Perhaps DD did it after all

Perhaps DD did it after all reminds us that truth is often stranger than fiction; this short story ends with a tongue in cheek confrontation.

A chapter from Stones in my Clog by Bernard Preston, DC.

1. Bernard Preston
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2. Stones in my clog
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3. Perhaps DD did it after all

There are few questions that will make your chiropractor drag his or her heels and hang their head more than an enquiry as to how the first chiropractic adjustment came about. The first manipulation in modern history anyway.

Back in the mists of time, Hippocrates and the ancients used manipulation avidly but for the next few thousand years, medical doctors practised selective hearing. Until our very recent history, read the last decade, the official view was that manipulation is highly dangerous, and is practised only by quacks.

It’s only since Chiropractors have gotten their act together, and done serious research proving that manipulation is, in fact, far safer and more effective than orthodox care for certain conditions that medicine has begun to change its official view. Oh, and a lawsuit that splattered a lot of mud on their faces, but more of that later.

First let's go back to that first chiropractic adjustment; it was given by a strange man, one Daniel David Palmer, or DD for short. There were no white mice to experiment on in those days, so he chose the janitor of the building where he practised magnetic healing to be his first guinea pig. The year was 1895, the same coincidentally that another extraordinary man, Wilhelm Röntgen, discovered Xrays.

Palmer and Röntgen remain to this day faithful bedfellows. Remember that medicine was still using leaches and blood letting in 1895, and the official treatment for typhoid was to wrap the patient in a sheet soaked in high quality whiskey. A pleasant way to die, I suppose, if you like booze.

The problem does not lie therein but in the fact that Dr Quack Palmer happened to choose a deaf man for his first patient, freeing up a pinched nerve in the mid back apparently. The next day the janitor claimed that he could again hear the trams on the street outside, something he hadn’t been able to do for years.

Well, as every chiropractor knows, the Vestibular Auditory nerve does not pass anywhere near the mid back nor, in fact, the neck. It’s a cranial nerve, travelling directly from the ear to the brain. So the cure of Harvey Lillard’s hearing is an absurdity, and only the most dyed in the wool chiropractors actually believe it. It is an anatomical impossibility, and to my knowledge has never been repeated. Well, that was until Mr Simons consulted me…

Stones in my Clog

by Bernard Preston DC

Perhaps DD did it after all

‘Doctor, while I was waiting for the consultation for our daughter, I began reading a pamphlet telling how the first Chiropractic treatment cured a deaf man.’ Mr Simons was a youngish man, probably mid-thirties and I blanched when I noticed that he had hearing aids in both ears, but went through the history in the usual way. The treatment of his baby daughter’s colic had been routine, but for them it had been little short of miraculous. The ringing in his ears, or tinnitus as it is called, had started some five years earlier. The buzzing, as he described it, swelled to such a crescendo that on bad days he could no longer hear ordinary conversation. It came in waves, often lasting days, driving him and his family crazy. His doctor’s diagnosis was Meniere’s disease, though in certain respects the diagnosis did not fit. He did not suffer from dizziness and he only rarely had headaches, though Mr Simons did frequently experience discomfort in the upper neck. The doctors had told him nothing more could be done. He was rapidly going deaf, as proved by audio-conduction tests.

‘These hearing aids helped substantially in the beginning, but now I’m having great difficulty communicating with my clients. It’s all very trying.’

‘Mm, I see you are an architect. I can imagine you must be having. You’re not exposed to loud noise, I presume. Heavy metal as a teenager?’ I enquired. He shook his head. ‘So how would you describe the pain … I’m sorry, the discomfort?’

‘Oh, it’s much worse than a discomfort! For days on end it’s like having a swarm of bees in my head. I can’t hear myself think! Then for no obvious reason it quietens down for a day or two. Not for long, mind you. Then it surges back to this terrible buzzing.’

‘Were you sick at the time when it started?’

‘Yes, I had a sore throat for a few days.’

‘Were you treated?’

‘I believe I went to the doctor and he prescribed penicillin.

Afterwards they said that it could have been the cause.’I nodded. ‘Yes, certain of the penicillins do have this as a serious side-effect. They have been withdrawn from the market now.’

Mr Simons scowled. ‘Too late to help me!’

Again I nodded. ‘Shall we take a look, Mr Simons? Could you please undress, down to your underclothes.’

I went through the usual diagnostic exam, looking for a scoliosis, and a pelvis imbalance, problems in his feet and hips, shoulders, and up through his neck. He did indeed have nerve-conduction deafness as confirmed by the two classical tests, and if I rubbed my fingers together, one arm’s length from either of his ears, he couldn’t hear the sound, but otherwise the other cranial nerves were intact. He had minor fixations of two joints in his spine, one in his neck and another between the shoulder blades, but nothing that I could remotely suggest would likely cause the deafness or the tinnitus that was tormenting him. I concluded with a quick examination of the jaw joints and found a loud crackling sound in his left jaw joint.

‘Mr Simons, I am not sure. Frankly, I’m almost certain I can’t help you. You don’t have any major problems in your spine. A few fixations that I would expect to find in anybody who spends long hours behind a computer or working at a drawing table as you probably do but, in fact, you do have a problem in your jaw joint that needs attention. Whether it will help your tinnitus is another matter. Probably not.’

‘Well, your treatment for our baby’s colic was so spectacular and I am in any case desperate. If you think there is the slightest chance your treatment could help …’ His voice trailed off.

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One of the greatest pains to human nature is the pain of a new idea.

Walter Bagehot

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‘Remember your child has had infantile colic for three months. You’ve had this for five years. Our standard treatment schedule is about six to ten treatments over the next month during the initial phase of care. If there are any encouraging signs, because it is a chronic condition, then obviously we should continue into the rehabilitation phase. There will be lots of exercises for your neck and back, and of course your jaw joints.’

Mr Simons had his eight treatments and I quickly phased him into an occasional, but regular treatment, not asking too many questions about the tinnitus but focusing on the joints in his back and jaw. I was a bit embarrassed to ask, to be honest.

One day about three months later Mr Simons came in for his regular monthly treatment. I was running late, and glad that I could make up a little time. He had no pain, no real stiffness, and the consultation would be very quick. At the end he said, ‘Doctor, you haven’t noticed something.’

‘And what is that, Mr Simons?’

‘I’m not wearing my hearing aids.’

‘Really. Since when?’

‘For the last month I have needed them less and less. The buzzing in my ears has reduced so much that on most days I can hear people just fine without them.’

‘Didn’t you say that the condition had some ebbs and flows?’ This from oh ye of little faith fame.

‘That’s true, but it hasn’t been this good for more than four years.’

Unfortunately, Jaap our clinic director and I had some very sharp words shortly thereafter, and I never heard the results of the new conduction tests or whether the dramatic improvement in Mr Simons’ tinnitus was but a temporary affair, so this will remain another of those anecdotes which have of no scientific value whatsoever.

But, I am now rather less cynical of DD’s first chiropractic adjustment given more than a century ago. Talk to any doctor and they will have a veritable store of unexplained anecdotes. Of course, there is a very close connection between the jaw joint and the ear. They are after all only millimeters apart, and the trigeminal nerve which brings sensory information from the TMJ to the brain has its sensory nucleus in the upper part of the neck.

Was his brain simply being bombarded by the crackling sounds in his jaw joint? Ask any person with TMJ problems and they’ll probably tell you they also suffer from neck pain.

‘Good evening ladies and gentlemen, and welcome to Saturday at Eight on KTV. I am Jeremy Dawes and this is, as always, a live recording in which I interview well known personalities who have been at loggerheads in the press of late. Welcome also to our studio audience and a big welcome to all of you at home; and of course to our antagonists, Dr Palmer, the founder of Chiropractic, and Dr Doolittle, chairman of the Riverbend Medical Association.’

There was a round of applause from a full house. Both Drs Palmer and Doolittle were popular men in Riverbend, and the inflamed letters in the press had roused local interest.

‘Dr Doolittle, would you like to sound off the first salvo in our debate. Why are you so antagonistic to Chiropractic in general, and Dr Palmer in particular?’

‘Actually Jeremy, I would start by taking issue with you for calling Mister Palmer, Doctor Palmer. He is no doctor at all and there is a law in our state making it an offence for any person to wilfully and falsely pretend to be a qualified doctor, or use any name or title implying that he is qualified to practise medicine according to modern scientific methods. Mr Palmer is a fake!’

Dr Doolittle finished heatedly. It was indeed a good rousing start, just what Mr Dawes had been hoping for. Not many people would be switching channels, not even to the big game that started in ten minutes.

‘How do you answer to that, Dr Palmer? Should I be referring to you as Mr Palmer?’ Jeremy Dawes was an experienced interviewer and was not going to be browbeaten by either of the adversaries.‘To put it bluntly, Jeremy, I make no claim whatsoever to be qualified to practise Medicine. I am a doctor of Chiropractic and I practise Chiropractic.’

‘Yes, but Dr Doolittle says you are pretending to be a qualified doctor, and that you are misleading the public. A fake, I believe he said,’ replied the studio interviewer, enjoying the malarkey. This was going to boost the programme’s figures.

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‘I think, Jeremy, that Dr Doolittle is suggesting that the public is very gullible. In the same complex where I practise there is a woman claiming to be a doctor of Dentistry. Is she also misleading the public? Is she also a fake doctor?’ Dr Palmer, or DD as he was affectionately known to his patients, maintained a very even tone in his voice.

Jeremy nodded to Dr Doolittle. ‘No, of course not. Dentists are governed under a separate ordinance and are therefore exempt from regulation under the medical ordinance.’

‘You haven’t answered Dr Palmer’s question, Dr Doolittle. He asked if this dentist is misleading the public by calling herself doctor?’

‘No, she is not, but that is not the point. What Mr Palmer is doing is pretending to be a doctor qualified to treat medical conditions.’

‘I think not and this is very much Dr Palmer’s point, Dr Doolittle.’ Jeremy Dawes was enjoying himself. ‘When the public sees “Doctor of Dentistry” Dr Palmer is stating that the public knows quite well not to consult her for a gynaecological problem, nor for that matter to consult a “Doctor of Chiropractic”. How do you respond to that?’

Dr Doolittle became a little flustered for a moment. ‘Well, it’s still an offence for any unqualified person to infer that they can practise medicine.’

‘Exactly my point, Dr Doolittle. I don’t claim to practise Medicine. I practise Chiropractic.’ At this there was some scattered applause from the studio audience. ‘I only treat the spinal column and some other joints of the body.’

‘Ah, but you purport to use manipulation of the spinal column as a way of curing disease,’ said Dr Doolittle triumphantly. ‘That is the practice of Medicine.’

‘Really, Dr Doolittle! Are you saying that Medicine uses manipulation as a way of treating disease?’ Jeremy edged in. His role was not to be too visible, but as any stage personality knows every good entertainer should never be too far from centre-stage.

‘No, of course not. That is bogus. You can’t treat disease by manipulation of the spinal column. That is unscientific hogwash!’Dr Palmer edged in: ‘If you were walking around the campus of the University of Southern California and you may see the name Dr. H. Allsopp, Dean of Physics. Is he also pretending to be a qualified medical doctor? Is he misleading the public? Would a man who thought he was having a heart attack go knocking on Dr Allsopp’s door?’

Chiropractic deafness

‘Obviously not, Mr Palmer. You are being obtuse and unnecessarily facetious.’

‘Well then, why would the name Dr T. Sutcliffe, Doctor of Chiropractic in the next block be so misleading.’

‘I’m sorry Mr Palmer, but this is becoming absurd. No prestigious university like UCLA would ever entertain the idea of having an unscientific cult on their campus.’

Jeremy Dawes let the debate run on. He could see the studio audience were entranced. This was no time to barge in.Dr Palmer gave a little smile. ‘Are you always down on people you’re not up on, Dr Doolittle? The Los Angeles Chiropractic College has a very prominent position on the UCLA campus. Right next door to Physics, I believe.

Dr Doolittle blanched for a moment, nonplussed. However, a skilled debater he soon regained his composure. ‘Is that so? In any event the role of curing disease by means of manipulation of the spine is clearly unscientific. You people put yourselves above the law by advertising your services as ‘doctor’ in the yellow pages. If you just kept to your proper designation, just as physiotherapists do for example, you wouldn’t find yourselves being harassed by the law.’

Jeremy Dawes deemed this a good point to change the direction of the debate. ‘Okay, I think we have aired the subject of whether Chiropractors should be allowed to call themselves ‘doctor’ or not sufficiently. We are going to ask our home viewers to SMS how they vote on the first point. Our studio audience can also vote now. Use the mobile numbers you can see on your screens, and we will give you the result before the end of the program. Now Dr Doolittle, would you like to substantiate your claim that Chiropractic is an unscientific cult?’

‘Yes, certainly. The NINCDS conference in the 1980’s declared that the case studies produced by Chiropractors did not constitute scientific proof. Chiropractic is still in the doldrums of philosophical dogmas and certainly can’t be described as anything better than an unscientific cult.’

‘What do you have to say to that, Dr Palmer?’

‘It is true that case studies do not in themselves constitute scientific proof but Dr Doolittle is misleading us. That NINCDS conference on the whole produced a very favourable report on Chiropractic that led to the integration and acceptance of chiropractic within the general health care community. It’s his own opinion, not that which stemmed from the NINCDS conference, that we are an unscientific cult.’

‘That report was misguided in my opinion. There is no acceptable research that chiropractic is a safe and proven treatment for neck pain, for example.’

‘Did you know, Dr Doolittle that, after an in-depth review of the scientific literature by no less an authority than the International Task Force of the “Decade of the Bone and Joint 2000-2010”, that their committee declared that no scientifically admissible studies have been done evaluating the practice of surgical fusion for chronic neck pain without radiculopathy. The Task Force found that there was more scientifically admissible research validating Chiropractic than Medicine for the treatment of neck pain, and that therapies involving manual therapy and exercise are more effective for patients with neck pain than medicines and surgery.’

‘This must have been a review done by chiropractors. Of course they found that Chiropractic was more effective.’

‘What do you have to say to that, Dr Palmer?’ asked Jeremy Dawes.‘I’m afraid that Dr Doolittle is behind the times and has not been keeping up with the current literature. There were four eminent medical doctors on that committee.’

At this there was a great cheer from the studio audience. Dr Doolittle went white.‘Do you have anything further to add, Dr Doolittle?’

‘Only that manipulation of the neck is deemed by us to be extremely dangerous. There have been deaths and many others have had strokes after manipulation of the neck. As you know a chiropractor in Canada was recently found guilty of stroking a patient by the highest court, despite the testimony of the best scientists that Chiropractic could bring to the fore.’

Jeremy looked to Dr Palmer for an answer.Dr Palmer said: ‘There is no therapy that is totally safe. It is indeed true that a Mrs Lewis died seventeen days after a cervical manipulation, and the courts found that the causative factor was the adjustment she received. An extensive review of the literature reveals that in a ten-year period there have been only twenty-three known cases of vertebral artery dissection leading to stroke after manipulation, during which time 135 million cervical manipulations were given. That is 1 in 6 million and makes the Chiropractic adjustment not only the scientifically proved most effective therapy, when combined with exercise, but also by far the safest.

‘Oh, but these deaths are grossly under reported.’

‘Quite the contrary, Dr Doolittle. Each Chiropractic disaster, and there have been some, are very widely reported, just because they are so rare. You hear very little of medical complications because they are so common.’

‘You are exaggerating, Dr Palmer. Was sort of medical complications?’

Dr Palmer shuffled amongst his papers. Putting on his glasses he read, ‘A study using U.S. National data reported that, after cervical spine surgery in patients older than seventy-five, half the patients reported difficulty swallowing and hoarseness with vocal cord paralysis in 3.2% of the cases; there were nerve root palsies, postoperative spinal cord injury and six out of two thousand patients had vertebral artery injury, of which two had serious clinical sequelae.’

‘Oh, I don’t believe that.’

‘That’s because you don’t keep up with the literature, Dr Doolittle. It was reported by a senior neurosurgeon on the Task Force committee.’

Jeremy Dawes interrupted. ‘Dr Doolittle, it’s been said that whatever people in general do not understand, they are always prepared to dislike; to them the incomprehensible is always obnoxious. Could that apply to you?’

‘Of course, not Jeremy! I understand exactly what Mr Palmer is purporting to do.’

‘Fine. My last question to you, Dr Doolittle, concerns the Sherman antitrust laws. Dr Palmer, Mister Palmer you assert, has, as you know, in letters to the press claimed that you are simply continuing the conspiracy of which your association, the American Medical Association, has already been found guilty of in a federal court. That court found that the AMA had conducted an illegal conspiracy to destroy Chiropractic by withholding research that proved that Chiropractic was twice as effective as Medicine in treating certain musculo-skeletal complaints. What have you to say to that?’

‘I have nothing further to say, other than what I have already written. However, what we are talking about here, is the treatment of deafness with manipulation of the spine, and that is not a musculo-skeletal complaint.’

‘Dr Palmer?’

‘Quite so. I was not treating Mr Willard for deafness but for a pinched nerve in his back. But Dr Doolittle is being disingenuous. Why does he not give a straightforward answer? Is he, or is he not, still conducting Medicine’s illegal campaign to disinform the citizens of Riverbend about the safety and effectiveness of Chiropractic?’

‘No, I absolutely deny that I have been doing anything illegal or immoral,’ blustered Dr Doolittle.

‘Dr Palmer, I have a last question for you. Dr Doolittle paints a Manichean medical view of healthcare, in which Healthcare is pitted in an urgent struggle between purely good Medicine, and a preposterously dangerous and unscientific cult. What is the Chiropractic viewpoint of Medicine?’

‘I’m positively in favour of good Medicine, Jeremy, but it’s true, I do have serious doubts about the way Medicine promotes the uncontrolled use of many medicines. Their own research confirms my doubts. But good Medicine can do things, save lives, and improve health in ways that we cannot possibly emulate, nor do we try to. In the same breath I can state that I am on public record as having contradicted some of my colleagues who have made absurd claims of what Chiropractic can do. The way Dr Doolittle describes health care in such categorical black and white terms is, in my opinion, dangerously misguided and typical of the illegal conspiracy that Medicine has been conducting.’ ‘All right, we’ll leave that point for now as we are running out of time, and I still have one more guest to introduce to you. But do either of you have anything further to add before I bring in our last guest?’ asked the programme host.

‘Yes, I do,’ said Dr Doolittle. Would Dr Palmer tell us about this man Harvey Lillard that he supposedly cured of deafness.’‘All I can say is that it happened, and it’s true that I can’t explain it. At the time I found a pinched nerve in his mid-back. I know there is no correlation with the ears.’

‘Thank you, Dr Doolittle. Now, to end our show tonight, Ladies and Gentlemen, and before we have the final vote, I have invited a renowned Dutch architect, a Mr Simons, to join us tonight from our studio in Maastricht in the Netherlands. Are you there, Mr Simons?’ asked Jeremy Dawes as a large screen flickered to life. Mr Simons appeared briefly, vanished and reappeared again, clearing his throat nervously. He had never been on national television before. There was brief applause from the studio audience.

‘Yes, I’m here, Mr Dawes. Can you hear me?’

‘Yes, we have a very good satellite hook-up, Mr Simons. Welcome to Saturday at Eight. Would you please tell us your story?’

Mr Simons replied: ‘Yes certainly. After I took some medicine that was prescribed for a sore throat five years ago, I developed severe ringing in the ears and started going deaf. The buzzing sound became so loud that, for three years, I had to use these two hearing aids.’ He held them up for the audience to see, the TV cameras zooming in on the tiny devices in his hand. ‘Some months ago I consulted a local Dutch chiropractor, a Doctor Preston. He examined me and found a problem in my jaw joint, and what he described as a subluxation in my neck. He was quite honest and told me that he thought it unlikely that he could help my deafness, but I pleaded with him. You see, the treatment of our baby for colic was so miraculous, and I was desperate. I was ready to try anything.’

‘What! That quack manipulated your baby! You’re not serious are you, Mr Simons?’

‘Please, Dr Doolittle, don’t interrupt our guest,’ remonstrated Jeremy Dawes angrily.

Mr Simons hesitated, a little shocked by the intrusion. ‘It wasn’t the kind of manipulation he did to my neck, Dr Doolittle. He used a little gadget which gave an impulse onto his thumb. It was very gentle. But, getting back to my own case,’ he continued, ‘after a few months of treatment I found that I no longer needed the hearing aids. As you can see, I can hear perfectly well without them.’

‘So, Dr Palmer, are you chiropractors again claiming to be able to cure deafness?’ asked Dr Doolittle smiling for the first time.‘That is an absurd question, Dr Doolittle. Of course not. Oh, and thank you for addressing me as doctor. All that Mr Simons is pointing out that some very strange things happen in healthcare periodically that cannot be scientifically explained, and that the cure of Harvey Lillard’s deafness is not as reprehensible as you claim. It happened, and if Harvey was still alive, he would the one here tonight testifying to what happened.’

‘Ladies and gentlemen, a round of applause for our studio guest in the Netherlands please. Many thanks, Mr Simons.’ There was loud burst of clapping a few wolf-whistles as the screen faded. ‘Now, before you vote, ladies and gentlemen, on which of our guests has in your opinion been more convincing, I’d like to leave you with one last thought. Not my thought, it’s not original, I confess. A famous medical doctor once said that when a lot of remedies are suggested for a disease that it means that it can't be cured. Can we draw a corollary that when no known remedies exist for a disease, that it also means it can’t be cured?’

Stones in my clog

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