The Chiropractor
D. D. Palmer
    Standard dictionaries use these two terms as synonyms, meaning nearly one and the same.  Medical dictionaries make only a slight difference.  In the practice of chiropractic there is a vast difference; this discrimination should be duly considered.  Chiropractors should make a special distinction between constipation and costiveness.  The two conditions resemble each other in the infrequency of evacuation, in no other sign or symptom are they alike.  In the character of the stool there is a great difference.  In costiveness the feces are scanty, dry, hard, compact and in chunks, yet the color is normal; the fluids from the spleen, pancreas, liver and intestine give it the normal color.  In constipation the character of the stool may be normal; the sluggish movement of the feces may be owing to atony, a lack of tone or tension, or a relaxed condition of the bowels, or the organs of the abdomen may be flacid, weak and displaced.

    The prolapsed condition of the stomach, kidneys, uterus, bowels, rectum, the conditions known as hernia, floating kidneys, prolapsus uteri, and hemorrhoids are because of a lack of tone, a relaxation of the abdominal nerves.  Chiropractors should become aware of this condition resulting from relaxation and undue tension.

    Constipation is due to functional inactivity of the intestinal canal, or from a lack of biliary, pancreatic and other secretions; obstructions of the intestinal canal, or paresis, paralysis of the intestinal walls, or the use of certain food or drugs, or a general depression of vital activity.  Each of these when known will suggest to a chiropractor the change of injecta necessary and the proper adjustment -- not adjustments.  In constipation there is a lack of vermicular or muscular motion, waves of alternte circular contraction and relaxation of the intestinal tube by which the contents are propelled onward, as is the circulation of the blood by the nervi vasorum.

    There is a condition known as reversed peristalsis, in which the waves of contraction and relaxation are reversed, the contents of the intestinal tract, or a portion of it is reversed and thrown backward.  When the bile is furnished in an unusual quantity it is thrown upward and into the stomach, and from thence it is ejected through the mouth.  In peristaltic unrest the bowels are in a state of abnormal mobility, the evacuations too frequent.  The lesion should be located and the over-tense nerves restored to their normal tonicity.

    Coarse food, such as corn meal and graham, increases the vermicular motion, because of its action, excitation by chafing of the nervous tissue of the intestine, whereas, white flour does not excite, it is smooth and pasty.

    Costiveness is accounted for by a lack of moisture; the kidneys are too active, they secrete and excrete more than their usual quantity of fluid, thereby robbing the stool tract of its normal amount of moisture.  Bear in mind that costiveness is because of a k.p. luxation and constipation is not.  In costiveness adjust the 12th dorsal, for by its displacement the distance between its inferior articulating processes and those of the first lumbar are increased, thereby stretching the nerves which innervate the kidneys.  Tense nerves, like stretched wires of a musical instrument, increases vibration, excitement and heat, a condition known as inflammation.  Constipation and costiveness are two entirely, distinctly different conditions.

    Bones have a normal limit in their movement--I refer to the mobility of joints, the articulations, the places of union between two or more bones -- more than normal is abnormal, pathological.

    How do I diagnose, determine the nature of the case and know where to adjust?  This is done in far less time than it takes to describe the diagnostication, and much more comprehensive were you to see it performed.  For the class a few cases demonstrated is worth more than any number not shown or proven.  For example, a case is presented for class benefit.  An ingrown toe nail, a callus on the plantar surface, soft and hard corns.  I may say to you that the ingrown toe nail is because of a lumber luxation, the soft and hard corns are from slightly displaced joints, that is, the articular surfaces of the toe joints are subluxated the same as in the joints of the vertebral column.  These displaced bones, whether in the joints of the toes or the vertebral column, stretch nerves which are attached to the surfaces of those bones, or to be more definite, the nerves are attached to muscles which are secured to bones by tendons, tension creates conditions known as disease.  There are no foramina in the toe joints, and those in the spine, together with the long gaps betweene the occiput and atlas and the atlas and axis, have nothing whatever to do with the tension of the spinal nerves and their branches.  The hard and soft corns are the same, except that soft corn is between the toes and is kept soft by moisture.  The foot has seven tarsal bones and the hand has eight carpal bones.  The callus on the bottom of the foot is because of a displaced tarsal bone, or at the articulation of the tarsal and metatarsal bones.  To demonstrate that the callus on the plantar surface was because of a subluxated tarsal bone, that the corn was from a slightly displaced toe joint and the ingrown toe nail came from a lumbar luxation I would make the adjustment for each at different clinical lectures, but for a private practice I would adjust all three ailments at the same call.

    (Cordelia, Risley, and Mrs. Kale).

    It is well to know of the construction of the parts we are handling.  This branch of knowledge is known as anatomy.  We should be acquainted with the vital processes of animal organisms -- physiology.  It is necessary that we should be acquainted with material and vital changes known as diseases -- pathology.  We ought to know specifically of the cause of disease as comprehended by chiropractors -- etiology.  The nature of the disease should be known -- diagnosis.  About one chiropractor in a hundred can give a definition of these terms and make intelligent use of that knowledge. However, I would rather have you comprehend one idea than to learn a dozen you do not understand.

    How do I diagnose?  First: I make use of clinical diagnosis.  I study the signs of disease as exhibited by outward appearance which indicate a certain disease or morbid condition, also, the symptoms as related by the patient, who usually considers all cases where the evacuation of the bowels are infrequent, or incomplete, more or less fecal matter retained in the intestine, as constipation.  As I question the patient I bring in differential diagnosis, by which I determine whether the condition is one of constipation or costiveness.  Then the diagnosis of exclusion is made use of.  There may be symptoms which might belong to and be associated with other diseases; these I exclude, leaving only one or more symptoms or signs which unerringly point to a certain vertebral luxation.  Very few chiropractors make use of differential diagnosis; in fact not one in a hundred chiropractors make any diagnosis at all, have no use for physiology, pathology, anatomy, symptomatology, orthopedy or etiology.  We ought to so conduct our exercises that each student would see the utility of being acquainted with these branches.

    If I determine that I have a case of costiveness, of which the larger share of those who consider themselves suffering from constipation are; to assure myself and the patient that I am correct I make use of physical diagnosis.  I palpate the spine in order to locate the 12th dorsal vertebra.  The region of the 12th dorsal is readily found by placing the thumb under the lower rib, the outstretched finger will give you the location of the 12th dorsal, making an allowance for the difference in the height of your patient; in time you will do this unconsciously.  Having located the 12th dorsala by the means spoken of and a certain rate of motion best adapted to determine such inequalities in the contour of the spine as are caused by slight or partial displacements, NOT A CLOSING TOGETHER, NOT AN OCCLUSION.  A displacement displaces vertebrae, spreads them apart, does not draw them together.  To close them up would not be displacing.  To luxate, dislocate would not be to draw the bones more compactly together.  I proceed to palpate on both sides of the spine, using one finger and thereby determine which one or both of the 12th pair of nerves and the one or both of the kidneys are affected.  This is determined by the rigidity of the nerves; those affected will be swollen and sensitive to pressure.  Palpation is made by a verticle movement back and forth of a half-inch.  The sensitive, contracted nerve or nerves may be followed to the affected kidney or kidneys.  This procedure is known as nerve-tracing, an art not known to pathologists, the subcutaneous nerves thusly followed are not known to anatomists.  This diagnosis is of no value to the one who does not comprehend it or does not make use of it, to the one who adjusts anywhere and everywhere regardless of the determination of the nature of disease it is is valueless, to the one who adjusts without making a scientific discrimination, it is worthless, to the one who adjusts every other vertebrae today and the intervening one tomorrow it would be despised, to the one who adjusts every vertebrae for any and all diseases, commencing at the atlas in order to drive the disease down and out it would be condemned.  A student of the Bohemian thrust wrote me “I lay awake at night searching the depths of my creative ability for a painless thrust.  For the last three years I have clinked each vertebrae of the entire spine without pain or discomfort to the patient.  With this thrust I cannot jump about here and there in the spine, but must start at the sacrum and end at the occiput, and I have the satisfaction of knowing that I have set every vertebrae where it belongs, plump against the facet of its neighbor.”  This method was called “reconstruction of the spine for constitutional correction.”  This developer and discoverer had no use for specific, definite, scientific adjusting.

    In chiropractic there is no need of a laboratorial diagnosis, whether made by chemical analysis, microscopical examination, or a bacteriological study of the discharges from the kidneys or bowels, they do not tell chiropractors anything of value.  A laboratorial diagnosis is not chiropractic, it is allopathic -- I say, examine the living for morbid or abnormal functions -- you will not find them in the lifeless cadaver or the inert cast-off refuse.  Normal urine is of a clear amber color.  There should not be any deposit in the bottom of the vessel.  One urination may show an off color or a deposit, and the next micturition look o.k.

    An osteopath author says, “Constipation is the cause of a large per cent of diseases.  “He should have said, Constipation is associated with a large number of diseases, and then in all probability nine-tenths of his constipation cases are those of costiveness.

    One chiropractic author speaks of “an analysis of the morbid substance: of urine.  He evidently has the same idea of urine as has another author of equal chiropractic intelligence who says, “The poisons resulting from the constipation go through the body and cause this fevered condition.”  Morbid urine would be that which is diseased.  Disease is functions performed in a greater or a lesser amount than normal.  What are the functions of urine?  What are the physiological actions of the feces?  In what organic system do you place the stool or urine?  Why not talk and write on biology?  Living tissue, only, exhibits functions, they alone have power to create health or disease.  Feces and urine have no nervous tissue, they have no functions to perform.  Poisons are not created within the body.  That which has a deleterious effect on the nervous system is from without.  All fevered conditions are because of diffused inflammation.  The morbid process known as inflammation is the result of nerve tension.  Nerve tension is because of trauma or toxine.  The condition of constipation does not produce poison. . . Poisons decrease or increase nerve action.  Evacuation and micturition remove waste material.  The organic waste products, the undigested residue of the food, epithelium, intestinal mucus and other waste material are not tissue, they do not assist in forming any definite structure of the body.  It is difficult for some persons to clear their mentalities of the cobwebs of superstition.

    In many diseases the evacuation of the bowels is not normal because of the constructive and assimilative changes known as anabolism and the retrograde and destructive processes of catabolism.

    There has been much determined by chiropractors, yet there remains much more to be ascertained and defined by us with clearness concerning anatomy, physiology, pathology, symptomatology, etiology and diagnosis which is not in accord with noted authors on these subjects, also, some statements made by standard authors which we as chiropractors do not agree with.  Were we to agree with the doctines of allopaths, we would be allopathic.  For allopaths to agree with us would be to make chiropractors of them. (Dr. Kulp).

    Much has been written by medical men regarding spinal pathogenesis, the special origin or development of disease because of abnormalities of the spine, but it remained for chiropractors to demonstrate that such is a fact.