16th to 19th Century Scientific Foundation: The Correlation between

Somatic Dysfunction And

Visceral DiseaseBy

Tariq J. Faridi, B .Sc. M.Ed. Ph D ( c )

WHY DO I WANT TO SHARE THIS?

NO VIDEOS, SOFTWARE OR BOOKS FOR SALEJUST THE TRUTH ABOUT CHIROPRACTIC

Show the scientific foundation Chiropractic was laid on• so that you can have confidence in the scientific validation

of the link between subluxations and visceral disease• what two moderately trained hands can do in restoring the

memory of wholeness and awaken the innate intelligence for the body to heal itself

• that you have the confidence in yourself and impart it to your patients, so that they can be confident in and passionate about chiropractic as the best insurance for the detection, prevention and reversal of chronic conditions before they occur

• that you can detect and reverse them, before they even become symptomatic

Objectives:

1.Antiquarian research and 16th to 20th century scientific research validating the link between somatic dysfunction and visceral disease

2.Scientific Validation of 110 years of chiropractic adjustment and reversal of visceral disease

3.Evidence-based patient education`34

Avicenna Ambroise Paré Galenz

1741 Nicholas Andry Writes Patient Education Book

on Scoliosis Prevention for Parents

The word ‘orthopaedia’ was devised by a Parisian paediatrician, Nicholas Andry, who was Professor of Medicine at the University of

Paris and also Senior Dean of the Faculty of Physik. In 1741 he published a book entitled ‘Orthopaedia: or, The Art of Correcting and

Preventing Deformities in Children. By such means that may be easily put into Correcting and Preventing Deformities in Children. By

such means that may easily be put into practice by parents themselves and all such as are employed in Educating Children’. In the preface he stated: “As to the title, I have formed it of two Greek

words viz Ỏρθος, straight and Πάίδον, a child. Out of the two words I have compounded that of Orthopaedia to express in one term the

design I propose which is to teach the different methods of preventing and correcting the deformities of children”. His method for correcting excessive curvature of a child’s leg was “to apply as soon

as possible a small plate of iron on the hollow side of the leg and fasten it about the leg with a linen roller. In a word, the same method must be used in this case, for recovering the shape of the leg, as is

used for making straight the crooked trunk of a young tree.”

Sir Nicholas Andry, published at the age of 81:

Orthopaedia: The Art of Correcting and Preventing Deformities in Children

1867 James Paget Warns MDs of the cases DCs will cure, which will take away their Income

“AFTER systematic lectures on the chief injuries of the bones and joints, it may be useful if I try to enforce by particular illustrations some of the general principles that I stated; and it may secure your attention if I use the form of speaking of the Cases that Bone-setters Cure. For few of you are likely to practise without having a bone-setter for an enemy; and if he can cure a case which you have failed to cure, his fortune may be made and yours marred”.

(Brain 1893, 16:321-352)

“In the following pages I deal in a somewhat discursive and desultory manner with the result of several years‘ enquiry into the symptoms

evoked in the sensory nervous system by disease of the viscera. For many years the subject, has been present in my mind, and although for a

long time I could not appreciate the value of all the phenomena, yet by carefully noticing each circumstance in every case, and by grouping the

symptoms together, I formulated for myself certain tentative laws of a somewhat vague nature, trusting that with extended experience these

would become more denned and be of a less general nature. What I have published on this subject' does not fully accord with the results obtained

by Dr. Head,2 and although in many respects his results are more reliable than mine, there are a few points on which we are in conflict.”

Thesis: DISTURBANCES OF SENSATION WITH SPECIAL REFERENCE TO THE PAIN OF VISCERAL DISEASE(Sherrington’s Friend, includes Sherrington’s unpublished findings)

1905 CS Sherrington – Integrative Action of the

Nervous System and 37 Papers – Nobel Prize

In the year 1883, a legacy of $80,000 was left to the President and Fellows of Yale College in the city of New Haven, to be held in trust, as a gift for her children, in memory of their beloved and honored mother Mrs. Hepsa Ely Silliman.

On this foundation Yale College was requested and directed to establish an annual course of lectures designed to illustrate the presence and providence, the wisdom and goodness of God, as manifested in the natural and moral world.

1933 Neville T. UssherSpinal curvatures -- visceral disturbances

in relation thereto.

The suit claimed that the defendants had participated for years in an illegal conspiracy to destroy chiropractic. On August 24, 1987, after endless wrangling in the courts, U.S. District Court judge Susan Getzendanner ruled that the AMA and its officials were guilty, as charged, of attempting to eliminate the chiropractic profession.

The AMA offered a patient care defense; however, data from Workmen's Compensation Bureau studies served to validate chiropractic care. Specifically, studies comparing chiropractic care to care by a medical physician were presented which showed that chiropractors were “twice as effective as medical physicians, for comparable injuries, in returning injured workers to work at every level of injury severity.”Evidence at the trial showed that the defendants took active steps, often covert, to undermine chiropractic educational institutions, conceal evidence of the usefulness of chiropractic care, undercut insurance programs for patients of chiropractors, subvert government inquiries into the efficacy of chiropractic, engage in a massive disinformation campaign to discredit and destabilize the chiropractic profession and engage in numerous other activities to maintain a medical physician monopoly over health care in this country.

Chester Wilk

Attorney G. McAndrews

Bonica, JJ Autonomic Innervation of the Viscera in Relation to Nerve

Block Anesthesiology 29:293-813 Jul-Aug 68

"Research Status of Spinal Manipulative Therapy" in 1975, historian Elizabeth Lomax, MD, presented her findings to the US government stating that as a result of her two hundred and fifty year scrutiny of scientific literature, "the physician could clinch the diagnosis by finding tenderness in the appropriate vertebra".She Studied Articles Published between 1725 and 1975 (referenced the works by Andre Nicholas to Osler Head Sherrington, and Pre Beal Authors.

(Part 1)

The Spinal Cord as the Organizer of Disease

Processes : Some Preliminary

Perspectives

The Spinal Cord as the Organizer of Disease

Processes : The Peripheral Autonomic

Nervous System

The Spinal Cord as the Organizer of Disease

Processes : Hyperactivity of sympathetic innervation

as a common factor in disease

The Spinal Cord as the Organizer of Disease Processes : Axonal

transport and neurotrophic function in relation to somatic dysfunction

In a paper "Understanding Manipulative Medicine in General Practice" published in JMPT in 1989, states "Then suddenly we find ourselves in practice where 80% of our patients complain to us for some sort of musculo-skeletal pain, 80% may sound high, yet remember that visceral and systemic diseases very frequently manifest themselves initially as musculoskeletal pain.“

Again John McM. Mennel concludes his article as follows: "Joint dysfunction is not only a diagnosis but an early sign of visceral and systemic diseases".

Conclusions

MR imaging is a valuable tool for diagnosing atlantoaxial instability and has a sensitivity of 100% and a specificity of 90% based on our proposed diagnostic criteria (peridental effusion, lateral facet arthropathy, focal myelopathy, and an abnormal spinolaminar line). Additionally, MR imaging may provide earlier warning signs of instability that predate the clinical symptoms. Further investigations to confirm both these findings and the diagnostic efficacy of our criteria would be invaluable.

References1. Zikou AK, Alamanos Y, Argyropoulou MI, et al. Radiological cervical spineinvolvement in patients with rheumatoid arthritis: a cross sectional study. J Rheumatol 2005;32:801–062. Naranjo A, Carmona L, Gavrila D, et al. Prevalence and associated factors ofanterior atlantoaxial luxation in a nation-wide sample of rheumatoid arthritispatients. Clin Exp Rheumatol 2004;22:427–323. Kauppi M, Hakala M. Prevalence of cervical spine subluxations and dislocationsin a community-based rheumatoid arthritis population. Scand J Rheumatol1994;23:133–364. Rojas CA, Bertozzi JC, Martinez CR, et al. Reassessment of the craniocervicaljunction: normal values on CT. AJNR Am J Neuroradiol 2007;28:1819–235. Brattstrom H, Granholm L. Atlanto-axial fusion in rheumatoid arthritis: anew method of fixation with wire and bone cement. Acta Orthop Scand1976;47:619–286. Kauppi M, Neva MH. Sensitivity of lateral view cervical spine radiographstaken in the neutral position in atlantoaxial subluxation in rheumatic diseases.Clin Rheumatol 1998;17:511–147. Bundschuh C, Modic MT, Kearney F, et al. Rheumatoid arthritis of the cervicalspine: surface-coil MR imaging. AJR Am J Roentgenol 1988;151:181–878. Gupta V, Khandelwal N, Mathuria SN, et al. Dynamic magnetic resonanceimaging evaluation of craniovertebral junction abnormalities. J Comput AssistTomogr 2007;31:354–599. Laiho K, Soini I, Kautiainen H, et al. Can we rely on magnetic resonance imaging when evaluating unstable atlantoaxial subluxation? Ann Rheum Dis 2003;62:254–56

Only Structures Innervated by c1-c3 are known to cause Migraines!! Example of Headache Pills – Imitrex – Naproxen – 2 %

“Cervicogenic headache is pain perceived in the head but referred from a primary sourcen in the cervical spine. The physiologic basis for this pain is convergence between trigeminal afferents and afferents from the upper three cervical spinal nerves. The possible sources of cervicogenic headache lie in the structures innervated by the C1 to C3 spinal nerves, and include the upper cervical synovial joints, the upper cervical muscles, the C2-3 disc, the vertebral and internal carotid arteries, and the dura mater of the upper spinal cord and posterior cranial fossa. Experiments in normal volunteers have established that the cervical muscles and joints can be sources of headache.”

Bogduk, Nikolai The anatomical basis for cervicogenic headache JMPT, 15:67-70 January 1992.

Bogduk N. Curr Pain Headache Rep. Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. 2001 Aug;5(4):382-6

Abstract: The neuroanatomical basis for cervicogenic headache is convergence in the trigeminocervical nucleus between nociceptive afferents from the field of the trigemenial nerve and the receptive fields of the first three cervical nerves. Only structures innervated by C1-C3 have been shown to be capable of causing headache. These are the muscles, joints and ligaments of the upper three cervical segments, but also include the dura mater of the spinal cord and posterior cranial fossa and the vertebral artery.

In 1906 Sir Charles Sherrington published The Integrative Action of the Nervous System, which was a collection of ten lectures delivered two years before at Yale University in the United States. In this monograph Sherrington summarized two decades of painstaking experimental observations and his incisive interpretation of them. It settled the then-current debate between the ‘‘Reticular Theory’’ versus ‘‘Neuron Doctrine’’ ideas about the fundamental nature of the nervous system in mammals in favor of the latter, and it changed forever the way in which subsequent generations have viewed the organization of the central nervous system. Sherrington’s magnum opus contains basic concepts and even terminology that are now second nature to every student of the subject. This brief article reviews the historical context in which the book was written, summarizes its content, and considers its impact on Neurology and Neuroscience.

‘. . . he is the scientist’s philosopher because he had advanced natural knowledge himself by skilled observation and experiment, by 50 years’ unremitting work in the laboratory, and because his own interpretation of his discoveries had given a new extension to the biologist’s outlook. Physiologists will know this well enough. To those who have had to struggle with the mass of detailed material about the brain and cord Sherrington’s Integrative Action of the Nervous System brings order out of chaos; it is hard reading at first, because every sentence is charged with meaning, some of it direct enough, but some reaching out to half formed pictures of wider landscape. Though it was published in 1906 it is still as refreshing as it was then. It has needed no revision, but Sherrington’s experimental work went on at high pressure for another 30 years, filling in the gaps and strengthening the framework. . . .’

"Where is the wisdom we have lost in knowledge, and where," asked T. S. Eliot, "is the knowledge we have lost in information?" There are perhaps 30,000 biomedical journals in the world, and they have grown steadily by 7% a year since the seventeenth century. [1, 2] Yet only about 15% of medical interventions are supported by, solid scientific evidence, David Eddy, professor, of health policy and management at Duke University, North Carolina, told a conference in Manchester last week.

This is partly because only 1% of the articles in medical journals are scientifically sound. [2, 3] and partly because many treatments have never been assessed at all. "If," said Professor Eddy, "it is true, as the total quality management gurus tell us, that ‘every defect is a treasure’ then we are sitting on King Solomon's mine.“

BMJ 1991 (Oct 5);303:798–9.

We need less research, better research, and research done for the right reasons

What should we think about a doctor who uses the wrong treatment, either willfully or through ignorance, or who uses the right treatment wrongly (such as by giving the wrong dose of a drug)? Most people would agree that such behavior was unprofessional, arguably unethical, and certainly unacceptable.

What, then, should we think about researchers who use the wrong techniques (either willfully or in ignorance), use the right techniques wrongly, misinterpret their results, report their results selectively, cite the literature selectively, and draw unjustified conclusions? We should be appalled. Yet numerous studies of the medical literature, in both general and specialist journals, have shown that all of the above phenomena are common. This is surely a scandal.

BMJ 1994;308:283-284 (29 January)

Max Planck Quote:“A scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.”

Somatization, somatoform symptoms, & somatizing patients (SOMATIC PAIN)

1) the clinical report of multiple somatic complaints that are medically unexplained – STETHOSCOPE TELLS NOTHINHG

2) significant functional impairment or disruption in every day life – THALAMIC NEURON THEORY – THE CURE AND CAUSE OF ALL DISEASE IN THE CNS -

Somatization, somatoform symptoms, & somatizing patients (SOMATIC PAIN)

1) the clinical report of multiple somatic complaints that are medically unexplained – STETHOSCOPE TELLS NOTHINHG

2) significant functional impairment or disruption in every day life – THALAMIC NEURON THEORY – THE CURE AND CAUSE OF ALL DISEASE IN THE CNS -

LEE, T. N Med Hypotheses. 1994 Nov;43(5):285-302.

Pain initiated or caused by a primary lesion or dysfunction in the nervous system

Two types Peripheral Neuropathic pain: Lesion in

Peripheral Nervous system Central Neuropathic pain: Lesion in

Central Nervous system

The Thalamic Neuron Theory (TNT) postulates that the central nervous system (CNS) is involved in all disease processes, as the CNS not only processes incoming physical and chemical information from the periphery, it also sends out physiological commands to the periphery in order to maintain homeostasis for the entire body. Inherent in its capacity to learn and adapt (i.e. to habituate) is the CNS' ability to learn to be sick (pathological habituation) by looking in certain deranged central neural circuitries, leading to chronic disease states.

The Thalamic Neuron Theory (TNT) postulates that the central nervous system (CNS) is involved in all disease processes, as the CNS not only processes incoming physical and chemical information from the periphery, it also sends out physiological commands to the periphery in order to maintain homeostasis for the entire body. Inherent in its capacity to learn and adapt (i.e. to habituate) is the CNS' ability to learn to be sick (pathological habituation) by looking in certain deranged central neural circuitries, leading to chronic disease states.

Ancient Egyptians wandering uterus

Hippocrateshysteria

Galen (2nd century)sexual deprivation

in females

History (cont.) Robert Whytt (1714–1766)

Spinal reflexes responsible for “nervous” conditions.

“Nerves” were a common affliction from the late 18th to early 20th century.

Paul Briquet (1796–1881)

Comprehensive listing of symptoms in 1859 monograph based on 400 (mostly) female patients from the Salpêtrière hospital in Paris from 1849-1859.

Reaffirmed Sydenham’s view of hysteria as a nervous condition, not solely seen in women, and characterized by many predisposing factors.

In DSM-III somatization disorder was co-named “Briquet’s syndrome” in recognition of the French psychiatrist’s seminal contributions.

History (cont.) SO WHAT HAPPENED, IF WE KNEW IT THEN?

WE DEVIATED FROM LOOKING AT THE CNS AND PALPATING THE SPINE

AND SWITCHED TO THE USE OF THE STETHOSCOPE

STETHOSCOPE WAS INITIATED ON FEAR BASED MEDICINE AND PALPATION AND ADJUSTMENTS WERE INITIATED BASED ON CNS AS

THE MASTER CONTROLLER, PALPATION, CLOSE TOUCH WITH THE PATIENT, LOVE OR FAITH BASED MEDICINE, BELIEF IN THE INNATE INTELLIGENCE

AUTO IMMUNE SPECIALISTS BELIEVE IN INNATE INTELLIGENCE

Stretch reflex is monosynaptic - causes contraction in response to stretch

▪ Regulates skeletal muscle length and tone

▪ all monosynaptic reflexes are ipsilateral reflexes - input and output on same side

▪ only one synapse in the CNS - between ad single sensory and motor neuron

▪ Sensory receptors are found in muscle spindles▪ e.g. Patellar reflex –

muscle spindles in the quadriceps muscles, hit with a mallet stretches the quadriceps and its tendon - results in contraction

History (cont.) Treatment of nervous disorders

Contemporary medical establishment focused on methods to bring humors into balance, like…

bleeding

blisteringpurging

Meanwhile, in France, there was a burgeoning spa industry offering special curative waters, wraps, poultices, and massages.

The curative powers of these treatments has never passed peer-review muster, but the spas live on. Go figure…

All contemporary systems borrow heavily from Briquet’s (1859) monograph (summarized by Mai & Mersky, 1980)

430 patients seen over a 10 year period.

Etiologic factors were youth, female gender, “affective” and “impressionable” temperament, family history of the disorder, low social class, migration, sexual licentiousness, situational difficulties, and poor physical health.

Briquet considered the "effective part of the brain" the final common pathway that mediated these causative agents.

In treatment, Briquet emphasized the importance of an improvement in social circumstances and the need to minimize environmental problems.

Somatization disorder per DSM-IV (APA, 1994)A. A history of many physical complaints beginning before age 30

years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning.

B. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance:

(1) four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination)

Alternative descriptive systemsAlternative descriptive systems Medically unexplained symptoms

Ultimately atheoretical

Popular with neuropsychologists (Binder & Campbell, 2004)

Abridged somatization (Escobar et al., 1987)

Based on this group’s experience with the Epidemiological Catchment Area (ECA) studies of the early 1980s

A “less restrictive operational definition of the somatizer”

4+ unexplained symptoms for men; 6+ such symptoms for women

Multisomatoform disorder (Kroenke et al., 1997)

DSM somatization disorder too restrictive, but undifferentiated somatoform disorder too inclusive

Three or more medically unexplained symptoms, regardless of gender

2+ year history of somatization symptoms

Functional somatic syndromes (Barsky & Borus, 1999)

“are characterized more by symptoms, suffering, and disability than by disease specific, demonstrable abnormalities of structure or function”

Nosology (cont.)

Summary & suggestions for a new diagnostic Summary & suggestions for a new diagnostic approachapproach

Mayou et al., (2005) suggest:

Redistribution of the various somatoform disorders among the different axes of the DSM

- For instance, hypochondriasis could be renamed “health anxiety” and reclassified as an anxiety disorder.

- Conversion could be classified as a dissociative disorder.- Somatization disorder might more accurately be

considered a personality disorder with mood and anxiety disorder features.

- These suggestions are more consistent with clinical reality.

Medicine’s Absurd Explanation

Mayou et al., (2005): (cont.)

Specific symptoms might reasonably be coded on Axis III as "somatic symptoms" or "functional somatic symptoms.”

As noted, many studies have indicated that a less extensive level of symptomatology is still associated with clinical impairment and psychiatric comorbidity (Escobar et al., 1987; Kroenke et al., 1997).

While it might seem to be a matter of semantics, the fact that patients presenting with even a few somatoform symptoms tend to show marked increases in health care utilization, should be enough to encourage those in clinical and health policy fields to consider changes to the current diagnostic scheme.

ABSURDITY (cont.)

Avoiding dualism

As discussed earlier, many have criticized the nature of the DSM typology (Engel, 2006; Kirmayer et al., 2004; Mayou et al., 2005; Sharpe & Carson, 2001).

Diagnoses within this category basically call for ruling out physical causes for the symptoms presented thus making such symptoms de facto “mental” or “psychogenic.”

The "mental" view of somatoform symptoms has been an obstacle to more effective treatment of such symptoms by primary care personnel (Mayou et al., 2005; Sharpe & Carson, 2001; Stone et al., 2002), perhaps due to stigma or a sense of a lack of seriousness.

ABSURDITY (cont.)

Masi et al., (2000) attempted to identify prevalence of somatic symptoms in children and adolescents (n=162) referred to a pediatric neurology/psychiatry practice for EBD

- Somatic symptoms were reported in 69.2% of the sample

- Headache was most common, reported in 50.6% of sample

- Younger children showed higher reporting of abdominal complaints, and there were no gender differences in overall symptom report

- Patients with anxiety and depression reported a higher level of somatic symptomatology, particularly headache

- authors concluded that somatoform symptoms should be considered as a possible indication of unidentified psychiatric disorder

HEADACHES AND ANXIETY IN CHILDREN