect motion of the arm without relaxation of its antagonistic muscles1 which takes time4 ,muscular ,control ,considerable contral over one's own muscles is necessary in order perfectly to relax arm and shoulder muscles just before the adjustment and then to utilize a measured and determined quantity of force in a desired direction4 ,to acquire this much practice is necessary--practice on the living subject4 ,the desired end may be hastened1 however1 by acquiring the abstract property of muscular control or by developing control already gained4 ,many different forms of exercise will aid in the acquisition of muscular control and the ability to relax and then to follow the relaxation with an instantaneous whiplike contraction in a given direction4 ,the best of these is without doubt bag-punching4 ,the movements employed with a punching-bag1 especially the lateral quadruple movement with both elbows and both hands1 tend to develop precisely the sort of control needed for correct adjusting4 ,the beginner can do no better than to practice in this way1 by which1 it must be remembered1 only a necessary property1 and not by any means the exact movement1 may be acquired4 ,amount of ,force ,the amount of force used in an adjustment varies so much in different spines and in different parts of the same spine that it is quite impossible to state any correct estimate of it in terms of physical units4 ,in general the ,cervicals move with least resistance1 then the ,dorsals1 then the ,lumbars1 and finally the ,sacrum and ,ilia as hardest of all to displace or replace4 ,in developing additional force when it is found that the force first used on any vertebra has been insufficient to move it1 remember this law3 ,work equals one-half ,mass times the square of the ,velocity4 ,in other words1 doubling the speed of the movement increases its effectiveness four-fold2 tripling it1 nine-fold4 ,the increase in force should never be effected by increasing the weight or pressure upon the patient's body1 for reasons which should be clear from a study of previous pages1 but always by increasing the speed of the movement4 ,names ,used to ,describe ,movements ,the names herein employed to indicate certain movements1 each a well-defined method of procedure for the accomplishment of some special end1 are the names or descriptive terms which seem to be in the most general use at this time4 ,few of these movements have arrived suddenly2 most of them are the result of gradual growth and evolution3 so with the terms by which they are known2 they have gradually become a part of the common language of the profession4 ,usage sanctions them1 though some of them are cumbersome1 unwieldy1 or entirely inappropriate4 ,illustration3 ,fig4 #g4 ,morikubo ,move4 ,for correction of a lateral and rotated ,atlas 7,l4 ,a474 ,pisiform contact with anterior transverse4 ,,special ,,technic ,,morikubo ,,move ,a movement for the correction of a lateral and rotated ,atlas1 indicated for use only when the ,atlas is recorded as ,r4 ,a4 or ,l4 ,a4 ,the position of the patient's head renders the transverse process inaccessible unless it be anterior on the side from which adjustment is to be given4 ,position of ,patient ,place two sections of the bifid bench together so as to secure the effect of a solid bench with an upward sloping front4 ,have patient lying on back with back of head resting firmly on bench1 chin slightly uptilted4 ,then turn patient's head so that it faces sidewise and rests flatly on the side of the least prominent transverse4 ,this exposes the anterior transverse in front of the tendons of the sterno-mastoid muscle4 ,use of ,hands ,stand leaning over head of bench and carefully place the pisiform bone of adjusting hand upon the tip of the transverse process1 being careful to push aside the sterno-mastoid tendons if they interpose themselves between the pisiform and the process4 ,the fingers of the adjusting hand extend downward toward the clavicle and rest lightly1 very lightly1 upon the patient's neck4 ,with the other hand firmly grip the wrist of the adjusting hand1 fitting the pisiform of the upper hand into the hollow below the styloid process of the radius4 ,movement ,this is delivered straight downward toward the bench4 ,it should be light and quick and the hand should not follow the process in its movement4 ,this movement is painful and should not be used if avoidable4 ,when used it requires the utmost care and a careful measuring of force4 ,err1 if at all1 on the side of overcaution4 ,the technic will be better understood after study of the more detailed description of 8,the ,recoil01 since the position and use of hands1 arms1 and shoulders is much the same for both4 ,,pisiform ,,anterior ,,cervical ,,move ,indicated for rotation of a ,cervical vertebra in which one transverse process is anterior to its normal position or more anterior than its fellow which may also be somewhat1 though less1 anterior4 ,placing ,patient ,as for the ,morikubo ,move place the patient in the dorsal recumbent posture with head resting on bench and chin uptilted4 ,turn patient's face slightly away from the side of the selected anterior transverse and steady the head with the free hand while palpating4 ,illustration3 ,fig4 #h4 ,pisiform anterior ,cervical move4 ,making ,contact ,palpate downward from the ,atlas transverse along the posterior margin of the sterno-mastoid1 dipping deeply into the neck and exploring with the tips of the first three fingers until the offending process is felt as a nodule of bone plainer to the touch than those above and below4 ,always reach across the neck to the selected transverse2 if it be the right1 stand on the patient's left and use left hand for palpating and for contact hand as well4 ,having found the process1 gently move aside any tissues which tend to interpose between the finger and the bone1 change hands so that the palpating hand is free and the other holds the contact spot clear of interposed tissue and plainly points it out1 then place pisiform bone of contact hand gently but firmly against the front of the process so that a mass of bone is felt between the pisiform and the bench when downward pressure is made4 ,completing ,position ,it will be noted here that the head is unstable and tends to rock with slight pressure or movement of the contact hand4 ,steady the head by placing the knee upon head of bench and against side of patient's head1 not roughly but so that the head cannot move further toward the adjuster4 ,now reinforce the contact hand by gripping the wrist with the other1 press slightly downward to tighten the contact and avoid slipping1 and you are ready for ,the ,movement which is directed sharply downward toward the bench4 ,this move rotates the vertebra around its vertical axis and puts a strain in a backward direction on the whole column at this point4 ,care must be used1 because the move at best is painful4 ,it is easy to slip across the end of the transverse4 ,take every precaution to avoid imprisoning a muscle1 nerve1 or blood-vessel between the contact hand and the vertebra4 ,rightly used this move is valuable1 perhaps most valuable of all anterior ,cervical moves1 but it requires nice judgment4 ,,last ,,finger ,,contact ,this movement differs from the preceding one in two important particulars2 the contact hand must be so selected with relation to the side of vertebra adjusted that the fingers will extend upward toward the patient's head1 and the opposing hand supports the head instead of reinforcing the contact hand4 ,placing ,patient ,as for preceding move4 ,the head will remain in this position only until the contact is made1 after which it will be raised by the supporting hand until a tight contact is felt and the neck muscles drawn fairly taut4 ,illustration3 ,fig4 #i4 ,last finger contact for anterior ,cervical4 ,making ,contact ,palpate with left hand if standing on patient's left to adjust a right1 anterior subluxation4 ,find the offending anterior transverse1 draw tissues away with middle finger of palpating hand1 change to middle finger of free hand which marks and holds the point of contact4 ,now place 7with care7 the base of the little finger of the hand which was used for palpating1 at a point just below the condyle of the last metacarpal and a little to the palmar side1 in direct contact with the front of the transverse4 ,the last finger will be flexed toward the radial side and a shallow depression thus left for the contact4 ,completing ,position ,hold contact lightly and slip the free hand under the patient's head1 which faces slightly toward the adjuster4 ,raise the head1 bending the neck away from the adjusting hand and toward patient's chest until it is felt that the contact is secure and that further movement would put the neck upon a strain4 ,you are ready for ,the ,movement which is delivered entirely with contact hand1 downward and toward the back of the neck4 ,the delivery is difficult because the force arm is flexed at the elbow and the position awkward4 ,practice1 however1 will soon render one adept4 ,uses ,for rotated vertebrae which have one transverse anterior to the other1 ,cervicals only4 ,this move gives a slightly less advantageous force angle than the preceding1 but is less likely to be painful4 ,,second ,,metacarpal ,,contact ,position of ,patient ,place patient supine on bench so that his head extends beyond the end of bench and is supported by the upraised knee of the palpater4 ,stand at head of bench so as to face patient's feet4 ,use of ,hands ,differing from their use in the preceding moves the hands are so placed that the adjusting hand for a right1 anterior subluxation will be right hand1 for a left anterior the left hand4 ,the opposite hand supports the head after contact is made4 ,making ,contact ,contact point on hand is second metacarpal at the end of the condyle1 or second metacarpo-phalangeal joint4 ,this is placed in front of the offending transverse1 the head having been rotated away from that side and other tissues drawn carefully aside from the bone4 ,the back of the hand is downward toward the clavicle1 fingers semi-flexed on palm1 thumb resting on jaw4 ,supporting ,head ,the following position is the correct one for supporting the head in all ,cervical adjustments delivered in the above position of patient and adjuster4 ,cup the supporting hand slightly and fit the patient's ear into the cupped palm4 ,let fingers extend toward the base and back of the neck1 the finger position varying according to the amount of rotation of the head so that the fingers are in all cases directly under the head weight4 ,the wrist then flexes on the hand1 and wrist and forearm are brought up across the patient's forehead so that a force delivered from the opposite side cannot cause the head to roll or move upon the supporting hand4 ,after placing both hands draw the head so that the chin is tilted upward until it is felt that contact is snug and tight4 ,this supporting position is invaluable and much neglected by adjusters1 who might save themselves much annoyance and many failures by its constant use4 ,in the study of succeeding ,cervical moves refer to this description frequently4 ,we shall call it the ,hook ,support1 because the arm and hand resemble a hook which grasps the under side of the head and curves over the upper4 ,movement ,this is delivered entirely with contact hand and in a direction as much posterior as can be achieved without slipping past the end of the process4 ,if the head is sufficiently rotated away from the contact side the angle of force is better than with a straight lateral adjustment1 which it somewhat resembles1 but not so good for anteriors as either of the two preceding moves4 ,it is chiefly useful when the other two fail4 ,,occipito--,,atlantal ,,move ,to move an ,atlas so disposed that its one side is posterior while the whole vertebra is laterally displaced in the same direction2 to move1 for instance1 an ,atlas ,r4 ,p4 ,have patient lying on back in position ,c with head projecting beyond bench and supported by adjuster's knee4 ,placing of ,hands ,place the first three fingers of one hand under the most laterally prominent transverse so as to hold it firm1 first placing the first finger carefully just behind and against the end of that transverse and then reinforcing it with the second and third fingers1 slightly tensed1 and resting their tips on the lamina close underneath the occipital bone4 ,next place the other hand so that the thumb rests firmly upon the patient's jaw and the first finger extends backward along the lower margin of the occipital bone4 ,to complete the position rotate the head gently toward the side of the laterally prominent ,atlas1 until it rests1 face toward the side1 and is supported by the three fingers of the one hand and the heel and wrist of the same hand4 ,it will be noted that when the head is rotated the first finger of supporting hand slips to a position directly upon the tip of the transverse process and the other two take its place against the posterior aspect of the tip of the transverse4 ,the ,atlas now rests with its intertransverse line almost vertically upward from supporting fingers1 which hold it against further rotation4 ,movement ,when the neck muscles have been thoroughly relaxed by slight and gentle movement1 throw the upper elbow sharply away from your body1 which has the effect of transmitting force through the thumb to the jaw and sharply rotating the head still further1 loosening its articulation with the now firmly held ,atlas4 ,the condyloid joints thus loosened tend to settle into their proper relations1 the weight of the head causing it to slip downward--laterally upon the ,atlas4 ,uses ,this is really a movement of the head rather than of the ,atlas and is an easy movement when practicable4 ,it requires complete relaxation and will often fail4 ,it is probable that many apparent ,atlas subluxations are really subluxations of the head upon that bone which leave ,atlas and ,axis in normal relation4 ,this move is most used to loosen the ,atlas when it resists ordinary adjustments4 8,,the ,,break0 ,no4 #a 7,lateral ,cervical ,move7 ,the principle involved in this and the three succeeding moves is the same4 ,the contact is made with the end of the laterally prominent transverse process of a ,cervical vertebra other than the ,atlas1 and the movement is directed entirely from side to side4 ,it is to be used only for lateral and not for rotary or anterior or posterior subluxations1 a point to be remembered as it is just as easy to produce as to correct subluxation with this move4 ,position ,have patient lying on back in position ,c1 with head projecting beyond bench and supported by adjuster's knee4 ,following a record previously made count downward to a subluxated vertebra and palpate both transverses with the two hands at once to find if one is prominent laterally1 remembering that the record indicates merely the position of the spinous process4 ,having found the laterally prominent transverse1 place the tip of the finger of the corresponding hand on the spinous of the subluxated vertebra2 that is1 if a right subluxation1 use right hand and if a left1 use left hand4 ,then draw the hand around until the middle of the proximal phalanx of the first finger rests against the end of the transverse4 ,the tip of the finger will be freed from the spinous by this movement4 ,hold the adjusting hand tense1 edgewise to the neck1 fingers together and pointing downward4 ,the thumb may rest against the patient's jaw or may be free2 the essential thing is the snug contact of the first finger against the transverse4 ,illustration3 ,fig4 #aj4 8,the ,break10 ,no4 #a1 from right4 ,contact2 first phalanx with end of right transverse4 ,movement ,with the hand in position and the head supported by the ,hook ,support1 bend the head laterally1 keeping the face upward1 until it is felt that further movement would strain the muscles4 ,deliver the movement in a straight lateral direction1 quickly and entirely with the contact hand4 8,,the ,,break0 ,no4 #b ,for the ,atlas only1 and for straight lateral displacement of that vertebra4 ,position and ,contact ,position of patient's head and of supporting hand exactly as in using ,break ,no4 #a4 ,contact is made with the end of the ,atlas transverse on the laterally prominent side4 ,contact point on hand is second metacarpo-phalangeal joint1 or rather1 the condyle of the second metacarpal4 ,movement ,as for ,break ,no4 #a4 8,,the ,,break0 ,no4 #c ,position ,have patient sitting erect on bench or stool and stand before him4 ,for a right subluxation use left hand and for a left1 right hand4 ,contact point is the middle of the proximal phalanx of the first finger and the fingers reach backward and downward1 thumb upward so as to be out of the way4 ,movement ,force should be applied entirely with the contact hand to avoid the possibility that movement of the head may bring about movement of some other vertebra than the desired one4 ,but in practice the force is usually divided between the head and the vertebra4 ,the ,hook ,support cannot be used in this position4 ,uses ,the use of this position for the ,break avoids the necessity for the patient to lie down again in a new position after having ,dorsals and ,lumbars adjusted4 ,it is extremely convenient4 ,but on the other hand it is undeniably harder for the patient to relax his muscles when sitting up with head flexed sidewise and a sense of lost equilibrium than when lying down4 ,the ,break ,no4 #a will be found the better for the average case4 8,,the ,,break0 ,no4 #d ,position ,same as ,break ,no4 #c except that adjuster stands behind patient and rests the thumb upon the base of the neck posteriorly while the fingers extend downward and forward toward the clavicle4 ,as with ,no4 #c1 the supporting hand rests against the opposite side of the head and forces it sidewise to tighten the contact4 ,illustration3 ,fig4 #aa4 8,the ,break10 ,no4 #c4 ,movement ,properly1 a quick lateral movement of contact hand while the head is firmly held by the opposing hand4 ,,note3 8,the ,break0 is unfortunately named and it would be well if some less suggestive term were generally substituted4 ,,the ,,rotary ,no4 #a ,for the correction of rotation only1 and usable in the ,cervicals from #b to #g inclusive4 ,philosophy of the ,rotary ,a study of the ,cervical articulations will make it clear that if a force be applied laterally to the spinous process the probable result will be a rotation of the vertebra1 which swings one articular process back from its fellow but leaves the other in close1 but modified1 contact4 ,thus the spinous process may appear to the left while the left articular process is fitted firmly against that of the adjacent vertebra1 while those on the right are separated4 ,similar rotation1 modified only by the difference in shape of the vertebrae1 occurs in the ,lumbar region4 ,a movement applied to the spinous process might correct this condition or might complicate it according to the manner of application4 ,but the most direct line of force for correction is along a line which would pierce the separated articular processes almost in an antero-posterior direction4 ,the ,rotary approaches this very closely4 ,it is a setting forward of the articular process against its fellow by applying a movement directly to the transverse process1 which lies very close to the articular process4 ,the great safety of the movement lies in the fact that it is impossible with any reasonable amount of force to move the transverse process too far4 ,if the vertebra is not subluxated so as to indicate this movement1 gentle attempts to use it will fail4 ,the deceptive bent spinous process may sometimes be detected in this way4 ,the chief objection to ,rotary ,nos4 #a and #b is that the ,dorsals and ,lumbars cannot be adjusted in this position and the patient must rise from the bench and lie down again to have his ,cervicals adjusted4 ,this is obviated if ,no4 #c is used but the latter position fails to secure the perfect relaxation of muscles of ,nos4 #a and #b1 and is therefore recommended as an alternative only4 ,the commonest obstacle to the use of this move is the voluntary or involuntary contraction of the neck muscles4 ,the ,hook ,support1 q4 v41 will limit this resistance by affording a sense of perfect security to the patient4 ,if muscles are contractured a slight 8check0 will be felt as the head reaches a certain degree of rotation1 and beyond this point it will refuse to move though easily movable within the radius limited by the 8check40 ,it is as if the head were held by an inelastic cord4 ,it is best when contracture is present not to attempt moving the head too far but to deliver the movement with the muscles as much relaxed as possible4 ,illustration3 ,fig4 #ab4 ,the ,rotary1 ,no4 #a4 ,ready for the movement4 ,position and ,palpation ,place patient in position ,c as described under ,technic of ,palpation4 ,stand at head of bench with patient's head supported by one knee and perhaps also by one hand4 ,palpate chiefly to discover the numbers of vertebrae1 following a record previously made4 ,finish palpation with the tip of the first finger of either hand resting upon the spinous process of the vertebra to be adjusted4 ,placing ,contact ,consider here which way the vertebra is to be moved2 if toward the right use right hand and if toward the left use left hand for adjusting4 ,draw the adjusting hand straight around until the first finger1 about the middle of the proximal phalanx1 rests against and behind the transverse process4 ,it is important that the finger be drawn straight around1 and not upward or downward1 except with the second ,cervical with which the finger may pass slightly upward to the transverse4 ,to insure correct placing of finger let patient's head be absolutely at rest1 supported by the ,hook ,support with face turned slightly away from the adjusting hand4 ,reinforce contact finger with the other three fingers held close together behind it4 ,the thumb may or may not be placed against patient's jaw as desired1 but one must be careful not to lose exact contact by drawing adjusting hand upward from a lower ,cervical in an attempt to reach the jaw4 ,use of ,second ,hand ,meanwhile the other hand supports the head and holds its weight as described under the ,hook ,support1 q4 v4 ,turning ,head ,next1 holding the first finger gently but firmly pressed against the transverse process1 turn the head in the direction of the subluxation and away from the adjusting hand4 ,that is1 if the vertebra be subluxated to the right turn the face toward the right1 the use of the terms 8right0 or 8left0 referring to the spinous process4 ,movement ,when the head is drawn around so that the vertebrae are thoroughly separated on the side toward which movement is to be directed1 and the patient's muscles are thoroughly relaxed though it is felt that further rotation of the head would put them upon a tension1 give the movement4 ,it consists in a quick throw of the adjusting hand1 force transmitted from shoulder through an outward fling of the elbow1 directed upward and inward against the transverse process4 ,it replaces the articular process against its fellow1 moving one vertebra1 smoothly and easily4 ,all force should be delivered with contact hand4 ,the hand moves through very little space4 ,the principle of the movement is transmitted shock4 ,illustration3 ,fig4 #ac4 ,the ,rotary1 ,no4 #b4 ,,the ,,rotary ,no4 #b ,a transition in technic between ,no4 #a and ,no4 #c4 ,position ,patient lies face upward on closed table1 head resting upon forward section4 ,adjuster stands at side of patient1 choosing the side according to the subluxation so as to face across the table in the direction toward which spinous process is to move4 ,palpation is difficult in this position on account of the increase in the curve of the ,cervicals1 so that it is best to follow a record previously made4 ,having found the subluxation make contact as follows4 ,contact ,reach across patient's neck with right hand for a right subluxation or left hand for a left1 and find spinous process4 ,then draw the middle finger straight around until the palmar surface of the middle finger just below the second joint fits snugly behind the transverse process4 ,place the other hand under the head and with both hands working together turn the head toward you1 chin upraised1 and draw the neck into a greater flexion until it is felt that contact is firm and close4 ,movement ,the movement is a quick drawing toward the adjuster of the second1 or contact1 finger1 which has been1 as it were1 hooked over the transverse4 ,the transverse is thus drawn sharply forward and the vertebra rotates around its vertical axis so that the spinous follows1 or tends to follow1 the transverse in the same arc of movement4 ,,rotary ,no4 #c ,position ,patient sitting erect1 both feet evenly on floor and hands not braced4 ,stand in front of the patient but to one side or the other as for ,rotary ,no4 #b4 ,use right hand for adjusting right subluxations and left hand for lefts4 ,contact ,as for ,no4 #b1 contact is with palmar surface of second finger but may be shifted to third finger for the lower vertebrae if desired4 ,the thumb is usually placed on the mandible and aids the opposite hand1 placed on the other side of the head1 in turning and otherwise controlling the head4 ,movement ,turn the head away from the adjusting hand until the neck muscles feel taut as a result of position and not of contraction4 ,the movement then is given as a sharp jerk of the contact hand forward4 ,illustration3 ,fig4 #ad4 ,the ,rotary1 ,no4 #c4 ,,anchor ,,move ,no4 #a ,theory ,it is held that a vertebra often loses its proper relation with the vertebra below1 and consequently with all the vertebrae1 or the entire column of the spine below1 without being disturbed in its relation to the one1 or ones1 above2 that1 in other words1 the column may be divided into two sections by subluxation1 the upper section set askew upon the lower4 ,with this reasoning it would clearly be desirable to so adjust the spine as to move a given vertebra1 and with it all vertebra above1 so to speak1 upon the vertebra below4 ,to do this all vertebrae above the one to which force is applied must needs be firmly anchored to prevent strain between them4 ,such a move has been devised by ,bunn for ,cervical use and is here described from the author's few observations only4 ,further study may modify the technic somewhat4 ,illustration3 ,fig4 #ae4 8,anchor ,move10 ,no4 #a4 ,for a ,p4 ,l4 subluxation4 ,position ,patient is placed as for ,dorsal and ,lumbar adjustments in position ,b4 ,move is applied to rotated1 postero-rotary1 and antero-rotary subluxations and face turned toward side from which move is to be made4 ,adjuster1 after palpation which discovers the vertebra to be moved and the direction of movement1 stands at the head of table facing patient's feet4 ,contact ,with the palms of both hands resting against the side of the neck and thumbs extended at right angles to hands1 make contact with both thumbs on one vertebra as follows3 ,if vertebra is to be rotated toward patient's left1 place right thumb against spinous process on its left side and left thumb upon right transverse process from behind it4 ,press firmly with the palm and fingers of each hand against the vertebrae above1 gripping around neck and base of skull so as to hold all parts together4 ,movement ,the move is delivered simultaneously with the two hands1 forcing spinous process toward the right and transverse in an anterior direction4 ,the head must be raised from the bench and wholly supported by the hands and the head turns with the vertebra4 ,uses ,a powerful comparatively easy move which has the advantage of wide applicability and of avoiding the change of posture of the patient which mars many ,cervical moves4 ,illustration3 ,fig4 #af4 ,posterior ,cervical move4 ,,anchor ,,move ,no4 #b ,position ,same as for ,no4 #a4 ,contact ,for a left subluxation to be moved toward the right1 place the left thumb upon the right side of the spinous process so that it hooks over the spinous in position to draw or pull the spinous4 ,place right thumb against the end of the left transverse as much on the anterior side as possible so that it may exert a prying force in a posterior direction4 ,movement ,simultaneous application of force with the thumbs tends to rotate the vertebra as does ,no4 #a1 but unlike ,no4 #a the tendency is to bring the vertebra out in a posterior direction instead of driving it more anteriorly4 ,uses ,this move is applied to rotated ,cervicals which are anterior1 more on one side than on the other4 ,,posterior ,,cervical ,,move ,uses ,for a posterior ,cervical below the ,atlas4 ,the common and careless practice of moving such a vertebra with the ,rotary1 or the dangerous practice of using the ,recoil may be avoided by this move and much better results obtained4 ,position ,patient in position ,c1 head projecting well beyond bench so as to allow for a dropping backward of the head4 ,palpate as for the ,rotary and hold palpating finger on tip of spinous process of posterior vertebra while contact is made4 ,contact ,contact point is middle of radial surface of first phalanx of first finger and is placed against the tip of the spinous process1 directly between it and the floor1 as the patient lies4 ,hand is held rigid and edgewise1 fingers together so that the contact finger is well supported4 ,completing ,position ,use the free hand to hold the head with the ,hook ,support1 q4 v4 ,turn the patient's chin slightly away from the adjusting hand and drop the elbow of adjusting arm down until a straight line could pass through elbow1 spinous process1 and patient's chin4 ,it may be well to crouch and rest the elbow against one knee for solidity4 ,then allow the head to drop backward until chin is elevated and further backward flexion would strain the muscles4 ,you are ready for the movement4 ,movement ,a quick throwing movement upward and inward1 or toward patient's chin4 ,as nearly as may be the force should tend to pass along the spinous process in a direction exactly anterior to the 7then7 plane of the vertebra4 ,,note3 ,either hand may be used with this movement4 ,illustration3 ,fig4 #ag4 ,movement for correction of a lateral ,atlas whose prominent transverse is posterior4 ,,double ,,contact ,,move ,uses ,this is indicated for postero-rotary or postero-lateral subluxations4 ,its line of force is a bisector of the angle between the straight anterior and the straight lateral movement4 ,illustration3 ,fig4 #ah4 ,a movement for ,atlas when laterally displaced4 ,contact3 metacarpo-phalangeal joint with end of prominent transverse4 ,contact ,there are two points of contact1 both on the first finger1 one 7first secured7 on the radial side of the second phalanx and the other on the radial side of the proximal phalanx4 ,the first contact point is placed against the tip of the spinous1 the other behind the transverse process4 ,press slightly against the two processes with the finger so as to feel them plainly4 ,completing ,position ,hold the head with the ,hook ,support and turn the face away from the adjusting hand 7right hand for a ,p4 ,r41 left hand for a ,p4 ,l474 ,drop elbow low and hold it well away from your body so that there appears an obtuse angle between wrist and forearm with the point of the angle toward you4 ,be careful of this point as the tendency is to make an angle with the point away from you--a weak position4 ,drop head backward until firm resistance is felt4 ,movement ,force is delivered in an antero-lateral direction as above described1 entirely with adjusting hand4 ,,the 8,t4 ,m40 ,no4 #a ,uses ,for subluxations listed ,r or ,l but not ,posterior and upon ,c #f1 ,c #g1 ,d #a1 and ,d #b only4 ,this movement applies a lateral force to the spinous process so as to correct rotation of the vertebra1 but ,i repeat that it is inappropriate for posterior or postero-lateral subluxations4 ,position ,patient lying in position ,b as for ,dorsal adjustment4 ,find the subluxation by following the record and perceiving that the count assumed to be correct permits the subluxations to correspond to those recorded and that a vertebra in this region is ,r or ,l1 ,r4 ,a4 or ,l4 ,a41 ,r4 ,s4 or ,l4 ,s41 ,r4 ,i4 or ,l4 ,i4 ,the laterality of the spinous process determines the next step4 ,for a right subluxation turn the face toward the left and use right hand for contact hand4 ,for a left subluxation turn the face to the right and use left hand for contact hand4 ,contact ,thumb of contact hand is placed upon and against the side of the spinous process so that it presses firmly4 ,the thumb is extended almost at right angles to the hand which rests upon the patient's shoulder with fingers extending1 and gripping1 over the clavicle4 ,be sure of the solidity of the position4 ,next place the other hand upon the patient's forehead and press the head backward1 or toward the side of the contact hand1 until the neck is well flexed and the tissues tightened between the now opposing hands4 ,illustration3 ,fig4 #ai4 ,the 8,t4 ,m410 ,no4 #a4 ,movement ,when this tightened condition is reached a quick decisive movement of both hands in opposite directions1 but chiefly of the hand applied to the head1 will secure an easy movement of the vertebra4 ,this move is a very valuable adaptation of the old crude and other dangerous 8,t4 ,m410 of which ,no4 #b1 below1 is another1 more like the original move but possessing several 8safety0 features4 8,t4 ,m40 ,no4 #b ,position of ,patient ,the patient sits erect on a flat seat with both feet resting upon the floor as during palpation4 ,placing ,hands ,after careful palpation and selection of a vertebra to be adjusted in this way1 stand directly behind the patient4 ,if the vertebra is subluxated to the right use right hand for adjusting 7or contact7 hand1 if to the left use left hand4 ,hold the hand so that the thumb is at right angles to the hand and tense and firm4 ,place the palmar surface of the end of the thumb against and upon the tip of the spinous process and grasp the neck firmly with the fingers1 which extend over the base of the neck and toward the clavicle4 ,the other hand is placed easily on the top of the head4 ,position of ,head ,the completing of position after contact has been made is governed by two considerations2 the need for relaxing the neck muscles and for so supporting the vertebrae above the contact that movement will take place only at the point of contact4 ,if the neck muscles are contracted the movement is almost always defeated and should always be abandoned to avoid strain4 ,to secure the desired position ask the patient to relax his muscles and allow you to place his head as desired4 ,if he seeks to place it himself the necessary muscular contraction on his part will defeat the movement4 ,the movements of the head must be passive4 ,with thumb and remainder of adjusting hand properly placed1 use the other hand upon the head as follows3 ,first flex the head forward on the chest as far as possible1 then rotate it slightly so that the face is turned a little toward adjusting hand4 ,then flex the head sidewise until a resisting pull of muscles indicates that they have been stretched taut4 ,it is well during the third movement described to let the forearm swing down at right angles to the hand so that it presses firmly against the ends of all the ,cervical transverses1 distributing the force among them4 ,or1 after placing contact hand rest the elbow in the angle at the base of the neck and let the forearm extend upward along the side of the neck4 ,then flex the wrist until the hand will rest upon the patient's head and perform the movements of the head as described above4 ,illustration3 ,fig4 #bj4 ,the 8,t4 ,m410 ,no4 #b4 ,note position of right arm and hand of adjuster4 ,movement ,a quick1 simultaneous movement of both hands in opposite directions1 two-thirds of which is given with the hand which holds the head4 ,the thumb in contact with the spinous process moves slightly inward toward the median line but its chief use is to hold the vertebra very firmly4 ,to this end part of its force is directed forward against the shoulder and through the ball of the thumb4 ,failure to place the head properly or in securing sufficient flexion of the neck before move is attempted are the chief causes of failure4 ,force must be delivered quickly and sharply and the best adjustment of this kind is usually the one in which the head and hands move through the least space4 ,uses ,this movement is obviously useful only for the correction of rotation1 since the force is directed sidewise against the spinous process4 ,the 8,t4 ,m40 was originally intended as a ,cervical adjustment1 but its greatest use is now from ,c #f to ,d #b inclusive4 ,above the sixth its use is questionable because of the possibility of moving more than one vertebra or some other than the one desired4 8,,the ,,recoil0 7,pisiform ,contact7 ,position of ,patient ,this movement is best given on bifid bench of the type commonly known to the profession4 ,place patient on forward section so that its rear edge rests just below the axilla2 this may be ascertained by passing a hand under patient's arm after he is in position1 when the edge of the bench should be felt about an inch below the hanging arm4 ,the thighs should rest on rear section so that the pubic symphysis is free of the bench4 ,the semicircular pubic cut is an advantage in that it avoids injury without making necessary too great a suspension between sections4 ,thus the abdomen and the lower part of the thorax are suspended between sections4 ,under them an abdominal support may be used but it must have the quality of elasticity in a high degree and must lie always below the plane of the other two sections or it will interfere with a perfect adjustment4 ,for adjustment of the last two ,cervicals or any ,dorsal down to the sixth1 it is best to turn patient's head toward the direction of the subluxation4 ,this curves that section of the spine into an arc toward the convex side of which movement may be made more easily than toward the concave4 ,the patient's hands may lie under the table1 loosely1 or may reach back and rest upon the buttocks1 palm upward4 ,whichever position secures best relaxation is to be used in any case4 ,this movement may be used with the roll4 7,see ,fig4 #cj and p4 #bhe47 ,illustration3 ,fig4 #ba4 ,after palpation4 ,finger ready to guide contact hand to a spinous process4 ,position of ,adjuster ,stand on either side of patient1 feet apart for base and poise4 ,the direction of the feet and position of body will vary according to the direction of the adjustment1 by the following two rules3 ,rule #a4 ,for movement of a vertebra away from the side on which you stand1 place your arms and hands in such a position that the pisiform bone of adjusting hand1 both elbows1 and both shoulder joints 7shoulders being dropped loosely forward7 will fall in the same plane and that the plane of direction in which the vertebra is to be moved4 ,in other words1 let the force be applied in a line straight from your body through the vertebra4 ,always shift your feet to a proper position from which to direct the movement4 ,rule #b4 ,to move a vertebra toward the side on which you stand1 step close to patient's body and support yourself with one knee against the adjusting table at the most convenient point4 ,then place arms so that contact point1 elbows1 shoulders1 and the mid-point of the body's base1 between the feet1 are all in the same plane4 ,this insures balance during and after the movement and is the attitude from which the greatest and most carefully measured force can be delivered4 ,it will be seen that the desire is always to deliver all force in one plane and thus avoid conflict of forces and waste or misdirection through the predominance of one force over the other1 and to use both arms with equal facility in the move4 ,there are at least a hundred ways to hinder this movement by varying the preliminary positions4 ,and no one can know the real efficiency of the move who has not become instinctively adept at taking position4 ,use of ,hands and ,arms ,use of hands for palpation has been described4 7,p4 #df47 ,the palpating hand comes to rest with the middle finger on the spinous process of the vertebra to be adjusted4 ,the heel of the hand is raised1 the first and third fingers doubled back1 and the heel lowered again4 ,now the middle finger alone is a slender pointer guiding to the contact point4 ,place pisiform bone of other hand snugly against the process to be moved4 ,the hand should rest in a slight arch1 pisiform against spinous1 fingers rigid and flexed on hand1 last finger firmly anchored1 or pressed into the flesh1 to prevent slipping4 7,fig4 #bb shows the position47 ,the anchoring fingers must always extend away from the adjuster4 ,to turn the fingers back across the spine1 in moving a vertebra toward you1 is always an error1 and the price is partial loss of use of one arm4 ,with the adjusting hand satisfactorily placed1 grasp its wrist firmly with the other hand so that the pisiform of the supporting hand rests in the hollow between the wrist and the metacarpal bone of the extended thumb4 ,by this contact force is driven directly through the chain of bones across the wrist and to the pisiform bone without spreading4 ,in grasping the wrist let the thumb extend around the forearm in one direction and the four fingers in the other4 ,beware of gripping only with thumb and first finger in which case the edge of the supporting hand will rest on the back of the contact hand and spread the delivered force too widely4 ,illustration3 ,fig4 #bb4 8,the ,recoil40 ,ready for the movement4 ,movement ,i have said1 but have not sufficiently emphasized the command1 that the shoulders must be dropped loosely forward4 ,let me add that just before the movement is given the head should be allowed to sag downward and the muscles to become relaxed4 ,this movement given with stiff shoulders and upraised head becomes a push4 ,the desired movement is a throwing movement4 ,force is released from both shoulders at once1 concentrated at the same instant by a slight shifting forward of the elbows1 and strikes the spinous process as one force1 which is the resultant of the two meeting at the wrist of contact hand and being united there4 ,the two arms use the contact hand as a passive instrument for driving the vertebra4 ,the objective point1 the distance to which the movement is mentally thrown at the instant of delivery1 should be the center of mass of the vertebra1 varying according to the section of the spine4 ,contact ,point ,the exact contact point of hand with vertebra varies4 ,if the vertebra is to be moved toward the right the pisiform rests against 7not upon7 the left side of the spinous2 if toward the left and inferior1 against the right side and just above1 in the notch between it and the next superior process4 ,the rule is to so place hand that the spinous process is between the pisiform and the direction to which movement is given4 ,on the hand the contact may be said to vary1 according to the direction of subluxation and position of adjuster1 so as to describe a circle around the pisiform in the course of the various changes of position necessary to the use of this movement4 ,no error could be greater than to attempt to use always the same face of the pisiform and to adapt the position of hands and arms to this end1 when any face or aspect of the little bone is equally good with any other4 ,which ,hand ,used ,when standing on patient's right use left hand for palpating hand and right hand for contact with the vertebra1 using left hand again to grip and reinforce the contact hand4 ,exception to this is made by introducing an extra change of hands with ,c #f1 or #g1 ,d #a1 ,l #d or #e1 and ,sacrum4 ,the change is necessitated by the insecurity of the usual position or the fact that it cramps the wrist of contact hand4 ,to make the change3 palpate as usual1 hold subluxation with second finger of palpating hand1 substitute second finger of other hand and withdraw palpating hand1 which is then free to make the contact4 ,when standing on left side exactly reverse the use of hands4 ,palpate with the same hand which would be used if patient were sitting4 ,introduce no unnecessary move into the placing of the hands4 ,this will be found to produce better results than any other technic for this portion of the move4 ,delivery of ,force ,in using this movement it is perhaps best to deliver nearly equal force with both hands2 certainly whatever forces are released by the arms should be simultaneous4 ,it is possible1 however1 to allow one arm to preponderate in the movement without marring its efficiency1 but the amateur adjuster will do well to balance his forces at first4 ,speed and ,concentration ,speed is a prime essential4 ,by its employment a very ordinary amount of muscular strength can be made to accomplish a large amount of work and very difficult adjustments may be accomplished4 ,concentration of mind at the instant of adjustment1 so as to secure muscular control and perfect co-ordination of the two arms as well as to direct and concentrate the forces used at a given and strictly limited area1 is also essential4 ,uses ,for ordinary adjustments of ,dorsal or ,lumbar subluxations1 excepting the middle four ,dorsals1 for breaking ankyloses by repeated applications of force1 and for overcoming muscular resistance in patients who are unable to relax at all1 this form or style of adjusting is probably the best4 ,it is most useful in the ,dorsals4 ,in many instances ,lumbar vertebrae will move better by application of a slightly slower force1 especially if a roll is used4 ,the ,recoil may be used with the roll4 ,while it is easily possible to move any ,cervical in this way1 making no change in the technic except to use the ulnar side of the fifth metacarpal bone for the contact instead of the pisiform1 it is inadvisable in most cases above the sixth1 and in some instances absolutely unpardonable4 ,the shock to the nervous system and the danger of moving two or more vertebrae or of subluxating a normal one are too great4 ,in at least one instance hemiplegia instantly followed the use of this move on the ,axis1 and headaches and nerve exhaustion are frequent sequelae4 ,for these reasons it is probably best never to use 8,the ,recoil0 above the sixth ,cervical4 ,for every form of subluxation there is an easier and safer mode of correction4 ,name ,this has been called 8,the ,recoil0 because of a belief that if force be applied to a vertebra in the form of a very rapidly transmitted shock the vertebra will rebound to the shock and settle in its normal position1 the intelligence within the body utilizing the force thus blindly applied to bring about this result4 ,this belief is erroneous4 ,first the vertebra and all surrounding tissues are misshapen to fit their abnormal position and relation and this shape gives them a tendency1 if rapidly loosened1 to settle into the old abnormal position4 ,second1 there is no such conscious intelligence which has power to replace a subluxated vertebra4 ,if this supposition were correct1 then the ,innate ,intelligence would do well to utilize those jars and shocks which ordinarily produce subluxation to bring about normality and keep the spine perfectly aligned4 ,there is no such internal rebound or recoil as stated above4 ,the chief value of the movement lies in its speed1 according to principles equally applicable to other moves1 and in accord with the ,law of ,momentum4 ,sources of ,information ,this movement as described above contains many essential principles which follow ,parker and ,palmer1 developers of 8,the ,recoil10 but the technic is considerably modified to suit the author's own views4 ,it cannot be claimed1 therefore1 that this is 8,the ,recoil0 as now taught by ,palmer1 since the chief stress is here laid upon the movement of the vertebra in a predetermined direction and not upon the withdrawal of the hands to let 8,innate0 do the work4 ,the name 8,recoil0 is really inappropriate for the move as described4 ,,the ,,heel ,,contact ,a movement for the adjustment of posterior1 postero-superior1 or postero-inferior subluxations in the ,dorsal region 7except middle four7 and in the ,lumbar4 ,may also be used for postero-laterals when laterality is very slight4 ,given with patient in position ,b4 ,contact point1 heel of hand with spinous process4 ,heel ,contact ,by the 8heel of the hand0 is here meant the depression between the scaphoid and pisiform bones4 ,this hollow forms a natural receiver for a spinous process and thus avoids lateral slipping4 ,the four fingers of adjusting hand are spread out and anchored upon the patient's body4 ,the wrist is held at a right angle to hand and the arm straightened1 the elbow being outrotated until it 8locks10 that is until it will move no farther4 ,the other hand grasps the wrist of the adjusting hand4 ,adjusting ,hand ,the rule is to use the right hand for adjusting hand if standing on patient's right and palpating with left1 or to use left hand if on left side and palpating with right4 ,the fingers are to be directed toward the patient's feet4 ,exception to this rule is made with the last two ,lumbars1 where it is more convenient to change hands and direct the fingers toward the head4 ,illustration3 ,fig4 #bc4 8,heel contact40 ,movement ,this is given almost entirely with adjusting arm2 that is1 with the arm whose hand is in contact with the vertebra4 ,the supporting hand serves merely to guide the force to a definite point as if a straight rod were working through a fixed circlet4 ,indeed1 the force in this movement is delivered almost straight down from the shoulder4 ,shoulder should be dropped well out of its socket so as to secure play for a sudden downward movement without raising the hand from its contact4 ,if the shoulder is stiff or the head of the humerus remains in the glenoid cavity the movement cannot be properly given without raising the hand4 ,movement is quick1 sharp1 and deep1 i4 e41 directed to the center of mass of the vertebra4 ,it may be directed straight toward floor to correct a posterior1 inclined slightly toward the head or feet to correct approximation1 or--as some aver--slightly sidewise to correct a mild degree of rotation4 ,,pisiform ,,double ,,transverse ,no4 #a ,an adjustment to be used only in the ,dorsals from fourth to ninth inclusive1 for posterior or postero-rotary subluxations4 ,it is probably best to use this movement only for straight posterior subluxations and to apply either the ,pisiform ,single ,transverse or the ,two ,finger ,double ,transverse to the rotary displacements in this region4 ,contact ,both pisiform bones1 each upon a transverse process and both upon the same vertebra4 ,with patient in position ,b and the adjuster standing upon his left the contact should be made by the following exact method4 ,palpate with right hand1 which comes to rest upon the spinous process of the subluxated vertebra4 ,note if it be ,p4 ,r4 or ,p4 ,l41 because this fact will govern the next movement4 ,let the first finger of palpating hand reach outward about one inch and upward to a point opposite the tip of the next superior spinous process1 which point will approximate the position of the transverse4 ,this first upon the side of the posterior transverse1 which will be the right with a left subluxation or the left with a right one4 ,let second and third fingers1 now abandoning the spinous1 follow the first and rest over the assumed position of the transverse4 ,now palpate with a deep1 limited1 massage movement until the club-shaped extremity of the transverse is felt under the middle finger4 ,hold this point with the middle finger1 drawing away the other two1 and guide the free hand to an exact contact upon the transverse4 ,thus if standing on the left1 as predicated1 the left hand will be first to make contact and with the most posterior transverse1 with which most exact contact is necessary4 ,with pisiform placed1 let the fingers extend away from your body2 if on the side of the spine opposite you1 let them extend downward so as to follow the curve of the rib and to be anchored upon the rib connected with the transverse of contact2 if on the same side1 let fingers extend downward parallel with the column4 ,illustration3 ,fig4 #bd4 ,pisiform double transverse adjustment as it should be given1 elbows locked4 ,now--still using the original palpating hand--palpate on the other side from the first contact until the other transverse is discovered4 ,mark its tip with a quick1 deep pressure and a sharp withdrawal of the fingers1 so that a spot of anaemia appears momentarily4 ,carefully place the pisiform of the palpating hand in contact1 guided by the anaemic spot4 ,if this second contact is on the side on which you stand the fingers will be toward the head2 if on the opposite side1 they will follow the rib curve outward and downward4 ,re-read the above directions carefully4 ,it will be seen that the technic is quite free from unnecessary movements4 ,the two hands are now placed almost exactly at right angles to each other1 arched fingers anchored to prevent slipping4 ,if you stand on the patient's right the use of hands is1 of course1 exactly reversed1 the left hand being palpating hand1 and making the first contact4 ,completing ,position ,when hands are in position and adjuster standing so as to face directly across the spine1 the arms are rotated outward until the elbows 8lock40 ,the adjuster leans over so as to have shoulders directly over the spine1 draws the body back from the shoulder girdle to secure freest play in the shoulder joints1 and drops head loosely between the shoulders so as to relax the trapezius and prevent any checking of the force4 ,movement ,directly downward from the shoulders through straight1 stiff arms4 ,the force is delivered separately with the two arms and yet simultaneously4 ,if the vertebra is straight posterior1 equal force must be applied on the two sides2 if it is posterior and slightly rotated 7,p4 ,r4 or ,p4 ,l471 most force must be applied to the more posterior transverse4 ,considerable practice and looseness of shoulder are required to use this movement properly4 ,it is a regrettable fact that few adjusters do use it correctly1 most of them giving a thrust instead of a transmitted shock4 ,,pisiform ,,double ,,transverse ,no4 #b ,this modification of the pisiform double transverse move is here described because of its popularity rather than because the author wishes to recommend it4 ,the position is the same as for ,no4 #a1 and the uses also1 except that it tends to correct postero-inferior subluxations and is not at all adapted for use with superiors4 ,contact ,both pisiforms below the two transverses 7caudad74 ,after palpation which discloses the posterior transverse the hands are placed as follows3 ,palpating hand rests always on the side of the spine next the operator2 opposite hand crosses the spine4 ,both are slanted upward so that the fingers point toward the head with the axes of the hand slightly diverging above4 ,the wrists are thus crossed in such a way as to force the forearms to be somewhat flexed on the arms and to slant away from the wrists at an obtuse angle4 ,this with the contact below the transverses1 renders it impossible not to force the vertebra in an upward 7superior7 direction when movement is given4 ,illustration3 ,fig4 #be4 ,two-finger double transverse4 ,movement ,a comparatively slow thrusting movement1 which tends to spring the spine4 ,the merit of this method lies in its comparative painlessness4 ,its technic is not attractive4 ,,two ,,finger ,,double ,,transverse ,a movement for posterior or postero-rotary displacements from fourth to ninth ,dorsal inclusive4 ,it serves the same purpose as the ,pisiform ,double ,transverse but is less painful and often easier of delivery4 ,the palmar surface of the fingers1 with the flesh of the patient's back1 make a compound cushion which acts as a shock-absorber4 ,palpation--,contact ,the usual downward gliding movement of left hand if standing on right or of right hand if standing on left will serve for the discovery of the vertebra listed for adjustment4 ,the gliding hand stops with the second finger indicating the spinous process4 ,the first finger reaches upward and outward to the assumed location of the transverse on the side nearest the adjuster2 then the second finger reaches to a similar point on the other side1 both fingers pointing toward patient's head4 ,now the fingers are rolled a little to make sure that they are in contact with the ends of the transverse1 the palmar surface of the tip of each finger being the proper contact point4 ,the heel of the contact hand rests near1 but not on1 the surface of the body over the midspinal line4 ,supporting ,hand ,the ulnar edge of the free hand is now placed across the tips of the two contact fingers so that it rests directly above the ends of the transverses but separated from them by the finger tips4 ,the upper arm is then straightened and the elbow outrotated until it locks firmly so that the arm makes a straight line directly above the transverses4 ,the body is drawn away from the shoulder girdle1 pulling the head of the humerus out of its socket as far as possible to allow free play1 for all force is to be given by this straight arm4 ,movement ,if the subluxation is a straight posterior the force is driven directly downward so as to be distributed equally to the two contact points4 ,if it be a postero-rotary1 most force is directed to the more prominent 7posterior7 transverse4 ,force should be delivered quickly1 keeping in mind the principle of transmitted shock4 ,contrary to the general belief1 as much force can be developed with this move as is needful for any ordinary adjustment4 ,the fact that it is often recommended for use with children or with sensitive or frail patients has led to the belief that it is a relatively ineffective move1 whereas its value in such cases lies only in the fact that it inflicts less pain than some others4 ,illustration3 ,fig4 #bf4 ,pisiform single transverse move1 ,no4 #a4 ,,pisiform ,,single ,,transverse ,,move ,no4 #a ,like the movement just described1 this adjustment may be used in the ,dorsals from fourth to ninth inclusive4 ,it should be limited to those subluxations which are rotated without being posterior4 ,in such an instance the spinous process appears to be laterally displaced without being posterior1 or may appear slightly anterior because it is describing an arc about a fixed center of rotation in the body of the vertebra4 ,one transverse process appears anterior and the other posterior to the line of their fellows4 ,palpation ,palpate as for the ,recoil and use the same adjusting hand as in that movement1 i4 e41 right hand if standing on right side and palpating with left1 or left hand if standing on left and palpating with right4 ,when the palpating fingers have discovered the subluxated spinous process1 the first finger seeks a point even with the tip of the next superior spinous process and about an inch to the side on which is the posterior 7prominent7 transverse4 ,the second and third fingers follow and1 dipping inward with a rolling or massage motion1 discover the end of the transverse4 ,contact ,now the adjusting hand is placed with its pisiform resting directly upon the blunt end of the transverse4 ,if the contact is on the same side of the spine with the adjuster the fingers of adjusting hand extend across the spine and are anchored on the other side1 the hand arching sharply and fingers extending somewhat downward4 ,if contact is on opposite side of spine the fingers follow the rib curve downward and outward and are similarly anchored4 ,in every case the fingers should extend away from1 and never toward1 the adjuster's body4 ,to violate this rule renders one arm almost useless through its position4 ,at this juncture the palpating hand becomes a reinforcing hand1 to grip the wrist of the other and to aid in the movement4 ,movement ,the force is directed in a straight anterior direction1 quickly and decisively1 as if a spinous process were the lever used4 ,remember that contact must always be made with the posterior transverse4 ,to drive this anterior is to rotate the vertebra around its vertical axis and to bring the spinous process toward the median line1 while the opposite1 and more anterior1 transverse becomes more posterior1 as it should be4 ,,pisiform ,,single ,,transverse ,no4 #b ,uses ,for rotated first or second ,dorsals with which1 for any reason1 the 8,t4 ,m40 fails4 ,this move involves a use of the head as a lever1 as does the 8,t4 ,m40 ,no4 #b4 ,inadvisable unless the posterior transverse of the rotated vertebra can be palpated--but often used in cheerful disregard of this detail by those sublimely capable adjusters who do not need to find a vertebra before moving it4 ,palpation--,contact ,palpate as for ,no4 #a above4 ,very deep palpation will be necessary because the spinous process here is nearly horizontal to the body and the transverse is very deeply placed1 overlaid with heavy muscles4 ,when process is found place pisiform bone of free hand upon it1 pressing the muscles aside as much as possible to avoid bruising and resting a considerable amount of weight upon the contact hand4 ,fingers of contact hand may extend across the spine or downward and parallel with the spine4 ,or1 the hands may be changed so that the palpating hand becomes the contact hand and is placed with the fingers gripped over the base of the neck toward the clavicle4 ,head ,leverage ,the free hand is now placed upon the forehead and the head1 which faces toward the contact hand1 is flexed backward until the muscles seem taut4 ,movement ,is a quick1 but fairly gentle1 movement of both hands together1 so that the head is rocked still further backward at the instant an anteriorly directed force is applied to the prominent transverse4 ,the result is rotation of the vertebra--unless there be a loose articulation in the ,cervicals which gives way under the force applied to the head4 ,,the ,,edge ,,contact 78,point #b ,contact0--8,knife ,move407 ,name ,this movement has various names4 ,the name 8,point #b ,contact0 is handed down from the days when ,palmer used three contact points and three moves and designated the middle of the ulnar side of the fifth metacarpal bone as 8,point #b40 ,the name 8,edge ,contact0 was applied later1 during the improvements in its technic when the hooking of the thumbs stiffened its efficiency and made it very valuable4 ,it has since been rediscovered 7though in constant use7 and re-named 8,knife ,move40 ,uses ,a movement which uses the spinous process as a lever and is applicable to ,d #b1 #c1 or #d1 and to any ,dorsal or ,lumbar from ,d #h down1 when posterior1 postero-superior1 or postero-inferior4 ,it does not correct rotation except insofar as the shape of articular processes may aid an anteriorly directed move in rotating the vertebra4 ,some ,chiropractors have used the ,edge ,contact in the ,cervicals but this is always improper1 as it is practically impossible in some1 and difficult in all1 cases to cover only one spinous process when the head is resting on its side4 ,illustration3 ,fig4 #bg4 ,the edge contact in ,lumbar region4 ,palpation ,same as for ,recoil or ,heel ,contact1 q4 v4 ,contact ,using the same adjusting hand as for the ,heel ,contact1 place the middle of the ulnar edge of the fifth metacarpal bone in contact with the spinous process4 ,if the vertebra be superior1 place the edge of hand above1 if inferior1 place the hand below4 ,this contact is especially good for ,s or ,i vertebrae4 ,position of ,hands and ,arms ,the fingers of adjusting hand cross the spine at a right angle to its long axis4 ,the back of hand will be toward patient's head except in adjusting the last two ,lumbars1 with which a change of hands is made necessary by the upward slant of the lower half of the ,lumbar curve4 ,the palpating hand now grips the adjusting hand so that the fingers of the upper hand1 held close together1 press against and reinforce the lower on its dorsum and just above the contact point4 ,the thumbs are hooked together as shown in ,fig4 #bg1 so that the hands may be stiffened and their tendency to roll avoided4 ,the elbows are outrotated and locked as in the ,pisiform ,double ,transverse ,move and both shoulders are loosened4 ,movement ,this is chiefly delivered with the upper arm1 using upper hand to drive the lower4 ,force should be quickly delivered when patient is relaxed4 ,the direction of force should be determined by the direction of subluxation and by the slant of the spinous process4 ,thus1 when patient lies prone upon a bifid bench and sways downward against a lax abdominal support1 the spinous processes of the lower dorsal make an acute angle with the plane of the floor4 ,if one be superior1 contact above it and force driven straight toward the floor will tend to correct the subluxation4 ,there is a slightly different force angle for every subluxation correctable by this move4 ,this move is less painful than the pisiform contact and may often be used to advantage1 especially in the ,lumbar region4 ,,lumbar ,,single ,,transverse ,for the correction of a rotated ,lumbar4 ,best used on second and third4 ,this movement should never be attempted unless the transverse process can be palpated4 ,lumbar transverses are sometimes short or fragile1 and unless they can be distinctly felt no force should be applied where they are believed to lie4 ,contact ,pisiform bone with posterior transverse4 ,illustration3 ,fig4 #bh4 ,lumbar single transverse move4 ,palpation and ,placing of ,hands ,palpating as if for other movements1 pause with the second finger of palpating hand indicating the spinous process of the vertebra to be moved4 ,note that if the spinous process be to the right of the median line the left transverse will be posterior1 if to the left1 the right transverse4 ,the transverse may then be found as in the ,dorsals2 it should lie even with the interspace above the spinous process1 deeply overlaid with strong muscles4 ,when the transverse has been located by a deep1 probing movement of the fingers1 place adjusting hand1 pisiform on transverse1 close to the spinous process for greater solidity and fingers extending downward and outward from the midspinal line parallel with the lower rib curve4 ,if the adjuster stands on the side of the patient opposite to the transverse to be moved the hand opposite the palpating hand becomes the contact hand1 as in other moves4 ,but if the posterior transverse is on the same side with the adjuster1 a change of hands is made and the palpating hand becomes contact hand4 ,to accomplish this the adjuster must turn and face away from the patient with arm extended straight downward to the contact4 ,after contact is made the remaining hand reinforces the adjusting hand by gripping the wrist4 ,movement ,in making the contact press downward1 deeply and firmly1 so as to crowd the muscles aside and place the pisiform directly upon the transverse4 ,movement is given after the patient's body has been swung downward for a considerable distance1 and is sharp and decisive1 directed straight toward the floor4 ,,lumbar ,,double ,,transverse ,,move ,a movement sometimes applied to posterior or postero-rotary ,lumbars4 ,palpation and ,contact ,from the spinous1 find first the more posterior transverse and make contact with it1 since most force must be directed there4 ,stand facing patient's head and place right hand on right transverse and left hand on left4 ,contact point in this move is the tuberosity of the scaphoid with the posterior surface of the transverse4 ,fingers curve away from median line so as to avoid the rib curve4 ,movement ,after heavy1 steady pressure downward1 force is delivered with a quick1 throwing movement1 most force on the posterior side4 ,,the 8,,spread0 ,,move ,upon the theory that when two forces are simultaneously applied1 the one to drive some vertebra cephalad 7by its spinous process7 and the other to drive some lower vertebra caudad1 the intervening vertebrae tend1 if anterior1 to be drawn outward or toward a more posterior position1 this move is predicated4 ,the author does not believe that it accomplishes its purpose1 but will briefly describe it for the benefit of those who do4 ,position ,patient is placed over a roll which rests under the thighs so as to flex thighs and pelvis on the ,lumbar spine1 or an adjustable table is so tilted1 both sections sloping downward from the middle1 as to accomplish the same result4 ,contact ,the usual method1 if only a single vertebra is anterior1 is to make contact with the vertebrae immediately adjacent1 crossing the hands and having fingers of upper hand pointing toward head and of lower hand toward ,sacrum4 ,but some adjusters use this move differently1 making contact with ,sacrum and with the mid-dorsal region in general and applying a slow force with both hands4 ,contact is with heel of hand upon spinous process4 ,,sacral ,,adjustments ,the adjustment of the comparatively fixed sacrum is difficult at best and requires a very considerable force1 violently applied4 ,it is probable that nine-tenths of all attempts to move sacra fail4 ,in children1 when sacrum does not articulate properly with the ilia1 and in adults in whom the sacrum has been loosened by trauma and remains in an abnormal relation to surrounding structures1 it can be moved4 ,the sacrum is described as being posterior at the base or at the apex1 and its axis for rotation is believed to be a transverse line through the sacroiliac articulations4 ,force for its adjustment is applied at right angles to the curve of the sacrum at the point of contact4 ,the best contact is with the heel of the hand against a part of the sacrum1 the wrist of the adjusting hand being gripped and reinforced by the other hand4 ,if standing on patient's left1 the right hand becomes adjusting hand for sacrum as for the last two ,lumbars1 if on the right1 the left hand4 ,another contact is with the pisiform and adjacent soft part of hand upon the sacral base1 the pisiform hooking against the first sacral spinous process4 ,do not mistake an anterior fifth ,lumbar for a posterior sacral base4 ,discriminate between iliac and sacral subluxations by noting that with the latter both sacroiliac articulations1 and with the former only one seems abnormal4 ,illustration3 ,fig4 #bi4 8,bohemian ,move0 for correction of anterior fifth ,lumbar by transmitting shock through spine4 ,,iliac ,,adjustments ,palpation ,with patient sitting erect on flat surface1 feet on floor1 stand behind and examine both sacroiliac articulations at once with the palmar surfaces of the fingers of both hands4 ,if the two articulations are similar in every line neither ilium is subluxated1 though the sacrum may be rotated on its transverse axis between the ilia1 so as to be posterior or anterior at base or apex4 ,but no examination of the ilia is complete without investigating also the lumbosacral articulation4 ,it sometimes happens that though the first sacral spinous process naturally completes the lumbar curve and there is no lumbosacral subluxation the crests of both ilia appear much posterior to their normal relation to the upper part of sacrum3 this is a double iliac displacement4 ,usually the ilia are both normally articulated2 this is one of the most difficult joints to weaken and is seldom affected except by the most extreme force4 ,when iliac subluxation exists one side is affected alone nine times out of ten4 ,the tenth case may show double subluxation4 ,movement ,nine-tenths of the so-called 8iliac adjustments0 are quite amusingly ineffective4 ,the force required really to move an ileum 7save in joint disease or in children7 is tremendous and not to be commanded by the ordinary adjuster4 ,the light jars applied as a routine procedure by so many ,chiropractors are in reality nothing more than single percussion strokes which stimulate the sacral nerves4 ,place patient in position ,b and apply the hands to a posterior ilium as to a posterior sacrum1 making contact with the most prominent portion of crest or posterior border and driving in a direction which would represent a part of the circumference of a circle of which the transverse sacral axis of rotation touches the center1 or the center of fixation in the sacroiliac joint4 ,,coccygeal ,,adjustments ,examination ,place patient on an angle table1 i4 e41 one which rises in the center and slopes away toward either end4 ,separate the thighs slightly1 patient lying face down1 and insert the rubber-covered second finger1 palmar surface upward1 very carefully into the rectum4 ,the tip of the coccyx may then be felt and its movability and position determined4 ,unless it is immovably fixed in an abnormal position it should not be molested2 the movable coccyx responds to mere muscle tension by changes of position and cannot act as a primary cause of nerve impingement4 ,usually this examination will be rendered unnecessary by the external palpation which may disclose the movability of the coccyx and at once render further exploration superfluous4 ,when the coccyx is anteriorly subluxated and ankylosed in that position it may be a factor in producing constipation1 hemorrhoids1 etc41 but its influence in other diseases1 especially of the nervous system1 has been greatly overrated by those who have not yet fully accepted the doctrine that nerve impingement is the primary cause of all disease4 ,illustration3 ,fig4 #cj4 ,edge contact with 8,roll10 q4 v4 ,attitude of patient for coccygeal adjustment4 ,movement ,when it has been decided that the coccyx must be moved1 the position and use of hand is the same as for the palpation4 ,the finger hooks under the tip of the coccyx1 draws upon it until a tight contact is secured and then jerks sharply backward upon it with a view to its abrupt fracture4 ,no mitigation of the jerk in the hope of previously loosening or gradually replacing the bone is of value for osseous tissue must be broken before any movement may take place4 ,this movement is painful and the region of the newly fractured coccyx may remain sore for a period ranging from a few days to several weeks4 ,it is wise to warn the patient of the facts before proceeding4 ,the fractured coccyx may be absorbed1 or may be reankylosed in a proper position or in a new abnormal position1 or may remain loose and movable4 ,,adjustment ,,of ,,curvatures ,we have previously discussed in detail the nature and discovery of curvatures4 ,a few words should be said here about their correction4 ,if the sole object of the adjustment is to correct the curvature it is best to select for adjustment those vertebrae which are most subluxated in the direction of the curvature4 ,according to the length of the curvature a series of from two to six1 separated by some distance1 are chosen4 ,these are adjusted until they cease to be the most prominent ones in the curvature and then others1 then most prominent1 are chosen and adjusted until they in turn cease to be most prominent4 ,in this way the curvature may eventually be straightened1 or nearly so4 ,it is doubtful if any curvature can be absolutely eradicated1 although it may be straightened until unnoticeable except by the expert4 ,to overcome a curvature it may be necessary to break every rule which governs ordinary adjusting and to invent new ways of placing the hands or of delivering force4 ,no two require exactly the same measures and he is most successful with curvatures who is most adaptable to changing conditions4 ,one rule may be safely laid down4 ,do not alternate from day to day1 loosening at the same time many vertebrae1 but choose the ones most in need of adjustment and follow your choice as long as it is indicated4 ,the chief vertebra is nearly always the one at the angle or point of the curvature4 ,the sharp1 angular curve of ,potts' ,disease1 involving two or three vertebrae1 should warn against adjustment1 usually1 since in this disease the vertebrae are fragile and easily fractured4 ,if a case has not progressed too far a cure may be effected1 but great caution in taking such cases must be exercised4 ,every ,chiropractor should be well informed on the diagnosis of ,potts' ,disease1 or spinal caries4 ,many months are usually required for the straightening of a curvature--how many can scarcely be estimated in advance of the experiment with any case4 ,often the case which seems simplest requires the longer time1 while a very pronounced curvature1 as in some cases of rachitis1 may yield in a few months4 ,,preferable ,,adjustments ,the selection of the move with which to correct each subluxation depends upon the adjuster's concept of the kind and direction of the subluxation and of the mechanics of the different corrective moves in his repertoire4 ,the move used should be one in which the application of force is exactly along opposite lines to the lines of force which originally produced the subluxation4 ,omitting involved explanations as to the elements of each displacement and the manner of change in bone1 muscle1 ligament1 cartilage1 etc41 and presupposing a comprehension of the principles of each adjustment named1 there follows here a list of possible subluxations of each vertebra in turn1 from ,atlas down1 with a simple statement of the ,,right ,,move for that subluxation4 ,in each instance there are other moves than the one listed which would move the vertebra and some which would partially correct it1 but none which would quite so definitely tend to correct the displacement4 ,unfortunately it is not a fact that every movement of a vertebra is an adjustment4 ,if this were true subluxations would not exist1 because they could never have been produced4 ,too often the adjuster uses a move because it is easy1 because its use has become habitual with him1 rather than because it is indicated by the conditions of the case--then blames ,chiropractic because his results are negative or bad4 ,the move which is suited to a certain kind of subluxation of one vertebra may be quite out of place with another1 in a different part of the spine4 ,thus the ,recoil is quite proper for a posterior ,lumbar and is contraindicated with a posterior middle ,dorsal4 ,if all vertebrae were shaped exactly alike1 if all were equal in size1 if subluxation were possible only in one direction1 then one method of adjustment would be quite sufficient4 ,diversity of technic is demanded1 but a discriminating diversity1 with a good reason for every move used4 ,first ,cervical ,subluxation4 ,adjustment4 ,right--,r4 ,break1 or straight lateral4 ,right1 posterior--,r4 ,p4 ,rotary lateral4 ,right1 anterior--,r4 ,a4 ,morikubo4 ,right1 superior--,r4 ,s4 ,break4 ,right1 inferior--,r4 ,i4 ,break4 ,right1 posterior1 superior--,r4 ,p4 ,s4 ,rotary lateral4 ,right1 posterior1 inferior--,r4 ,p4 ,i4 ,rotary lateral4 ,right1 anterior1 superior--,r4 ,a4 ,s4 ,morikubo4 ,right1 anterior1 inferior--,r4 ,a4 ,i4 ,morikubo4 ,left--,l4 ,break4 ,left1 posterior--,l4 ,p4 ,rotary lateral4 ,left1 anterior--,l4 ,a4 ,morikubo4 ,left1 superior--,l4 ,s4 ,break4 ,left1 inferior--,l4 ,i4 ,break4 ,left1 posterior1 superior--,l4 ,p4 ,s4 ,rotary lateral4 ,left1 posterior1 inferior--,l4 ,p4 ,i4 ,rotary lateral4 ,left1 anterior1 superior--,l4 ,a4 ,s4 ,morikubo4 ,left1 anterior1 inferior--,l4 ,a4 ,i4 ,morikubo4 ,anterior 7entire ,atlas7--,a4 ,morikubo 7both sides74 ,posterior 7entire ,atlas7--,p4 ,rotary lateral 7both sides74 ,,note4--,all right subluxations adjusted from right side1 all left from left side4 ,second ,cervical ,posterior--,p4 ,posterior ,cervical move4 ,posterior1 right--,p4 ,r4 ,double contact on right side4 ,posterior1 left--,p4 ,l4 ,double contact on left side4 ,posterior1 right1 inferior--,p4 ,r4 ,l4 ,double contact on right4 ,posterior1 right1 superior--,p4 ,r4 ,s4 ,double contact on right4 ,posterior1 left1 inferior--,p4 ,l4 ,i4 ,double contact on left side4 ,posterior1 left1 superior--,p4 ,l4 ,s4 ,double contact on left side4 ,right 7lateral7--,r4 ,break 7,same if ,r4 ,i4 or ,r4 ,s47 ,right 7rotary7--,r4 ,rotary 7,same if ,r4 ,i4 or ,r4 ,s47 ,left 7lateral7--,l4 ,break 7,same if ,l4 ,i4 or ,l4 ,s47 ,left 7rotary7--,l4 ,rotary 7,same if ,l4 ,i4 or ,l4 ,s47 ,superior--,s4 ,posterior ,cervical move4 ,inferior--,i4 ,posterior ,cervical move4 ,anterior 7entire ,vertebra7--,a4 ,ventral transverse contact on most anterior side4 ,anterior1 right 7lateral7--,a4 ,r4 ,second metacarpal contact from right4 ,anterior1 right 7rotary7--,a4 ,r4 ,pisiform ,ant4 ,cerv4 contact on right4 ,anterior1 left 7lateral7--,a4 ,l4 ,second metacarpal contact from left4 ,anterior1 left 7rotary7--,a4 ,l4 ,pisiform ,ant4 ,cerv4 contact on left4 ,third ,cervical ,same as second4 ,fourth ,cervical ,same as second4 ,fifth ,cervical ,same as second4 ,sixth ,cervical ,posterior--,p4 ,the ,recoil1 hands reversed4 ,posterior1 right--,p4 ,r4 ,recoil1 hands reversed4 ,posterior1 left--,p4 ,l4 ,recoil1 hands reversed4 ,posterior1 right1 superior--,p4 ,r4 ,s4 ,recoil1 hands reversed4 ,posterior1 right1 inferior--,p4 ,r4 ,i4 ,recoil1 hands reversed4 ,posterior1 left1 superior--,p4 ,l4 ,s4 ,recoil1 hands reversed4 ,posterior1 left1 inferior--,p4 ,l4 ,i4 ,recoil1 hands reversed4 ,right 7lateral7--,r4 ,break 7,same if ,r4 ,i4 or ,r4 ,s47 ,right 7rotary7--,r4 ,rotary 7,same if ,r4 ,i4 or ,r4 ,s47 ,left 7lateral7--,l4 ,break1 from left 7,same if ,l4 ,i4 or ,l4 ,s47 ,left 7rotary7--,l4 ,rotary 7,same if ,l4 ,i4 or ,l4 ,s47 ,superior--,s4 ,edge contact move4 ,inferior--,i4 ,edge contact move4 ,anterior 7entire vertebra7--,a4 ,pisiform ,ant4 ,cerv4 contact on most anterior side4 ,anterior1 right 7lateral7--,a4 ,r4 ,second metacarpal contact from right4 ,anterior1 right 7rotary7--,a4 ,r4 ,pisiform ,ant4 ,cerv4 contact on right4 ,anterior1 left 7lateral7--,a4 ,l4 ,second metacarpal contact from left4 ,anterior1 left 7rotary7--,a4 ,l4 ,pisiform ,ant4 ,cerv4 contact on left4 ,seventh ,cervical ,same as sixth ,cervical1 except that ,t4 ,m4 may be used on right or left rotary subluxations4 ,first ,dorsal ,posterior--,p4 ,recoil1 hands reversed4 ,posterior1 right--,p4 ,r4 ,recoil1 hands reversed4 ,posterior1 right1 superior--,p4 ,r4 ,s4 ,recoil1 hands reversed4 ,posterior1 right1 inferior--,p4 ,r4 ,i4 ,recoil1 hands reversed4 ,posterior1 left--,p4 ,l4 ,recoil1 hands reversed4 ,posterior1 left1 superior--,p4 ,l4 ,s4 ,recoil1 hands reversed4 ,posterior1 left1 inferior--,p4 ,l4 ,i4 ,recoil1 hands reversed4 ,posterior1 superior--,p4 ,s4 ,heel contact4 ,posterior1 inferior--,p4 ,i4 ,edge contact4 ,superior--,s4 ,heel contact4 ,inferior--,i4 ,edge contact4 ,right--,r4 ,t4 ,m4 7,same if ,r4 ,s4 or ,r4 ,i47 ,left--,l4 ,t4 ,m4 7,same if ,l4 ,s4 or ,l4 ,i47 ,anterior--,a4 ,no correction4 ,second ,dorsal ,posterior--,p4 ,heel contact4 ,posterior1 superior--,p4 ,s4 ,heel contact4 ,posterior1 inferior--,p4 ,i4 ,edge contact4 ,posterior1 right--,p4 ,r4 ,recoil4 ,posterior1 right1 superior--,p4 ,r4 ,s4 ,recoil4 ,posterior1 right1 inferior--,p4 ,r4 ,i4 ,recoil4 ,posterior1 left--,p4 ,l4 ,recoil4 ,posterior1 left1 superior--,p4 ,l4 ,s4 ,recoil4 ,posterior1 left1 inferior--,p4 ,l4 ,i4 ,recoil4 ,left--,l4 ,t4 ,m4 7,same if ,l4 ,s4 or ,l4 ,i47 ,right--,r4 ,t4 ,m4 7,same if ,r4 ,s4 or ,r4 ,i47 ,anterior--,a4 ,no correction4 ,third ,dorsal ,posterior--,p4 ,heel contact4 ,posterior1 superior--,p4 ,s4 ,heel contact4 ,posterior1 inferior--,p4 ,i4 ,edge contact4 ,posterior1 right--,p4 ,r4 ,recoil4 ,posterior1 right1 superior--,p4 ,r4 ,s4 ,recoil4 ,posterior1 right1 inferior--,p4 ,r4 ,i4 ,recoil4 ,posterior1 left--,p4 ,l4 ,recoil4 ,posterior1 left1 superior--,p4 ,l4 ,s4 ,recoil4 ,posterior1 left1 inferior--,p4 ,l4 ,i4 ,recoil4 ,right--,r4 ,pisiform single transverse 7on left7 7,same if ,r4 ,s4 or ,r4 ,i47 ,left--,l4 ,pisiform single transverse 7on right7 7,same if ,l4 ,s4 or ,l4 ,i47 ,anterior--,a4 ,no correction4 ,fourth ,dorsal ,same as third ,dorsal4 ,,note4--,while the ,recoil is here1 the preferred move for posterior and postero-lateral subluxations1 the pisiform double transverse or the two finger double transverse may be used if both transverses are palpable4 ,fifth ,dorsal ,posterior--,p4 ,double transverse move4 ,posterior1 superior--,p4 ,s4 ,heel contact4 ,posterior1 inferior--,p4 ,i4 ,double transverse4 ,posterior1 right--,p4 ,r4 ,double transverse4 ,posterior1 right1 superior--,p4 ,r4 ,s4 ,double transverse4 ,posterior1 right1 inferior--,p4 ,r4 ,i4 ,double transverse4 ,posterior1 left--,p4 ,l4 ,double transverse4 ,,note4--,the pisiform double transverse and the two-finger double transverse1 apply force in exactly similar directions and may therefore be used interchangeably4 ,the latter is preferable for children4 ,posterior1 left1 superior--,p4 ,l4 ,s4 ,double transverse4 ,posterior1 left1 inferior--,p4 ,l4 ,i4 ,double transverse4 ,right--,r4 ,pisiform single transverse 7,same if ,r4 ,s4 or ,r4 ,i47 ,left--,l4 ,pisiform single transverse4 7,same if ,l4 ,s4 or ,l4 ,i47 ,anterior--,a4 ,no correction4 ,sixth ,dorsal ,same as ,fifth ,dorsal4 ,seventh ,dorsal ,same as ,fifth ,dorsal4 ,eighth ,dorsal ,same as ,fifth ,dorsal4 ,ninth ,dorsal ,same as ,fifth ,dorsal4 ,tenth ,dorsal ,posterior--,p4 ,heel contact4 ,posterior1 superior--,p4 ,s4 ,edge contact4 ,posterior1 inferior--,p4 ,i4 ,edge contact4 ,posterior1 right--,p4 ,r4 ,recoil4 ,posterior1 right1 superior--,p4 ,r4 ,s4 ,recoil4 ,posterior1 right1 inferior--,p4 ,r4 ,i4 ,recoil4 ,posterior1 left--,p4 ,l4 ,recoil4 ,posterior1 left1 superior--,p4 ,l4 ,s4 ,recoil4 ,posterior1 left1 inferior--,p4 ,l4 ,i4 ,recoil4 ,right--,r4 ,recoil 7,same if ,r4 ,s4 or ,r4 ,i47,a ,left--,l4 ,recoil 7,same if ,l4 ,s4 or ,l4 ,i47,a ,anterior--,a4 ,no correction4 ,a ,note4--,the use of this move is not quite mechanically correct1 but it is advised because of the possible danger of using the transverse processes as levers4 ,eleventh ,dorsal ,same as ,tenth ,dorsal4 ,twelfth ,dorsal ,same as ,tenth ,dorsal4 ,first ,lumbar ,posterior--,p4 ,heel contact4 ,posterior1 superior--,p4 ,s4 ,heel contact4 ,posterior1 inferior--,p4 ,i4 ,heel contact4 ,posterior1 right1 superior--,p4 ,r4 ,s4 ,recoil4 ,posterior1 right1 inferior--,p4 ,r4 ,i4 ,recoil4 ,posterior1 left--,p4 ,l4 ,recoil4 ,posterior1 left1 superior--,p4 ,l4 ,s4 ,recoil4 ,posterior1 left1 inferior--,p4 ,l4 ,i4 ,recoil4 ,right--,r4 ,lumbar single transverse move1 if transverse is palpable1 otherwise ,recoil4 7,same if ,r4 ,s4 or ,r4 ,i47 ,left--,l4 ,lumbar single transverse move1 if transverse is palpable1 otherwise ,recoil4 7,same if ,l4 ,s4 or ,l4 ,i47 ,anterior--,a4 ,no correction4 ,second ,lumbar ,same as ,first ,lumbar4 ,third ,lumbar ,same as ,first ,lumbar4 ,fourth ,lumbar ,posterior--,p4 ,heel contact4 ,posterior1 superior--,p4 ,s4 ,heel contact4 ,posterior1 inferior--,p4 ,i4 ,heel contact4 ,posterior1 right--,p4 ,r4 ,recoil1 hands reversed4 ,posterior1 right1 superior--,p4 ,r4 ,s4 ,recoil1 hands reversed4 ,,note4--,the ,heel contact may be substituted for the ,recoil above if force be carefully directed in the proper direction in delivery4 ,posterior1 right1 inferior--,p4 ,r4 ,i4 ,recoil1 hands reversed4 ,posterior1 left--,p4 ,l4 ,recoil1 hands reversed4 ,posterior1 left1 superior--,p4 ,l4 ,s4 ,recoil1 hands reversed4 ,posterior1 left1 inferior--,p4 ,l4 ,i4 ,recoil1 hands reversed4 ,right--,r4 ,lumbar single transverse move1 if transverse is palpable1 otherwise ,recoil4 7,same if ,r4 ,s4 or ,r4 ,i47 ,left--,l4 ,lumbar single transverse1 if transverse is palpable1 otherwise ,recoil4 7,same if ,l4 ,s4 or ,l4 ,i47 ,anterior--,a4 ,no correction4 ,fifth ,lumbar ,posterior--,p4 ,heel contact4 ,posterior1 superior--,p4 ,s4 ,edge contact4 ,posterior1 inferior--,p4 ,i4 ,edge contact4 ,posterior1 right--,p4 ,r4 ,recoil4 ,posterior1 right1 superior--,p4 ,r4 ,s4 ,recoil4 ,posterior1 right1 inferior--,p4 ,r4 ,i4 ,recoil4 ,posterior1 left--,p4 ,l4 ,recoil4 ,posterior1 left1 superior--,p4 ,l4 ,s4 ,recoil4 ,posterior1 left1 inferior--,p4 ,l4 ,i4 ,recoil4 ,right--,r4 ,recoil 7,same if ,r4 ,s4 or ,r4 ,i47 ,left--,l4 ,recoil 7,same if ,l4 ,s4 or ,l4 ,i47 ,anterior--,a4 8,bohemian0 anterior fifth ,lumbar move4 7,not always advisable47 ,sacrum ,posterior base--,b4 of ,s4--,p4 ,heel contact on base4 ,posterior apex--,a4 of ,s4--,p4 ,heel contact on apex4 ,entire ,sacrum posterior ,sac4 ,p4 ,heel contact between sacroiliac articulations4 ,coccyx ,to be adjusted only when ankylosed in an abnormal position and then by leverage of finger through rectum4 ,a ,,final ,,word ,some useful information pertaining to adjustment will be found in section entitled1 8,practice10 q4 v4 ,after a careful and painstaking study of the foregoing pages it will still be found that the student is not by any means equipped for the work4 ,he must practice these things to learn them4 ,we learn to do by doing4 ,the chief use of this section will be as a reference and guide during the practice of adjusting4 ,,the ,,cause ,,of ,,disease ,disease a ,morbid ,process ,disease has been variously regarded as an entity1 a process1 a condition4 ,it has been mentioned in terms which would almost personalize it1 such as1 8attacked by pneumonia10 8seized with cramps10 8in the clutches of tuberculosis40 ,men have endeavored constantly to discriminate between diseases and to learn the appearance and peculiarity of each1 and have resolved each into its peculiar elements only to learn that the merging lines between two diseases or between cases of the same disease are imperceptible4 ,it is no more possible to define any one disease within exact limits and to distinguish it from all others than to consider one function of the human body without studying its interdependence with others4 ,disease is a process4 ,it is a natural process4 ,it follows certain well-defined laws and consists in the abnormal performance of function in some bodily organ or organs1 or in the untimely performance of some function which would be normal in its proper chronological relation with other functions or at another period of the body's development4 ,the balance of function of the body is destroyed--some function intensified or diminished--that is all4 ,every disease1 properly studied1 reveals its functional base4 ,disturbances of the functions of growth1 nutrition1 and repair produce changes in structure1 physical evidences of disease4 ,it is probable that every disease has a certain amount of structural change connected with it2 it is hard to conceive of functional derangement without structural change1 in a universe in which ,nature is eternally building1 destroying1 or modifying organic peculiarities to meet changing functional demands4 ,but in many instances this structural change is so slight as to be undiscoverable2 such diseases are called 8functional0 to distinguish them from those in which structural pathologic changes are directly discernible1 called 8organic40 ,beginning of the ,process ,recognizing the fact that disease consists in a succession of steps or a series of events1 each depending upon the next preceding one and making possible its successor1 and desiring to arrest or check this process and correct the damage done1 in other words1 8to cure disease10 the question arises1 8,where does this process begin80 ,if we wish merely to check the process or to modify it1 as does medicine1 the etiology of the disease is less important than the present state4 ,it is then more important that we understand the changes which are taking place in the body at the time of our attempt1 the condition of each organ at that time1 and the general recuperative or resisting power of the individual4 ,but if we would correct all the damage done instead of merely preventing further damage or building up internal resistance against a still active destructive process2 if we would so eliminate the effects of the earlier steps as to make the resumption of the disease process most improbable1 we must know each step from the beginning to the present1 understand their sequence and relation1 and go back to the beginning with our correction1 removing the cause4 ,the ,cause of ,disease ,since each event in the morbid process depends upon the preceding one and makes possible those which follow1 it is possible to stop at any point in the chain of events and declare1 8,here lies the ,cause of ,disease40 ,this explains the various etiologies adhered to each by a school of intelligent and scientific men1 yet each apparently disagreeing most flatly with the others4 ,no matter which step we select as our 8ultimate cause0 it truly is the cause1 or one of the causes1 of succeeding steps1 which succeeding steps may well stand in our minds as the whole of the disease4 ,thus the physician1 having found a germ1 is quite content to look forward from the invasion of the germ and consider that as the primarily necessary requisite for disease production4 ,in retrospect he follows disease back within the body to the time of entrance of the germ and then leaves the body to study the life habits of the germ and its favorite mode of conveyance4 ,he has unwittingly left the direct line of investigation and followed a spur-track4 ,so with the osteopath who discovers contractured muscles drawing a member1 or a bone1 from its normal position4 ,he proceeds to a study of the effect of such contracture upon other tissues and strives to relieve it by treatment--of the muscle4 ,the dietist discovers that certain food combinations cannot be properly cared for by an individual and that if taken they tend to develop toxins deleterious to the system4 ,whereupon he undertakes to discover food combinations which the body can care for and believes that he has solved the question of etiology4 ,now it is most important that we find the primary cause1 the one which makes possible the operation of all the rest and without which all would be powerless to harm man4 ,this we shall expect to find at the point of entrance of disease into the human organism4 ,the primary cause must be the first step which concerns man1 the first change from normal to abnormal1 on which all subsequent changes depend4 ,it is useless to pass outside of the consideration of man and those forces which directly affect man1 in our search for the cause of disease4 ,we are powerless to affect outside forces or to control or amend the laws of nature through which disease exists4 ,let us attempt then to resolve disease into its successive steps and to find the first which concerns man4 ,correcting that1 we shall have corrected1 fully and completely1 the process which constitutes disease4 ,by striking at the root we may destroy the entire growth4 ,vital ,energy ,irritability is the property of being susceptible to excitement or stimulation4 ,stimulation is the process of increasing the functional activity of any organ4 ,inhibition is the act of checking1 restraining1 or holding back the functional activity of any organ4 ,these definitions1 taken from ,gould1 are here introduced as a necessary preface to an attempt to set forth1 without unnecessary reference to1 or discussion of1 any other theory as to the etiology of disease1 the ,chiropractic explanation of its presence4 ,chiropractic maintains that all the chemical and physical activities of the human organism are controlled1 directly or indirectly1 through a third form of energy transmitted through the ,nerve ,system2 that while all three forms of energy are interdependent and closely related in their ultimate expression1 one of the three is the primary and most essential form1 and especially indicative of life4 ,we may call this third form ,vital ,energy4 ,there are several good reasons for believing that this nerve force is the primary form in which energy is expressed in man and for believing that it controls and directs the others in greater degree than it is controlled and directed by them4 ,of the four forms of tissue of which the body is composed--connective1 epithelial1 muscular1 and nervous--the latter is the one damage to which is followed by the greatest and most permanent consequences4 ,it is a fact that there are several organs whose removal leads to certain death because of their importance in the general economy of the body1 but it is also true that section of the nerves leading to these organs just as certainly causes death by the cessation of their functions4 ,there is no organ in the body aside from the nerves themselves which does not immediately cease to act upon withdrawal of its nerve force and at once begin a process of degeneration or atrophy4 ,pathologic changes in the ,nerve ,system invariably are followed by pathologic changes in the organs controlled by the diseased segment but the converse is not true4 ,excitation or inhibition of nerve activity produces corresponding and responsive change in the activity of the organs innervated1 but excitation of an organ does not necessarily produce similar changes in the ,nerve ,system4 ,that system possesses the power of inhibiting or permitting responsive action1 in other words1 the power of choice4 ,research in ,comparative ,anatomy develops the fact that the differences in power of complex action possessed by different organisms are entirely measurable by differences in the structure and complexity of their nerve mechanisms4 ,further1 by studying the effects of removal or extirpation1 or of pathologic changes in various parts of the nerve system it has been demonstrated that the ,brain is the center for those higher forms of activity known as psychic1 for the power of accelerating or inhibiting the responses of the lower centers of the nerve system to stimulation from without1 and for the conveyance of authority to act to all the lower centers4 ,the ,nerve ,system is the morphologic1 physiologic1 and dynamic center of the organism and the ,brain the center of the ,nerve ,system4 ,we may1 then1 logically expect to find in the ,brain1 or in the channels by which power is distributed from the ,brain to lower centers or organs1 the initial step in the disease process1 which is our present quest4 ,one ,nerve ,system ,all nerve tissue in the body is organized and linked together in a complicated aggregation of individual units1 communicating by contact1 and forming one great ,nerve ,system having its directing center in the ,brain4 ,it is said by some writers to consist of two distinct systems--cerebro-spinal and sympathetic--but would better be described as consisting of central organs--brain and spinal cord--and peripheral organs--cranial1 spinal1 and sympathetic peripheral axons connecting with cells in the central axis and linked together in a net-work improperly separable into separate or distinct divisions1 the fibres of different parts being bound together in such a way as to establish an intricate intercommunication1 closest on the one hand between the cranial and sympathetic and on the other between the spinal and sympathetic4 ,the sympathetic system may be regarded as nothing more than a medium for proper distribution of impulses originating in the cerebro-spinal system1 and a series of reflex centers deriving their power to act from the central axis4 ,the proper action of sympathetic ganglia has been demonstrated to depend upon the integrity of the spinal nerve fibres1 or rami communicantes1 which pass to and terminate in the ganglia with their telodendria 7terminal arborizations7 in contact with the dendrites 7cellulipetal processes7 of the ganglion cells4 ,it will appear that interference with one division or part of the nerve system may be followed by effects partly manifested through a distant part2 that excitation or inhibition of a spinal nerve may correspondingly excite or inhibit sympathetic fibres4 ,chiropractic ,hypothesis ,chiropractic has accepted1 as a convenient working hypothesis amply justified by years of clinical experiment and anatomical and physiological research1 the proposition that all disease in the human body is primarily made possible by injury to 7stimulation or inhibition of7 some part of the nervous mechanism4 ,injury to other tissues1 unless the injury also involves nerve tissue1 is quickly repaired and the body goes on without disease4 ,or the injury is sufficient at once to render the body untenable and death ensues4 ,few pathological changes follow trauma unless nerve tissue be injured4 ,this theory to be logical must and does include the entire nerve system4 ,also1 since it is noted that each nerve cell presides over the nutrition of its own processes and possesses its own power of repair1 it follows that unless an injury be of fatal nature or of permanent duration1 even injuries to nerves tend toward automatic cure4 ,we must seek a permanently operating interference with nerve tissue4 ,the brain1 enclosed within the comparatively solid cranium1 is so well protected that nothing except fracture of the skull1 violent concussion1 or shutting off of its blood supply from without1 will produce permanent change there4 ,also1 unless there be pressure by foreign substance against the brain1 an injury will be repaired in time and the body resume its normal functional activity4 ,it has been demonstrated that comparatively few diseases occur in this way4 ,such as do are called traumatic2 i4 e41 caused by wound or injury4 ,in the broadest sense all disease is caused by trauma1 as we shall presently show4 ,the upper or cephalic peripheral nerves1 called cranial1 leave the skull by foramina in its base 7except the auditory7 and are so protected by the immobility of the bones of the skull as to be comparatively free from direct injury4 ,peripheral injuries occur to cranial nerves but are repairable2 even section of the trigeminal for neuralgia is usually followed after an interval by a reunion of the severed parts4 ,as will be shown later1 the special end organs of the cranial nerves are not free from the effects of spinal subluxation and their nuclei 7deep origins7 often share in morbid changes in the brain tissue due to nutritional disturbances4 ,the sympathetic portion of the nervous system might be classed with the cranial as regards infrequency of permanent interference were it not for the proximity of the great gangliated cord to the transverse processes and bodies of the vertebrae4 ,this proximity renders it liable to sustain permanent impingement in vertebral subluxation4 ,trauma ,affects ,spinal ,nerves ,with the exception of the first pair of ,cervical nerves and the ,sacral and ,coccygeal1 all spinal nerves pass through foramina of exit which are composed each of two movable vertebrae4 ,the ,chiropractic hypothesis is based upon the discovery that in addition to the part these vertebrae may take in general movements of the spine it is possible that their relation to each other may be changed by the application of force from without1 and that this change once produced tends to remain permanently4 ,these permanent vertebral subluxations occur with great frequency1 a fact clinically demonstrable by palpation and by the ,x-,ray4 ,the discovery of this fact led to the ascertaining of two more1 namely1 ,no disease is ever found without accompanying subluxation4 ,since each organ or tissue is connected with some definite and special vertebra1 subluxations accompanying disease bear a relation to disease which is controlled by a general law1 operative alike on all human organisms4 ,the latter fact required one other for its complete demonstration2 namely1 that the removal of the subluxation is always followed by the complete disappearance of the disease4 ,given more perfect methods of correcting subluxations it would follow that proof of the ,chiropractic theory would be so complete and overwhelming as to meet at once with general acceptance4 ,the difficulty lies in the fact that with our present methods much time is often required for complete correction of the vertebral displacement and much skill is needed even for successful investigation of the results obtainable4 ,the theory is too often judged by unskilled or imperfect applications of it4 ,every school of ,chiropractic accepts the presence of the subluxation and has spent much thought and time in the effort to deduce the law governing its connection with disease4 ,diverse conclusions have been reached owing to the difficulty experienced in completely eradicating the subluxation4 ,when it is accomplished the results are absolutely conclusive4 ,when it is partially or relatively accomplished the results are so good in a great per cent of cases as to lead sometimes to the erroneous belief that the subluxation did not cause the disease since mere partial correction of the subluxation suffices to bring about the apparent total removal of the disease4 ,in every case of thorough experiment the results warrant the recommendation of the subluxation theory as at least a proper working hypothesis4 ,without attempting here to review all the various conclusions reached or the methods by which they have been attained1 we would simply state our own conclusion1 which we believe is the only one compatible with demonstrable facts4 ,it is briefly this3 ,since every portion of the body is connected through the nervous system with the spinal nerves and since it has been proven that this connection is reasonably constant and anatomically demonstrable2 since the removal or correction of a subluxation leads in all cases to the complete disappearance of disease from the organs or tissues innervated from the subluxated portion of the spinal column1 we conclude that the subluxation is the primary cause of disease4 ,the final test of the correctness of any theory is the result of its application4 ,since ,chiropractic secures a larger percentage of results than any other known system of healing it is safe to assume1 at least1 that it has discovered the way to remove the primary cause of disease4 ,that the ,chiropractic theory1 or more properly the subluxation theory1 does not include all of the etiology of disease is evidenced by the facts of contagion and infection1 by the effect upon the organism of the introduction of poison1 by the consequences of worry1 anger1 and other abnormal mental states and conditions4 ,these facts do not in the least invalidate the theory4 ,they merely require explanation which will make clear their relation to the subluxation4 ,that such explanation is abundantly at hand strengthens the position of ,chiropractic more than would negation of all other causes save the one we concentrate upon4 ,the ,mentalist who holds that all diseases exist in and are but figments of the mind is as far afield as the ,physicist who holds that special nerve energy is nonexistent4 ,the ,chiropractor views ,man as a complex psycho-physical unit1 self-operating and internally self-healing until environmental forces disturb the nice adjustment of the machinery4 ,disease is produced by1 and is1 a series of events1 chief and most permanent of which is the subluxation4 ,we may consider its etiology according to the order in which the events take place thus3 ,direct ,chain ,concussion of ,forces4 ,subluxation of ,vertebra4 ,impingement of ,nerve4 ,excitation or ,inhibition4 ,disease--,abnormal ,function4 ,accessory ,chains ,between the last two steps above1 or following the last1 are often introduced one or more of the following accessory chains which modify or increase the final effect and are themselves made possible by the first four steps in the direct chain4 ,pathogenic germ4 ,poisonous excretions from germs4 ,tissue destruction by chemical action of such toxins4 ,reflex muscular tension tending to increase subluxation and thus augment nerve impingement and its effects4 ,or ,dietetic error4 ,abnormal chemical action4 ,tissue destruction or nerve irritation by chemical poisons4 ,reflex motor disturbances which further limit digestive power4 ,or ,abnormal mental condition4 ,waste of nerve energy with production of toxins4 ,general metabolic disturbance4 ,increased disease wherever disease previously existed4 ,these are offered merely as illustrations4 ,there are many accessory chains which aid in the production or development of disease and act as secondary causes4 ,concussion of ,forces ,man was so created1 so provided with means for repair1 growth1 etc41 that the body tends to maintain its own functional balance--perfect harmony among all its parts--unless interfered with by some outside agency4 ,there are certain natural laws such as the law of gravitation and the law of momentum and inertia which operate without regard for man or man's welfare4 ,if man1 wittingly or unwittingly1 allows himself to come into violent conflict with one of these laws by falling to the ground or in meeting sudden and unexpected opposing force or mass while in motion1 that which may be termed a concussion is produced by the meeting of the outside force and the internal bodily resistance4 ,many such concussions may occur without serious damage4 ,some produce wounds or injuries which it is possible for the body to heal without causing serious disturbance of function4 ,other concussions are so violent as to produce displacement of structure which tends to remain permanently4 ,under ,spino-,organic ,connection will be found an explanation of the manner in which force applied to various parts of the body tends to affect the spine4 ,now the displacement of a bone cannot be corrected by the body without outside aid4 ,no method is provided for such correction4 ,produced by outside force affecting the body1 it can only be reduced by outside force4 ,it is this failure of ,nature to make man adaptable to every untoward circumstance which renders him susceptible to disease4 ,subluxation ,as has been previously stated by no means all concussions of forces produce subluxation4 7,all subluxations1 however1 are produced by concussion of forces47 ,it may be added that not all subluxations impinge nerves and that when they do not so encroach upon nerve tissue they produce no noticeable effect after the first temporary soreness has disappeared4 ,every subluxation1 however1 evidences a tendency to disease4 ,once moved from its normal position and the poise and symmetry of the body disturbed1 there are influences which tend more readily to affect the same vertebra4 ,the subluxated vertebra is more easily disturbed by jars1 strains1 etc41 than the normal one because such jars are less regularly distributed to all its parts4 ,a reflex muscular tension due to other and more pronounced subluxations and their disease effects may in turn increase the slight deviations throughout the spine1 rendering them in their turn capable of producing disease4 ,when the spine or any part of it has lost its perfect regularity disease is made possible1 if not a fact at once4 ,the average number of subluxations in each individual is about nine and one-third4 ,of this number probably not more than one-third 7though no accurate figures are available7 are actually productive of conditions nameable as disease at any given time4 ,discrimination between those which do1 and those which do not1 produce discoverable symptoms in a given case is a matter which requires a nice technical skill and perfect judgment4 ,impingement of ,nerves ,when a vertebra has lost its normal articular relations with its fellows and occupies an abnormal position as a consequence in regard to all surrounding or adjacent tissues it may impinge nerve tissue in two ways1 by tension or by constriction4 ,by the displacement of one vertebra of a pair the size and shape of the intervertebral foramen may be altered 7occlusion7 constricting the nerve which passes through the opening4 ,that this change in the size and shape of the foramina does frequently occur is shown by the frequency with which alterations in the shape of vertebrae appear in dry spines1 by post-mortems which have demonstrated the altered foramina in the cadaver and by permanent occlusion of the foramina in ankylosed spines so that the occlusion may be preserved4 ,adding cartilage changes in the intervertebral disks to alterations in bone shape and position1 especially the latter1 we find full and sufficient reason for all the pathological phenomena which follow the subluxation4 ,explain it as you will1 these morbid results do follow subluxation and can be experimentally produced in animals4 ,moreover1 the disease may be directed to a desired organ or region by selection of the particular vertebra to be displaced4 ,the suboccipital1 sacral1 and coccygeal nerves cannot be constricted as they pass through the foramina because they do not emerge through complete rings formed of separate and movable bones4 ,but these nerves may be pressed upon or stretched by displaced bone1 as may also the great gangliated cord of the sympathetic1 especially the ,cervical portion of it4 ,tension of the ,cervical sympathetic cord by subluxation of vertebrae is a very common occurrence4 ,whether the impingement be by constriction or by tension the effect is much the same depending upon the degree to which the molecular continuity of the nerve substance is impaired--interference with the function of the organ connected with the nerve and sometimes swelling and pain in the nerve itself followed by degeneration4 ,the effects are chiefly noticeable in peripheral tissues4 ,s4 ,weir ,mitchell says 7#ahgb71 8,a continuous pressure upon a nerve results in the degeneration of the nerve and a disturbance of function of the parts innervated by that nerve40 ,no clearer statement can be made4 ,it must not be understood that all nerve impingement is due directly to subluxation of a vertebra4 ,a dislocated shoulder would produce a similar effect of nerve tension4 ,but dislocated shoulders are seldom met with as permanent conditions4 ,likewise there may be secondary impingement from new growths1 themselves due to some primary subluxation4 ,aneurism of the thoracic aorta often produces hoarseness by impingement of the recurrent laryngeal4 ,not all impingement is sufficient to produce noticeable disease4 ,to a certain extent the power of adaptation inherent in the body can overcome its deleterious effects and suppress all signs of its existence until an overtax upon bodily energy lessens this adaptative power4 ,then disease appears and we say that the overtax caused it4 ,excitation or ,inhibition ,a slight impingement serves as a mechanical irritant to increase the action of the nerve and the functions of the attached peripheral organs4 ,such stimulation beyond the normal is always followed by a reaction1 or fall to subnormal action4 ,heavy impingement1 especially the impingement due to marked occlusion of foramina1 partly or wholly paralyzes the affected nerves4 ,often the impingement produces only a latent weakness in some organ1 a weakness which may be brought to light only through the introduction of some secondary cause which takes advantage of the susceptibility of the organ to produce some definite disease4 ,as an instance of this we may mention typhoid fever4 ,no typhoid case is found without subluxation in the region of the second ,lumbar2 yet the latent weakness produced by that subluxation may not have been observed until the typhoid germ found a fertile feeding and breeding ground in the weakened tissue and proceeded to multiply there and develop its toxins4 ,effect ,upon ,single ,cell ,each nerve cell is trophic to its processes and to the tissue cells to which these processes are distributed4 ,the growth1 nutrition and repair of each cell of the body is dependent upon the integrity of the axon which supplies it4 ,the effect of nerve impingement upon the single cell is a weakening of cell structure and a disturbance1 slight or great1 of the special function possessed by that cell4 ,dunglisson says of diseases1 8,all 444 are dependent upon modified cell-action40 ,effect ,upon ,organs ,each organ is but an aggregation of cells of some special type or kind4 ,nerve ,impingement usually involves either a whole nerve trunk or many of its fibres and thus weakens either the entire organ or many of its cells and increases or diminishes its special function4 ,some organs are innervated by more than one nerve and may be injured only in part by a localized impingement4 ,alteration of the action of one organ often tends to affect the entire body1 as in subluxation of the fourth ,dorsal interfering with the nerve supply to the liver the secretion of bile becomes altered in character or quantity and the entire system suffers1 through deranged digestion1 from this alteration in a necessary secretion4 ,every disease presents symptoms only indirectly referable to the organ which is primarily affected and the problem of the diagnostician is to so discriminate between direct and indirect symptoms as to be able to locate disease4 ,simple ,subluxation ,disease ,we have considered a chain of events by which disease is produced without the intervention of any secondary cause4 ,such a condition may be called1 for convenience1 a simple subluxation disease4 ,its existence depends directly upon the subluxation which is the first change manifest in the individual and upon which all the other changes depend4 ,the two facts that not all subluxations impinge nerves and not all nerve impingements cause demonstrable disease explain why we do not1 in practice1 find a disease to correspond with each subluxation discovered by palpation4 ,it must be remembered that there may be latent weakness following a subluxation and of importance because it renders the patient susceptible to infection or to the action of other secondary causes4 ,,secondary ,,causes ,among the secondary causes of disease may be mentioned the pathogenic germ1 poisons1 dietetic errors1 abnormal mental states1 bodily excesses1 exposure to sudden temperature changes1 and inhalation of non-poisonous but irritating substances as the most common4 ,many others might be included but these will suffice for complete illustration of the principle4 ,it will be our endeavor to show how each of these secondary causes operates by virtue of a previous susceptibility1 or breaking down of the normal resisting power of the organism caused by subluxation1 and how each in turn may bring about increase in subluxation and thus1 both directly and indirectly1 increase disease4 ,bear in mind these two all-important facts4 ,none of these secondary causes can operate without previous subluxation4 ,a subluxation may produce disease without the aid of any secondary cause4 ,,germ ,,diseases ,these comprise a large portion of the febrile affections4 ,most germ diseases are characterized by fever and the presence of circulating toxins with resulting disturbance of the metabolic processes of the body4 ,it is generally agreed among pathologists that the greater number of varieties of micro-organisms found at times in man are not pathogenic4 ,some aid in the decomposition of food in the alimentary canal2 others have various beneficial functions to perform4 ,but some1 under proper conditions1 feed upon and destroy living tissue4 ,these are the so-called pathogenic germs4 ,the pathogenic germs are many4 ,they enter the body by various routes1 in the air we breathe1 the food we eat1 the water we drink2 sometimes they are communicated by direct contact with other persons or with objects infected with them4 ,the term 8contagious0 is applied to those diseases whose germs may be carried through the air from one to another2 8infectious0 refers to those communicable only by contact4 ,in every healthy individual are found multitudes of germs of both the pathogenic and harmless varieties4 ,we are constantly exposed to the influence of the former yet by no means all bodies into which pathogenic germs find entrance contract disease4 ,this fact has caused much study and among pathologists and bacteriologists generally the conclusion has been reached that the development of colonies of micro-organisms sufficiently to produce disease depends upon what is known as 8susceptibility0 of the organism4 ,there must be a latent weakness of which the micro-organisms take advantage4 ,this amounts to the admission that the body contains the inherent property of successfully resisting all germ action4 ,indeed1 the fundamental proposition of ,serum-,therapy is that under stress of the presence of dilute germ infusions the body does develop special chemicals which neutralize the germ poisons and kill the germs and which remain after the inoculation to guard against any further entrance of germs of the same kind and vulnerable to the same protective chemicals4 ,this theory is sufficiently correct to have served as an unassailable basis for a most illogical procedure4 ,the truth is that the auto-protective power of the body must be lower than normal and the germs must find a weakened area for development and multiplication before they can develop sufficiently to produce disease4 ,once they gain a foothold they tend to multiply with great rapidity and to develop alarming symptoms often leading to death4 ,only in a few instances does modern science believe that a pathogenic germ can successfully attack a healthy body1 but is claimed that there are a few germs1 such as the ,klebs-,loeffler bacillus 7diphtheria producer7 and the bacillus of anthrax1 which may find lodgment in any organism1 healthy or unhealthy1 to produce disease4 ,now1 the susceptibility of the body to germ invasion requires explanation4 ,merely to say that one is susceptible and another is not leaves too wide a field of possibility for error4 ,it is easy to reason from the fact that all persons are at some time exposed to contagious or infectious diseases while comparatively few contract them that some persons are vulnerable to certain diseases while others are not4 ,it is plain that while a person may be susceptible to typhoid fever because he has a weakness in the intestines1 he may be quite immune from pneumonia or tuberculosis or any other infectious or contagious disease4 ,but why this difference8 ,let us look at the problem from another angle4 ,chiropractors find with every contagious or infectious disease certain subluxations whose location with relation to the disease is constant and demonstrable4 ,thus all cases of pulmonary tuberculosis show a third ,dorsal subluxation with only enough exceptions to prove the rule2 tonsilitis is invariably accompanied by subluxation of the second1 third or fourth ,cervical4 ,correction of the subluxation is1 in all except the most fully and virulently developed cases1 followed by a radical cure4 ,indeed1 in many of the germ diseases it is possible to abort the fever with improvement of all symptoms in from five minutes to twelve hours4 ,we are so accustomed to checking germ diseases at once that failure to do so leads us to immediate investigation of our palpation and adjustment to discover some technical error in the application of the principles of ,chiropractic to the case in question4 ,it is manifestly impossible by vertebral adjustment to raise the body beyond normal power4 ,nothing is added to the body2 no energy is utilized other than the energy of the body itself which is provided by ,nature and released through restoration of the normal carrying capacity of nerves4 ,the highest goal attainable is normality1 and it is observed that no matter whether the impingement be in the nature of an excitation or an inhibition of nerve action the effect of a correct adjustment is always in that direction--toward normality4 ,it may be as well to digress here long enough to remark that abnormal change is never the result of adjustment but always of maladjustment1 and those who claim to be able to produce stimulation by moving a given vertebra one way and inhibition by moving it another are entirely wrong4 ,it is evident from the results of adjustment in germ disease that the normal body is entirely capable of throwing off the poisons and exterminating the germs1 which conclusion quite agrees with science4 ,the fact1 not known by other branches of science1 and asserted by ,chiropractic is simply that the subluxation is the factor which determines susceptibility4 ,upon ascertaining that a certain vertebra is in normal alignment we may say with absolute certainty that the organs innervated by the nerves passing through its foramina are not and cannot be the site of any pernicious germ activities4 ,to go further1 it has been demonstrated in a number of cases that the subluxation existed before the contagion or infection developed4 ,a man has been known to have a second ,lumbar subluxation for many years without effects other than a tendency to constipation and on the appearance of a typhoid epidemic to contract the disease4 ,correction of the subluxation afforded a cure4 ,such instances might be cited in great numbers4 ,no person without the necessary subluxation ever contracts a germ disease and the necessary subluxation can be exactly located for the vast majority of such diseases4 ,unfortunately it is impossible to find a person who has not some subluxations and is not1 therefore1 subject to some form of contagion or infection4 ,so far ,chiropractic agrees with general knowledge of germ disease and its etiology1 simply adding the explanation of susceptibility which all other modes of investigation have failed to afford4 ,in one particular we find apparent disagreement4 ,we have said that several bacilli are supposed to have power to cause disease in healthy bodies4 ,diphtheria is a disease caused by one of these4 ,yet ,chiropractic adjustments have rapidly aborted diphtheria1 apparently proving that the body has power to react strongly enough to conquer even this germ1 providing the nerve channels be opened to allow of exertion of its full activity4 ,it is probable that all diseases fall under the same law and that no germ can find lodgment in healthy tissue4 ,chiropractic affirms this as a truth and as yet no experience has tended to disprove it2 the belief is strengthened by the years4 ,the experiments which are said to have proven that certain micro-organisms can attack healthy tissue are based upon the supposition that careful examination demonstrated the absence of disease in the animals experimented upon by inoculation4 ,since these experiments and these examinations were made without any knowledge of vertebral subluxations1 and consequently without discovering whether or not there existed latent weaknesses of various organs1 we doubt the validity of the experiments4 ,our own examination of human and animal spines has thus far failed to discover any perfectly normal specimens4 ,our clinical experience with diphtheria at least absolutely disproves the conclusions of ,pasteur and others in regard to its origin4 ,increase of ,subluxations ,it has been observed that in many instances the subluxation which existed previous to infection or contagion is greater and more noticeable during the febrile and active stage of the disease than before1 and this fact has led some careless or insufficiently skilled palpaters to assume that the disease caused the subluxation4 ,the development of germ life is accompanied by the excretion of toxins of greater or less virulence which circulate through the blood and affect the entire body4 ,this poison1 irritating sensor nerves1 brings about motor reactions in the segments irritated and1 since the normal operation of the laws of reflex action is interrupted somewhat by subluxation1 and since the muscles immediately around a subluxated vertebra tend to pull upon it with unequal leverage1 this motor reaction is likely to increase already existing malalignments1 especially in the same body segment in which the poison is generated and in which the irritation is consequently greatest4 ,thus subluxation is most pronounced during the activity of the disease caused by it and reacting upon it and thus a disease which began as a localized destructive process may manifest systemic effects through its action upon other abnormal spinal segments4 ,,diet ,the internal chemistry of the body varies so greatly under changing conditions1 the operation of any two different organisms is so hard to compare accurately1 that it is impossible to set down any rule for diet which will apply properly to all patients or to all with the same disease or habit of body4 ,in fact1 only experiment with an individual can determine the exactly proper diet for him4 ,through lack of judgment or of observation of the effects of certain foods upon us we often eat that which our bodies cannot properly digest and assimilate4 ,sometimes through accident or negligence we partake of food which is proper in kind for us but improper in quality1 perhaps partially decomposed4 ,improper food1 when taken into the body1 tends to exert a deleterious effect upon health4 ,this fact should not lead us to confine ourselves to reasoning superficially that improper foods cause disease or that dietary measures will cure disease4 ,some ,chiropractors have held that the hunger of individuals for certain foods is a safe guide to a proper diet4 ,this is manifestly untrue in some cases2 the voracious appetite of the convalescent typhoid patient is an example4 ,but it would probably be true if all men were normal4 ,close observation of a few exceptionally well-developed and normal individuals has disclosed an interesting fact4 ,if a man has no subluxation in that portion of the spine which controls the stomach1 the ingestion of decomposing food1 even though the alteration be so slight as to escape notice on casual examination1 induces immediate vomiting followed by no untoward consequences4 ,only occasionally does one find persons without subluxations in some way affecting the stomach2 in such cases the body promptly rejects and expels injurious material4 ,this carries us to the rather surprising conclusion that the normal person is not susceptible to the influence of bad food4 ,in the majority of individuals1 some degree of abnormality existing1 improper food has a decidedly bad effect4 ,passing through the alimentary canal it is improperly digested2 toxins are developed2 these chemically affect the entire body1 perhaps leading only to a congestion and inflammation of some part of the lining of the alimentary tract1 perhaps producing a general fever1 malaise1 diarrhea1 and the other effects of a general poisoning4 ,it has been found that proper adjustment is followed by quick relief in such cases1 the commonest effect being the rapid expulsion of the deleterious matter by vomiting and diarrhea with breaking of the fever and lessening of all symptoms4 ,it has also been observed that during the suffering from dietetic error the subluxation controlling the stomach or some part of the small intestines is often found increased in degree with tension of the adjacent muscles4 ,with adjustment and relief of the other symptoms the muscular tension tends to disappear4 ,this motor reaction from the irritation of food poison undoubtedly serves to increase subluxation already existing1 thus intensifying effects4 ,but for its primary effect food poison requires a previous subluxation lowering the natural protective power of the body4 ,food poisoning is often a secondary cause of disease4 ,when it is found in any specific case that certain foods exert a bad influence upon the progress of the case1 that the symptoms are aggravated by the taking of these foods1 they must be abandoned4 ,yet no rigid diet need be prescribed in any case4 ,every patient will require a different diet1 nor is it possible to understand the intimate chemical relations within the body sufficiently to fix a proper diet except by experiment4 ,a word here about fasting4 ,if improper food were a primary cause of disease1 fasting would be an effective1 though somewhat radical1 removal of the cause of disease and a logical procedure4 ,since improper food is not a primary cause of disease and since nature requires food for the repair work made possible through adjustments1 it would seem unwise for ,chiropractors to prescribe fasting4 ,also it is well to remember that fasting and starvation are synonymous and their symptoms identical4 ,,poisons ,any substance taken into the body and not usable as food may be considered poison4 ,most drugs administered as medicine or used habitually are either directly poisonous and commonly so considered or are poisonous in the sense that they do not build but rather tend to injure the body4 ,injurious substances accidentally taken into the body2 certain products included in the preparation of otherwise nutritious foods1 alcohol1 tobacco1 etc41 affect the body in varying degrees but in accordance with the same laws4 ,poisons may be internally generated through the action of pathogenic germs or through the failure of the body to digest food and to prevent injurious chemical changes in it4 ,it has even been said by some that abnormal mental states so affect metabolism as to cause the formation of certain auto-toxins which injuriously affect the entire body4 ,however poison may make its appearance in the body its presence is associated with certain bad effects4 ,poison may be corrosive1 destroying tissue wherever it touches2 it may be stimulating1 affecting the nerves so as to increase their activity1 following which waste of energy there is a weakening reaction2 it may be narcotic1 lowering some physiologic process below normal4 ,if a man without subluxation--and therefore normal--have poison introduced into his body one of two effects will follow4 ,either the poison will be sufficient to produce death in a short time1 and will do so1 or the poison will be ejected from the body and the patient recover naturally and without treatment1 and recover fully4 ,this is the statement of the ideal1 not the real4 ,the fact is that no person has yet been found without subluxation in some part of the spinal column4 ,occasional cases have been reported but always by ,chiropractors whose statements are open to question on account of imperfect training in vertebral palpation or a known habit of unconsidered statement4 ,and in the weakened body1 whose natural protective power has been lowered1 the effect is different4 ,the body fails to throw off all the poison normally and some of it remains in the circulation and tends to cause progressively increasing damage4 ,in addition to the direct effect of the poison upon the tissues1 the irritation of sensory nerves gives rise to a motor reaction which increases subluxation generally throughout the spine but especially in the segment in which the sensory irritation is greatest4 ,if the poison be taken into the stomach the vertebrae affecting that organ are most affected in the resulting motor disturbances4 ,when vaccine virus is introduced into the arm the greatest influence is upon the last two ,cervicals and first ,dorsal1 causing increased weakening of the nerves to the arm4 ,if the vaccination does not 8take0 it is because the body is so normal as to be able to take up and rapidly excrete the poison or to neutralize it with an internally generated antitoxin4 ,this tendency of poisons to increase subluxations already existing has caused many to conclude that new subluxations could be produced by the motor reactions from poison4 ,the laws governing reflex action make this impossible4 ,if a mild stimulus be applied in the segment occupied by a given1 and normally aligned1 vertebra1 the resulting contraction will tend to appear on the same side as the irritation and would--if sufficient to subluxate the vertebra--draw it toward the irritated side4 ,if a stronger stimulus were applied the resulting reaction would appear on both sides and with sufficient intensity on the opposite side to the irritation so that the difference between the contractions on the two sides would never be sufficient to overcome the fixity and inertia of the vertebra4 ,if this bit of theorizing be doubted1 let me add that if poisons could cause subluxation they would undoubtedly cause drawing of the vertebra toward the irritated side--which is not the way we find them in poisoning cases4 ,almost without variation1 the subluxation is away from the affected side4 ,such a subluxation produces most impingement on the side of the irritation2 the only kind which could follow poisons would produce its effects on the opposite side4 ,in acute poisoning cases which may possibly proceed to a rapidly fatal termination1 while immediate adjustment may be sufficient to cause the expulsion of the poison and the recovery of the patient it is probably wisest to administer an antidote or to call a physician with a stomach pump4 ,just so1 the pulmotor should be summoned for gas asphyxiation2 but at least one case was recently encountered in which an adjustment started the heart and artificial respiration movements restored consciousness before the pulmotor could arrive4 ,there are few1 if any1 acute poisoning cases in which an adjustment will not aid4 ,sometimes it should be assisted by other measures not strictly within the province of ,chiropractic4 ,chronic poisoning1 such as lead poisoning from paint work1 yields well to adjustments providing the secondary cause1 the persistent inhalation of lead fumes1 be discontinued4 ,poisons may wound or injure the body whether or not it be normal2 in such case they might properly be classed with trauma4 ,but no poison causes disease except through the medium of vertebral subluxation previously produced4 ,some subluxation which has never been sufficient to produce active disease may be so increased by the action of poisons as to be of serious effect even though the poison has long since been eradicated from the body--for the subluxation is permanent until affected by force outside itself4 ,in considering the etiology of any disease the possibility of its being augmented by medicines1 drug habits1 or dietetic errors should be weighed with other evidence4 ,,exposure ,by this term is especially meant exposure to sudden temperature changes4 ,the body may sustain a very high or a very low outside temperature providing the change is gradual enough so that the heat-regulating mechanism may adapt itself properly to protect the body and maintain an even temperature within4 ,a sudden change from a very warm room to a very cold atmosphere2 a quick transportation from cold air to a superheated apartment2 or a sudden draft of air whose temperature is sharply at variance with surrounding air and therefore with the condition of the body surface may have a very bad effect4 ,the skin and mucous membranes of the body have become accustomed to a certain temperature2 the change irritates them4 ,and the immediate result is a motor reaction increasing subluxation in the same body segment in which the irritation is greatest and probably producing first an irritation of the nerves at the spine and then an inflammation of the exposed surface4 ,thus a 8cold0 is produced4 ,one who has no subluxation affecting the respiratory tract--a rare degree of normality--may escape coryza1 bronchitis1 or pneumonia1 the most common effects1 but may suffer a congestion of the stomach walls or of other parts of the body4 ,it is said that the cold 8settled on the stomach40 ,the fact is that the motor reaction takes advantage of the weak parts of the spine and affects them most1 like the pernicious habit of spine-stretching which used to prevail among ,chiropractors4 ,this explains why 8cold in the head0 is so very frequent4 ,the fourth ,cervical vertebra is situated at the middle point of the neck and is very freely movable and easily subluxated and1 in fact1 more often displaced than other ,cervicals4 ,noxious or poisonous vapors may have an effect identical with that of sudden temperature change4 ,sleeping in an improperly ventilated room often appears to cause 8cold40 ,careful study of the part of the body exposed to draft1 and of spino-organic connection1 will show that in most instances the effect of such exposure is first felt in the same body segment4 ,it is a well-known fact that not all people are 8subject to colds40 ,one may be 8subject to lung colds10 another to 8cold in the head40 ,the susceptibility is entirely governed by the condition of the spine1 the person having no middle ,cervical subluxation being immune from coryza even though subjected to the same exposure which will produce it in others4 ,the pollen of plants produces hay fever in the susceptible in much the same manner that draft produces coryza1 both acting as secondary causes4 ,,bodily ,,excesses ,in this division of secondary causes may be mentioned overwork1 continuous loss of sleep1 overeating1 venereal excesses1 etc4 ,they act in this manner4 ,wasting and overusing the bodily resources they lower the general vitality4 ,now1 though there be subluxations at various points in the spine there is still transmitted through each impinged nerve a certain amount of ,vital ,force which to a certain extent maintains the functions of the body and keeps it in a state of activity sufficient for ordinary demands4 ,when the entire stock of vitality is lowered through excess the amount of energy passing through each nerve in the body is lessened1 but the effect of such lessening is felt most where there is subluxation4 ,at the high tide of vitality the subluxations are not sufficient1 perhaps1 to produce serious disease4 ,at low ebb1 every organ whose nerve is interfered with suffers keenly4 ,under such conditions the body is much more subject to adverse influences1 to shocks and jars1 to contagion or infection1 to the action of cold or exposure4 ,thus bodily excess acts as a secondary cause of disease4 ,,abnormal ,,mental ,,states ,there are many who believe that fear1 worry1 hate1 grief1 etc41 are in themselves sufficient to produce disease in a normal organism4 ,shock following the demise of a loved one or some deep disgrace is occasionally alleged as a cause of death or of a rapid decline in health which terminates fatally4 ,the failure of ,suggestive ,therapeutics to cure disease except when it is largely imaginary rather argues against this theory4 ,it is also true that proper ,chiropractic adjustments not only lead to the cure of disease apparently caused by abnormal mental states but also1 restoring proper blood-supply and nutrition to the brain1 induce a happier mental state in the patient4 ,even insanity has been cured in a number of cases by ,chiropractic4 ,we hold that worry1 fear1 etc41 are abnormal2 that they arise from the improper expression of ,mind through disordered brain-cells4 8,diseases of the ,mind10 in the strictest sense1 cannot occur1 but only diseases of the physical medium through which mind is expressed and translated to the physical plane of being--the brain4 ,a condition of abnormal mental expression or activity1 especially worry1 fear or anger1 probably has a two-fold effect3 it rapidly wastes the body energy and1 like bodily excess1 renders every subluxation more effective2 it is possible that it may also really produce auto-toxins1 generated by abnormal brain-action and affecting the body metabolism adversely4 ,in this way disease appears through the action of abnormal mental states as secondary causes4 ,they themselves are the result of subluxation of the first or second1 sometimes third1 ,cervical1 impinging the nerves which control the blood-supply to the brain and hence its nutrition4 ,correction of the subluxation causes them to disappear4 ,,inflammation ,inflammation is a morbid process characterized by the presence of increased temperature and one or more of the symptoms1 pain1 redness1 and swelling4 ,it is distinguished from fever by being confined locally1 while fever is a general functional disturbance showing elevation of temperature1 increased katabolism1 decreased secretion1 etc4 ,our clinical experience with fevers leads us to accept ,metchnikoff's conclusion that the essential phenomenon of inflammation is hyperaemia4 ,upon the hyperaemia depend the swelling1 pain1 and local increase in heat-production4 ,hyperaemia in turn depends upon disturbance of the vasomotor nerves either as a direct result of some local subluxation or as an indirect consequence of local irritation4 ,a newly acquired subluxation produces an acute irritation of the pre-ganglionic axons which connect the spinal nerves with the sympathetic ganglia4 ,if these ganglia send out post-ganglionic axons which are vaso-motor in function1 an inflammation may be produced without the intervention of any secondary cause4 ,on the other hand1 there may be a subluxation producing weakness of some part2 through injury to that part or the introduction of poisons or irritants such as germ infection1 sensory end-organs are affected and the motor reaction which follows increases the subluxation2 this slight increase produces acute irritation of the nerve and hyperaemia1 with its resultant phenomena1 follows4 ,stated briefly1 irritants produce inflammation only by acting through the medium of the spine4 ,if the spine be normal these irritants are insufficient to produce morbid process4 ,local inflammation tends to develop toxins1 especially if it be of bacterial origin1 which may in turn affect the entire organism--an effect which will be discussed presently4 ,exception must be made in those traumatic cases in which hyperaemia is essential to the reparatory process1 and which are attended by what may be termed a normally increased heat-production4 ,this beneficent and reparatory condition cannot be termed disease or morbid process4 ,the normal temperature of the body depends upon the balance maintained between heat-production and heat-expenditure4 ,this balance is maintained through a complicated nerve mechanism consisting of various nidi in thalamus1 medulla1 spinal cord and sympathetic ganglia1 and a network of communicating axons of both the cerebro-spinal and sympathetic systems1 controlling the amount of blood passing through any given body area at a given time1 the secretion of the perspiratory glands1 the internal metabolic processes1 etc4 ,most important are the vaso-motor nerves1 directly1 but not originally1 derived from the sympathetic1 and governing the size and caliber of all blood-vessels so as to control the amount of blood flowing to and through the surface capillaries on the one hand1 or the deep-seated1 heat-making organs on the other4 ,more than seventy per cent of the body's heat expenditure is through the skin by evaporation1 radiation1 and direct conduction4 ,the major portion of the heat production is in the muscles and the parenchymatous viscera1 such as liver1 spleen1 etc41 where metabolism is active4 ,this mechanism is so delicately adjusted that when the outside temperature is lowered the amount of blood passing to the skin is reflexly lessened while internal heat production is increased and the bodily temperature retained at normal4 ,conversely1 the body perspires freely and the surface is flushed with blood in a high temperature1 so that heat production is lessened and its discharge accelerated1 again tending to maintain an even and normal temperature4 ,the nervous mechanism is responsive to many and various forms of stimuli--thermic1 emotional1 mechanical1 physiologic need1 toxic4 ,poisons in circulation may affect the bulbar center and produce general fever4 ,a number of centers in the spinal gray may be stimulated with like result4 ,or there may be purely local irritation which results in local hyperaemia and inflammation4 ,it will always be found that the primary cause of any permanent derangement of the mechanism lies in vertebral subluxation impinging some of the nerves and thus throwing the mechanism out of its natural balance and poise4 ,other forms of disturbance are transient and the very nature of the mechanism makes it normally capable of adjusting itself to thermic1 mechanic1 or emotional stimuli in a short time4 ,only the subluxation produces permanent elevation of temperature4 ,when such elevation does occur there are many associated changes1 increased katabolism1 lessening of secretions1 anorexia1 sometimes mental changes1 such as delirium or coma4 ,fevers vary according to the part of the nerve mechanism affected and the action of any secondary causes4 ,fever due to vertebral subluxation alone without any secondary cause operating is very rare4 ,ordinarily fevers come about in this way4 ,a subluxation occurs which weakens tissue and permits germ invasion2 toxins enter the circulation from the germ action and motor reaction increases the original subluxation and causes local inflammation2 germ activity is favored by the increasing degree of abnormality and toxins from rapid tissue destruction are added to those already present4 ,the poison-loaded blood then affects the general centers for heat regulation1 blood becomes internally engorged1 and a chill 7internal fever7 followed by general increase of temperature occurs4 ,at this juncture any subluxation previously existing is likely to be increased and to add its quota of harm to the rapidly developing picture4 ,our problem is to find the original subluxation which controls the site of the original pathologic change and to correct that4 ,in nearly all cases where this is done1 even partially1 the body is enabled to care for the remainder of the damage and to throw off the accumulated toxins4 ,it is not uncommon that the temperature falls two degrees in five or ten minutes after a proper adjustment4 ,we expect always to abort or check a fever in twenty-four hours or less4 ,there are cases in which the temperature drops after adjustment but presently rises again4 ,this indicates the virulence of the autointoxication or that some other area of poison production is operating than the one our first adjustment would control4 ,a correct diagnosis will enable one to give specific adjustment and check practically any fever except a chronic one with much tissue destruction already accomplished2 even some of these yield4 ,the commonest cause of fever is at the fifth or sixth ,dorsal vertebra1 long known as ,center ,place1 or ,fever ,center4 ,here emerge many pre-ganglionic fibres which distribute their impulses through lower neurons in the sympathetic system to the coeliac plexus and thence to the blood-vessels supplying the major portion of the abdominal viscera4 ,adjustment here causes a sudden contraction of these abdominal vessels and a forcing of the blood to the surface with rapid cooling4 ,often1 however1 this adjustment is followed by a recrudescence which indicates that some other vertebra must be adjusted4 ,many fevers1 such as typhoid1 pneumonia1 tonsilitis1 etc41 yield to specific local adjustment without any involvement of the so-called ,center ,place4 ,i have said that we expect to check or abort a fever with spinal adjustments4 ,the facts that we do so and that the more rapidly we accomplish the result the more rapid the convalescence and the less likely are complications and sequelae argue loudly against the correctness of any theory which supposes fever to be a beneficial and cleansing process4 ,according to such theory it would be totally wrong and dangerous to abort a fever but wiser to encourage it in taking its course4 ,the exact opposite proves true under ,chiropractic4 ,the very fact that fevers do diminish and disappear under proper adjustments is a proof that they are abnormal1 since adjustment does not in any case tend to lessen normal processes1 but only to restore normality no matter in what way the functions of the body have departed from that condition4 ,all the clinical evidence gathered by ,chiropractors in regard to inflammations and fevers tends to prove the correctness of the theories herein set down4 ,fever plays a part in so many diseases that it has been considered advisable to consider the subject under a special head4 ,,in ,,conclusion ,the vertebral subluxation is the primary cause of all truly pathological conditions4 ,through its existence the action of a large number of secondary causes becomes possible4 ,upon no other hypothesis can we explain the remarkable percentage of cures of all known classes of disease through the specific vertebral adjustment4 ,,the ,,process ,,of ,,cure ,nature is the only real curative agent4 ,neither suggestion1 manipulation1 adjustment1 nor any other known method applied by ,man for the eradication of disease has in itself any power to heal4 ,no man possesses power to do more than so arouse the vital energies of the patient that the body heals itself4 ,we contain within our own bodies the possibilities of perfect normality4 ,unless interfered with by powerful outside force we should continue normal from birth to death and death itself would only occur through the simultaneous wearing out of all the parts of the human mechanism4 ,the ,chiropractor1 insofar as his work succeeds in its purpose1 assists the body by adjusting displaced structure and affording the body a free and unhindered opportunity for the exercise of its own self-healing powers4 ,it may be interesting and instructive to analyze the process of cure and to study the exact effects of vertebral adjustment as we have studied the exact effects of vertebral subluxation4 ,cure of ,simple ,subluxation ,disease ,an acute subluxation--that is1 one resulting entirely from concussion of forces within twenty-four or forty-eight hours prior to the moment of adjustment--rarely produces a condition which could be named as any particular disease4 ,the symptoms are those of 8wrenched back10 if any4 ,a single adjustment usually suffices to correct such subluxation just as a single movement might correct a dislocated humerus within the same period1 and any symptoms promptly disappear4 ,this is probably the maximum benefit to be derived from adjustment and the best time for its administration1 because it leaves the spinal column in an exactly normal condition and no more susceptible to further jars or shocks than before the injury4 ,all disease which might have resulted from that subluxation has been fully prevented4 ,older subluxations must be dealt with differently because they present a different condition4 ,adaptative changes have taken place in the shape of the vertebra itself and of every surrounding tissue as they prepare to make the best of their situation4 ,but a vertebra once displaced has lost its poise and broken or modified the reflex arcs through its nerves so that it becomes more likely to respond to further forces applied1 or to muscular contractions within the body1 by further change of position4 ,such changes are always followed by further adaptation of the surrounding parts4 ,the degree of nerve impingement must change to keep pace with the developing malposition and thus1 by gradually successive steps1 disease develops in the area of peripheral distribution of the nerves4 ,the nerve is under a thumbscrew gradually tightening4 ,to adjust such a vertebra many successive movements are required4 ,an apparently full and free movement of a subluxation meets the elastic resistance of the solidly packed tissues and the pull of the modified intervertebral disk--strains at these tissues--and rebounds so as to settle almost1 but not quite1 in its old abnormal position4 ,the amount gained in a single adjustment can rarely be appreciated by palpation4 ,to the touch it would appear that no change had been made1 except occasionally in the ,cervical region4 ,but with repeated adjustments the vertebra will be found to have approached its normal position4 ,sometimes in a few weeks1 sometimes in a few months1 the gain becomes palpable and then perhaps visible to the eye in thin subjects4 ,the relief of impingement then is not usually an instantaneous process1 but proceeds by gradual steps4 ,each movement of the vertebra is accompanied by a shock to the nerve against some part of which the bone is pressing1 which may produce some disturbance in the diseased organs and may even appear to have aggravated disease for a time4 ,some pain and soreness around the vertebra may accompany the necessary adaptative changes of shape which readapt the tissues to their proper shape and relation4 ,as the impingement of the nerve is gradually relieved the disease is gradually modified and finally disappears4 ,as the course of adjustments nears its conclusion and the impingement has been reduced to a comparatively slight one there may appear a stage of irritation of the nerve which is a reduplication of the first steps which appeared in the development of the disease4 ,as most subluxations appear not all at once but by a series of changes1 so disease develops synchronously1 passing from stage to stage with the changes in the impingement4 ,often it passes through first an acute and active stage due to irritation and then a chronic and comparatively passive stage due to heavier1 inhibiting impingement4 ,under adjustment these successive stages tend to reappear in reverse order1 the most alarming sometimes appearing last and just before the cure is completed4 ,it must be remembered that from the moment one practitioner administers medicine or other remedy and the other adjusts a vertebra1 the clinical courses differ widely4 ,no text-book on medical practice has as yet described the clinical course of the various diseases under ,chiropractic adjustment4 ,in chronic diseases where the nerves are paralyzed there may be a period under adjustment during which no change is apparent4 ,this is followed by a period of rapid gain leading to complete recovery4 ,this may be accounted for by the fact that the nerves are degenerated and must be repaired all along their course before communication is reestablished between nerve centers and peripheral organs4 ,when this repair is sufficiently completed to allow communication1 the cure is really well advanced1 although evidence of it then first appears4 ,this has been noted especially in locomotor ataxia4 ,cure of a ,germ ,disease ,first1 under adjustment1 the acute or acutely increased impingement is relieved4 ,the caliber of the blood-vessels is at once regulated and the destructive action of fever checked4 ,at the same time the vitality of the local tissue in which the germs are active is suddenly increased and there ensues a struggle between the body1 as represented by its phagocytes and auto-protective chemicals1 and the germs1 which if adjustments be continued results in the rapid destruction of the germ colony4 ,also the elimination of the toxins already in the body proceeds so rapidly that if the fever can be held in check it takes only a short time for the body completely to overcome and eradicate the germs4 ,cure of ,mental ,disease ,mental diseases--so-called--usually depend upon disturbance of the blood-supply to the brain1 controlled by the ,cervical sympathetic4 ,adjustments1 relieving the pressure on the sympathetic ganglia or cord and perhaps the direct impingement from the vertebral arteries1 restore a normal circulation to the brain4 ,the time required by ,nature to effect a cure depends upon the rapidity with which the impingement is removed and the amount and character of the damage to brain tissue which must be repaired4 ,the cure often requires time for a change of materials in brain cells or fibre tracts1 by which they are reconstructed and again become capable of expressing normal function4 ,cure of ,dietetic ,disease ,when the subluxation is corrected1 or partially so1 the appetite changes and the craving for food becomes more normal4 ,adjustments may lessen a voracious appetite1 increase a too capricious one1 or abolish a perverted4 ,at the same time the stomach is enabled to digest its contents more properly1 the intestines to take it up and continue it1 and the tissues to assimilate that which is brought to them4 ,the body eliminates its waste with less effort and in some extreme cases the first effect of the adjustment may be to cause vomiting and diarrhea and thus purge the alimentary tract of materials which have become unusable4 ,if injurious diet be persisted in the effects of the adjustments will be partly counteracted1 the tendency of the poisons generated within the body being to increase subluxation while the tendency of the adjustments is to correct them4 ,cure of ,poisoning ,cases ,in acute poisoning by way of the alimentary canal and sometimes when poison has been injected hypodermically1 the body rids itself of the menace to its integrity by means of vomiting1 diarrhea1 and increased secretion of urine4 ,chronic cases tend rather toward the gradual absorption and removal from the body of the poisons and their cure depends upon the cessation of the poisoning2 i4 e41 it is useless to try to cure a morphine case while the patient is still using the drug4 ,in acute poisoning the muscular contraction often increases subluxation and counteracts the effect of the adjustments1 so that it becomes necessary to give very frequent adjustments until relief is had4 ,cure of ,exposure ,disease ,after the acute irritation of nerves arising from the exposure and causing irritation has been removed1 perhaps by the first adjustment1 if the exposure is not repeated the body heals itself with great rapidity1 repairing with comparative ease the damage done4 ,cure of ,bodily ,excess ,disease ,this depends upon the nature of the excess4 ,if it be overeating1 perhaps a more moderate diet will of itself and without adjustments enable the body to rid itself of the bad effects and restore general equilibrium4 ,adjustments will aid and accelerate this process4 ,venereal excess is most often engendered by an improper state of mind1 perhaps demanding attention as a mental disorder1 or by an irritation of the genital organs which demands local adjustment for its relief4 ,normality of the reproductive tract leads to sane forgetfulness and libidinous habits always suggest sexual weakness or disease4 ,often where a cure would be possible with right habits1 no cure can be effected without their correction4 ,a little good sound advice which will arouse the will of the patient to co-operation may aid4 ,boys with the masturbation habit offer small chance for favorable results in enuresis or nervous disorders unless the secondary cause be understood and overcome4 ,,adjuncts ,in this connection the author cannot forbear a reference to the use of other methods to relieve disease in combination with the ,chiropractic adjustment4 ,from the foregoing study of the laws governing the cause and cure of disease it will be seen that therapeutical methods have little direct bearing upon the removal of disease4 ,the logical method of effecting the cure is the removal of the cause4 ,the subluxation being always the primary cause1 its correction is always the logical method of effecting a cure4 ,not sometimes but always4 ,we know that when the subluxation is corrected the body naturally heals itself4 ,can we accelerate and aid that healing with stimulant or narcotic8 ,logic says no2 experience says no3 the use of any method which strikes at the disease beyond its primary cause and operates upon some of the effects of that cause without touching the cause itself is inconsistent with belief in ,chiropractic4 ,administration of poisonous drugs to the well body is considered poisoning2 their administration to the sick body is also poisoning1 whose symptoms combine with the disease to produce different outward signs4 ,fasting is starvation4 ,massage is stimulation or inhibition4 ,spondylotherapy means exhaustion of the spinal nerve centers in riotous expenditure of their stored-up energy4 ,it would require a wisdom beyond the human to improve upon the natural healing processes with which the body has been provided4 ,it should be our entire business to remove the obstructions which hinder the full exercise of that healing power--the subluxations--to remove them dexterously and decisively and to interfere in no other way4 ,other methods may and do serve to scatter or modify disease but not to cure it--unless they affect subluxations1 as they sometimes do without intent4 ,this accidental adjustment factor is valueless in the presence of a scientific and intelligent adjustment4 ,let ,medicine1 ,osteopathy1 ,spondylotherapy1 ,christian ,science1 ,massage1 and ,electricity have their field4 ,it is not ours4 ,nor can any of these methods be rationally combined with ,chiropractic4 ,their basic principles contradict ours2 their application interferes with the results of adjustment4 ,if you claim to remove the cause of disease1 do so1 and do not mar your work by treatment of effects4 ,,spino-,,organic ,,connection ,it has been said in a previous section that when subluxation and disease are associated the subluxation always precedes the disease and that the former is the cause1 the latter the effect4 ,so clearly do we understand this law that we are able to say what subluxation would cause a certain disease and err by only so many cases per centum as there are variations from the usual structure of the spinal column and the nervous system4 ,but merely to state that a second ,dorsal subluxation causes heart disease is not enough4 ,we must know why and how it causes heart disease and whether1 perchance1 some other subluxation may sometimes have a like effect4 ,we must map out the sphere of malign influence of each possible subluxation so that when our fingers encounter it it at once and inevitably suggests its possible effects1 from which1 by diagnostic methods1 we may choose the one toward which most symptoms point4 ,and we must know the relation of every nerve in the body to peripheral organs and their functions so that when we encounter indubitable evidence of some functional or organic disease we may know exactly where1 in the spinal column1 to seek for its cause4 ,we have learned how to discover a subluxation1 how to adjust it1 and how that adjustment permits a natural cure of its abnormal effects4 ,we must now learn exactly where to apply adjustment for any given organ in the body or for any disease4 ,it must be understood in interpreting this statement and all those which follow in this section that it is never proper to adjust a vertebra merely because it is stated to be the cause of a disease believed to exist in a patient4 ,no vertebra should be moved unless palpation determines it to be subluxated4 ,rather let it be known that as a rule the statements of spino-organic connection here made will prove to be verifiable by palpation4 ,there is no rule in ,chiropractic without some exceptions1 and mere diagnosis of disease is too notoriously unreliable to serve as a guide to adjustment without the verification of the trained touch4 ,the ,field of ,study ,we wish to know the relation existing between each part of the ,nerve ,system and other parts and between each part and the other organs of the body4 ,especially we wish to understand the relation between each part of the ,nerve ,system and the spinal column1 by which permanent subluxations of the latter interfere with the former's action and therefore with the peripheral organs4 ,this requires a general knowledge of anatomy1 physiology1 and pathology which we shall presuppose the reader to possesses so that we may present only facts to which his attention should be particularly called4 ,let us begin with the relation of nerve tissue to other tissues where this relation can be most clearly comprehended1 namely1 with the development of the human embryo4 ,segmentation ,the complete human organism represents the snarled fusion of a series of similar1 yet specialized1 somatic segments1 each presenting most of the attributes of a simple animal1 though the association and co-ordination of all are required for the production of higher animal phenomena4 ,the embryo is composed of such segments placed with their centers in the same axial line4 ,each segment contains in association which is morphologic1 physiologic1 and anatomical1 a segment of nerve matter and a somatic 7body7 segment4 ,the neural segments are arranged end to end so as to form the rudimentary beginning of the complete central nerve axis of the adult human body2 the somatic segments blend together with somewhat indefinite lines of cleavage which are to become much more indefinite and obscure by changes in relative form due to differences in the growth rate of different parts or to involuntionary changes following functional inutility at various periods4 ,gray says1 8,the intrinsically segmental nature of the spinal cord is expressed by the association of each definite segment with the somatic segment supplied by its nerve40 ,within each segment there may be observed at an early period cell migrations from the walls of the primitive neural tube and amoeboid projection of axonic and dendritic processes from these cells1 which serve to bring the other tissues of the segment under the control of the nerve elements2 there is an assumption of command1 as it were1 by the nervous system1 so that the epithelial1 connective1 and muscular tissues of each segment are linked in sensomotor and vegetative co-ordination by the contact association of the nerves which ramify them--sensomotor because the nerves are presently to carry the only force capable of inciting activity of any kind in other tissues1 vegetative because the functions of growth1 nutrition1 and repair1 in each somatic cell1 depend upon the continuity of communication between it and the lowest nerve cell in the nerve pathway which connects it with the higher motor and sensor centers4 ,development of the ,nerve ,system ,already may be noted a hint and a prophecy of that future segmental organization by which it becomes possible for some spinal vertebra to become displaced and thus begin a morbid process which may diffuse itself throughout an entire body segment1 involving neural and somatic elements together4 ,already the simple organization begins to become rapidly complex and difficult to trace4 ,cell masses begin to migrate from the walls of the primitive neural tube to a position laterad to become the spinal ganglia2 these send out long dendritic processes which marvellously thread their way to a predetermined peripheral connection which is to bring some cutaneous1 or muscular1 or joint tissue into sensor relation with the dorsal1 or ,sensor1 portion of the cord and through it with the brain2 at the same time they send their axonic processes inward to mingle with and communicate with the dendrites of other sensor cells remaining in the central axis to form the gray matter of the cord1 and thus1 migrating1 keep up communication both with the central axis and the periphery4 ,other cell masses migrate ventrolaterad to form the sympathetic ganglia and they also send out afferent and efferent processes which make a connection on the one hand with the periphery and on the other with the source from which the cells developed1 the situation to be occupied by the cord4 ,from this view it is seen that the sympathetic system is merely an offshoot from the same source with all the rest of the peripheral nerve system1 merely a mechanism for the proper distribution of nerve impulses from the central organs1 and that it retains its connection in all its parts with those organs4 ,its ganglia1 like those of the cord1 are always and from the beginning under the domination of the upper or cephalic end of the neural tube4 ,this cephalic end rapidly expands4 ,its growth is faster than the rest of the neural tube and from its walls1 by proliferation1 develop the structures of the cerebrum1 mid-brain1 and hind-brain4 ,it also gives off ganglionic masses from which grow sensor processes to form the afferent elements of the cranial nerves and contains1 like the cord1 motor nuclei1 or nidi1 from which motor axons grow toward the periphery to come into relation with definitely predetermined organs4 ,the ,spinal ,column and ,cranium ,now appear the primitive cartilaginous and membranous elements from which a bony wall is to be built around the central nerve axis1 primitive vertebrae1 the upper known as cranial and numbering four1 and the lower1 or spinal1 numbering usually thirty-three4 ,these bone structures develop around the brain and spinal cord4 ,later the cephalic vertebrae fuse into a solid vault1 the cranium1 completely enclosed except for various foramina for the passage of spinal cord1 nerves1 and blood-vessels4 ,the succeeding twenty-four vertebrae remain separate and movable upon each other and leave between them the openings for the emergence of the spinal nerves4 ,the last nine segments fuse eventually into two immovable or false vertebrae called ,sacrum and ,coccyx4 ,these latter also contain foramina from which nerves issue4 ,the ,adult ,nerve ,system ,when this development and growth of new parts is completed the ,nerve ,system appears as a set of complex organs made of a central axis1 brain and spinal cord1 and peripheral connections made up of forty-three pairs of directly attached nerves 7#ab cranial and #ca spinal7 with two great gangliated cords and numerous other sympathetic ganglia and communicating cords situated outside the skeletal axis but communicating with it intimately by means of interchange of fibre bundles between the sympathetic and the cerebro-spinal nerves4 ,illustration3 ,schematic diagram of ,spinal nerve and ,rami4 ,a3 ,spinal nerve4 ,b3 ,spinal ganglion4 ,c3 ,posterior nerve root4 ,d3 ,anterior nerve root4 ,e3 ,white ramus communicans4 ,f3 ,gray ramus communicans4 ,g3 ,sympathetic ganglion4 ,h3 ,sympathetic cord4 ,after ,gray ,parker #ca4 ,interchange of fibre bundles between spinal and sympathetic nerves4 ,but we who have viewed the embryonic development even briefly and sketchily1 understand that all these complex organs are merely an aggregation of neurons1 each neuron made up of a cell body1 one or more axons1 and dendrites2 that the nerve cells are the controlling elements and the axons the centrifugal carriers of nerve energy1 while the dendrites are the centripetal processes through which each nerve cell receives communications4 ,the ,body ,axis ,the skull and spinal column1 taken together1 constitute the bony axis of the body1 the center of organization of the skeleton2 to these parts are attached other skeletal structures1 mandible1 ribs and sternum1 extremities1 classified as the appendicular portion of the skeleton4 ,likewise are attached1 directly or indirectly1 the voluntary muscles which move the skeleton1 and the vessels and viscera4 ,any given structure in the body can be traced to a supporting connection with this bony axis4 ,the bony axis contains the neural axis4 ,its strength and solidity are such as to preserve the integrity of the most vitally important tissue of the body from every form of injury if such protection be possible4 ,through openings in the bony axis--foramina--the central nerve organs give off or receive the nerve bundles which bring them into communication with every other structure of the body4 ,and the body has been so arranged that every single part of it is partly or wholly under control of nerves emerging through these foramina4 ,even the brain and spinal cord themselves respond to changes in the blood-vessels which are controlled by nerve impulses which have emerged through the intervertebral or cranial foramina and returned by other routes to supply the muscular coats of the vessels4 ,concussion of ,forces ,affects ,spinal ,column ,reverting for a moment to the primitive segmental arrangement which is none the less persistent and important because in the completed human the regularity of contour of the segments has been wholly lost and aberrant organs have moved from their original positions carrying their nerve supply with them1 let us first state and then illustrate a general law4 ,any violence applied to the body tends to affect the spinal column4 ,such violence does or does not produce permanent displacement of a spinal segment according as it does or does not succeed in overcoming the internal resistance4 ,but whatever effect upon the spine is accomplished will occur most noticeably in the same body segment to which violence was applied4 ,that is1 force applied to any body segment tends to subluxate the vertebra which would impinge the nerves controlling that segment4 ,thus diseases are primarily segmental and later general just as the body is primarily segmental and later co-ordinated into complicated functional systems1 all more or less interdependent4 ,if a man falls so that he strikes first on the point of his shoulder the force will be transmitted almost directly across the line of the spine1 at right angles1 and may subluxate the sixth or seventh ,cervical or first ,dorsal4 ,if subluxation occurs it is because the law of gravity causes the remainder of the body to keep moving downward after the shoulder strikes and until it too comes to rest4 ,the subluxation which results is a right one if the left shoulder be struck and vice versa4 ,now the brachial plexus is chiefly controlled by these three vertebrae and a right subluxation tends to impinge most the nerves on the left side1 so that if any permanent effect of the fall follow it will be a permanent weakness or disease of the left shoulder or arm1 with possible slight extensions along other branches of the same plexus1 as to the latissimus dorsi4 ,also by the internal sympathetic communications from this same region the larynx1 trachea1 or large bronchi may be affected1 occasionally the heart1 all structures segmentally associated with the arm4 ,this law applies throughout the body and can be fully demonstrated by any one having a complete knowledge of nerve connections and body segmentation upon being furnished with a complete and accurate history of any injury to the body4 ,it goes further than this4 ,toxins or other secondary causes operating within the body tend always to produce their motor reactions and consequent effect upon any subluxated vertebrae in the same body segment with the peripheral irritation1 so that if the stomach contain a poison which affects the spine the sixth or seventh ,dorsal vertebrae will be most affected and the stomach itself the organ to suffer most4 ,the spinal column is peculiarly adapted1 with its strong ligaments1 its cartilage cushions1 its perfect flexibility and flexuousness1 to withstand jars and shocks4 ,yet the spine is the door by which disease enters the organism4 ,concussion of forces1 the energy from the environment encountering the bodily resistance1 is of no serious effect upon the organism--of no permanent or irreparable effect--unless it affects the spine and brings about vertebral subluxation1 disturbance of the normal alignment between vertebrae1 and thereby interrupts the perfect healing and controlling influence exerted by the vital part of the segment1 the central nerve portion4 ,when a concussion of forces does produce subluxations1 does disturb the perfect poise and balance of that center of structure of the body1 its consequences affect an entire body segment1 producing1 or tending to produce1 disturbances through the entire segment4 ,disease is the indirect consequence of the contact of man with his environment and is natural but not normal4 ,the spinal column is a center or a series of centers for disease4 ,in this column will be found the primary cause--the introductory element--by which disease first makes its appearance in a previously healthy body4 ,comparative ,anatomy ,the study of ,comparative ,anatomy is necessary to a complete understanding of the human organism4 ,we may trace in the simplest forms of animal life the beginnings and foreshadowings of the same plan of organization4 ,we may follow it through the ascending scale and watch its complexity develop1 and by viewing each step in the process we may come fully to realize that the original plan has been preserved throughout1 though often in such form that by study of the single species we should fail to recognize it4 ,we lack space for complete consideration of this subject and shall merely suggest certain facts and phases4 ,no clear analogy can be drawn until we reach the worm1 with its rudimentary spinal column and nerves4 ,roughly speaking1 dissection of one spinal segment with its nerves and their controlled area--if this were possible--would separate from the rest a fairly regular layer similar to all the other layers4 ,this is the primitive segmentation4 ,it is shown much more clearly in the fish but the segments have begun to curve with their periphery directed slightly caudad and some have already shown a preponderating growth over other segments and a change of shape from the original symmetry4 ,the reptiles and birds show still more complicated segmentation4 ,it is notable that in these lower animals the purely reflex portion of the nervous system is highly developed while the volitional and sensory portions1 the cerebral hemispheres1 are yet rudimentary4 ,in birds1 particularly1 the cerebellum is very highly developed because its function of co-ordination of muscles for the maintainence of equilibrium is required in a high degree for flying4 ,those land animals which walk on all fours approach still closer but their arrangement is much more readily comprehensible than in man4 ,as the animal stands on all fours with head extended1 a gigantic cleaver slicing out each vertebra and pair of nerves and slicing straight toward the base of support might be said to divide the body approximately according to the structural and functional arrangement in segments4 ,yet no segment so separated would exactly correspond to the nerve distribution2 there would be enlargement of some organs with extension into the zone previously occupied by their neighbors2 enlargement here and atrophy there2 invagination of one organ by another and overlapping and intermingling of parts4 ,even the relation between the spinal cord segments and the vertebrae has departed much from the primitive so that the growth of the vertebrae has exceeded that of the cord and the cord terminates opposite the ,lumbar region instead of at the end of the ,sacral canal4 ,it may here be remarked that in the human embryo the cord at first occupies the entire length of the neural canal formed within the vertebrae2 that in the adult it terminates opposite the lower border of the body of the first ,lumbar vertebra and that the nerves1 still retaining their original foramina of exit and their relation to the somatic segments1 pass downward within the canal to their respective openings and collectively form a brush like mass called 8cauda equina40 ,causes of ,segmental ,changes ,the causes of the change in the shape1 form1 and relation of the different segments are functional3 the body changes to meet the changing needs of its environment and the steady progressive functional development from one species to another4 ,when the animal at last assumes the erect position1 doing more intricately and intelligently the bidding of a developing and improving central nervous system1 the change of position and the force of gravity bring about a gradual downward1 or caudad1 tendency of the parts of the somatic segments most remote from the spine and of the nerves which supply them4 ,the nerves1 muscles1 and bones of the lower extremities change from almost a right angle to an extremely obtuse angle1 less obtuse during infancy and more so in the adult4 ,the forelegs become arms and hang at the sides1 extending downward from the part of the spine which controls them4 ,the ribs tend more obliquely downward and outward from the spine and the tendency of all the nerves is downward from their attachment to the spinal cord to their emergence from the intervertebral foramina4 ,in the neck and head alone is this rule varied1 the tendency of the nerves and some other structures there being to run from the spine either at right angles or upward4 ,it seems almost symbolic and indicative of the purpose of creation that the body1 which is less strong and vigorous in ,man than in the lower animals1 should tend more and more obliquely downward from its central axis1 while the cranium1 containing a highly specialized mass of cells and fibres1 the organ of ,mind1 which marks ,man's supremacy in the animal kingdom and is his crowning glory1 is reared above the body it dominates4 ,in all the form changes which mark the growth of the body the organs are arranged to afford the greatest possible economy of space and convenience for use4 ,this perfect and matchless mechanism adapts itself to the changing habits and environments and to the quality and needs of the ,mind which inhabits it4 ,necessity for ,table of ,spino-,organic ,connection ,to the practitioner who is fully equipped with an instantly available knowledge of all the nerve connections in the body and to whom palpation of a subluxation at once suggests its somatic sphere of influence as a weakened or diseased area1 or to whom mention of a disease immediately calls to mind the organ1 or segment1 which is primarily affected and its nerve connection with the spine1 any tabulation of spino-organic connection or of diseases and adjustments1 for reference1 is unnecessary4 ,but the ordinary practitioner finds it difficult to acquire and retain such an array of information and much more convenient to refer to reliable and easily read tables which will supply at once any such information desired4 ,no specific adjustment is possible without knowledge of the vertebra which controls the part diseased and toward the healing of which the nerve energy should be directed4 ,specific adjustment without correct diagnosis is of course impossible4 ,and whenever correct diagnosis has been made it is essential that the mind of the ,chiropractor should revert to one certain vertebra which he expects to find subluxated as the primary cause of the disease4 ,diagnosis is essential in order to find out what organ is the site of the disease1 for all disease is primarily segmental4 ,the location of the disease having been determined1 a quick reference to a table showing the spinal connection with that location makes specific adjustment possible4 ,the value of specific1 as against general1 adjustments will be considered under 8,practice40 ,method of ,investigation ,one who wishes to determine for himself the proper specific adjustment for a certain disease must1 in order to be able to attach any weight to his conclusions or to announce them with any hope of credence by the scientific world1 proceed very much after the following method1 which sets down what may be termed 8standard test conditions0 for research into the spino-organic connection4 ,he must make a correct diagnosis which serves to determine the nature and location of the disease process4 ,in this he may be greatly aided by vertebral palpation and nerve-tracing1 especially in differential diagnosis4 ,any case which affords less than a quite positively correct diagnosis should be excluded from the test list because any conclusion based on a doubtful diagnosis must itself be doubtful and may be seriously misleading4 ,he must then ascertain as far as possible the known anatomical nerve connection between the spine and the diseased part4 ,if several connections are known he must decide according to nervous physiology1 by recognizing the morbid functions which constitute the disease and learning which nerves control these functions and which must therefore be deranged in order that the disease may exist4 ,i may say right here that to attempt to answer the problems of ,chiropractic on the assumption that standard anatomies are incorrect in their statement of nerve connections is as hopeless as the wail of the schoolboy that the answers in his arithmetic are wrong because his sums fail to come out that way4 ,the investigator must next be accurate in ,palpation1 selecting the subluxation which would1 from his knowledge of the body segmentation1 seem most likely to influence the nerves involved1 and positively ascertaining the number of the subluxated vertebra4 ,no one who cannot count vertebrae accurately can positively say which vertebra he has adjusted4 ,more than that1 no one who has not counted the vertebrae in the special case in question can say which vertebra he has adjusted4 ,no mere regional localization will suffice for scientific investigation4 ,correct and accurate adjustment must follow selection of the single vertebra and the adjuster must know that he has used the one special movement1 or form of adjustment1 which is mechanically right for that kind of subluxation and has so moved the vertebra as to release impingement4 ,mere movement of a vertebra is not necessarily an adjustment or even a maladjustment2 it may be movement without permanent change of relation or release of impingement4 7,see 8,preferable ,adjustments10 p4 #aee47 ,there follows the observation of the progress of the case and this must be so careful and accurate that the observer knows to a certainty whether the disease is progressing unfavorably1 or favorably1 or whether it has been entirely eradicated4 ,he must know the value of every changing symptom1 the real meaning of each new development4 ,every diagnostic method should be at his command for this work4 ,constant vigilance and constant thought should mark each step of his work4 ,finally he must be so cautious and careful in his statements that no doubtful conclusion is allowed to escape from his own mind4 ,we may believe or suspect or hope for proof of our theories but we have no right to state as a fact anything except that which has been proven under the most rigidly guarded scientific test conditions4 ,failure to observe any of the precautions mentioned renders worthless the results of investigation4 ,nothing further than a mere presumption can be based upon research which fails to observe all these rules4 ,it will be readily understood that there are few ,chiropractors whose training has been sufficient to enable them successfully to accomplish such research4 ,there are thus many things connected with the spino-organic connections which are commonly held as facts but which should be classed as presumptions4 ,and the prevalence of the habit of general adjustment rather than specific makes the future final solution of all these problems remote4 ,kinds of ,evidence ,acceptable ,it will be seen that of the three kinds of evidence--,anatomical1 ,physiological1 and ,clinical--which are admissible in reasoning upon the connection between the spine and disease1 only one form--clinical evidence--has been adduced by ,chiropractic4 ,for anatomical and physiological corroboration of our apparent clinical findings we are obliged to turn to standard works on these subjects2 fortunately we find it in abundance4 ,anatomy1 fortified now by research in the morphologic relations of the parts studied and by physiological and pathological experiment which has thrown much light on the proper viewpoints from which to describe structure1 contains sufficient data on the nervous system to enable us to explain practically every fact observable in a ,chiropractic clinic4 ,it is true that there are a few statements in the ensuing outlines for which we cannot as yet find the anatomical or physiological proof4 ,but it must be remembered that anatomists and physiologists have never studied the body with a knowledge of the subluxation theory to aid them in gaining perspective and that ,chiropractors1 as a class1 have not yet delved deeply enough into anatomy and physiology to extract all the available and illuminating information from them4 ,ofttimes the facts we value most are most obscure in the texts because to others they seem least important4 ,but they are there4 ,armed with information concerning ,chiropractic facts it is probable that the scientist of the future will corroborate all of our clinical findings of today and emphasize the rational explanations of them4 ,in the following tables it has been found best to insert in parentheses the capital letter 7,p7 to call attention to any statement in support of which we have gathered less than all three forms of admissible evidence and which is therefore as yet presumptive4 ,it is well1 however1 for the practitioner to be careful lest he regard too lightly such presumptive statements4 ,unless there is very strong and reasonable ground for such presumption or a general belief in its correctness all mention of it is omitted4 ,those labelled presumptive are merely so indicated because they have not yet been proven and not because they have failed to serve as a convenient and useful guide to adjustment4 ,for each presumption offered there is either clinical or anatomical justification but not both4 ,,special ,,nerve ,,connections ,this section does not purport to state with any degree of completeness the various nerve-paths by which spinal vertebrae come into relation with all1 or nearly all1 the peripheral organs of the body4 ,it merely points out some of the more interesting and important connections1 some of the paths which serve to explain the common effects of vertebral adjustment4 ,it is not expected that this resume of the subject will be more than suggestive to the student2 certainly it cannot1 in so brief a space1 be a complete exposition4 ,outline of ,nerve ,system ,let us begin with the observation that almost every organ of the body1 including the central nerve organs themselves1 may be adversely affected by spinal subluxation impinging spinal nerve axons at their exit from1 or entrance through1 intervertebral foramina1 or by spinal subluxation producing direct impingement upon some part of the sympathetic system and similarly interfering with its power to functionate4 ,the ,nerve ,system may be divided into two great divisions1 the central axis and the peripheral system which distributes nerve energy from1 and brings stimuli to1 the central axis4 ,the central axis consists of the brain and spinal cord2 the peripheral system of #ab pairs of nerves attached to the brain and having exit 7except the eighth7 through foramina in the base of the cranium1 #ca pairs of spinal nerves emerging through intervertebral foramina whose parts are movable upon each other 7except the foramina for sacral and coccygeal nerves71 and an intricate system of sympathetic fibres and ganglia arranged in a double chain of ganglia in front and at the sides of the vertebral column1 three great prevertebral plexuses1 the cardiac1 coeliac1 and hypogastric1 and numerous scattered ganglia and communicating cords which bind the ganglia together and connect them with spinal or cranial nerves and with the periphery4 ,the peripheral system is somewhat complex and numerous intercommunications are established by which nerve impulses originating in the central axis and leaving by one part of the peripheral system may exercise a controlling influence over another part4 ,plexuses1 or intertwinings of nerve axons1 are so numerous and complicated that it is difficult to follow each set of nerve stimuli from their origin to their final destination and effect without considerable study4 ,direct ,distribution of ,spinal ,axons ,the spinal nerve axons1 taken as a whole1 establish paths between the motor gray of the ventral horn of the spinal cord and all voluntary muscles of the body below the head except the trapezius and sternomastoid1 partially innervated by the eleventh cranial1 and between the sensor cells of the dorsal spinal gray and gracile and cuneate nuclei of the medulla on the one hand and the sensor end organs in skin and mucuous membrane1 muscles1 tendons1 and joints on the other4 ,the ventral cornu receives impulses from the cortico-spinal axons of the direct pyramidal1 crossed pyramidal1 rubrospinal1 and other smaller tracts which bring the spinal gray under the direct voluntary domination of the volitional centers in the brain or of the indirectly voluntary pathway through the cerebellum4 ,the spinal nerves are the direct media for motion of the body or its parts in relation to its environment4 ,the sensor gray of the cord is similarly in communication with the conscious sensation area in the cerebrum and with the cerebellum by way of the dorsal tracts of the cord1 the lemnisci1 and the cerebellar peduncles4 ,in the main these nerves of motion and sensation are arranged as follows3 ,the ,cervical plexus is composed of the intertwining of axons from the anterior primary divisions of the four upper ,cervical nerves4 ,its branches pass to and innervate many voluntary muscles of the neck and side and back of head1 and supply sensor fibres to the adjacent cutaneous areas4 ,branches also communicate with the last three cranial nerves and one long branch1 the ,phrenic1 or ,internal ,respiratory ,nerve of ,bell1 passes through the neck and thorax to the diaphragm1 as its motor nerve4 ,the ,brachial plexus is made up of the anterior primary divisions of the four lower ,cervical nerves and the greater part of the first ,thoracic4 ,it is distributed chiefly to the voluntary muscles and integument of the shoulder and arm1 forearm1 and hand1 but sends branches to some muscles of the neck and upper back as well4 ,it1 like the ,cervical plexus1 receives branches from1 but gives none to1 the ,cervical sympathetic4 ,the ,thoracic nerves are not arranged in plexiform fashion like those above but pass separately1 for the most part1 to their destinations4 ,they are distributed to the walls of the thorax and abdomen following the curve of the ribs in direction4 ,the last ,thoracic sends one division downward as far as the outer aspect of the ilium4 ,the ,lumbar1 ,sacral1 and ,pudendal plexuses are formed of the ventral divisions of the ,lumbar1 ,sacral1 and ,coccygeal nerves and distribute branches to the integument and voluntary muscles of the lower abdomen1 pelvis1 and lower extremities4 ,from two of the sacral nerves branches known as 8,visceral0 pass through the plexus to terminate in the walls of the uterus and rectum4 ,all of the thoracic nerves and the first and second1 sometimes the third and fourth1 lumbar give off branches to the sympathetic ganglia1 known as white rami communicantes4 ,direct ,distribution of ,cranial ,nerves ,the distribution of the #ab pairs of cranial nerves is not so definitely to voluntary muscles and to areas from which conscious sensation is to be derived as is the case with the spinal1 although the cranial nerves present many analogies with the spinal and there is abundant reason for considering them as in one series of #dc pairs4 ,there is direct distribution of some cranial nerve fibres to secreting glands1 but these fibres are probably merely derived from sympathetic trunks and carried in company with the axons of cranial origin4 ,there is also some direct distribution of cranial nerve axons to visceral walls made of non-striated muscle1 as in the case of the vagus distribution to the respiratory and alimentary tracts and that of the spinal accessory to the heart4 ,this is a resemblance to the sympathetic4 ,the cranial nerves carry afferent impressions from the special sense organs1 except those of the sense of touch1 which function is divided with the spinal nerves4 ,various intercommunications exist between the cranial and sympathetic divisions of the peripheral system1 by means of which axons starting with one division may be finally distributed with another1 or by which an axon of the sympathetic may pass to one of the sensor ganglia of the cranial system and influence its nutrition and condition1 and therefore its power to act4 ,there is a limited intermingling of spinal fibres with the lower cranial4 ,distribution of ,sympathetic ,the sympathetic system directly innervates most of the nutritive or vegetative system1 the alimentary tract and its accessory organs1 the vascular systems1 the genito-urinary system1 and the ductless glands4 ,to a limited degree it shares this control with the cerebro-spinal and to a much greater degree it brings the central axis into indirect connection with these viscera4 ,gray says1 8,the distinction of the sympathetic system from the cerebrospinal system is made merely for reasons of convenience4 ,the two systems are intimately connected and the sympathetic is morphologically a derivative of the central axis disseminated in connection with the nutritive apparatus and establishing relationships among the vegetative organs40 ,structure of ,nerve ,pathways ,most pathways which carry nerve impulses from their origin or inception to the organ in which they are finally expressed as action of some sort or translated into sensation or into stimuli which pass out reflexly over a connected neuron1 are composed of more than one neuron4 ,the neurons of a nerve pathway are arranged end to end with the axons all pointing in one general direction so that the nerve energy travels always in the same direction over the entire nerve path4 ,impulses are transferred from the first neuron in the chain to the second1 and from second to third1 etc41 by contact of the telodendria of the one neuron with the dendrites or receptive processes of the next4 ,part of the nerve pathway may be within the central axis and part within the trunk of a peripheral nerve4 ,several peripheral pathways for afferent impulses may be joined to an efferent pathway so as to complete reflex arcs and the efferent cell be under the controlling influence of some upper neuron coming down from the central axis with the power either to permit or to inhibit the reflex acts which would otherwise take place as a result of peripheral stimuli4 ,several such lower cells may be under the domination of one upper neuron4 ,in some instances the nutrition of ganglia or nerve trunks1 or of parts of the central axis itself1 is under the control of sympathetic neurons terminating in connection therewith1 so that interruption of the normal action of the sympathetic neuron may be followed by effects manifested through some distant part of the cerebrospinal system4 ,in the following pages we shall discuss nerve pathways with reference to the explanation of diseases caused by vertebral subluxation impinging nerves either by tension or constriction1 and therefore our grouping of parts will differ somewhat from any anatomical or physiological grouping with another object in view4 ,important ,nerve ,pathways ,to brain3 ,c #b1 #c1 or #d to superior cervical ganglion by direct impingement1 through internal carotid nerve to sympathetic plexuses following branch arteries from ,circle of ,willis4 ,the blood-supply of the brain is under control of the cervical sympathetic and most brain lesions or diseases are due to vascular changes leading to anaemia1 hyperaemia1 inflammation1 or hemorrhage4 ,to meninges3 ,loop between first and second cervical nerves to trunk ganglion of vagus and through meningeal branches of vagus 7,p71 or by way of internal carotid nerve to pial sympathetic plexuses4 7,p7 ,the connection of the first1 second1 or third cervical with cerebral meningitis is established clinically but there is still doubt as to the explanation4 ,eye and ,muscles1 ,retina1 ,optic ,nerve3 ,the external muscles of the eye1 the four recti and two oblique with the levator palpebrae superioris1 are innervated by the ,oculomotor1 or third cranial1 and the fourth and sixth cranial1 which receive branches from the cavernous plexus of the sympathetic derived from the internal carotid branch of the superior cervical ganglion4 ,as the ganglion lies in front of the transverse processes of the second1 third1 and fourth cervical vertebrae1 direct impingement upon it by subluxation of one of these vertebrae may cause strabismus or other affection of the external ocular muscles4 ,the eye-ball receives filaments from the ciliary or ophthalmic ganglion1 which in turn is connected with the cervical ganglion by way of cavernous plexus and internal carotid nerve4 ,this pathway controls the radial fibres of the iris and dilates the pupil as a part of the light accommodation reflex mechanism4 ,loss of pupillary reaction1 especially with small pupils1 suggests upper cervical subluxation4 ,the retina1 containing the cells of origin of the optic nerve axons and being the special end-organ of the sense of sight has no direct spinal or sympathetic connections but its blood-supply1 and therefore its nutrition1 is influenced by branches from the sympathetic which enter with the central artery of the retina4 ,retinal hemorrhage has been cured by cervical adjustment1 ,c #b1 #c1 or #d4 ,the conjunctiva is innervated by the sympathetic and by the fifth cranial1 or trigeminal4 ,olfactory ,nerve3 ,nerve of smell1 distributed to the ,schneiderian membrane over the upper portion of the nasal septum and over the upper lateral wall4 ,there is no known connection by which the trunk of the olfactory nerve can be reached by adjustment but the condition of the special end organs in the membrane and their ability to functionate depend not only upon the integrity of their axons but also upon the nutrition and moisture of the membrane in which they are embedded4 ,this is under the control of the ,vidian nerve and of branches from the spheno-palatine1 or ,meckel's ganglion1 both connected with the carotid plexus of the sympathetic and therefore responsive to adjustment of ,c #b1 #c1 or #d4 ,this is also the route by which epistaxis is usually checked4 ,the external nasal muscles1 like those of the rest of the face except some of the muscles of mastication1 get their supply from the facial nerve1 which connects with the sympathetic plexus on the middle meningeal artery4 ,it may be said parenthetically here that peripheral facial paralysis 7,bell's palsy7 yields to adjustment and proves the value of this connection4 ,the nasal integument is under the sensor control of the trigeminal and trophic disturbances may result from its involvement4 ,trigeminal ,nerve3 ,this is the great sensor nerve of the face and carries a motor division1 the inferior maxillary1 to some of the muscles of mastication1 as the temporal1 masseter1 and buccinator4 ,it has connected with it four ganglia1 which also receive sympathetic roots1 and the ganglion of origin of its sensor axons1 the ,gasserian or semilunar1 also receives direct sympathetic communications4 ,the importance of this communication is shown by the powerful effect of adjustment of third or fourth ,cervical for tic dolouroux4 ,ear3 ,the external ear receives branches from the vagus and from the first and second cervical nerves4 ,the middle ear and ,eustachian tube are supplied by the tympanic plexus made up of branches from the glosso-pharyngeal1 otic ganglion1 facial nerve and the small deep petrosal from the sympathetic on the carotid artery4 ,by all these routes communication from the third and fourth cervicals is possible but especially is the latter important4 ,the fourth cervical is the especially frequent subluxation with middle ear disease4 ,to the internal ear and auditory or acoustic nerve there appears to be no direct route from the spine4 ,it has not yet been conclusively established within the writer's knowledge that adjustments will affect auditory deafness but ,meniere's ,disease1 inflammation of the semicircular canals1 has been cured repeatedly by adjustments of ,atlas or ,axis1 by what route ,i am unable to state4 ,teeth and ,gums3 ,it is probable that the only connection between the vertebrae and the teeth is an afferent one by way of the trigeminal4 ,toothache may be stopped by adjustment of ,c #c1 or ,c #d1 but no evidence is at hand to show that the condition of the teeth is improved or that more than a temporary effect can be had4 ,trophic changes in the gums may be due to vascular disturbances controlled by the sympathetic4 ,tongue3 ,the hypoglossal1 motor nerve to both the intrinsic and extrinsic muscles of the tongue1 receives direct axons from the loop between the first and second ,cervical nerves4 ,sympathetic fibres pass to the blood-vessels and secreting glands of the tongue4 ,tonsils3 ,receive fibres from the spheno-palatine ganglion and by this means are brought under the domination of ,c #b1 #c1 and #d4 ,abundant clinical evidence in tonsilitis1 simple1 follicular1 and suppurative1 proves this to be the practically1 as well as anatomically1 correct nerve connection4 ,salivary ,glands3 ,the parotid receives branches from the great auricular nerve from the second and third cervical1 and from the sympathetic on the external carotid artery1 branches from the superior cervical ganglion4 ,the submaxillary and sublingual glands are connected with the submaxillary ganglion1 which receives a sympathetic root and which1 with the chorda tympani also carrying fibres derived from the sympathetic1 controls the secretions of these glands4 ,pharynx3 ,the pharyngeal plexus is a mixture of sensory axons from the glosso-pharyngeal1 motor components from the vagus and probably sensor from the same nerve1 and sympathetic branches from the superior cervical ganglion4 ,all of these may be influenced by the upper cervical adjustment4 ,larynx3 ,according to anatomy the larynx is innervated by the superior and inferior1 or recurrent1 branches of the vagus and by sympathetic branches from the superior cervical ganglion4 ,clinically the sixth cervical adjustment cures laryngitis and aphonia4 ,the explanation probably lies in the fact that the thyroid branches of the middle cervical ganglion1 lying in front of the transverses of the sixth1 communicate within the thyroid gland with the recurrent laryngeal and with the external laryngeal branch of the superior laryngeal4 ,thyroid ,gland3 8,the nerves to the thyroid are amyelinic and are derived from the middle and inferior ganglia of the sympathetic40 7,gray47 ,the middle cervical ganglia are situated in front of the transverse processes of the sixth cervical vertebra4 ,clinically1 the sixth cervical reaches goitre4 ,muscles of ,neck3 ,the platysma is supplied by the facial nerve2 the sternomastoid by the spinal accessory and cervical plexus2 the infrahyoid region by the first three cervical nerves2 the suprahyoid region by the facial and the ansa cervicalis2 the anterior and lateral vertebral muscles by the cervical nerves from second to seventh inclusive1 but especially the second1 third1 and fourth4 ,it will be seen that muscular disturbance in the neck may result from any cervical subluxation4 ,torticollis1 which usually involves the sternomastoid1 yields to the second cervical most frequently4 ,lymph ,nodes of ,head and ,face3 ,these lymph nodes are controlled by the cervical sympathetic4 ,pathological changes in one or more nodes requires careful cervical palpation to determine the presence of a subluxation away from the affected side4 ,muscles of ,back3 ,the trapezius is innervated by the spinal accessory and by the third and fourth cervical nerves2 the latissimus dorsi by the sixth1 seventh1 and eighth cervical through the middle or long subscapular4 ,occasionally a tender nerve1 traceable from the lower reaches of the latissimus to the cervical region has mislead the practitioner into imagining a cervical connection over the back with internal viscera4 ,the second layer of the back is supplied by the third1 fourth1 and fifth cervical nerves4 ,the third layer is innervated by the middle and lower cervical and upper three thoracic nerves except the serratus posticus inferior which is supplied by the ninth1 tenth1 and eleventh thoracic4 ,the fourth and fifth layer are supplied by the posterior primary divisions of the spinal nerves and any given section of these layers may be traced to a vertebra directly above1 or cephalad4 ,thoracic ,walls3 ,the parietal muscles of the thorax are innervated by the intercostal nerves and a very definite segmental association with the spine is traceable4 ,diaphragm3 ,phrenic nerve1 which arises from fourth cervical chiefly2 lower intercostals1 especially eighth and ninth2 and phrenic plexus of the sympathetic which may sometimes be reached from the fourth or fifth dorsal vertebrae through the gangliated cord4 ,for motor disturbances of the diaphragm adjust fourth cervical4 ,abdominal ,muscles3 ,these are supplied by the lower intercostals and the transversalis and internal oblique make connection with ,l #a by the iliohypogastric4 ,cremaster is supplied by ,l #a and #b by way of the genital branch of the genitofemoral4 ,perineal ,muscles3 ,the anterior perineal group are supplied by the perineal branch of the internal pudic which traces to the second1 third1 and fourth sacral nerves4 ,the posterior perineal and ischiorectal region is also supplied by the sacral and coccygeal nerves4 ,trachea and ,bronchi3 ,vagus and sympathetic filaments from first and second thoracic ganglia4 ,the latter receive preganglionic fibres from first dorsal nerve in all probability1 as this adjustment reaches the bronchi4 ,lungs3 ,the third thoracic ganglia connect with the pulmonary plexus and establish a connection from third dorsal vertebra direct to the lung parenchyma4 ,the ,pleurae have a similar connection or may sometimes be reached by the first dorsal4 ,heart and ,pericardium3 ,in #ee of all heart disease or improper action the second dorsal is responsible2 in #dj the first dorsal1 and perhaps in the remaining #e the atlas or axis4 ,the former nerves 7,t #a and #b7 furnish pre-ganglionic fibres which stream upward through the gangliated cord to terminate in the three cervical ganglia in relation with the dendrites of new neurons 7amyelinic7 which form the superior1 middle1 and inferior cardiac nerves and pass into the thorax to mingle with vagal fibres to form the superficial and deep cardiac plexuses1 controlling the heart4 ,probably the upper cervicals occasionally affect the vagus through the loop between the first and second cervical nerves4 ,thoracic ,aorta3 ,controlled by sympathetic from first thoracic ganglion or last cervical ganglion1 and thus by seventh cervical or first dorsal vertebra4 ,abdominal aorta--,coeliac ,axis3 ,the upper portion of the abdominal aorta is innervated by the coeliac or solar plexus of the sympathetic4 ,sub-plexuses from the coeliac accompany the various branches of the aorta and are widely distributed to the blood-vessels and to the glands and non-striated muscle of the abdominal organs4 ,the coeliac plexus receives fibres from the right vagus and from the greater1 lesser1 and least splanchnic nerves1 by the latter route making connection with the thoracic ganglia of the sympathetic from fifth to last4 ,these ganglia receive pre-ganglionic fibres from the thoracic spinal nerves in the form of white rami communicantes1 so that it is not incorrect to say that the coeliac plexus and its branches are largely controlled by the condition of the last eight thoracic nerves4 ,through this intricate plexus it is difficult to trace the relations of each abdominal organ with the particular vertebrae of which subluxation would produce disease in said organ4 ,by the aid of clinical experimentation covering a period of years and by diligent search among anatomies and physiologies1 we have arrived at the conclusions indicated in succeeding statements4 ,the most important spinal connection with the abdominal blood-vessels is that of the fifth dorsal vertebra1 for the fifth dorsal nerve1 by its rami1 seems greatly to influence the caliber of the aorta and coeliac axis4 ,illustration3 ,a4 ,cortico ,spinal nerve4 ,b4 ,spino ,ganglionic nerve4 ,c4 ,ganglio ,ganglionic nerve4 ,d4 ,ganglio ,peripheric nerve4 ,e4 ,blood ,vessel ,wall4 ,parker ,fig4 #cb4 ,schematic representation of nerve pathway from brain to periphery by way of sympathetic4 ,liver3 ,fourth thoracic nerves 7especially the right7 to gangliated cord1 via great splanchnic nerve to coeliac plexus1 by hepatic plexus to interior of liver4 ,the hepatic plexus gives off the cystic plexus which controls the gall-bladder4 ,stomach3 ,sixth and seventh dorsal nerves by white rami to and through the ganglia of the gangliated cord to coeliac plexus4 ,the gastric plexus is an offshoot of the coeliac and gives off ,auerbach's plexus to the muscular coat1 and ,meissner's plexus to the submucous and mucous coats of the stomach4 ,the nutrition of the stomach walls1 their peristaltic action1 and the secretory action of the stomach glands are thus brought under the direct influence of the sixth or the seventh dorsal subluxation4 ,pancreas3 ,eighth dorsal nerve by great splanchnic to coeliac plexus1 to hepatic and superior mesenteric plexuses1 and by the pancreatico-duodenal branches of the former and pancreatic branches of the latter to the pancreas4 ,spleen3 ,the coeliac plexus1 the left semilunar ganglion1 and the left vagus and right phrenic nerves give off branches which form the splenic plexus4 ,spinal connection by way of ninth dorsal nerve1 by rami communicantes to gangliated cord to great splanchnic nerve to coeliac plexus to splenic plexus4 ,many nerve pathways like this one are less indirect than they sound2 various names have been given to different parts of the same pathway through which1 often1 the axons pass without interruption4 ,on the way from the cerebral cortex to one of the abdominal viscera there may be only three1 sometimes four or five1 neurons connected end to end4 ,duodenum3 ,coeliac plexus by way of duodenal branches of hepatic plexus and branches from the superior mesenteric plexus4 ,spinal connection from eighth dorsal nerve and possibly branches from the upper lumbar ganglia of the sympathetic may join the superior mesenteric plexus1 as results in duodenal disease are occasionally reported following specific adjustment of ,l #a or #b4 ,jejunum and ,ileum3 ,connection same as for duodenum1 by superior mesenteric plexus4 ,adjustment of ,l #b in typhoid fever is undoubtedly correct so that it is probable that the lumbar ganglia send branches to this vicinity4 ,peritoneum3 ,nerve supply to the peritoneum is rather general owing to its great extent4 ,it is supplied by the sympathetic from both the lower thoracic and lumbar portions of the gangliated cord through the various abdominal plexuses and in general it may be said that any localized peritoneal disease will yield to the same adjustment as would be made for disease in the immediately subjacent organ4 ,suprarenal ,capsules3 ,these important glands are supplied by amyelinic fibres derived from the gangliated cord by the lesser splanchnic nerve and connecting with pre-ganglionic fibres from the tenth dorsal nerve4 ,the suprarenal plexus is an offshoot of the coeliac4 ,kidneys3 ,tenth1 eleventh1 and twelfth dorsal nerves by way of lesser and least splanchnic nerves to renal plexus1 an offshoot of the coeliac4 ,mc,connell's experiments and the frequently duplicated clinical feats of ,chiropractors prove this to be a vital and dominant nerve pathway in kidney disease4 ,ureters3 ,nerves derived from inferior mesenteric1 pelvic1 and spermatic plexuses4 ,most important connection seems to be from first lumbar nerve by lumbar ganglia to inferior mesenteric plexus4 ,caecum and ,vermiform ,appendix3 ,the inferior mesenteric plexus1 which supplies these organs probably carries to them chiefly fibres derived from the lumber ganglia which complete a connection with the second lumbar vertebra1 especially on the right side4 ,colon3 ,third and fourth lumbar vertebrae1 influencing lumbar ganglia and thus inferior mesenteric plexus4 ,rectum3 ,lower lumbar ganglia by inferior mesenteric and plevic plexuses1 through superior and inferior hemorrhoidal plexus to rectum4 ,adjustment ,l #d or #e4 ,visceral branches from the third and fourth sacral nerves also pass directly to the rectal wall and sacral adjustment may affect rectum or anus4 ,bladder3 ,the urinary bladder is innervated by the vesical plexus from the pelvic1 and by sacral nerve fibres direct4 ,it is said that the vesical plexus contains many spinal nerve fibres which are derived from the second and fourth lumbar nerves especially4 ,clinically the second or the fourth lumbar will control the bladder much oftener than the sacrum4 ,prostate ,gland1 ,seminal ,vesicles1 ,penis1 and ,urethra3 ,by the vesical and prostatic plexuses derived from the pelvic plexuses1 divisions of the hypogastric plexus1 which is formed of the abdominal aortic plexus and filaments from the lumbar ganglia4 ,the latter receive filaments from the second and third lumbar nerves4 ,there is a connection with the sacral nerves also by the pelvic plexus1 though the lumbar adjustment appears the more potent4 ,testes and ,scrotum3 ,ilioinguinal from second lumbar1 genital branch of genito-femoral from second and third lumbar nerves1 internal pudic nerve from the pudendal plexus1 and spermatic and pelvic plexuses4 ,the most effective adjustment for scrotal or testicular diseases is ,l #c4 ,uterus and ,vagina3 ,uterovaginal plexus from the pelvic and containing spinal nerve fibres from ,l #d1 ,l #e1 and sacrum4 ,ovaries and ,fallopian ,tubes3 ,the ovarian plexus receives fibres from the abdominal aortic and through it from the lumbar ganglia1 influenced by second lumbar adjustment4 ,brachial ,plexus3 ,the brachial plexus of spinal nerves arises from the nerves from the fifth cervical to the first thoracic inclusive and controls the voluntary muscles of the upper extremity1 with its integument4 ,muscle groups1 rather than single muscles1 are represented for the most part in the spinal segments giving off these nerves1 and the ramification of the nerves within the plexus is such that almost any given muscle might be affected by more than one spinal subluxation4 ,below are given the principal connections3 ,pectoralis ,major and ,minor ,muscles3 ,sixth or seventh cervical through internal anterior thoracic nerve and first dorsal through external anterior thoracic4 ,shoulder ,joint3 ,the joint1 muscles covering the joint1 and integument of this region are innervated by the circumflex nerve which traces through the plexus to fifth and sixth cervical nerves4 ,sixth cervical adjustment usually affects this joint4 ,serratus ,magnus ,muscle3 ,sixth cervical by long thoracic1 or ,external ,respiratory ,nerve of ,bell4 ,elbow ,joint3 ,sixth cervical vertebra by musculocutaneous nerve4 ,anterior ,arm ,muscles3 ,sixth cervical4 ,posterior ,arm ,muscles3 ,seventh cervical and first dorsal4 ,lumbosacral ,plexus3 ,this plexus1 derived from the anterior primary divisions of the lumbar1 sacral1 and coccygeal nerves1 supplies the muscles and integument of the lower extremity1 taking with it axons derived from the sympathetic by the lumbar ganglia to supply the blood-vessels1 perspiratory glands and sebaceous glands of this region4 ,the latter are responsive to adjustments of the first or second lumbar vertebrae4 ,hip-,joint3 ,third and fourth lumbar nerves by femoral and obturator or accessory obturator nerves and fifth lumbar or first sacral by the nerve to the quadratus femoris or the great sciatic4 ,fourth lumbar seems the most potent connection and is usually adjusted for hip-joint disease4 ,psoas ,magnus ,muscles3 ,anterior branches of the second and third lumbar nerves4 ,anterior ,thigh ,muscles3 ,supplied mostly through the femoral nerve from the second and third lumbar nerves4 ,internal ,thigh ,muscles3 ,second and third lumbar nerves 7chiefly but not wholly7 through the obturator1 accessory obturator and femoral nerves4 ,gluteus ,maximus3 ,from the fifth lumbar and first and second sacral nerves through the inferior gluteal branch of the sacral plexus4 ,obturator ,externus3 ,second1 third1 and fourth lumbar nerves through the obturator nerve4 ,posterior ,thigh ,muscles3 ,fourth and fifth lumbar and sacral nerves through the great sciatic4 ,great ,sciatic ,nerve3 ,this great nerve1 direct continuation of the sacral plexus1 arises from the fourth and fifth lumbar and first three or four sacral nerves and is widely distributed to muscles and integument of the lower extremity4 ,sciatica1 or sciatic rheumatism1 is most commonly relieved by adjustment of fourth or fifth lumbar vertebra2 but there is a condition commonly diagnosed as sciatica which is really a sciatic neuritis and due to vasomotor disturbance affecting the blood-supply to the nerve trunk4 ,this responds to adjustment of first or second lumbar because the amyelinic fibres which control these blood-vessels are derived from lumbar ganglia of the sympathetic4 ,anterior ,leg ,muscles3 ,fourth and fifth lumbar and first sacral nerves through the anterior tibial4 ,posterior ,leg ,region3 ,fourth and fifth lumbar and first and second sacral through the internal popliteal and posterior tibial4 ,knee-,joint3 ,this joint receives branches from the great sciatic through both internal and external popliteal1 and from the femoral and obturator4 ,it is therefore connected with the lower lumbar and sacrum and with the second lumbar4 ,the latter connection seems oftenest involved in knee joint inflammations4 ,foot3 ,fourth and fifth lumbar and sacral nerves through the great sciatic and its branches4 ,sensor ,areas of ,lower ,extremity3 ,in general1 any given cutaneous area receives sensor branches from the nerve which supplies the subjacent muscle area4 ,for accurate diagnostic purposes a good chart of sensor distribution may be consulted4 ,,diseases ,,and ,,adjustments ,the appended list includes the diseases with which the profession has had experience but is not in any sense a complete list of diseases4 ,it is merely intended for quick and handy reference4 ,in obscure cases or diseases not mentioned it is suggested that the practitioner carefully diagnose the case with reference to the location of the morbid process and then refer to ,special ,nerve ,connections to find the nerve pathway between the spine and the organ indicated as the seat of the disease4 ,standard works on anatomy and physiology will explain more fully the paths and functions of the nerves but information gleaned from them must be sought out and pieced together from scattered statements and discussions4 ,a ,disease ,adjustment4 ,abscess ,according to location4 ,accommodative iridoplegia ,c #c or #d4 ,acid stomach ,d #f or #g4 ,acne ,d #aa or #ab4 ,acoria ,d #f or #g4 ,acromegaly ,c #a or #b1 ,d #aj1 #aa1 or #ab4 ,addison's disease ,d #aj4 ,adenitis ,according to location4 ,adenoids of pharynx ,c #b or #c4 ,adiposis dolorosa ,d #h and ,d #aa or #ab4 ,adrenals1 tuberculosis of ,d #aj4 ,ageusia ,c #a or #b4 ,ague ,d #d1 ,d #i1 ,d #aa or #ab4 ,albuminuria ,d #aj1 #aa1 or #ab4 ,albumosuria ,d #h1 ,d #aj1 #aa or #ab4 ,alcoholism ,c #a1 ,d #aj1 #aa or #ab4 ,amenorrhoea ,l #d or #e4 ,amnesia ,c #a or #b4 ,amyosthenia ,general4 ,amyloid liver ,d #d4 ,amyloid kidney ,d #aj1 #aa or #ab4 ,anachlorhydria ,d #f or #g4 ,anaemia ,d #d1 ,d #i and ,d #aa or #ab4 ,sometimes ,l #d4 ,anaesthesia1 general ,c #a or #b4 ,anasarca ,d #aj1 #aa or #ab4 ,aneurism ,d #a or according to location4 ,angina pectoris ,d #b4 ,aniscoria ,c #d4 ,anorexia nervosa ,c #a1 ,d #f or #g4 ,anosmia ,c #a or #b1 ,c #d4 ,anthracosis ,d #c4 ,anterior poliomyelitis ,c #c or #d4 local zones for permanent paralyses following4 ,anuria ,d #aj1 #aa or #ab4 ,or ,l #b or #d4 ,aortic stenosis ,d #b4 ,aphasia ,c #a or #b4 ,aphonia ,c #f4 ,aphthous stomatitis ,c #b4 ,apoplexy ,c #b1 #c4 ,appendicitis ,l #b4 ,apraxia ,c #a or #b4 ,argyll-,robertson pupil ,c #a or #b4 ,arrhythmia ,c #b or ,d #b4 ,arteriosclerosis ,d #aj1 #aa or #ab and local4 ,arteritis ,according to location4 ,arthritis ,according to location4 ,arthritis deformans ,d #aj1 #aa or #ab and according to location4 ,ascarides ,l #b or #c4 ,ascites ,d #d4 ,asphyxia1 gas ,d #b or #c1 ,atlas 7,first aid only74 ,asthenia ,to correct disease producing same4 ,asthenopia ,c #d4 ,asthma ,d #a4 ,ataxia1 cerebellar ,c #a or #b4 ,ataxia1 locomotor ,general adjustment4 ,athetosis ,c #a or #b4 ,atrophic cirrhosis of liver ,d #d4 ,atrophy ,according to location4 ,aural discharges ,c #a1 #b1 #c or #d4 ,b ,back1 pain in ,according to location4 ,barber's itch ,c #e1 ,d #aj1 #aa or #ab4 ,bell's palsy ,c #b1 #c or #d4 ,biliousness ,d #d4 ,blepharitis ,c #c or #d4 ,blepharospasm ,c #c or #d4 ,blindness ,c #a1 #b1 #c or #d4 8,blood poisoning0 ,d #aj1 #aa or #ab and local4 ,boils ,d #aj1 #aa or #ab and according to location4 ,bradycardia ,d #a or #b1 possibly ,c #b4 ,bright's disease ,d #aj1 #aa or #ab4 ,bronchitis ,d #a4 ,bronchiectasis ,d #a4 ,broncho-pneumonia ,d #a1 ,d #c4 ,c ,caked breast ,d #c4 ,calculi1 cystic ,l #b or #d4 ,calculi1 hepatic ,d #d4 ,calculi1 renal ,d #aj1 #aa or #ab4 ,cancer ,no cure4 ,cancrum oris ,c #b or #c1 ,d #aa or #ab4 ,canker 7mouth7 ,c #b4 ,carbuncle ,according to location4 ,carcinoma ,no cure4 ,caries of spine ,according to location4 ,see 8,prognosis40 ,cataract ,c #b1 #c1 or #d4 ,catarrh1 nasal ,c #d4 ,catarrhal gastritis ,d #f or #g4 ,catarrhal stomatitis ,c #b or #c4 ,cerebral abscess ,c #a or #b4 ,cerebrospinal meningitis ,c #b4 ,cervical glands1 enlargement of ,any cervical4 ,cervico-brachial neuralgia ,c #f4 ,cervico-occipital neuralgia ,c #a or #b4 ,chickenpox ,c #e1 ,d #aj1 #aa or #ab4 ,chills ,d #e4 ,chlorosis ,d #d1 ,d #i1 ,d #aa or #ab4 ,cholangitis ,d #d4 ,cholecystitis ,d #d4 ,cholelithiasis ,d #d4 ,cholera infantum ,d #e or #f1 ,d #aj1 #aa or #ab1 ,l #b4 ,chorea ,c #a or #b4 ,chyluria ,d #h1 ,d #aa or #ab4 ,cirrhosis of liver ,d #d4 ,claw hand ,c #f or #g or ,d #a4 ,clubfoot ,l #d or #e4 ,colic1 hepatic ,d #d4 ,colic1 renal ,d #aj1 #aa or #ab4 ,colitis ,l #b or #c4 ,collapse ,c #a1 ,d #b1 and according to associated condition4 ,coma ,according to cause4 ,conjunctivitis ,c #c or #d4 ,constipation ,d #d1 ,d #aj1 or ,l #c1 #d or #e4 ,contractures ,according to location4 ,coryza ,c #d4 ,coxalgia ,l #d4 ,cramp ,according to location4 ,croup ,c #b or ,c #f4 ,cutaneous eruptions ,d #aj1 #aa or #ab4 ,cyanosis ,d #b1 ,d #c or ,c #b4 ,cystitis ,l #b or ,l #d4 ,d ,deafness1 catarrhal ,c #d4 ,deafness1 central ,c #a or #b 7,p74 ,delirium ,c #a or #b4 ,dementia ,c #a4 ,dengue ,d #e1 ,d #aj1 #aa or #ab 7,p74 ,dentition1 disorders of ,d #f or #g4 ,diabetes insipidus ,d #aj1 #aa or #ab4 ,diabetes mellitus ,d #d1 ,d #h1 ,d #aa or #ab4 ,diarrhoea ,d #aj1 #aa or ,l #b1 #c4 ,dilatation of heart ,d #b4 ,diphtheria ,c #b1 ,c #f and ,d #aa or #ab4 ,dipsomania ,c #a or #b1 ,d #aa or #ab4 ,dropsy1 abdominal ,d #d4 ,dropsy1 cardiac ,d #b4 ,dropsy1 renal ,d #aj1 #aa or #ab4 ,duodenal ulcer ,d #h or #i4 ,duodenitis ,d #h or #i4 ,dysentery ,l #b1 #c1 or #d and ,d #aa or #ab4 ,dysmenorrhoea ,l #d4 ,dyspepsia ,d #g4 ,dysphagia ,c #b or ,d #f or #g 7,p74 ,dyspnea ,d #a or ,d #b or ,d #c4 ,dysuria ,l #b or ,l #d or sacrum4 ,e ,earache ,c #b or ,c #d4 ,ecchymoses ,d #aa or #ab4 ,eczema ,d #aa or #ab and according to location4 ,embolism1 cerebral ,c #b or #c4 ,emphysema ,d #c4 ,encephalitis ,c #a1 #b or #c4 ,endocarditis ,d #b4 ,enlarged glands ,according to location4 ,enlarged heart ,d #b4 ,enlarged liver ,d #d4 ,enlarged tonsils ,c #b or #c4 ,enteralgia ,d #i or #aj1 or ,l #a or #b4 ,enteritis ,d #i or #aj1 or ,l #a or #b4 ,enterocolitis ,d #i or #aj1 or ,l #a1 #b or #c4 ,enteroptosis ,d #i1 #aj1 #aa or ,l #a1 #b1 #c4 ,enterospasm ,d #i or #aj1 or ,l #a or #b4 ,enuresis ,l #b or #d4 ,epilepsy ,c #a or #b1 sometimes ,l #c4 ,epistaxis ,c #d4 ,epithelioma ,no cure4 ,eructations ,d #f or #g4 ,eruptions1 cutaneous ,d #aa or #ab4 ,erysipelas ,c #e and ,d #aa or #ab4 ,exophthalmic goitre ,c #f or #g4 ,f ,facial hemiatrophy ,c #a or #b4 ,facial paralysis ,c #a or #b4 ,faecal obstruction ,l #b1 #c or #d4 ,fainting ,d #b4 ,false angina ,c #a or #b4 ,fatty degeneration of heart ,d #b4 ,fatty degeneration of liver ,d #d4 ,fatty infiltration of heart ,d #b4 ,fatty infiltration of liver ,d #d4 ,felon ,c #f or #g or ,d #a4 ,fever ,d #e4 ,locate organ of origin4 ,fibroid tumor ,according to location4 ,follicular tonsilitis ,c #b or #c4 ,g ,gallstones ,d #d4 ,gangrene ,according to location4 ,gastralgia ,d #f or #g4 ,gastrectasia ,d #f or #g4 ,gastric neuroses ,d #f or #g4 ,gastric ulcer ,d #f or #g4 ,gastritis ,d #f or #g4 ,gastro-duodenitis ,d #g or #h4 ,gastroptosis ,d #f or #g4 ,gland1 mammary ,d #c4 ,glaucoma ,c #b or #c4 ,gleet ,l #c and ,d #aa or #ab4 ,glossitis ,c #b or #c4 ,glycosuria ,d #d and ,d #aa or #ab4 ,goitre ,c #f4 ,gonorrhoea ,l #c4 ,gonnorrhoeal rheumatism ,d #aa or #ab and ,l #c4 ,gout ,d #aa or #ab and ,l #d4 ,granulated lids ,c #d and ,d #aa or #ab4 ,h ,hay fever ,c #c or #d4 ,headache1 anaemia ,to correct anaemia4 ,headache1 bilious ,d #d4 ,headache1 neuralgic ,c #a4 ,headache1 neurasthenic ,c #a or #b4 ,headache1 ocular ,c #b or ,c #d4 ,headache1 of constipation ,d #d or ,d #i or #aj1 or ,l #d or #e4 ,headache1 toxic ,locate toxin-forming organ4 ,headache1 uterine ,l #d or #e or sacrum4 ,hematemesis ,d #f or #g4 ,hematuria ,d #aj1 #aa or #ab4 ,hemicrania ,c #a1 #b or #c4 ,hemiplegia ,c #b or #c4 ,hemoptysis ,d #c4 ,hemorrhoids ,l #d or #e or sacrum4 ,hepatic hyperemia ,d #d4 ,hepatoptosis ,d #d4 ,hernia1 diaphragmatic ,c #d 7,p74 ,hernia1 femoral ,l #d4 ,hernia1 inguinal ,l #b or #c4 ,hernia1 umbilical ,d #h4 ,herpes facialis ,c #d4 ,herpes zoster 7shingles7 ,vertebra above nerve involved4 ,hiccough ,c #d4 ,hodgkins' disease ,general adjustment4 ,hydrocele ,d #aj1 #aa or #ab and ,l #d4 ,hydrocephalus ,c #b and ,d #b4 ,hydronephrosis ,d #aj1 #aa or #ab4 ,hydropericardium ,d #b4 ,hydrothorax ,d #c4 ,hyperaemia ,according to location4 ,hyperaesthesia1 general ,c #a or #b4 ,hyperchlorhydria ,d #f or #g4 ,hypertrophy ,according to location4 ,hysteria ,c #b4 ,hystero-epilepsy ,c #b4 ,i ,icterus ,d #d4 ,icterus neonatorum ,d #d4 ,ileocolitis ,l #b1 #c or #d4 ,impacted gallstones in ducts ,d #d4 ,impotence ,l #c or sacrum4 ,incontinence of urine ,l #b or ,l #d4 ,incompetency1 aortic ,d #a or #b4 ,incompetency1 mitral ,d #a or #b4 ,incompetency1 pulmonary ,d #a or #b4 ,incompetency1 pyloric ,d #f or #g4 ,incompetency1 tricuspid ,d #a or #b4 ,infantile paralysis ,c #c or #d and according to location4 ,inflammation1 general ,d #e4 ,inflammation of appendix ,l #b4 ,inflammation of bladder ,l #b or #d4 ,inflammation of bowels ,d #i or #aj1 ,l #b1 #c or #d4 ,inflammation of bronchi ,d #a4 ,inflammation of kidneys ,d #aa or #ab4 ,inflammation of larynx ,c #f4 ,inflammation of lungs ,d #c4 ,inflammation of meninges ,c #a or #b4 ,inflammation of ovaries ,l #b or #c4 ,inflammation of pharynx ,c #b4 ,inflammation of pleurae ,d #c4 ,inflammation of stomach ,d #f or #g4 ,inflammation of vertebrae ,next above inflamed one4 ,inflammation of uterus ,l #d or #e4 ,influenza ,c #d1 ,d #a1 ,d #aa or #ab4 ,intestinal neuralgia ,d #i or #aj1 ,l #a or #b4 ,intestinal neuroses ,d #i or #aj1 ,l #a or #b4 ,intestinal obstruction ,see 8,practice40 ,intussusception ,see 8,practice40 ,insanity ,c #a or #b1 sometimes ,l #d4 ,insomnia ,c #b4 ,iritis ,c #c or #d4 ,j ,jaundice ,d #d4 ,k ,keratitis ,c #c or #d4 ,kyphosis ,see 8,curvatures40 ,l ,lactation1 disorders of ,d #c4 ,lacunar tonsilitis ,c #b or #c4 ,la grippe ,c #d1 ,d #a1 ,d #aa or #ab4 ,laryngeal paralysis ,c #f4 ,laryngismus stridulus ,c #f4 ,laryngitis ,c #f4 ,lateral spinal sclerosis ,according to location4 ,lead poisoning ,d #d1 ,d #aa or #ab4 ,leucaemia ,d #i and ,d #aa or #ab4 ,leucorrhoea ,l #d4 ,lipoma ,according to location4 ,lobar pneumonia ,d #c4 ,lockjaw ,c #a1 #b1 or #c4 ,locomotor ataxia ,general adjustment4 ,lordosis ,see 8,curvatures40 ,lumbago ,l #c1 #d or #e4 ,lumbo-abdominal neuralgia ,any ,lumbar4 ,m ,malaria ,d #d1 ,d #i1 and ,d #aa or #ab4 ,malignant endocarditis ,d #b and ,d #e or #f4 ,mastoiditis ,c #a or #b4 ,measles ,c #e1 ,d #aa or #ab4 ,memory1 disorders of ,c #a or #b4 ,meniere's disease ,c #a or #b4 ,meningitis ,c #a or #b4 ,menorrhagia ,l #d4 ,metrorrhagia ,l #d4 ,migraine ,c #a1 #b1 or #c4 ,mitral incompetency ,d #b4 ,mitral stenosis ,d #b4 ,monoplegia ,according to location4 ,mouth breathing ,c #d or #e4 ,movable kidney ,d #aa or #ab4 ,mucous colic ,d #aj or ,l #c4 ,mumps ,c #d4 ,mutism ,c #a or #b or ,c #f4 ,myelitis ,according to location4 ,myocarditis ,d #b4 ,myopia ,c #d4 ,myositis ossificans ,according to location1 also ,d #aa or #ab4 ,myxoedema ,c #f4 ,n ,nephritis ,d #aj1 #aa or #ab4 ,nephrolithiasis ,d #aj1 #aa or #ab4 ,nephroptosis ,d #aj1 #aa or #ab4 ,neuralgia1 trigeminal ,c #c or #d4 ,neuralgia1 brachial ,c #f or #g or ,d #a4 ,neuralgia1 intercostal ,according to location4 ,neuralgia1 of feet ,l #d1 ,l #e or sacrum4 ,neurasthenia ,c #b4 ,neuritis ,according to location4 ,nodding spasm ,c #a or #b4 ,nystagmus ,c #a1 #b1 #c or #d 7,p74 ,o ,obesity1 pathological ,d #h and ,d #aa or #ab4 ,obstruction1 intestinal ,see 8,practice40 ,oculomotor paralysis ,c #b or #c4 ,oedema ,according to location4 ,optic atrophy ,c #c or #d4 ,optic neuritis ,c #c or #d4 ,orchitis ,l #c4 ,otitis media ,c #d4 ,ovarian disease ,l #b4 ,p ,pachymeningitis ,c #b4 ,pallor ,d #b or to correct anaemia4 ,palpitation ,d #b or ,c #b4 ,pancreatic calculi ,d #h4 ,pancreatic hemorrhage ,d #h4 ,pancreatitis ,d #h4 ,paralysis agitans ,c #a or #b4 ,paralysis1 brachial ,c #f or #g or ,d #a4 ,paralysis1 crural ,l #d or ,l #e4 ,paralysis1 facial ,c #a or #b4 ,paralysis1 diplegic ,c #a or #b4 ,paralysis1 hemiplegic ,c #a or #b4 ,paralysis1 monoplegic ,according to location4 ,paralysis1 sensory ,according to location4 ,parageusia ,c #a or #b4 ,paratyphoid fever ,l #b4 ,parosmia ,c #b or #c4 ,parotitis ,c #d4 ,pericarditis ,d #b4 ,perihepatitis ,d #d4 ,perinephric abscess ,d #aj1 #aa or #ab4 ,peritonitis ,d #i1 #aj and ,l #b1 #c or #d4 ,pertussis ,c #f1 ,d #a4 ,pharyngitis ,c #b or #c4 ,photophobia ,c #a or #b or ,c #d4 ,plantar neuralgia ,l #d or #e4 ,pleurisy ,d #c4 ,pleurodynia ,d #c4 ,pneumonia ,d #c4 ,priapism ,l #c or sacrum4 ,proctitis ,l #d or #e4 ,prolapsed kidney ,d #aa or #ab4 ,prolapsed uterus ,l #d or #e4 ,prostatic disease ,l #d or #e or sacrum4 ,ptosis ,c #d4 ,puerperal fever ,l #d1 ,d #e1 and ,d #aa or #ab4 ,pulmonary incompetence ,d #b4 ,pulmonary phthisis ,d #c4 ,pulmonary stenosis ,d #b4 ,pyelitis ,d #aa or #ab4 ,pyelonephrosis ,d #aa or #ab4 ,pyaemia ,d #e or #f and ,d #aj1 #aa or #ab4 ,q ,quinsy ,c #b or #c4 ,r ,rabies ,c #a or #b1 ,d #aj1 #aa or #ab4 ,rachitis ,see 8,adjustment of ,curvatures40 ,raynaud's disease ,c #f or #g or ,d #a1 or ,l #d or #e4 ,rectal fistula ,l #d or #e4 ,rectal neuralgia ,l #d or #e4 ,relapsing fever ,d #e1 ,d #i and ,d #aa or #ab4 ,renal colic ,d #aj1 #aa or #ab4 ,retinal hemorrhage ,c #d4 ,retinitis ,c #d4 ,retropharyngeal abscess ,c #b or #c4 ,rheumatic fever ,d #e or #f1 ,d #aa or #ab4 ,rheumatism ,d #aa or #ab and according to location4 ,rhinitis ,c #d4 ,roseola ,d #aj1 #aa or #ab4 ,rubella ,c #e1 ,d #f1 ,d #aa or #ab4 ,rubeola ,see 8,measles40 ,s ,salivation ,c #b1 #c or #d4 ,salpingitis 7,eustachian7 ,c #d4 ,salpingitis 7,fallopian7 ,l #b4 ,sarcoma ,no cure4 ,scarlatina ,c #e1 ,d #f1 ,d #aa or #ab4 ,scarlet fever ,c #e1 ,d #f1 ,d #aa or #ab4 ,sciatica ,l #d or #e1 or sacrum4 ,sclerosis ,according to location4 ,scoliosis ,see 8,curvatures40 ,scrofula ,d #aa or #ab and locally4 ,seminal emissions ,l #c4 ,septicaemia ,d #e1 ,d #aa or #ab1 and for site of entrance of toxins4 ,smallpox ,c #e1 ,d #e1 ,d #aj1 #aa or #ab4 ,sneezing ,c #d4 ,softening of brain ,c #b4 ,spasm ,according to location4 ,spermatorrhoea ,l #c4 ,splanchnoptosis ,caudad of ,d #e according to palpation4 ,splenic enlargement ,d #i4 ,splenitis ,d #i4 ,splenoptosis ,d #i4 ,spondylitis ,deformans ,general adjustment4 ,stenosis ,according to location4 ,stomatitis ,c #b1 #c or #d4 ,strabismus ,c #c or #d4 ,sudamina ,d #aj1 #aa or #ab4 ,sunstroke ,c #b1 ,d #b1 ,d #aa or #ab4 ,suppression of urine ,d #aa or #ab4 ,syncope ,d #b4 ,syphilis1 primary ,according to location of ulcer4 ,syphilis1 secondary ,d #e or #f1 ,d #aa or #ab4 ,syphilis1 tertiary ,no cure4 ,t ,tabes dorsalis ,general adjustment4 ,tapeworm ,d #h1 #i or #aj1 ,l #b or #c4 ,tenesmus ,l #d or #e4 ,tension1 high arterial ,d #e4 ,testicles1 pendulous ,l #c4 ,tetanus ,c #d1 ,d #e1 ,d #aj1 #aa or #ab4 ,thrush ,c #b or #c4 ,tic dolouroux ,c #c or #d4 ,tinnitus aurium ,c #a or #b4 ,tonsilitis ,c #b or #c4 ,toothache ,c #d4 ,torticollis ,c #b1 #c or #d4 ,toxaemia ,d #aa or #ab and local according to indications4 ,toxic gastritis ,d #f or #g4 ,tricuspid incompetency ,d #b4 ,tricuspid stenosis ,d #b4 ,trigeminal neuralgia ,c #c or #d4 ,tuberculosis of any organ ,see 8,special ,nerve ,connections0 to organ diseased4 ,tuberculosis1 general ,d #e or #f1 ,d #aa or #ab4 ,tuberculosis1 pulmonary ,d #c4 ,tumor ,according to location4 ,typhoid fever ,l #b4 ,typhus fever ,d #e and ,l #b 7,p74 ,u ,ulceration ,according to location4 ,ulnar neuritis ,d #a4 ,ununited fracture ,according to location4 ,uraemia ,d #aj1 #aa or #ab4 ,urethritis ,l #c4 ,urticaria ,d #aj1 #aa or #ab4 ,uterine catarrh ,l #d4 ,uteroversion ,l #d4 ,v ,vaccinia ,d #e1 ,d #aj1 #aa or #ab and for site of inoculation4 ,vaginitis ,l #c4 ,valvular lesions ,d #b4 ,varicella ,d #e or #f1 ,d #aj1 #aa or #ab4 ,varicocele ,l #c4 ,varicose veins of lower extremities ,l #b1 #c or #d4 ,variola ,same as ,smallpox4 ,varioloid ,same as ,smallpox4 ,vertigo ,c #a or #b4 ,locally for toxic vertigo4 ,vomiting1 pernicious ,d #f or #g or ,c #a4 ,w ,whooping-cough ,c #f1 ,d #a4 ,writer's ,cramp ,c #f or #g or ,d #a4 ,worms1 stomach ,d #f or #g4 ,worms1 intestinal ,any ,lumbar4 ,wryneck ,c #b1 #c or #d4 ,x ,xerostomia ,c #b4 ,y ,yellow fever ,d #d1 ,d #f1 ,d #aj1 #aa or #ab 7,p74 ,,conclusion ,the correct use of the foregoing table depends entirely upon correct diagnosis4 ,knowledge of the vertebra to be adjusted for the correction of any disease is useless unless the disease be recognized when met4 ,diagnosis may be1 and usually is1 aided by ,palpation and ,nerve-,tracing1 which may be considered as divisions of diagnosis since the subluxation and the tender nerve are evidences 7symptoms7 of disease4 ,but these two divisions can never wholly take the place of a complete diagnosis which calls to the aid of the examiner every harmless method of ascertaining the patient's condition4 ,the part may not suffice for the whole4 ,the ,chiropractor has an opportunity to become the best of diagnosticians because he has at his command all the usually taught methods and in addition ,palpation and ,nerve-,tracing1 which are especially useful in differential diagnosis4 7,see 8,schedule of ,examination407 ,the profession is at present lamentably weak in diagnosis and as long as they remain so they will fail to achieve the possible maximum of results from the application of a theory which1 per se1 is applicable to all disease but which is often imperfectly applied in practice4 ,,practice ,introduction ,the ensuing section is intended rather more for the use of the practitioner than for the guidance of the student but may furnish the student a preconception which will prepare him somewhat1 before leaving college1 to meet the problems of practice4 ,just as too frequently the young ,chiropractor overlooks the fundamental logic of ,chiropractic which may be epitomized with the terse command1 8,adjust the cause10 and considers his practice as requiring him to dabble in every suggested or discovered method of treating effects1 so1 too frequently1 the young ,chiropractor is prone to consider that his practice consists solely of the adjustment of vertebrae1 that he practices a mechanic art rather than a profession2 too frequently he overlooks the thousand details which lead to and surround the adjustment and are essential to its success4 ,the practice of ,chiropractic involves more than correct technic4 ,it includes the use of a vast fund of knowledge2 the constant study of diseases and of patients2 the art of controlling and directing others sometimes in their very trivial acts4 ,successful practice requires a proper setting1 proper business methods1 and a knowledge of psychology4 ,anyone entering upon a profession assumes a great moral responsibility and the greatest responsibility of all falls upon the doctor1 of whatever school4 ,he enters the stricken home at a time when all members of the household are off guard1 as it were1 at a time when all turn to him as to one of higher knowledge and of greater power for their guidance and often for their strength in affliction2 he becomes the repository of their most sacred confidences4 ,he who is unable to meet this responsibility1 to realize his influence and his power and to prepare himself with care and conscientious training to acquit himself well1 has mistaken his calling4 ,he is unfit for his ministry4 ,the thorough student wrestles not alone with the technic and the text-book branches necessary in practice but also studies his profession from every possible standpoint1 broadening his field of usefulness wherever possible4 ,this section does not by any means contain all the information not found elsewhere in this book but necessary to the ,chiropractor in his practice4 ,it is intended merely to suggest some of the many sides and phases of our work and to open the way for a life study of humanity and of professional life as a ,chiropractor4 ,,office ,,equipment ,value of ,first ,appearance ,the patient1 upon first entering an office1 consciously or unconsciously forms an estimate of the personality and standing in his profession of the occupant of that office4 ,this impression is gathered from the kind and arrangement of the furniture and visible equipment1 from the neatness or disorder of the room1 from countless little things which play each their part in making up the whole appearance4 ,this first estimate is sometimes the only one1 for an unfavorable first impression may lead to the loss of a prospective patient4 ,in any case it will play a part in all subsequent judgments which the patient may form concerning the ,chiropractor and his work4 ,many patients entering our offices have no previous knowledge of our profession2 their minds are open and curious1 alert for new impressions of some sort4 ,we may impress them as we choose4 ,every good business or professional man realizes the value of the first impression and strives for a good one4 ,therefore1 upon entering practice1 choose for yourself every article which shall have a place in your office4 ,your surroundings will then truly reflect your personality and will attract those upon whom that personality can work in harmony and understanding4 ,it is of no avail to attract the type of patients you cannot hold1 to draw through the borrowed judgment or taste of another surroundings alien to yourself and thus to attract people who will at once sense the incongruity and be repelled by it4 ,yet one may aspire4 ,and if you are able to perceive and appreciate truly professional surroundings you may hope to school yourself by association and study to harmonize with them4 ,choice of ,articles ,in choosing the contents of your office keep in mind good taste1 utility1 and the psychological effect upon all visitors4 ,remember that you expect to spend many hours each day in the company of your furniture1 and select such things as will contribute to a proper professional state of mind in yourself4 ,a ,chiropractor's profession is in many ways like1 yet in many ways unlike1 any other4 ,therefore his office equipment1 while following in general the equipment of other professional offices1 must be selected with an eye to the special and particular needs of the ,chiropractor and his patients4 ,too little attention has been paid thus far by the profession to the selection of office equipment4 ,furniture in ,general ,the furnishing of an office depends upon the amount and disposition of the room at your command4 ,one must have at least a waiting room and a private office even if a single rented room must be cheaply partitioned to make the division4 ,a larger suite is a better investment when possible4 ,in the waiting-room should be found easy chairs1 library table1 hall-rack1 mirror1 and an easy divan or couch4 ,the floor should be covered with a good rug or carpet and the walls properly and cleanly decorated and hung with restful1 pleasant pictures4 ,a book-case filled with carefully selected books is a good addition4 ,on entering your private office the patient should see your diploma1 which hangs in full view of the entrance and which bespeaks with no weak voice your fitness to practice1 your professional ability4 ,the importance of this point cannot be overestimated4 ,the intelligent visitor expects you to have had careful training and to possess thorough knowledge of your work4 ,if he notes the diploma as evidence of it and of your pride in your college he is assured4 ,if only two rooms are at your command the second must be at once consulting room1 adjusting room1 dressing room4 ,as such it should contain your desk1 desk chair1 chairs for the patient or patients1 adjusting table or tables1 towel cabinet1 lavatory1 and a curtained recess for a dressing-table1 chair1 and hooks for hanging clothing4 ,on the wall hang those charts from which it is at times necessary to explain a part of the human mechanism to the inquirer4 ,this room should convey a two-fold impression--business and professional4 ,it should contain the special paraphenalia of your profession and some of the suggestive contents of the ordinary business office1 such as desk1 card-index file1 typewriter1 etc4 ,let us consider these points more in detail4 ,waiting ,room ,in your waiting room new patients wait and form their estimate of you before your appearance4 ,they are tired patients1 worn perhaps with years of disease1 and their comfort must be considered4 ,some time is theirs for use in some way and the use of their minds during the waiting interval must be studied4 ,for these reasons first of all the waiting room should be furnished quietly1 in perfect taste1 but well furnished4 ,a good dark rug for the floor rather than matting or linoleum with their suggestion of bareness1 a tinted or papered wall done in a soothing shade1 upholstered furniture pleasing to the eye and comfortable for tired1 weak bodies1 and a library table with proper literature for the occupation of the mind--these are the proper furnishings for a waiting room4 ,let the table contain chiefly ,chiropractic literature and select that literature with care4 ,be sure that it reflects the view-point toward your profession with which you wish your patients to be impressed4 ,it must be scientific1 well written1 not sensational1 not dealing coarsely or vulgarly with the revolting diseases or features of disease1 but quietly convincing4 ,your literature must impress with the greatness of ,chiropractic without setting forth extravagant claims which your patients will expect you to vindicate4 ,your selection of books for the book-case must convince all observers of your proper literary taste or the book-case had better be omitted4 ,likewise the pictures on the walls must suggest pleasant things1 restful things1 good to contemplate4 ,when possible secure a high-ceilinged room with good ventilation1 plenty of fresh air without drafts4 ,and then let all the articles in the room harmonize4 ,one jarring note in form or color may mar the entire effect1 which should be that of comfortable simplicity4 ,private ,office ,even more important than the contents of the waiting room is the equipment of your private office4 ,it is in this room that your work is done4 ,there your patients confide to you their weaknesses2 there they determine finally whether to trust themselves to your knowledge and skill2 in that room they form their judgment as to your cleanliness1 your use of system2 there they meet you4 ,arrangement of ,furniture ,every bit of furniture for the private office having been carefully selected its arrangement should be studied4 ,when the patient first enters the private office he should be able to see your diploma4 ,he should also sit where he can notice it as he consults you and every other object within his vision during the consultation should be picked so as to avoid attracting his attention to anything foreign to his visit and its purpose4 ,two chairs are placed near the desk1 one an easy chair for yourself1 a revolving chair being preferable1 and a straight-backed leather-upholstered chair for the patient4 ,in placing these chairs be careful of two things3 let the strongest light shine over your own shoulder and bring the face of the patient out in clear detail2 and let your own chair be higher than the patient's so that he looks slightly upward to meet your direct gaze4 ,for the last mentioned point there is a sound psychological reason2 to control any dialogue with another person place yourself on a higher level than he and unconsciously he will obey the suggestion and lift his thought to meet yours1 offering it rather than commanding with it4 ,the light is arranged for its value in observing1 as a matter of diagnosis1 every indication in expression1 gesture1 and skin coloring4 ,hanging back of the desk where it may be easily reached but where its gruesome suggestion will not obtrude itself upon the nerves of the sensitive without your deliberate intention1 have a vertebral column for demonstration purposes4 ,there are many times when it is necessary to show a subluxation as it would occur4 ,beside the desk and within easy reach of your hand should be placed at least a single book-case section containing those reference works which you frequently consult4 ,the contents of this section will be considered later2 suffice now to say that they should be well bound and should be so placed that if a doubtful point arise they can be consulted at once without your rising4 ,i am not of the opinion that a pretension of unlimited knowledge is a valuable professional asset4 ,it seems better frankly to seek authoritative information1 even in the presence of the patient1 than to allow an error to creep into your work1 and your more intelligent patients will appreciate your care4 ,furthermore1 this placing of your books is convenient when you are alone and considering the cases which have passed before you during the day4 ,it tempts to study4 ,the desk should hold a typewriter1 significant of business methods1 and a card file for case records4 ,incidentally1 you should have neat bill-heads and printed stationery for all correspondence1 though blank white paper is better than over-ornate design or profuse coloring4 ,on the wall hang a few good anatomical and physiological charts upon which may be pointed out certain facts for the instruction of patients4 ,it may be suggested that these hang on racks so that the surface charts may be easily changeable and that those ordinarily exposed to view be such as will avoid unpleasant suggestion of any kind4 ,for instance1 an ,x-,ray chart of the body showing the skeleton is but one degree less repugnant to the average person than the bones themselves4 ,though your college training has robbed the subject of all emotion1 for you1 take thought for the feelings of your visitors4 ,adjusting ,tables ,for all purposes the best type of bench now on the market is probably that composed of two sections1 one fixed and the other--the rear one--sliding on a track4 ,both sections should be adjustable at various angles to the plane of the base and some of the best tables are made so as to permit changes in the distance from the floor to the entire top or to any part of the top1 a great advantage in that the table height may thus be made to suit the height of the adjuster4 ,an abdominal support is now indispensable but must be so elastic as not to interfere with the adjustment4 ,leather upholstery is more sanitary than plush and has come into general use4 ,an opening in the front section such that the face may look downward through it and straighten the cervical and upper dorsal spine for palpation and adjustment has been proven a disadvantage instead of a help and will be entirely unnecessary to one who follows the technic laid down in this book4 ,the ,roll ,a desirable addition to this table is an upholstered roll of quite solid material and about eight inches in diameter4 ,this can be placed under the patient's thighs on the rear section1 thus elevating the thighs and straightening the ,lumbar region so as to separate the spinous processes4 ,the roll is especially useful for the adjustment of posterior ,lumbar subluxations1 being inadvisable with rotation4 ,with a patient lying on the bifid bench in the ordinary adjusting position the ,lumbar spinous processes are crowded together and the bodies separated4 ,in rotation1 since the adjustment works by using a short power arm against a long weight arm 7distance from contact point to center of rotation against distance from center of rotation to anterior margin of body71 and since the heaviest portion of the vertebra--the body--is to be moved most1 this position of suspension secures the easiest adjustment4 ,but if the vertebra be posterior and a spinous process contact is used the best adjustment can be secured over the roll or with a table adjustable to an angle equal to that which would be secured with the roll4 ,cleanliness ,everything in the office should be kept scrupulously clean4 ,a lavatory with towel racks well filled with clean towels is an absolute necessity4 ,if no lavatory is inbuilt in the office a portable one may be secured which will answer every purpose4 ,it will be well if the patient observes that you carefully cleanse your hands before giving an adjustment4 ,the office should contain a towel cabinet with a stack of clean towels and a compartment for used towels4 ,or tissue towels may be used to save laundry bills4 ,before each adjustment a clean towel should be unfolded and placed upon the front section of the bench so that the patient rests head and face upon a perfectly clean surface4 ,when the adjustment is completed toss the towel into the used-towel compartment4 ,this use of towels minimizes the risk of contagion or infection from a germ-infested upholstery1 suggests care and cleanliness to your patient1 and gives the patient greater trust in you4 ,dressing-room ,a curtained recess separated by a screen from the remainder of the room will serve if no separate room is available for a dressing-room4 ,it is better1 if possible1 to have a separate dressing-room and better still to have separate dressing-rooms for men and women4 ,if extra rooms are not at your command and you use a curtained recess be sure that it contains good light1 a dressing-table with mirror1 a small chair1 and hooks for clothing4 ,provide also a few dressing-sacks for women though most of them will prefer to furnish their own4 ,the ,rest ,room ,it is a known fact that the patient who can be kept in a quiet1 restful1 and relaxed state for some time following the adjustment derives the greatest benefit therefrom4 ,having loosened subluxated vertebrae by adjustment their tendency is to settle in their old abnormal position and every movement of the patient for a time aids this tendency4 ,quiet permits adaptation of surrounding tissues to the changed position of the vertebra2 action facilitates the re-adaptation of the vertebra to the state of surrounding tissues4 ,if possible a special room should be provided in which patients may lie down in comfort for twenty or thirty minutes following an adjustment4 ,if more than one patient at a time is to rest1 separate rooms should be provided for men and women4 ,the rest rooms should have high ceilings and excellent ventilation without drafts4 ,the floors should be carpeted so as to soften footfalls and suggest quiet and rest4 ,potted plants adorn such a room very well and always afford a pleasant suggestion4 ,the patients lie on cots1 foldable for convenience when not in use1 and should lie on their backs as quietly as possible4 ,some prefer solid cots on rollers so that the cot may be noiselessly rolled beside the adjusting table after the adjustment1 the patient may by one turn move himself upon it1 and it may then be gently rolled into the rest room4 ,this is a more finished1 if more expensive1 handling of the problem4 ,it may be well to furnish some occupation for the mind and to this end1 since reading in such a position is injurious to the eyes1 a good phonograph is a valuable addition4 ,equip it with a soft parlor needle and select only soothing1 restful music4 ,just as you would avoid doing the walls of the rest room in striking or garish colors1 exciting to a diseased mind1 so avoid exciting or harsh music4 ,the object of this room is rest for mind and body4 ,let every thought be directed to that end4 ,with some patients the use of the phonograph or other amusement must be avoided4 ,study your cases with care4 ,the trip to the ,chiropractor's office is too often regarded in the light of an unpleasant necessity4 ,if proper care be used in equipping an office and if such means as have been suggested for the rest room be employed1 these in addition to the pleasing personality of the ,chiropractor may make of the visit a pleasant thing1 a part of the day to be anticipated with eagerness4 ,a ,complete ,suite ,the number of rooms in a perfectly convenient suite depends upon the approximate number of cases to be handled daily4 ,if it is needful to economize the practitioner's time a greater number of rooms will be required than would be desirable with a small practice4 ,a waiting room1 a consulting room1 two or more adjusting rooms1 and two rest rooms make probably the best number and employment of rooms4 ,it is desirable if possible that the adjusting room be used for that purpose only and that there be separate rooms for men and women4 ,each adjusting room can then have its own dressing room or recess4 ,or in addition to the other rooms named above there may be many small rooms each containing an adjusting table and a rest cot and each serving as the rest room after the adjustment4 ,if a sufficient number be provided as many patients can be handled in this way as time permits1 the practitioner need lose no time at all1 and each patient may have a room entirely to himself throughout his visit4 ,reference ,library ,this should consist of those standard works to which you will necessarily refer most often4 ,gray1 ,morris1 or other standard anatomical authority1 ,brubaker's or ,haliburton's physiology1 ,butler or ,osier on diagnosis1 ,delafield and ,prudden on pathology1 ,morat on the physiology of the nervous system1 ,bing on regional diagnosis of nerve lesions1 one or two good works on psychology1 gynecology1 histology1 etc41 a good medical dictionary1 and any books on ,chiropractic in which you have confidence make up an excellent list4 ,any standard works will suffice and this list is merely suggested for those who may be uncertain as to their own tastes4 ,always examine a book before buying it1 even those named above4 ,next to works on ,chiropractic no single book is as necessary or useful as a good medical dictionary1 preferably a large and complete one4 ,door ,sign ,your door should bear a sign in gold or black1 setting forth your name and business and perhaps your office hours4 ,it may read1 8,w4 ,r4 ,jones1 ,chiropractor10 or1 8,jones ,jones1 ,chiropractors10 with office hours appended4 ,avoid repetitions such as 8,dr4 ,w4 ,r4 ,jones1 ,chiropractor10 or 8,w4 ,r4 ,jones1 ,d4 ,c41 ,chiropractor40 ,advertising ,the word of a satisfied patient to his friend is the best advertisement4 ,beyond this1 considerable diversity of opinion exists as to what constitutes proper1 ethical1 and wise advertising4 ,i shall make no attempt to settle this question but shall simply suggest that while it is undoubtedly necessary often to explain to the public through various avenues what ,chiropractic is and what it can do it is wise to be as reserved and dignified as possible and to avoid offense to any4 ,thus it is clearly unwise to advertise that your competitor is a fraud1 much wiser to convince your readers by the logic and strength of your statements that you are not4 ,consider good taste and avoid unpleasant references to loathsome or vulgar diseases4 ,such advertising is associated in the public mind with quackery1 with patent medicines and medical institutes1 and no matter how sincere and right your motives may be it will be misinterpreted by those you wish to reach4 ,consider also the legal side of advertising4 ,study the laws of your state and avoid any statement which will conflict with the law4 ,in some states it is illegal to advertise with the term 8,dr40 unless you hold a medical license4 ,in others to advertise to 8treat10 8cure10 or 8heal0 disease is to practice medicine technically4 ,such statements miss the truth1 in any case1 because the ,chiropractor administers an adjustment and not a treatment and because ,nature alone can cure or heal4 ,collection ,cards ,different communities respond to different collection methods4 ,with one class of patients it may be better never to mention fees except to answer inquiry and simply to submit monthly statements of account to all patients4 ,with another it is necessary to charge in advance4 ,more ,chiropractors use this method than any other and many use cards for the purpose4 ,these cards are best printed with name1 address1 telephone number1 etc41 on one side and on the other six or twelve spaces ruled off at one end for punching to indicate adjustments given1 and the words1 8,good for six 7or twelve7 ,chiropractic adjustments at 7office7 7residence7 when properly countersigned40 ,a line should be left below for your signature and at the bottom the price of the card should be printed plainly4 ,if desired a space may be left for the patient's name so that the card may be made non-transferable4 ,the card is issued at the beginning of a course of adjustments and a duplicate is kept on file4 ,each time the patient is adjusted he presents his card before leaving and one space is punched out4 ,by this system both the patient and the adjuster may know exactly the number of adjustments given and accounts may be easily kept4 ,without it1 a book entry of some sort must be made for every adjustment4 ,the best thing about this system is that it reminds the patient that you expect to be paid in advance without the necessity of your saying so1 since the words 8in advance0 follow the statement of price on the card4 ,at the time of payment you give him1 as a receipt1 a card entitling him to a certain amount of your service at a stipulated place4 ,schedule of ,examination ,this method of procedure for the investigation of new cases is offered as a suggestion to be followed as far as the education of the ,chiropractor will permit4 ,if every practitioner adopts some such method of making his own diagnoses he will advance in ability much more rapidly than by accepting the diagnoses given his patients by physicians or others4 ,we should remember1 though without arrogance1 that our special ability to discover subluxations and our knowledge of their significance as the primary causes of disease renders us better prepared for correct diagnosis than our medical friends1 other education being equal4 ,it should be quite obvious that in attempting the accomplishment of any object it is necessary first to have in mind a clear preconception of the things to be accomplished1 and second1 to have a clear and concise1 yet complete1 outline of the steps to be taken1 their order or sequence1 and their relative importance in the accomplishment4 ,these two needs1 as regards a ,chiropractic diagnosis1 we shall endeavor to supply in this section4 ,chiropractic ,diagnosis properly consists of three parts1 ,vertebral ,palpation1 ,nerve-,tracing1 and ,symptomatology1 together with the reasoning necessary to properly weigh and summarize the facts ascertained4 ,of these three divisions two fall properly under the head of ,physical ,diagnosis and the third1 symptomatology1 should consist principally of physical diagnosis4 ,everywhere the physical or objective sign is given preference over the subjective symptom4 ,before a single question is asked of the patient relative to the case or its history1 every other means of obtaining information properly coming under the head of a ,chiropractic diagnosis should be utilized4 ,the questions should come last and be very few and direct4 ,they should serve only to illuminate the few remaining doubtful points in the mind of the examiner1 points which perhaps exist only because of some fault or weakness in his methods of examination4 ,the proper order of examination is as follows3 #a4 ,general ,observation4 #b4 ,vertebral ,palpation4 #c4 ,nerve ,tracing4 #d4 ,special ,examination4 #e4 ,history of ,case4 #f4 ,summary4 ,general ,observation ,observation of the patient with a view to determining any signs of disease should begin with the moment the patient steps into the office4 ,it should continue during your conversation and during the ,vertebral ,palpation and ,nerve ,tracing which follow4 ,the mind of the examiner should be constantly on the alert to note any sign on any exposed part of the patient's body1 or any motion which may betray the nature of the disease or diseases with which he suffers4 ,before preparing the patient for palpation observe temperament1 position and carriage of head1 body1 and limbs1 and facies4 ,ask male patients to strip to the waist and female patients to remove all clothing down to the waist except a loose gown or kimono1 which is worn reversed so that it opens behind and exposes the spine to direct examination4 ,no greater error can be committed than to attempt examination of the vertebral column through clothing or other covering4 ,examine with patient seated on a bench or stool with feet evenly placed upon the floor4 ,if the patient is for any reason unable to assume this position the examination may be varied somewhat4 ,while in this position continue observation of points mentioned above and observe also condition of skin1 whether abnormal in color1 moisture or nutrition1 or whether there is flushing1 cyanosis1 or pallor1 roughness1 eruption1 etc42 the condition of bones and joints other than vertebral2 general emaciation or obesity1 local malnutrition or hypertrophy2 evidences of operation1 scars etc42 and action of muscles more in detail than is indicated under position and carriage of parts4 ,having observed these things discontinue general observation and all other considerations for the time in favor of ,vertebral ,palpation4 ,vertebral ,palpation ,the primary object of ,vertebral ,palpation is the location of subluxations1 or partial displacements1 and the determination of the relative degree and direction of those found4 ,next comes the recording of subluxations in such a manner that a perusal of your record will enable you to reconstruct at any time a mental picture of the spine1 as far as possible4 7,see ,record47 ,with the making of the record the proper form of adjustment for the correction of each subluxation is decided4 ,finally1 by failing to find subluxation in certain segments you may safely eliminate those segments from consideration and confine your further attention to the remainder4 7,see ,spino-,organic ,connection47 ,it must be borne in mind that while the finding of a subluxation is not always positive evidence of the necessity for adjustment there1 the absence of subluxation of any spinal segment is proof positive that no disease exists in the corresponding somatic segment4 ,differential diagnosis is thus often greatly aided by palpation4 ,nerve ,tracing ,having thus narrowed the field of operation1 trace from spine to periphery every nerve tender enough to be traced1 noting the relation of the tender nerves to the subluxations already found by palpation4 ,whenever it is possible note the degree of tenderness of the various nerves and keep in mind through the remainder of the examination the fact that greater tenderness in some one segment indicated either greater or more acute disease in that segment4 ,it is best to use great caution about entirely eliminating any segment from consideration because of negative findings in attempted nerve tracing4 ,the fact that no nerve is traceable is not always proof that no impingement exists1 but only that no irritation exists4 ,only light or acute impingement may irritate a nerve4 ,in forty1 and possibly fifty1 per cent of all cases no nerves are traceable at any time4 7,see ,nerve-,tracing47 ,special ,examination ,the examiner has by this time formed some concept of the case in hand4 ,he has a clue to the possible nature of the disease and he has narrowed his observation to a few segments of the body or a few organs which demand a more special examination4 ,this may be accomplished by ,inspection1 ,palpation1 ,auscultation1 and ,percussion4 ,history of ,case ,having determined by these methods every fact possible of determination without information from the patient1 it becomes necessary to go somewhat into the history of the case4 ,the history of falls1 jars1 shocks1 or injuries of any kind should be taken first and these should be viewed in the light of their bearing upon the previously ascertained condition of the spine4 ,sometimes the definite history of an accident immediately preceding the development of disease symptoms suggests its connection with the disease and the exact nature of the accident points out to us some one of the several recorded subluxations as the one involved4 ,this in turn may aid a doubtful differential diagnosis4 ,each step in the process of examination helps to explain and clarify the facts elicited by other steps until the facts marshal themselves into a complete and comprehensible picture4 ,at this point it will be possible to stop in some cases and rest upon the evidence gathered4 ,if you are able at this time to state clearly the nature of the case1 the manner of its cause1 the site of disease and of the subluxations causing it1 the kind of subluxations1 and the chance of recovery under adjustment1 it is preferable to do so4 ,you will thus have made a complete diagnosis without recourse to information from the patient except the history of injuries4 ,sometimes1 however1 it will be necessary to go further into the case and ascertain the presence and nature of subjective symptoms4 ,if this be necessary1 the examiner should confine his questions to the parts indicated as diseased1 and thus limit the number of questions and make them all direct and essential4 ,it is important to avoid trivial or irrelevant questioning4 ,summary ,finally1 having ascertained all necessary facts1 mentally summarize them all1 combining the results of ,palpation1 ,nerve-,tracing1 and ,symptomatology so as to reach a definite conclusion as to the location and nature of the morbid process1 the subluxation producing it1 and the exact form of adjustment necessary to correct it4 ,the examiner should be able at the end of the examination to state exactly what he finds to be the condition of the patient1 to give reasons and nerve connections1 and to demonstrate a subluxation to back every statement4 ,the case record should contain all essential information relating to the diagnosis and the correction to be applied4 ,necessity for ,correct ,diagnosis ,diagnosis1 in a restricted sense1 means merely the naming of diseases4 ,but in the broader and more proper sense it means disease knowing and includes a knowledge of the causal factors1 the location and nature of disease1 the amount of damage to structure and of functional disturbance1 and the probable duration and outcome of the case either with or without ,chiropractic adjustments4 ,in this broader sense we use the term hereafter4 ,the object of diagnosis is correct adjustment4 ,including as it does palpation1 nerve-tracing1 and symptomatology1 the ,chiropractor's diagnosis of a case should embrace all the knowledge upon which he proceeds with his adjustment4 ,there are really two all-important questions which constantly recur to confront the busy practitioner4 ,one is1 8,what is the matter with my patient80 and the other1 8,what can ,i do to relieve him80 ,practice resolves itself into these two divisions1 diagnosis and adjustment4 ,the real question which should suggest itself to the thinking ,chiropractor is not1 then1 8,should a ,chiropractor study diagnosis80 but rather1 8,from what viewpoint should we study diagnosis8 ,upon what portions of the subject shall we concentrate our attention80 ,undoubtedly the most important branch of diagnosis to us is vertebral palpation4 ,by its use we discover those facts about the spinal column without which we are entirely unable to proceed as ,chiropractors4 ,knowledge concerning the spine is the most essential part of diagnosis4 ,next in order of importance comes the study of physical or objective signs throughout the body--the examination of the body for the discovery of all the changes in the size1 shape1 position1 etc41 of organs which indicate disease4 ,this includes nerve-tracing1 which in some cases is the most important branch of physical diagnosis after vertebral palpation4 ,finally1 a certain degree of examination for subjective symptoms may be necessary4 ,but the ,chiropractor of the future should become1 and probably will become1 par excellence a physical diagnostician4 ,for many reasons we should be able to rely upon our own diagnoses4 ,capability in diagnosis renders us independent of the errors or false beliefs of others4 ,since it includes a knowledge of subluxations1 not included in medical training but still vital to correct interpretation of morbid phenomena1 it can be more accurate than any diagnosis which ignores these causal factors4 ,a habit of diagnosing one's own cases enables one1 always resting on his own judgment1 to correct and improve himself through all errors1 for which he is then alone responsible4 ,a general knowledge of medical diagnosis1 of pathology1 bacteriology1 etc41 enables a ,chiropractor to meet the physician on common ground2 in fact1 it gives the ,chiropractor a distinct advantage1 since he knows not only what his medical friend knows but also the all-important facts regarding the spine which are unknown to others4 ,such knowledge and the ability to discuss disease intelligently also furnishes common ground with every patient4 ,each patient is a specialist in the disease he believes himself to have and he expects from his doctor a greater knowledge than his own4 ,the recognition of contagious or infectious diseases as such is an absolute necessity in order to obey the laws and safeguard the public health4 ,the exact condition and degree of vitality of the patient and the knowledge of the existence of abscess1 gangrene1 intestinal obstruction1 etc41 often warns the ,chiropractor that his adjustment would be dangerous to the patient4 ,much possible injury is avoided by accurate diagnosis4 ,even the frequency with which adjustments should be given depends upon diagnosis4 ,special ,cases ,there are certain cases which a ,chiropractor is powerless to aid and immediate recognition of such cases will save much trouble4 ,in intestinal obstruction from intussusception or from strangulated hernia1 for instance1 it is best to advise the calling of a surgeon immediately1 while in obstruction from volvulus or intestinal paralysis the adjustments may afford relief and should at least be tried first of all4 ,any internal abscess presents a possibility of rupture into a serous cavity or the substance of a parenchymatous organ and is therefore dangerous1 while a superficial abscess1 pointing toward the surface1 can best be cared for by adjustment4 ,a badly ulcerated or gangrenous appendix may rupture under adjustment and be followed by diffuse peritonitis4 ,the fragile walls of the ileum in typhoid may perforate under adjustment1 while in its earlier stages the disease is easily curable4 ,the rotted vertebral bodies in ,potts' ,disease 7spinal caries7 may be crushed under the heavy hand of an ignorant adjuster4 ,intelligent case-taking must include accurate diagnosis4 ,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 placed4 ,no hard and fast rules can be laid down but some general advice may be profitable4 ,acute fever cases may be adjusted1 until the fever is broken1 oftener than any other type of cases4 ,the chief object is the regulation of the temperature1 after which the body is able properly to repair itself4 ,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 control4 ,after such a series it is wisest to refrain from adjusting again for several days so that the patient may recuperate during the interval1 providing the fever does not return4 ,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 weeks4 ,in ordinary chronic cases1 with good vitality and reactive power1 the daily adjustment is best at first4 ,then after a course of from six to twenty-four adjustments according to the judgment of the practitioner1 the interval is lengthened and adjustments given on alternate days1 a day of rest intervening between each two4 ,in weak patients or those who are extremely sensitive1 the shock of the daily adjustment1 even at first1 and the demand on the body's recuperative power may be greater than can be met4 ,in this connection it may be mentioned that the author has encountered several cases of dorsal lordosis produced by too heavy and too frequent adjustments1 straining the ligaments faster than they could be repaired and continuing the strain over too long a period4 ,it is possible to over-adjust a patient1 producing a weakened spine and other deleterious effects1 just as it is possible to establish a 8tolerance0 for a drug by long continued use4 ,during a long course of adjustments it is well to allow the patient an occasional week of complete rest1 or even more1 and it may be wise after a time to reduce the number of adjustments to two per week in some cases4 ,on the other hand1 the practice of giving one adjustment a week from the beginning1 as followed by some practitioners who maintain offices in numerous localities and visit each one day per week1 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 weekly4 ,the interval is so long that all repair work started by each adjustment is completed and an involutionary change sets in before the next4 ,specific vs4 ,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 weakness4 ,the term 8specific adjustment0 implies that there is a particular reason existing and recognized for every vertebra adjusted4 ,general adjustment1 on the other hand means either the adjustment of all palpable subluxations1 or of all the most noticeable ones1 or of all found providing that no two successive vertebrae be adjusted1 according to the beliefs of different elements in the profession4 ,specific adjusting relies upon the diagnosis and requires correct interpretation of disease4 ,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 advisable4 ,let us consider some of the arguments for and against each method and reach a conclusion if possible4 ,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 vertebrae4 ,sometimes the less prominent subluxation causes a more acute or dangerous disease than the more pronounced4 ,specific adjusting tends to develop more discriminating and accurate palpation4 ,specific adjusting weakens and shocks the weak or nervous patient less than general adjusting4 ,it also concentrates the recuperative or reparatory power of the patient on the parts which most need repair4 ,the body possesses only a certain limited capacity for combating disease or building weakened tissue4 ,to scatter this force widely is to weaken its effect in any particular locality4 ,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 it4 ,we assert that in adjusting a vertebra we are removing the primary cause of disease4 ,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 coryza4 ,a correct answer to either question leaves an embarrassing discrepancy between theory and practice4 ,in favor of the practice of general adjusting it has been said that errors in diagnosis become unimportant if all subluxations be adjusted2 that if the spine be straightened the patient must recover4 ,against the first statement1 which is forceful because diagnosticians are so notably liable to err1 it may be said that errors in palpation are almost1 if not quite1 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 used4 ,the second statement is quite true2 but it is based upon the assumption that in ordinary practice the spine may be straightened completely4 ,as a matter of fact this rarely1 if ever1 occurs4 ,it is practically impossible ever to thoroughly 8line up0 a spine4 ,the best that has been done as yet except in acute subluxations is to so modify subluxations that disease disappears4 ,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 8lined up0 a spinal column in one1 six1 or a dozen adjustments1 as some have declared4 ,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-suggestion4 ,clinicians of proven ability1 who have examined more than five thousand spines each1 agree that no perfectly normal spine has been discovered1 whether the spine has been adjusted or not4 ,but the chiefest argument against general adjusting is that it scatters the reparatory forces of the body throughout many segments1 some of which are not really in need of attention1 while the one or two segments which need all possible concentration of energy receive only a diluted share4 ,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 subluxations1 two of which are ,lumbars1 ,i am unscientific and unwise4 ,what that case demands is an immediate localized improvement4 ,it is highly probable that the efficient ,chiropractor of the future will be a specific adjuster2 that every recognized body condition will suggest a definite and scientifically determined corrective measure2 and that guesswork will be largely eliminated4 ,talking ,points ,the things which it is most important that the ,chiropractor should set before his patient are the theories and facts peculiar to ,chiropractic1 perhaps adduced by ,chiropractic investigations alone4 ,these theories and facts have been discussed elsewhere in detail3 the subluxation theory1 easily demonstratable with a spinal column as an object lesson1 the relations between primary and secondary causes of disease1 the directness and completeness of the results of vertebral adjustments1 these explanations are more convincing than the display of a wealth of knowledge of methods and theories used by other schools of practice4 ,chiropractic has been builded not by virtue of previously established truths but solely on the vitality of the new principles enunciated by it4 ,these new ideas cannot hope for full and immediate credence and must be presented carefully1 with this fact in mind and with due consideration for the degree of intelligence of the listener4 ,avoid argumentative discussion with patients1 seeking rather to enlighten them about those facts peculiar to ,chiropractic and unknown to them than to antagonize them by contradicting their cherished beliefs4 ,it is much wiser to begin with that knowledge of disease which you hold in common with the patient and advance with him1 step by step1 from that firm foundation to new truths than to begin by attempting to tear down his beliefs4 ,reason from the known to the unknown4 ,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 old4 ,this process is much the simplest and easiest4 ,nevertheless in presenting ,chiropractic we must be gently positive4 ,chiropractic is known and provable4 ,always able to fall back upon the clinical test as a final argument with supreme assurance that it will not fail to vindicate our claims1 we may present an unshaken front before the most powerful and intelligent attack4 ,promises to ,patients ,the majority of patients will require from the ,chiropractor an expression of his belief in his ability or inability to cure them4 ,they will desire a statement as to the probable time required for a cure4 ,they may even ask a guarantee of success4 ,these questions are hard to meet truthfully and convincingly1 for the truth is that every ,chiropractor fails sometimes and is unable to predict that failure in advance and that no one wise enough to predict the length of time which will be required for the cure of any given case has yet arisen4 ,and these truths do not sound reassuring or convincing4 ,explain to the patient that nature alone is the curative agent and that the cure depends not alone upon the skill of the adjuster but upon the exact condition of the vertebrae1 the exact amount or degree of damage to tissue1 the patient's habits of living1 etc4 ,any accidental interjection of other factors into the case may have an important bearing4 ,you may assure him of the excellent results you have obtained in other cases similar to his1 or even cite individual cases if to do so does not violate a professional confidence4 ,but you had best avoid a promise to cure or an exact statement of the time which will be needed4 ,state your belief or opinion but do not bind yourself to a promise4 ,offer your best skill and closest attention2 you can do no more4 ,the patient should rely upon the skill of the ,chiropractor as upon the skill of his lawyer or his physician4 ,neither can honestly promise that he will succeed in his efforts1 even though all indications point that way4 ,re-,tracing of ,disease ,from the original concussion of forces which produces a nerve-impigning subluxation to the stage of chronic disease with which the patient usually approaches the ,chiropractor for relief1 disease develops by a series of gradual steps4 ,successive changes take place from time to time in the degree of subluxation as it is augmented by further jars1 strains1 etc41 or by the reaction of secondary causes upon it and with these changes come corresponding changes in the development of the disease4 ,perhaps the first effect of the bad subluxation is irritation of a nerve and acute functional disturbance such as pain1 fever1 etc4 ,the later effect may be paralysis and its attendant train of evils4 ,when the ,chiropractor begins adjustment he does not at once return the long-displaced and misshapen vertebra to its normal position4 ,he merely tends to do so1 his adjustments making slight and gradual changes from the abnormal back to normal4 ,thus it is that the subluxation passes back in reverse order through the successive stages of its development1 following a process which may be called the involution of the subluxation4 ,at the same time the morbid process resulting from the subluxation tends to retrace its steps1 passing in reverse order through the stages by which it developed4 ,pains which have not been felt for years may unaccountably return under the reawakening of the long dormant nerves4 ,headache1 long absent but once a prominent feature of the disease1 may again make its appearance4 ,the patient feels worse4 ,these changes1 however1 take place much more rapidly during the correction than during the development of the disease4 ,to a certain extent they are probably always present1 although in many cases they occur so rapidly or are modified so much by changed environment as to be unrecognizable4 ,in many cases it is possible by securing an accurate history and by careful observation of the patient's progress to observe a definite reappearance1 in reverse order1 of every important event in the history of the disease4 ,for instance1 if the patient has at one time had a severe fever1 perhaps lasting many weeks1 and has later developed a chronic weakness marking the increase in degree of subluxation1 the fever may reappear during adjustments1 last a day or two1 and disappear forever1 having been corrected beyond that stage4 ,if explained in advance to patients with chronic diseases1 the facts of retracing may not cause the patient to become discouraged as he would if he failed to understand them4 ,if he knows before your work is commenced that he may expect such phenomena but may possibly escape them he meets them as necessary parts of the process of cure4 ,if they are not explained in advance he is likely to feel that you are doing him injury and to discontinue your service just at the time he most needs them4 ,in fact1 it occasionally happens that if adjustments are stopped at some irritant stage of the cure that condition will remain and do great damage4 ,this theory of retracing has been much abused4 ,chiropractors have used it to cover a multitude of errors in practice4 ,with some it becomes a habit to call all unfavorable events which occur during adjustments retracing1 thus shifting the blame from their own shoulders to ,nature's4 ,this is a pernicious practice because it deceives the patient and also because too frequent repetition of this explanation finally deludes the practitioner into the belief that all such events really are retracing4 ,this view withdraws his attention from his own technic and he ceases to discover his own mistakes by ceasing to look for them4 ,it is best in the face of any painful or apparently unfavorable development always to examine our own work thoroughly to detect any possible error in diagnosis1 palpation1 or selection of move for correction4 ,it is always possible for us to err and our cases should be observed at every stage with the most minute care to insure accuracy in detail4 ,limitations of ,chiropractic ,there are many things which can be done better by others than by a ,chiropractor4 ,there are others for which the ,chiropractor's training does not fit him at all and to which his methods do not in any sense apply4 ,knowledge of these limitations is just as essential as acquaintance with the powers of the vertebral adjustment4 ,bony dislocations other than vertebral1 fractures1 wounds causing1 or likely to cause1 hemorrhage or severe internal injury1 should at sight be diverted into the hands of a surgeon4 ,the ,chiropractor receives no training in handling such cases and has neither legal nor moral right to attend them4 ,in obstetrics likewise no practical training is given which would prepare the practitioner for delivery and he is unprepared to use necessary asceptic or antiseptic measures4 ,some individual cases of disease usually curable will have advanced so far as to require surgical interference4 ,abscesses or suppurative diseases internally located or having any liability to discharge internally must be avoided4 ,gangrene1 cancer1 the advanced stages of tuberculosis 7usually7 are incurable4 ,quarantinable diseases as a class yield readily to adjustment unless some serum treatment has been administered1 when the chances of recovery are greatly lessened4 ,but such cases must be reported in conformity with the laws of the state and will probably then be taken out of the hands of the ,chiropractor--unfortunately4 ,the laws of the various states should be modified to permit ,chiropractors1 with precautions required of physicians to safeguard the public health1 to pass quarantine4 ,every effort should be put forth to secure such legislation but until it is secured in any state and the ,chiropractor's work is brought under the supervision of the authorities1 the laws must be respected strictly4 ,syphilis and gonorrhoea1 communicable diseases1 should be recognized and refused in practice4 ,the former in the primary and secondary stages 7not tertiary7 and the latter in all stages is corrective by adjustment but the liability of transmission of the disease warns against contact with it unless all precautions known to science be used to avoid possible transmission4 ,congenital anomalies of structure do not yield to ,chiropractic and are best let alone although no harm is likely to arise through any attempt to correct them by vertebral adjustment4 ,relation of ,chiropractic to ,other ,methods ,there are certain other methods which present a superficial resemblance to ,chropractic which leads many to believe them closely related4 ,such methods are ,spondylotherapy1 ,osteopathy1 etc4 ,there is a system called ,napravit or ,naprapathy which may be dismissed with the statement that it is ,chiropractic1 renamed4 ,spondylotherapy1 on the other hand1 is a system of treating disease which takes no account of the vertebral subluxation as its primary cause and seeks to cure disease by stimulating or inhibiting nerve action through the use of mechanical1 thermic1 or electrical means4 ,its resemblance is due solely to the fact that most of the treatment is applied to the spine4 ,as well might we say that serum injection for meningitis is ,chiropractic because the serum is introduced by lumbar puncture into the spinal canal4 ,osteopathy1 since the profession has become aware of the superior results obtainable by vertebral adjustment1 is rapidly adopting many ,chiropractic methods and counterfeiting it as far as possible4 ,perusal of their literature of various periods clearly shows that this is a new growth and that they have never adopted in theory what they sometimes use in practice4 ,in fact both the above methods treat disease1 following the theory of medicine with the use of different remedies only1 while ,chiropractic adjusts the cause of disease and avoids treatment of any kind4 ,chiropractic is not a branch of medicine1 never can be a branch of medicine because it is inherently and fundamentally antagonistic to the very basic principles of medicine1 and no statute can change the fact of such antagonism4 ,but unless we adhere strictly to the fundamental principles of our own practice and limit ourselves to the methods which grow from those principles ,chiropractic may become a part of medicine4 ,which brings us to ,the ,use of ,adjuncts ,there are many methods of treating disease which are more or less beneficial to the patient just as there are some which are always injurious4 ,shall we employ such of these methods as are beneficial as adjuncts to the practice of ,chiropractic8 ,or shall we adhere to the principle that the treatment of disease is erroneous and the adjustment of its cause the only logical method of procedure8 ,there is much to be said on both sides of this question which has so long agitated the profession4 ,in the class of beneficial adjuncts may be placed massage1 hydrotherapy1 spondylotherapy1 dietetics1 osteopathy1 ,christian ,science1 suggestive therapeutics1 mechano-therapy1 and many others4 ,each of these has its field of usefulness2 each taken alone is productive of some good in some cases at least4 ,each might possibly augment the results of ,chiropractic1 or hasten them in some cases1 if judiciously used4 ,by judiciously used we mean the avoidance of any method which would in the least interfere with proper vertebral adjustment or its results or which might carelessly cause subluxation4 ,osteopathy and mechano-therapy frequently cause subluxation because of the ignorance on the part of their users2 they need not do so4 ,among the pernicious adjuncts1 or those which are harmful if combined with adjustments or harmful whenever and however used1 may be mentioned drug medicine1 serum therapy1 and electricity4 ,the first two may sometimes prove the lesser evil if used alone4 ,with ,chiropractic they are always unnecessary and always tend to lessen the good effect of adjustments4 ,the latter alone is beneficial but in combination with ,chiropractic proves a double stimulant to the nerves and should be avoided4 ,the effect of these methods when used with ,chiropractic can never be accurately predicted4 ,one can only be certain that some unfortunate effect will follow4 ,as a secondary consideration the ,chiropractor has neither legal nor moral right to practice medicine unless he has received a state license to do so4 ,having admitted that the forms of 8mixing0 indicated as beneficial to the patient may be sometimes justifiable on the score of immediate good to the patient1 let us consider another side of the question4 ,just as surely as we admit into our practice any method which attacks the disease itself1 or which treats any other than the primary cause of the disease1 or which seeks to stimulate or inhibit the functions of the body without freeing the natural channels through which the natural healing power of the body should be manifested1 just so surely are we adopting the medical theory and making our profession a branch of medicine4 ,medicine uses many remedies for the cure of disease4 ,medicine is now broader than the mere administration of drugs4 ,and no matter how we vary the remedy1 or what treatment we select1 we are denying the truth of the ,chiropractic theory and admitting the truth of the medical principle when we use adjuncts in our practice4 ,nor are these adjuncts necessary4 ,it has been demonstrated by repeated observations that the ,chiropractors who use only the vertebral adjustment secure just as high a percentage of results as those who combine one or more other methods with it4 ,this is due to various reasons3 the greater perfection attained in ,chiropractic by those who apply themselves with concentration to the task of settling every problem by that means2 the fact that adjuncts often detract from the effect of adjustment as much as they add results of their own2 the tendency of the patient to prefer and to insist upon the easier and less painful methods rather than the adjustment4 ,the lay patient and the ignorant public are inclined to give credit for results obtained to the best known method used upon them4 ,thus in spite of the fact that ,chiropractic alone obtains a far greater percentage of results than any other combination of methods1 the patient is prone to believe that the change of diet or the massage effected a cure and to overlook entirely the least pleasant part of his 8treatment10 the adjustment4 ,he does not understand and cannot understand with a mind divided for the consideration of several methods1 the connection of the spine with his disease4 ,often he fails to understand if ,chiropractic is used alone but he is forced to conclude that the spine has such connection because adjustment of the spine cured him4 ,the use of adjuncts has done more to hold back the advance of the profession in the public mind than any other single factor except ignorance within the profession4 ,furthermore1 the ,chiropractor who knows that he can rely upon various other methods if his adjustment fails does not feel impelled to study his ,chiropractic as he should4 ,he weakens in practice1 relying more and more upon adjuncts4 ,it has been repeatedly proven that the ,chiropractor who uses only ,chiropractic becomes the better practitioner by necessity4 ,it has also proven that the man who is expert in ,chiropractic needs nothing else1 providing only that he refuses those cases to which ,chiropractic cannot apply at all4 ,the only real problem in ,chiropractic is the problem of adjustment4 ,all failures may be attributed either to lack of knowledge and proper application of ,chiropractic or to the fact that the patient has not vitality enough to recover from the disease4 ,do not shift the responsibility for failure upon the system1 since with one or two exceptions every known disease has been cured by some ,chiropractor1 thus proving its possibility4 ,realize that the work can be done and that its doing depends upon your own skill in diagnosis and technic4 ,it is inevitable that at some future time ,chiropractic will be used in connection with other beneficial methods which will enable us to get results sooner1 though not more surely4 ,it is also inevitable that ,chiropractic will fail to receive its proper place among healing methods unless we force the world to believe in it as we believe2 to know it as we know it4 ,if we develop our system in its purity until it obtains general recognition at its true valuation we shall have accomplished an infinite good for humanity for all time4 ,we should endeavor to accomplish the greatest good for the greatest number1 laboring rather for the ultimate recognition of the subluxation theory and its application at its real value than for immediate slight good or personal gain4 ,personality ,he who would succeed in ,chiropractic must have1 in addition to a thorough education in his profession1 a proper personality4 ,this is the medium through which his education becomes effective1 the channel through which he reaches the public1 gaining their confidence and approval that he may utilize his knowledge to their good4 ,many skillful and well-educated practitioners have failed because they lacked the proper personal qualities for attracting patients4 ,elements of ,personality ,the most essential elements of a proper personality are ,courage1 ,conviction1 ,confidence1 ,honesty1 ,sympathy1 and ,aggressiveness4 ,courage1 not recklessness or carelessness but a fearless willingness to assume responsibility--the heavy responsibility of our profession--is indispensable4 ,he who accepts the easy case or the chronic and slowly progressive one and refuses to face the appalling rush of a dangerous and acute malady2 he who shrinks through fear for his reputation from a grave risk1 has no right in ,chiropractic4 ,he has mistaken his calling4 ,while we acquire the knowledge of ,chiropractic we acquire also a great responsibility for its use2 we must utilize it wherever and whenever it is best for the patient1 whenever our chances of effecting a cure are the best chances1 without regard to ourselves or any personal risk4 ,by conviction is meant a firm and well-grounded belief in the greatness and efficiency of ,chiropractic4 ,sincerity in one's practice is a prime requisite for success4 ,a belief grounded in knowledge girds the ,chiropractor with an armor so strong that no adversity can pierce it4 ,he who practices ,chiropractic without believing in it is in his own mind a cheat and a fraud and cannot expect ultimate prosperity4 ,confidence in one's own ability and knowledge1 in one's power and skill to contest with disease1 begets confidence in others4 ,not conceit1 not exaggerated egotism1 but a healthy and sane assurance and faith in oneself1 engender that steadiness of mind and of hand which make for accuracy and excellence4 ,without honesty with oneself1 one's profession1 and one's patients1 one forfeits public confidence--and justly4 ,if we promise that which we cannot perform1 if we deceive our patients by misleading explanations of untoward events1 we deserve failure4 ,it is not intended here to refer to the cheerful and optimistic manner and habit of speech which often aids in the sick room to keep the patient's mind at rest4 ,this may sometimes deceive the patient as to the gravity of his condition and such deceit may be justifiable2 but it should never be extended to the family or to those who have a right to know the real condition and cannot be harmed by such knowledge4 ,strict honesty1 whenever harmless to others1 should be the fixed policy of all practitioners4 ,the weak1 strained minds of the very ill require and demand sympathy2 not the sort which expresses itself in fixed words or phrases of condolence with the unfortunate and at once forgets their needs and sorrows1 but the deeper1 unspoken feeling of desire to aid1 which springs from the heart and finds its best expression in active assistance4 ,if you do not care whether your patient is or is not benefited1 if you have no other feeling for him than a business interest in holding a case1 you lack the strongest impulse to hard work and study1 the desire to aid4 ,chiropractic is new4 ,its principles are yet unknown to the general public4 ,also this is an age of keen competition and it is our duty to our profession and to the world that instead of hiding our light under a bushel we proclaim our mission to all who will hear4 ,we must be intelligently and wisely aggressive4 ,we must bring ourselves into contact with the public in every legitimate way1 compelling it by force of logic and personality to see the reasonableness and greatness of our work4 ,question yourself in regard to these things4 ,examine your own characteristics to discover whether any of these essential elements of personality are lacking4 ,if one be found wanting cultivate it assiduously4 ,having chosen ,chiropractic as a life vocation1 work at it not alone for the acquisition of ever-increasing knowledge but for the unfoldment of a powerful and winning personality4 ,,chiropractic ,,prognosis ,prognosis is the determining1 in advance of the fact1 of the probable course1 duration1 or outcome of a disease4 ,a ,chiropractic prognosis is a prediction as to the changes which will take place in a case during and after ,chiropractic adjustments4 ,general ,prognosis is an opinion expressed of a disease without reference to any particular case4 ,it is based upon the experience of the profession and the average result obtained with the disease4 ,it furnishes only a basis for consideration of the special prognosis of an individual case4 ,this latter must be based upon the general prognosis of the disease and upon study of every modifying factor present in the case1 as general vitality1 living habits1 facility of adjustment1 apparent response to early adjustments1 and especially an estimate of the amount and kind of damage done to tissue and the probability of its repair4 ,only general prognosis can be set down as a guide to others4 ,to state even this with certainty and safety many precautions must be observed4 ,all cases included as a basis of conclusions must be handled under standard test conditions 7see index7 as far as may be2 in accepting the observations of others one must be sure that they are sufficiently trained and sufficiently careful and veracious to render their statements reliable4 ,in order to introduce the subject to the literature of the profession and to invite comment and discussion looking toward the ultimate development of a complete ,chiropractic prognosis we shall set down1 without further preliminary1 the general prognosis of those commonly described diseases concerning which we feel qualified to speak4 ,no statement is made without the gathering of reliable evidence4 ,,general ,,prognosis ,abscesses4--,those abscesses which would tend to discharge externally may be adjusted for with success and will rapidly develop1 point1 and discharge1 with quick recovery4 ,those which might break internally absolutely forbid adjustment because of the almost certain occurrence of peritonitis1 pyaemia1 or other grave condition4 ,acne4--,good1 but usually slow4 ,addison's ,disease4--,few cases reported1 and these slow cures4 ,adenoids of ,pharynx4--,prognosis so good as to contraindicate operation in every case4 ,the lymphoid growths gradually and slowly absorb under adjustment4 ,adiposis ,dolorosa4--,only one case seen1 the ,derkum case4 ,this reduced in six months of adjustment from #cfj to #bhj lbs4 in weight1 and was improved in every particular4 ,no final report received4 ,alcoholism4--,adjustments greatly aid a cure if alcohol be discontinued at once1 or if the daily consumption is gradually and steadily decreased4 ,no permanent cure can be secured without the aid of the patient4 ,acute alcoholic intoxication may be lessened at once by the aid of a single adjustment4 ,amenorrhoea4--,prognosis excellent4 ,one to several months required4 ,conservative amenorrhoea1 as in tuberculosis or other wasting disease1 disappears only with the occasion4 ,anaemia4--,if primary1 yields slowly but surely4 ,secondary anaemia depends upon some disease process and its prognosis is that of the disease which produces it4 ,angina ,pectoris4--,a case for careful diagnosis4 ,false angina recovers with general building of nervous system4 ,true angina1 usually associated with arteriosclerosis1 is frequently fatal and death may occur during any adjustment4 ,if this does not happen most cases recover1 though slowly4 ,let me repeat1 there is great danger in handling true angina pectoris4 ,anidrosis4--,usually responds to adjustments for the kidneys4 ,ankylosis4--,almost any ankylosis1 except that in which there is gross deformity of the bones1 would yield to repeated applications of force along right lines4 ,only vertebral ankyloses are amenable to ,chiropractic adjustment and those are usually broken in time4 ,anterior ,poliomyelitis4--,chiropractic experience with 8infantile paralysis0 has been very extensive and gratifying4 ,during the febrile stage the disease may be aborted by one or several adjustments with only slight and transient paralyses resulting4 ,the chronic paralysis which follows an unadjusted case is curable1 but restoration of the motor function and trophic tone of the paralyzed members is delayed while the ventral horn cells are regenerated1 the axons rebuilt1 and the atrophied muscles redeveloped4 ,often no apparent results will be obtained for one or several months1 after which gradual improvement progresses to a complete cure4 ,aphonia4--,prognosis excellent4 ,no failures reported4 ,apoplexy4--,the occasional case in which a premonitory partial paralysis precedes real hemorrhage responds remarkably to adjustment so that with care the hemorrhage may be averted4 ,after hemorrhage the absorption of the clot is slow and tedious1 but about #ej per cent recover4 ,appendicitis4--,in the early stages of the acute form1 and in nearly all chronic cases1 recovery is almost certain under adjustments4 ,signs of suppuration indicate immediate operative interference and drainage1 and failure to read the signs may lead to rupture1 peritonitis1 and death4 ,acute cases yield very quickly as a rule4 ,arthritis ,deformans4--,in well developed cases some almost complete cures have been effected in periods varying from two to four years4 ,prognosis good as to relief1 but poor as to complete recovery4 ,ascites4--,fair prognosis1 depending upon the nature of the portal obstruction4 ,cirrhotic ascites does not yield well4 ,asthma4--,spasmodic bronchial asthma is almost always curable except in the very aged1 but the usual posterior curvature in lower cervicals and upper dorsals requires time and persistent heavy adjustments for its correction4 ,the asthmatic paroxysm may be relieved instantaneously1 but will recur at intervals for a long period before the cure is fully established4 ,the cardiac form of asthma depends upon restoration of compensation for a leaking valve1 and yields by irregularly progressive diminution4 ,blindness4--,as a condition1 without qualifying terms1 blindness offers a bad prognosis4 ,most cases fail to develop sight under adjustments4 ,yet some individual cures in optic atrophy1 in detached retina1 and in other conditions1 attest the possibility4 ,cataract blindness perhaps yields best4 ,bradycardia4--,if symptomatic1 yields as does the disease4 ,if primary1 a few adjustments are usually sufficient4 ,in one case the first adjustment increased to #ij a pulse which had been at #fj for fifteen years4 ,in twenty-four hours1 without further adjustment1 the rate had settled at #fi and there remained4 ,bright's ,disease4--,prognosis good1 but some cases terminate abruptly with intercurrent disease1 such as pneumonia4 ,there is danger until the albuminuria has ceased and the strength of the patient markedly improved4 ,probably the diseased kidney area is simply walled off from the healthy tissue1 which then hypertrophies and takes on the work of the entire organ1 or pair of organs4 ,if too much damage has been done1 the case will terminate fatally in time1 even though its progress is checked by adjustments4 ,bronchitis4--,acute bronchitis is quickly checked as a rule4 ,chronic bronchitis may prove intractable1 or may require many months for a cure4 ,there are exceptional quick cures of the most chronic cases4 ,caked ,breast--,mammary ,inflammations4--,rapid and positive cure follows proper adjustments4 ,cerebral ,softening4--,prognosis bad4 ,cerebrospinal ,meningitis4--,serious always1 but no fatalities reported in adjusted cases4 ,failure to modify fever and cervical retraction within two or three hours1 and with one to ten adjustments1 is alarming4 ,chickenpox4--,like smallpox and the other exanthemata1 chickenpox should be modified at once by adjustment and all cases should be light1 eruption hastened1 and fever quickly broken4 ,sometimes the rash may be strongly marked and the disease run its usual course in all particulars except fever and prostration1 being a febrile with absence of all the consequences of fever4 ,cholangitis4--,recovers quickly under adjustment4 ,cholecystitis4--,prognosis excellent4 ,chorea4--,prognosis excellent in acute and subacute cases1 less favorable in chronic4 ,no figures are available1 but many chronic cases fail to respond at all4 ,cirrhosis of ,liver4--,doubtful4 ,no statistics have been compiled1 but it seems probable that most cases are unmodified by adjustment4 ,congestion of ,liver4--,prognosis good4 ,conjunctivitis4--,readily curable1 unless part of a more general infection4 ,constipation4--,prognosis usually good1 but some cases which have paralyzed the intestines with drugs1 or in which atony of the intestinal muscles exists from any cause1 are very stubborn4 ,one is led to believe that any case of chronic constipation would respond to proper adjustments in time1 but sometimes the time is prolonged more than seems reasonable4 ,coryza4--,some cases respond instantly1 others persist and run their usual course4 ,chronic nasal catarrh recovers in favorable climates1 and in unfavorable tends to become permanent1 though less severe and annoying under adjustment4 ,croup4--,always dangerous1 but no fatalities reported under adjustments1 which are powerfully effective4 ,croup requires constant attention until all symptoms subside1 usually within an hour or two4 ,cystitis4--,usually curable1 but some chronic cases prove intractable for an unknown reason4 ,there is no way of recognizing the curability of a case before the attempt4 ,deafness4--,variable outlook4 ,deafness due to catarrhal occlusion of the ,eustachian tubes is usually curable4 ,that due to middle ear disease sometimes yields4 ,that due to nerve disease is possibly--though not certainly--incurable4 ,diabetes ,insipidus4--,prognosis excellent4 ,few cases fail of cure1 and no fatalities are reported4 ,diabetes ,mellitus4--,always necessitating grave and careful consideration1 this metabolic disease is marvellously controlled by ,chiropractic adjustment4 ,probably #ij per cent of all cases are curable1 and only those presenting impossible problems of adjustment1 or those in the very last stages1 are hopeless4 ,diarrhoea4--,prognosis depends largely upon secondary causes4 ,adjustments sometimes produce diarrhoea to cleanse the intestinal tract of waste or poisons4 ,such a diarrhoea1 if instituted by ,nature without aid1 does not cease with adjustments until its purpose is accomplished4 ,nervous and infective diarrhoeas usually respond well4 ,dilatation of ,heart4--,compensatory hypertrophy and strengthening of the muscle usually follows adjustment4 ,diphtheria4--,under adjustment the false membrane tends to exfoliate and to be coughed out entire within a few hours1 with rapid recovery4 ,in children1 watch for possible strangulation from loosened membrane4 ,constant bedside attention is imperative until fever and membrane have disappeared4 ,convalescence1 unless antitoxin has been used1 is very rapid1 and physicians watching the clinical course of diphtheria under adjustment customarily doubt the diagnosis unless culture is made4 ,antitoxin modifies the prognosis toward gravity1 and in spite of adjustments persistent sequelae often follow its use4 ,dropsy4--,cardiac or renal dropsy disappears with improvement in the diseased organ4 ,dysentery4--,in temperate climates death is extremely unlikely4 ,recovery is often quick and easy1 but some cases persist4 ,the tropical amoebic dysentery seems hardest to master and may not improve at all4 ,dyspepsia4--,prognosis good4 ,endocarditis4--,if primary1 recovery is the rule4 ,occurring in the course of some other disease1 as rheumatic fever1 it renders the prognosis less certain and may terminate fatally4 ,likely to leave chronic valve weakness or contraction4 ,enteritis4--,prognosis generally fair4 ,no figures available4 ,enuresis4--,the majority recover within a few weeks or months1 with occasional exceptions4 ,failure to get results within a few weeks suggests a change of adjustment4 ,epilepsy4--,doubtful4 ,less than half of all cases recover1 and no case can be pronounced cured until all symptoms have been absent for a year4 ,cases with anterior cervicals offer the poorest chance4 ,it is usually possible to restore consciousness and muscular control by an adjustment during the grande mal1 in the instant between the tonic and clonic spasms1 but such immediate response does not--unfortunately--always mean that a cure will eventually be effected4 ,epistaxis4--,nose-bleed usually stops at once following proper adjustment4 ,erysipelas4--,cases adjusted early show little spreading of the eruption with but slight constitutional symptoms4 ,after eruption is fully developed it is more difficult to keep down the fever and recovery is slower1 but none the less certain unless cardiac or other grave weakness is present4 ,exophthalmic ,goitre4--,like other forms of goitre this may be reduced1 and with its reduction all other symptoms disappear4 ,many cures are on record4 ,friedrich's ,ataxia4--,in hereditary cerebellar ataxia 7which is probably congenital1 rather7 cures are limited to #dj per cent or less4 ,history of instrumental delivery1 with marked upper cervical subluxation1 argue for the natal origin of the disease and increase the probability of cure4 ,gallstones4--,prognosis excellent4 ,the calculi absorb under adjustment by a reversal of the chemical process by which their deposit was induced4 ,when small they may pass through the ducts and escape1 with slight pain4 ,adjustment during the painful passage of a gallstone may act upon the duct so as to lessen greatly the pain and hasten the passage4 ,gastralgia4--,like other gastric neuroses1 is easily curable but may sometimes require correction of a neurotic diathesis1 which means time4 ,gastric ,ulcer4--,usually recovers1 but occasionally leaves a fibrous cicatrix which cannot be affected by adjustment and which1 if located at the pylorus1 may produce stenosis1 with consequent incurable dilatation of the stomach4 ,operation is required for such a condition1 but the diagnosis is difficult1 and it may be best to test with adjustments for some time4 ,gastritis4--,prognosis good4 ,to prevent recurrence adjustments should continue after symptoms subside4 ,goitre4--,prognosis good4 ,one large goitre under the author's observation was reduced in one week so that the neck measurement decreased one inch4 ,most cases require several months for complete reduction4 ,gonorrhoeal ,rheumatism4--,more stubborn than other forms of rheumatism and sometimes defies adjustment4 ,no percentages are available4 ,it is probable that nothing but a general cleansing of the system will prevent recurrence4 ,hay ,fever4--,perhaps one-half of all adjusted cases recover fully1 some at once and some after several months4 ,by recovery is meant failure of the annual appearance of the attack with no symptoms at any time4 ,no case can be pronounced cured in less than a year4 ,the remaining half are modified little or not at all4 ,headache4--,nervous1 bilious1 ocular1 and reflex headaches yield well4 ,toxic headaches1 or those accompanying systemic infections1 give way slowly with the cleansing of the system4 ,hemorrhoids4--,excellent1 except when lower lumbars are anterior and defy adjustment4 ,hernia4--,in all sites and forms of hernia1 excepting strangulated hernia1 prognosis is good4 ,strangulation requires immediate surgical interference4 ,prognosis is better if a truss be used4 ,hodgkins' ,disease4--,prognosis theoretically good1 but the few cases under adjustment1 while benefited1 seem to have died of intercurrent disease1 so that it is well to suspend judgment4 ,hydrocele4--,theoretically hydrocele should respond well1 but in practice the author has seen several failures1 and no cures4 ,hydrocephalus4--,if due to cervical twisting at birth1 the prognosis is fair2 otherwise bad4 ,hypertrophy4--,adaptative hypertrophies1 those due to overstrain upon an organ1 do not and should not disappear until the strain has been relieved4 ,hypertrophy is sometimes accelerated by adjustment1 as in the case of defective heart valves1 when thickening of the wall restores and maintains compensation4 ,other hypertrophies tend to disappear under adjustment4 ,hysteria4--,good1 but slow4 ,some extreme cases refuse to respond4 ,instant recovery from hysterical coma is the rule following adjustment1 but the coma tends to recur4 ,immunity4--,there is no doubt that adjustments often confer immunity from infection and contagion1 but it is so difficult to strengthen every part of the body against every possible infection or contagion1 and so uncertain that immunity really exists in a given case1 that it is best always to assume the possibility of contagion and act accordingly4 ,adjustments following exposure to known contagion are always wise1 but one may never know1 if they succeed1 that the patient might not have escaped without them4 ,impotence4--,variable outlook1 according to secondary causes and pathology4 ,previous venereal disease renders the prognosis most doubtful4 ,nervous or vascular impotence is likely to respond well4 ,if due to cord disease1 the prognosis is to be made on the original disease4 ,influenza4--,mortality not more than #b per cent1 and that in the very aged and infirm4 ,duration varies greatly4 ,may yield at once1 first adjustment being followed by disappearance of fever1 profuse perspiration1 and completed convalescence in from twenty-four to forty-eight hours2 or may require several adjustments at frequent intervals to break fever4 ,insanity4--,no accurate tabulation of results in different forms of insanity has been made4 ,numerous successes1 interspersed with fewer failures1 have been reported4 ,the author has both succeeded and failed with acute dementia1 but the failure was a twenty-four-hour trial only1 and included but three adjustments4 ,intestinal ,obstruction4--,the prognosis of intestinal obstruction from intussusception or strangulated hernia is1 under ,chiropractic1 bad4 ,such cases are almost surely fatal unless operated4 ,faecal obstructions or masses of worms1 also volvulus1 respond quickly and prognosis is good4 ,careful diagnosis is required before taking a case of apparent complete obstruction4 ,irritable ,heart4--,if purely nervous1 recovery is quick and easy4 ,if there is a drug diathesis or organic disease1 slow and doubtful4 ,jaundice4--,yields readily1 but if of the obstructive form the obstruction must first be reduced or removed by adjustments4 ,laryngitis4--,a few adjustments suffice for simple acute cases4 ,specific laryngeal infections are more difficult4 ,laryngitis with ulceration1 which is either syphilitic or tubercular1 may not recover or may recover after a protracted struggle4 ,chronic laryngitis of other forms is curable1 but requires more time than acute4 ,leucorrhoea4--,fair prognosis only4 ,lumbago4--,good1 unless pain prevents proper adjustment4 ,true lumbago is quick to respond4 ,malaria4--,tenacity varies according to climatic conditions4 ,malarial cachexia always yields slowly1 sometimes defies adjustment altogether4 ,no reports are to be had on pernicious malaria4 ,other forms recover though paroxysms tend to recur several times before checked1 but of shorter duration than if no adjustment is given4 ,mastoiditis4--,good results in the few cases observed4 ,measles4--,excellent4 ,recovers quickly4 ,eruption hastened by early adjustment1 runs very mild course with little or no fever1 catarrhal symptoms disappear early4 ,no sequelae4 ,meniere's ,disease4--,labyrinthine disease of this character has been cured1 without reported failures1 but data is meagre1 not more than three or four cases having come under the author's notice4 ,menorrhagia--,metrorrhagia4--,results excellent1 and usually quick4 ,one fifty-two-hour intermenstrual hemorrhage from uterus was stopped in one hour by adjustment1 with no recurrence4 ,migraine4--,migraine1 or hemicrania1 gives a fair prognosis only4 ,most cases require a long course of adjustments4 ,movable ,kidney4--,prognosis good1 but change of position and complete fixation slow4 ,no treatment required--merely adjustment4 ,myelitis4--,transverse myelitis1 if adjusted in the acute stage1 may be checked as any other inflammation1 and the damage and resulting paralysis will be greatly lessened or altogether prevented4 ,the paralyses which follow myelitis require time for the rebuilding of the degenerated axons whose course is interrupted at the diseased area1 but tend to recover4 ,myocarditis4--,reports conflict4 ,it is well to consider this a grave condition and one open to investigation4 ,myxoedema4--,only one case known to have been under adjustment1 and this after several years was markedly improved1 but not yet quite cured4 ,nephritis4--,prognosis good4 ,acute cases show rapid1 chronic cases slow1 improvement4 ,neuralgia4--,prognosis excellent in any form4 ,trophic neuralgias1 such as herpes zoster1 are slowest as a rule1 but occasional cases of tic doloureux will require several months4 ,one may always expect a cure unless the patient1 in long cases1 becomes discouraged and stops adjustments4 ,neurasthenia4--,good1 but will be slow unless mental aid be given in the form of freedom from worry or strain4 ,neuritis4--,good1 but very uncertain as to time2 some cases show quick disappearance of all pain and some drag interminably4 ,optic ,atrophy4--,complete atrophy with total blindness is rarely cured1 though occasional partial or complete cures have been reported4 ,partial atrophy may slowly recover1 or recovery may cease at some point short of completion and case remain stationary thereafter4 ,ovaritis4--,good1 except in suppurative forms4 ,when adhesions have been formed1 results are doubtful4 ,pancreatitis4--,obscure1 hard to recognize1 and hard to cure4 ,prognosis probably bad4 ,paralysis ,agitans4--,probably in the earliest stages this is curable4 ,cure of a fully developed case is exceedingly doubtful and the writer has yet to see marked benefit in such a case4 ,paralyses4--,prognosis decidedly variable4 ,apoplectic hemorrhage recovers in about #ej per cent of all cases4 ,paralyses from central lesions require much more time than peripheral palsies because of the necessity for rebuilding degenerated nerve cells as well as fibres4 ,the paralyses following anterior poliomyelitis are almost certain to be cured if sufficient time is allowed4 ,most peripheral palsies1 except in the very aged1 are curable4 ,any other paralysis but a purely functional one recovers slowly1 but this form may yield almost in a day4 ,parotitis4--,mumps respond immediately and may be checked at any stage4 ,pericarditis4--,usually recovers4 ,effusions are stubborn and may become purulent1 in which case the prognosis is grave4 ,peritonitis4--,prognosis grave1 but some cases have been reported as cured under adjustment4 ,these are probably localized rather than diffuse inflammations1 usually pelvic4 ,pertussis1 or ,whooping-,cough4--,tends to run its course despite adjustments1 though some aborted cases are reported4 ,all cases mild under adjustment1 with small liability of complications4 ,a nervous cough is likely to persist for months after the infection has passed4 ,adjustments seem seldom to prevent contagion4 ,pharyngitis4--,acute form yields readily4 ,chronic pharyngitis is more stubborn1 but usually curable4 ,pleurisy4--,pleurisy1 unless purulent or tubercular1 yields well in varying periods4 ,purulent and tubercular pleurisy are stubborn and may not recover4 ,pneumonia4--,the author has had a wide and gratifying experience with pneumonia4 ,at every stage it seems amenable to adjustment1 and the usual effect of the first adjustment is a drop of from one to two degrees in the temperature with immediate softening of the consolidated area4 ,specific adjustments get best and quickest results4 ,pneumonia should always recover1 unless it occurs as an intercurrent event in some chronic and wasting disease1 as ,bright's ,disease4 ,potts' ,disease4--,tubercular caries of the bodies of the vertebrae is curable1 within limits4 ,occasional cases are seen in which ,nature has stopped the spread of the disease by walling off the morbid area with exostosis4 ,such cases should not be adjusted1 and the disease may remain latent through a long life4 ,when active the disease proves fatal unless checked1 which is possible in the earlier stages1 and becomes impossible when the vertebral bodies are too fragile to stand strong adjustments4 ,discernment in case-taking will avoid any fatalities under adjustment1 but by no means all cases of ,potts' ,disease are curable4 ,pregnancy4--,we may correct by adjustment any pathological conditions arising during pregnancy which would be amenable to adjustment under other conditions4 ,a course of adjustments during a normal pregnancy will render delivery easier and lessen1 but not abolish1 the pains4 ,great care must be exercised in the manner of adjustment4 ,prostatic ,enlargement4--,varies according to age and recuperative power4 ,prognosis is bad in the very aged and infirm1 but in more vigorous subjects quite good for steady reduction of the hypertrophied gland1 with subsidence of attendant symptoms4 ,venereal history is unfavorable4 ,pulmonary ,tuberculosis4--,in the early stages1 where little damage has been done to lung tissue1 recovery is rapid and quite certain4 ,in fully developed cases1 with characteristic symptoms and marked damage to tissue1 prognosis is very grave1 and it is usually wisest to advise a trip to the ,southwest in preference to adjustments4 ,tubercular cases should be studied with a view to estimating the exact condition and recuperative power of the patient before taking4 ,rachitis4--,prognosis excellent4 ,in a period varying from six months in the best to five to seven years in the slowest cases1 all show complete or nearly complete cures4 ,all deformity may be checked in a short time and proper bone nourishment established4 ,correction of deformities existing prior to adjustment is a growth process4 ,too many cases become discouraged at the slowness of the work and stop adjustments4 ,retinal ,hemorrhage4--,prognosis fair4 ,undoubted cures have been recorded1 as well as a few failures4 ,at least one case of hemorrhages followed by partially detached retina has been cured1 or nearly so1 by adjustments4 ,rheumatic ,fever4--,hard to adjust because of its painful nature4 ,results of proper adjustment usually1 but not always1 good4 ,rheumatism4--,muscular rheumatism yields more rapidly than articular4 ,acute tends to quick recovery1 chronic to more or less lengthened and slow improvement4 ,rheumatic diathesis may require many months of careful adjustment4 ,rubella4--,simply and easily checked4 ,rash slight1 and no prostration at all4 ,scarlet ,fever4--,data on quarantinable cases is meagre1 but scarlet fever1 or scarlatina1 seems to be quickly modified by adjustment4 ,one may expect a drop of from one to two degrees in temperature after first adjustment1 followed by steady rise1 which will again be checked by the next adjustment4 ,rash appears early1 and all symptoms are mild1 but several days are often required to put the patient at ease4 ,occasional sequelae1 such as endocarditis1 otitis media1 or other inflammations1 occur unless case be watched with great care4 ,no fatal terminations under adjustment except in cases which were at first misdiagnosed4 ,seminal ,emissions4--,prognosis excellent in cases uncomplicated by masturbation or excessive venery2 in such cases bad until habits are changed4 ,simple ,continued ,fever4--,always recovers4 ,usually drops one to two degrees shortly following correct adjustment1 with amelioration of all symptoms4 ,smallpox4--,infections vary in virulence4 ,in temperate climates all phases are hastened by adjustment and tend to recover without sequelae4 ,the milder smallpox due to infection by vaccination is also amenable to adjustment1 and prompt handling will often prevent serious poisoning4 ,splanchnoptosis4--,partial or marked relief is usual--and slow4 ,complete natural replacement of all viscera is the exception rather than the rule4 ,splenic ,enlargement4--,variable prognosis according to cause4 ,secondary enlargements due to systematic infection yield with the disappearance of the infection4 ,primary enlargements yield more readily as a rule1 with exceptions4 ,malarial spleen is slow to reduce4 ,splenitis4--,prognosis presumably good1 but few authentic cases reported4 ,spondylitis ,deformans4--,prognosis favorable for slow1 slight improvement1 but not for complete cure4 ,strabismus4--,excellent in young subjects1 less than fair in patients over thirty4 ,sunstroke4--,theoretically curable1 but no experience4 ,syphilis4--,the primary sore frequently dries under adjustment without the development of any secondary or tertiary stage4 ,if first adjusted during the secondary manifestations symptoms may readily disappear and no tertiary stage ever appear4 ,there are some authenticated cures eight and ten years past without recurrence of any sign4 ,in the tertiary stage the organic lesions do not respond4 ,prognosis is so hopeless in this stage that it seems useless to apply ,chiropractic at all4 ,tabes ,dorsalis4--,posterior spinal sclerosis1 commonly called from its chief symptom 8locomotor ataxia10 recovers in #dj to #ej per cent of cases adjusted4 ,no accurate pre-judgment can be formed as to the probabilities in any particular case without experiment1 nor has any adequate explanation been offered as to why some cases recover and others do not4 ,those cases which improve at all are likely to recover fully4 ,in any instance1 time is required for the regeneration of the dorsal column axons1 and while this is going on no improvement may be apparent at all4 ,tachycardia4--,if symptomatic1 as of exophthalmic goitre1 tachycardia yields as the disease does4 ,if primary1 a few adjustments usually establish a proper pulse rate4 ,tetanus4--,only one undoubted case has been brought to the writer's attention and this one a marvellous cure4 ,adjustments were given as often as every ten minutes for a time4 ,thoracic ,aneurism4--,cure exceedingly doubtful1 and fatal termination possible at any time4 ,little information is at hand4 ,tonsilitis--,quinsy4--,simple or follicular tonsilitis aborts under adjustment in from a few hours to two or three days4 ,quinsy1 or suppurative tonsilitis1 runs its regular course as to duration1 but is frequently a febrile after the first day4 ,spontaneous rupture of the tonsil will usually occur and sometimes two or three such ruptures will lengthen the case slightly4 ,sequalae are wanting1 but all forms of tonsilar inflammation tend to recur unless a long course of corrective adjustments is applied to the cervical region4 ,torticollis4--,acute spastic or rheumatic torticollis in which permanent contractures have not yet set in may be cured almost invariably in a period varying from a few days to several weeks4 ,chronic cases with permanent contractures yield very slowly1 but prognosis is good for a fairly accurate straightening of the neck4 ,such cases often leave slight abnormalities even in the most competent hands4 ,tuberculosis1 ,pulmonary4--,see ,pulmonary ,tuberculosis4 ,tumors1 ,benign4--,unlike malignant growths1 benign tumors1 fatty1 fibroid1 etc41 tend to gradual absorption under adjustment4 ,perhaps #ge per cent or more may be completely cured4 ,age is a factor1 tumors in young subjects being more readily curable than in the aged or infirm4 ,tumors1 ,malignant4--,prognosis bad4 ,if cancer in any form can be cured proof has escaped the author's diligent search4 ,it is wisest to refuse all cancerous cases4 ,typhoid ,fever4--,prognosis excellent if adjustments are commenced during first week of fever1 in which case the fever should be aborted at once1 followed by one or two mild exacerbations1 then permanently checked4 ,doubtful prognosis after first week1 because of liability to perforation during adjustment4 ,after second week of fever very grave prognosis under adjustment1 and better with nursing alone4 ,uteroversion--,prolapsus4--,uteroversio ns and prolapses are corrected1 sometimes rapidly but more often slowly and gradually4 ,favoring circumstances are freedom from overwork or overlifting4 ,some extreme cases result in failure4 ,valvular ,diseases4--,these may be grouped for prognosis4 ,no percentages have been compiled1 but it may be said that the prognosis is generally good as to relief and restoration of compensation1 but poor as to rebuilding of the valves4 ,many cases of apparent permanent and complete recovery are probably simply cases of excellent compensation4 ,death occasionally occurs despite adjustments4 ,varicocele4--,outlook good for a slow1 certain recovery4 ,varicose ,veins4--,probability favors cure in subjects not beyond middle life1 providing they are not greatly overweight or too much on their feet4 ,cure always slow4 ,,index ,a ,abdominal muscles1 #bdh ,abscesses1 #cbc ,acne1 #cbc ,adenoids of pharynx1 #cbc ,addison's disease1 #cbc ,adiposis dolorosa1 #cbc ,adjuncts1 #bae ,adjuncts1 use of1 #cae ,adjusting1 contact in1 #id definition of1 #hi general1 #cjc how to learn1 #afd principles of1 #hi rapid movement in1 #ic specific1 #cjc special technic of1 #ii speed in1 #aca technic of1 #hi ,adjusting position1 rules for1 #abg ,adjusting tables1 #bhd ,adjustment1 effect of1 #ahf1 #ahi object of1 #ij specific1 #bcj vertebral1 #hi ,adjustment of curvatures1 #aec ,adjustments1 coccygeal1 #aeb frequency of1 #cjb iliac1 #aej sacral1 #aej table of for any subluxation1 #aef ,advertising1 #bij ,age of subluxations1 #hd ,alcoholism1 #cbc ,amenorrhoea1 #cbd ,anatomy1 comparative1 #bbf nervous1 #bcd ,anchor move1 #aaf1 #aah ,angina pectoris1 #cbd ,anidroses1 #cbd ,ankylosis1 #eh1 #hh1 #cbd ,anosmia1 #cbd ,anterior cervical move1 #ajb1 #ajc pisiform1 #ajj ,anterior fifth lumbar1 #aej ,anterior poliomyelitis1 #cbd ,anterior subluxations1 #hd ,aorta1 abdominal1 #bej thoracic1 #bej ,aphonia1 #cbe ,apoplexy1 #cbe ,appendicitis1 #cbe ,appendix1 vermiform1 #bec ,approximation1 vertebral1 #hb ,arm1 anterior muscles of1 #bee posterior muscles of1 #bee ,arteria centralis retinae1 #bdc ,arthritis deformans1 #cbe ,ascites1 #cbf ,asthma1 #cbf ,atlanto-occipital move1 #ajf ,atlas1 #ah ,atlas move1 #ajf ,atlas palpation1 #ce ,axis1 #ai ,axis of body1 #bbc ,b ,back1 muscles of1 #bdg ,bag punching1 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#aeb ,coeliac axis1 #bej ,collection cards1 #bia ,colon1 #bec ,comparative anatomy1 #bbf ,concussion of forces1 #agh1 #bbd1 #bbf ,congestion of liver1 #cbh ,conjunctiva1 #bdc ,conjunctivitis1 #cbh ,contact1 close1 #id ,contact point1 #abi ,constipation1 #cbh ,coryza1 #cbh ,count1 #cj1 #cc difficulties in1 #cd verifying1 #cc ,cranial nerves1 distribution of1 #bdj ,croup1 #cbh ,cure of bodily excess disease1 #bad dietetic disease1 #bab germ disease1 #baa exposure disease1 #bad mental disease1 #bab poisoning cases1 #bac simple subluxation disease1 #bjh process of1 #bjh ,curvatures1 #aec causes of1 #ee compensatory1 #eg description of1 #ed record of1 #ef rotatory1 #ee ,curves and curvatures1 #ec ,d ,deafness1 #cbi ,diabetes insipidus1 #cbi mellitus1 #cbi ,diagnosis1 #bca1 #bge1 #bih ,diaphragm1 #bdh ,diarrhoea1 #cbi ,diet1 #aib1 #aic ,dietetics1 #cae ,dilatation of heart1 #cbi ,diphtheria1 #ahg1 #aij1 #cbi ,direction of subluxation1 #be ,disease1 cause of1 #afe functional1 #aff organic1 #aff ,diseases and adjustments1 #beg table of1 #beh ,displacements1 #hd ,door sign1 #bij ,double contact move1 #abj ,double transverse moves1 #ace1 #ach1 #aci1 #adh ,dressing room1 #bhf ,dropsy1 #ccj ,drugs1 #cae ,duodenum1 #beb ,dysentery1 #ccj ,dyspepsia1 #ccj ,e ,ear1 #bde ,edge contact1 the1 #add ,effect of adjustment1 #ahh1 #ahi ,effect of subluxations1 #gi ,elbow joint1 #bee ,electricity1 #baf1 #cae ,enuresis1 #ccj ,epidemics1 #ahi ,epilepsy1 #ccj ,epiphysis1 absent1 #fj ,epistaxis1 #cca ,erysipelas1 #cca ,eustachian tube1 #bde ,evidence1 kinds of acceptable1 #bcd ,examination1 schedule of1 #bib special1 #bif ,excesses1 bodily1 #bjj ,excitation1 #afb ,exposure1 #aih ,eye1 #bdb ,f ,fallopian tubes1 #bed ,fasting1 #bae ,fear1 #bja ,fees1 #bia ,fever1 #bje ,fever center1 #bjf ,fibrocartilages1 intervertebral1 #hc ,first appearance1 value of1 #bgg ,foods1 #aid ,foot1 #beg ,force in adjusting1 #ih ,freidrich's ataxia1 #cca ,frequency of adjustments1 #cjb ,furniture1 arrangement of1 #bhb office1 #bgh ,g ,gallstones1 #cca ,ganglion1 ciliary1 #bdc ,gasserian1 #bdd middle cervical1 #bdg sphenopalatine1 #bdd1 #bdf superior cervical1 #bdd1 #bdf ,gastralgia1 #ccb ,gastric ulcer1 #ccb ,gastritis1 #ccb ,general adjusting1 #cjc ,germ diseases1 #ahe ,germs1 #ahe pathogenic1 #ahe ,gland1 thyroid1 #bdg prostate1 #bec ,glands1 salivary1 #bdf suprarenal1 #beb ,gluteus maximus muscle1 #bef ,goitre1 #ccb ,gonorrhoeal rheumatism1 #ccb ,group method1 the1 #cg example of1 #ci ,gums1 #bde ,h ,habits1 #ae ,hay fever1 #ccb ,headache1 #ccb ,heart1 #bdi ,heat-regulating mechanism1 #bjc ,heel contact1 the1 #acc ,hemorrhoids1 #ccc ,hernia1 #ccc ,hip joint1 #bee ,history of case1 #big ,hodgkins' disease1 #ccc ,hook support1 #aje ,hydrocephalus1 #ccc ,hydrotherapy1 #cae ,hyperaemia1 #bjb ,hypertrophy1 #ccc ,hypothesis1 chiropractic1 #agb ,hysteria1 #ccc ,i ,ileum1 #beb ,iliac adjustments1 #aej ,ilium1 #aej ,immunity1 #ccd ,impingement of nerves1 #ahj1 #bji ,impotence1 #ccd ,individual subluxation1 #dj ,infection1 #ahf ,inflammation1 #bjb ,influenza1 #ccd ,inhibition1 #afi1 #ahb1 #ahi ,insanity1 #bja1 #ccd ,interiliac line1 #cd1 #fb ,intervertebral disks1 #hc ,intervertebral foramina1 #ah ,intestinal obstruction1 #cce ,iris1 #bdc ,irritable heart1 #cce ,irritability1 #afi ,j ,jaundice1 #cce ,jejunum1 #beb ,k ,key1 #ci ,kidneys1 #beb ,klebs-,loeffler bacillus1 #ahg ,knee joint1 #bef ,knife move1 #add ,kyphosis1 #ed ,l ,landmarks1 #fa ,laryngitis1 #cce ,larynx1 #bdf ,last finger contact1 #ajb ,lateral cervical move1 #ajg1 #aji1 #aaj ,lateral displacements1 #hd ,law of momentum1 #ih ,leg1 anterior muscles of1 #bef posterior muscles of1 #bef ,leucorrhoea1 #cce ,library1 reference1 #bhi ,limitations of ,chiropractic1 #bab ,liver1 #bea ,location of subluxations1 #gh ,lordosis1 #ed1 #he ,lumbago1 #cce ,lumbar1 anterior1 #aej ,lumbar plexus1 #bci ,lungs1 #bdi ,m ,maladjustment1 #hi ,malaria1 #cce ,major subluxations1 #ci ,massage1 #bae1 #cae ,mastoiditis1 #ccf ,measles1 #ccf ,meckel's ganglion1 #bdd ,mechano-therapy1 #cae ,medicine1 #cae1 #caf ,meniere's disease1 #ccf ,meninges1 #bdb ,menorrhagia1 #ccf ,mental attitude1 #fc ,mental states1 abnormal1 #bja ,metrorrhagia1 #ccf ,migraine1 #ccf ,minor subluxations1 #ci ,mixing1 #cae ,morikubo move1 #ii ,motor reaction1 #aic1 #aif1 #aii ,movable kidney1 #ccf ,movement for correction1 #bg ,muscles of abdomen1 #bdd of back1 #bdg of neck1 #bdg of perineum1 #bdi ,muscular control1 #ig ,muscular suggestion1 #if ,myelitis1 #ccf ,myocarditis1 #ccf ,myxoedema1 #ccg ,n ,naprapathy1 #cac ,napravit1 #cac ,neck1 muscles of1 #bdg ,nephritis1 #ccg ,nerve1 auditory1 #bde chorda tympani1 #bdf great sciatic1 #bef hypoglossal1 #bde inferior maxillary1 #bdd internal carotid1 #bdb olfactory1 #bdc phrenic1 #bdh recurrent laryngeal1 #bdf trigeminal 7trifacial71 #bdd ,vidian1 #bdd ,nerve connections1 special1 #bce ,nerve impingement1 #ahj1 #ahb1 #bji ,nerve paths1 #gj ,nerve pathways1 important1 #bdb structure of1 #bda ,nerves1 cranial1 #bdj optic1 #bdb spinal1 #bcg splanchnic1 #bej sympathetic1 #bdj traceable1 #fd ,nerve system1 #aga1 #bbb development of1 #bai1 #bbj outline of1 #bce sympathetic1 #aga ,nerve-tracing1 #fd1 #bif errors in1 #gc place of in diagnosis1 #fg suggestion in1 #fg technic of1 #fh ,neuralgia1 #ccg ,neurasthenia1 #ccg ,neuritis1 #ccg ,neurology1 #bcd ,neuron1 #bbj ,o ,observation of patient1 #bid ,occipital subluxations1 #ff ,occipito-atlantal move1 #ajf ,occlusion of foramina1 #ahj ,office equipment1 #bgg ,optic atrophy1 #ccg ,optic nerve1 #bdb ,oral suggestion1 #ie ,organs1 effect of impingement upon1 #ahc ,organ-tracing1 #fd ,osteopathy1 #baf1 #cac1 #cad1 #cae ,ovaries1 #bed ,ovaritis1 #ccg ,overadjustment1 #cjc ,p ,palpation1 atlas1 #ce cervical1 #db1 #dg1 #dh coccygeal1 #de difficulties in1 #ei dorsal1 #dc1 #df habits of1 #ae lumbar1 #dd1 #df pelvic1 #dd sacral1 #dd transverse1 #di vertebral1 #ae1 #bie ,pancreas1 #bea ,paralysis agitans1 #ccg ,parotitis1 #cch ,pectoralis muscles1 #bed ,penis1 #bec ,pericarditis1 #cch ,pericardium1 #bdi ,perineal muscles1 #bdi ,peritoneum1 #beb ,peritonitis1 #cch ,personality1 #cai ,pertussis1 #cch ,pharyngitis1 #cch ,pharynx1 #bdf ,pisiform anterior cervical move1 #ajj ,pisiform contact1 #abe1 #ace1 #aci1 #ada1 #adf ,pleurisy1 #cch ,plexus1 abdominal aortic1 #bec1 #bed ,auerbach's1 #bea brachial1 #bch1 #bed cardiac1 #bdi carotid1 #bdd cavernous1 #bdc cervical1 #bch coelic1 #bej1 #beb cystic1 #bea ,plexus1 gastric1 #bea hemorrhoidal1 #bec hepatic1 #bea1 #beb hypogastric1 #bec inferior mesenteric1 #bec lumbar1 #bci lumbosacral1 #bee ,meissner's1 #bea ovarian1 #bed pelvic1 #bec pharyngeal1 #bdf phrenic1 #bdh prostatic1 #bec pudendal1 #bci1 #bed pulmonary1 #bdi renal1 #beb sacral1 #bci1 #bed solar1 #bej spermatic1 #bec1 #bed splenic1 #bea superior mesenteric1 #bea1 #beb suprarenal1 #beb uterovaginal1 #bed vesical1 #bec ,pneumonia1 #cci ,point #b contact1 #add ,poisons1 #aig ,position ,a1 #bb ,position ,b1 #bc ,position ,c1 #bc ,positions for palpation1 #cj ,posterior cervical move1 #aai ,posterior subluxations1 #he ,potts' disease1 #ef1 #aed1 #cci ,practice1 #bgf ,preferable adjustments1 #aee ,pregnancy1 #cci ,preparation of patient1 #bb ,presumptive statements1 #bce ,private office1 #bhb ,process1 bent spinous1 #ei ,processes1 spinous1 #bj transverse1 #ba ,prognosis1 #cbb general1 #cbc ,prolapsus1 #cde ,promises to patients1 #cjf ,prostate gland1 #bec ,prostatic enlargement1 #cdj ,psychoses1 #bja ,pudendal plexus1 #bci ,pulmonary tuberculosis1 #cdj ,q ,quinsy1 #cdc ,r ,rachitis1 #cdj ,rami communicantes1 #agb white1 #bej ,recoil1 name of1 #acb1 #acc the1 #abe uses of1 #aca ,record1 the1 #bc the complete1 #bi sample of1 #bi use of1 #cj ,rectum1 #bec ,reference library1 #bhi ,reflex arcs1 #bda ,relaxation1 #ie ,rest room1 #bhg ,retina1 #bdb central artery of1 #bdc ,retinal hemorrhage1 #cdj ,retracing of disease1 #baa1 #cji ,rheumatic fever1 #cda ,rheumatism1 #cda ,roll1 the1 #bhe ,rotary move1 the1 #aaa1 #aae1 #aaf ,rotation1 axis of1 #hj vertebral1 #hj ,rubella1 #cda ,rules for adjusting positions1 #abg ,s ,sacrum1 #ag1 #ai1 #adi ,sacral adjustments1 #adi ,sacral plexus1 #bci ,salivary glands1 #bdf ,sample record1 #bi ,scarlet fever1 #cda ,schedule of examination1 #bib ,schneiderian membrane1 #bdc ,scoliosis1 #ee ,scrotum1 #bed ,second metacarpal contact1 #ajc ,segmentation1 #bai1 #bbi ,selecting movement1 #aef ,seminal emissions1 #cda ,seminal vesicles1 #beh ,sensor areas of lower extremity1 #beg ,serratus magnus muscle1 #bee ,serum-therapy1 #ahf1 #cae ,shoulder joint1 #bee ,signs1 #bij ,simple continued fever1 #cda ,single transverse moves1 #ada1 #adb1 #adf ,smallpox1 #cdb ,smell1 #bdc ,special cases1 #cja ,special nerve connections1 #bce ,specific adjustment1 #bcj1 #cjc ,spinal column1 #af1 #bbb ,spinal nerves1 distribution of1 #bcg ,spine1 #af ,spino-organic connection1 #bag ,spinous1 bent #ei ,spinous process1 #bj ,splanchnoptosis1 #cdb ,spleen1 #bea ,splenic enlargement1 #cdb ,splenitis1 #cdb ,spondylitis deformans1 #cdb ,spondylotherapy1 #bae1 #cac1 #cae ,spread move1 #adh ,stimulation1 #afi1 #ahi ,stomach1 #bea ,strabismus1 #cdb ,subluxation1 #bag direction of1 #be effect of1 #agi the individual1 #dj theory1 #agb ,subluxations1 age of1 #hg anterior1 #hd contiguous1 #cg effect of1 #gi increase of1 #aia1 #aic1 #aif1 #aii ,subluxations1 inferior1 #hc lateral1 #hd law governing location of1 #gh major1 #ci minor1 #ci occipital1 #hf posterior1 #he production of1 #gf secondary causes of1 #gg superior1 #hc varieties of1 #hj ,suggestion1 muscular1 #if oral1 #ie ,suggestive therapeutics1 #cae ,sunstroke1 #cdb ,supporting head in adjusting1 #aje ,suprarenal capsules1 #beb ,susceptibility1 #ahf ,sympathetic1 cervical1 #bdb ,sympathetic nerves1 distribution of1 #bdj ,sympathetic nerve system1 #aga ,syphilis1 #cdb ,t ,tabes dorsalis1 #cdc ,table of diseases and adjustments1 #beg ,table of subluxations and moves1 #aee ,tachycardia1 #cdc ,talking points1 #cjf ,teeth1 #bde ,tenderness #fi1 #ga ,tension1 #aha ,testes1 #bed ,tetanus1 #cdc ,theory of ,chiropractic1 #agb ,theory1 subluxation1 #agb ,thigh1 #bee1 #bef ,thoracic aneurism1 #cdc ,thoracic nerves1 #bch ,thrust1 #ia ,thumb move1 #aba1 #abc ,thyroid gland1 #bdg ,tipping1 vertebral1 #hb ,t4 ,m41 #aba1 #abc ,tongue1 #bde ,tonsilitis1 #cdc ,tonsils1 #bdf ,torticollis1 #cdd ,trachea1 #bdi ,transmitted shock1 #ia ,transverse adjusting1 #ace1 #ach1 #aci1 #ada1 #adc1 #adf1 #adh ,transverses1 #ba ,trauma1 effect of1 #agd1 #agh ,tube1 eustachian1 #bde fallopian1 #bed ,tuberculosis1 pulmonary1 #cdd ,tumors1 benign1 #cdd malignant1 #cdd ,typhoid fever1 #ahi1 #cdd ,u ,underscoring1 #bf ,ureters1 #bec ,urethra1 #bec ,use of adjuncts1 #cae ,uterus1 #bed ,uteroversion1 #cde ,v ,vagina1 #bed ,valvular disease1 #cde ,variations in number of vertebrae1 #fj ,varieties of subluxation1 #hj ,varicocele1 #cde ,varicose veins1 #cde ,vermiform appendix1 #bec ,vertebrae1 #af cervical1 #af dorsal1 #af lumbar1 #af variations in number of1 #af1 #fj ,vertebral palpation1 #ae1 #bie ,vertebra prominens1 #ag1 #ai ,vital energy1 #afi ,visceral nerves1 #bci1 #bec ,w ,waiting room1 #bhj ,worry1 #bja ,transcriber's ,notes ,punctuation1 hyphenation1 and spelling were made consistent when a predominant preference was found in this book2 otherwise they were not changed4 ,simple typographical errors were corrected2 occasional unbalanced quotation marks retained4 ,ambiguous hyphens at the ends of lines were retained4 ,the hierarchy of the ,table of ,contents has been used as the guide to the rest of the book1 even though the two sometimes differ4 ,index not checked for proper alphabetization or correct page references4 ,page #bf3 8,p ,r ,s0 has an underline below 8,p0 and a double-underline below 8,r04 ,page #cd3 8flexed far toward0 perhaps should be 8forward04 ,page #gi3 8as well all the details0 may be missing 8as0 after 8well04 ,page #aag3 8all vertebra above1 so to speak0 perhaps should be 8vertebrae04 ,page #adg3 8this move is predicated0 was printed as 8this more was predicated02 changed here4 ,page #aeh3 8,posterior1 right1 inferior--,p4 ,r4 ,i40 was printed as 8,p4 ,r4 ,l402 changed here4 ,page #ahg3 8but is claimed0 probably should be 8but it is claimed04 ,page #cjg3 8has been builded0 was printed that way4