Chiropractic is a system of healing that holds that disease results from a lack of normal nervous function caused by a disordered relationship between the musculoskeletal and nervous systems.
Controversial from its inception, chiropractic has grown into the largest nonallopathic healing profession in the United States, with nearly 35,000 active practitioners. Although considered by many a “marginal” group, chiropractors are licensed in all 50 states, are reimbursed by Medicare, Medicaid, and many third- party payers, and in 1984 earned an average yearly net income of $55,000.
The recent defeat of the American Medical Association (AMA) by chiropractors in a major lawsuit dramatically emphasizes chiropractic’s current strength. The public image of chiropractic has significantly improved, and opposition from medical organizations has abated. Chiropractic has successfully established itself as an alternative healing profession.At first glance, it seems an unlikely system to have achieved such success. Chiropractic was founded in 1895, just as medicine was being transformed into a dominant profession. Successfully uniting disparate elements of the medical community, the AMA reorganized in the early 1900s and developed into a powerful force, influencing nearly every aspect of the U.S. health care system. The homeopathic and eclectic sects, important mid-nineteenth-century competitors, virtually disappeared during the first decades of the twentieth century. Physicians actively and effectively suppressed competition from patent medicine vendors with pure food and drug legislation. Yet despite the impressive strength of the medical profession, chiropractic thrived. Whereas nearly every other form of unorthodox healing was being suppressed, banned, or co-opted, this system of healing established itself as an independent profession. By 1930 it was already the largest nonallopathic sect in the United States, with nearly 16,000 practitioners.
This extraordinary development does not fit easily into current historiographic models.
Broadly speaking, two models have been offered to explain medicine’s enormous growth during the late nineteenth and early twentieth centuries. According to the first, medicine benefited from scientific developments, which provided a new rational basis for medical practice and offered effective treatments. Proponents of this model point to the establishment of the germ theory of disease, the development of diphtheria antitoxin, the creation of salvarsan (for use against syphilis) and the discovery of insulin as evidence of how scientific progress fueled medicine’s expansion. According to the second model, political organization and lobbying were the critical factors behind medicine’s new strength. Proponents of this model point to demographic data suggesting that medical practice had little impact on morbidity and mortality and to the aggressive political maneuvering of the AMA to support their argument.Despite their differences, these two schools share the assumption that allopathic medicine established hegemony over health care during the early twentieth century. Neither approach provides a particularly useful framework for discussing chiropractic, because each virtually ignores unorthodox medicine. Although medicine clearly wielded the greatest influence on the U.S. health care system, the success of chiropractic demonstrates that there are important limits to medicine’s authority. A close examination of chiropractic history helps identify those limits and the forces that define them.