Introduction
The question of whether cervical spine manipulation can precipitate stroke has been a recurring and sometimes contentious topic in chiropractic literature since the late 20th century. Although the first published case report appeared in 19471 and 4 major epidemiological studies were conducted between 2001 and 2017,2–5 the profession’s Founder, DD Palmer, demonstrated caution regarding neck adjustments from the earliest years of chiropractic’s development. This paper re-examines conflicting historical narratives surrounding the location of the first chiropractic adjustment and DD Palmer’s early teaching practices, drawing principally on 2 foundational texts: DD Palmer’s The Chiropractor’s Adjuster (1910) and B.J. Palmer’s Fight to Climb (1950).
The Harvey Lillard Adjustment: Conflicting Accounts
On September 18, 1895, DD Palmer performed what is universally recognized as the first chiropractic adjustment on Harvey Lillard, a deaf janitor who reportedly regained his hearing. In Fight to Climb, B.J. Palmer, claiming to have witnessed the event as a teenager, asserted that the adjustment occurred in the neck rather than the fourth dorsal vertebra recorded by his father.6 He wrote:
"We saw him treat Harvey Lillard. We know it was in the neck – not fourth dorsal as he wrote in his book."
“Why did he treat Harvey’s deafness in the neck and say it was at the fourth dorsal? Answer is simple. Medical men said and emphasized it was dangerous to do anything in the neck. To move those vertebrae was to cause fracture or dislocation and cause complete paralysis or immediate death by crushing spinal cord. Father absorbed this fear, notwithstanding evidence of having restored Harvey’s hearing. Rather than have his students treat the neck and kill people, and kill off his own chiropractic idea, he shied all work away from the neck and down lower on the back where it was safer. He taught earlier students to keep away from the neck.”
B.J. Palmer added that by the time DD Palmer published his 1910 text, he had learned that cervical work was not inherently dangerous.
DD Palmer’s Own Record and Early Teaching Practices
DD Palmer’s contemporaneous account in The Chiropractor’s Adjuster (1910) is unequivocal and repeated.7 He stated:
“I replaced the displaced 4th dorsal vertebra by one move, which restored his hearing fully.”
"I adjusted the 4th dorsal, not a cervical…"
Palmer further described his own technical evolution as systematic: he first mastered adjustments in the dorsal region, then moved to the lumbars, the lower 6 cervicals, and finally the Atlas. Early graduates of the Palmer School of Chiropractic confirmed that formal instruction in cervical spine manipulation was not introduced until approximately 1901.8 (Table 1)
Discussion
The marked divergence between DD Palmer’s 1910 account and B.J. Palmer’s 1950 narrative raises important historiographic questions about how the early history of chiropractic has been interpreted. In Fight to Climb, B.J. Palmer claimed that his father deliberately avoided teaching neck adjustments because he had absorbed orthodox medicine’s warnings about the dangers of cervical manipulation.6 He further asserted that DD Palmer only later realized cervical work was safe. This explanation, however, appears only in B.J. Palmer’s retrospective account written more than 4 decades after the events in question and at a time when upper-cervical technique had become central to the identity and curriculum of the Palmer School of Chiropractic.
B.J. Palmer’s reliability as a historical narrator must also be considered. His own son, David D. Palmer, later observed that B.J. possessed a remarkable ability to tell stories in a vivid and engaging manner. David Palmer noted that it was regrettable that some of his father’s stories and experiences were pure fabrication, and that, as with many gifted storytellers, repeated telling sometimes allowed a tale to become accepted as fact.10 B.J.'s theatrical ability could create, in an exciting manner, an experience which never really happened. This characteristic of B.J.'s narrative style further cautions against accepting his 1950 account of his father’s early motivations at face value. B.J.'s narrative is therefore best understood as a later reinterpretation shaped by the institutional priorities of mid-20th-century Palmer chiropractic, rather than as neutral or contemporaneous evidence of DD Palmer’s actual clinical reasoning.
DD Palmer’s own writings present a more restrained and methodical picture. In The Chiropractor’s Adjuster (1910), he repeatedly and explicitly stated that the 1st chiropractic adjustment, performed on Harvey Lillard, occurred at the 4th dorsal vertebra.7 He wrote: “I replaced the displaced 4th dorsal vertebra by one move, which restored his hearing fully” and “I adjusted the 4th dorsal, not a cervical.” DD Palmer further described his technical development as a systematic progression, beginning with the dorsal region before moving to the lumbar spine, the lower 6 cervical vertebrae, and finally the atlas. Contemporary scholarship has largely supported the reliability of this account regarding the location of the Lillard adjustment.8,9 Recent historical analyses have found no contemporaneous evidence placing the first adjustment in the cervical spine and have confirmed that formal instruction in cervical manipulation at the Palmer School was not introduced until approximately 1901.
While DD Palmer did not explicitly articulate a fear of cervical work in his published writings, his documented actions and teaching practices demonstrate clear early restraint. He consistently located the foundational adjustment in the thoracic spine, delayed the introduction of cervical technique in the curriculum, and made no claims in The Chiropractor’s Adjuster that cervical adjustments were part of his earliest clinical repertoire.7 These observable choices, rather than later retrospective explanations, constitute the primary evidence of his initial approach.
In the socio-medical climate of the 1890s, warnings against forceful manipulation of the neck were common in orthodox medicine and were grounded in anatomical concerns about cervical instability. Although modern concepts of vertebrobasilar insufficiency were not yet articulated, physicians were aware of the mechanical risks of fracture, dislocation, and direct spinal cord injury. A well-known example from 1840 involved a 15-year-old girl who suffered immediate hemiplegia and paraplegia after forcible twisting of her neck; postmortem findings showed swelling around the atlas and axis.11,12 Such cases reinforced strong medical admonitions against untrained or lay manipulation of the cervical spine. DD Palmer, who had studied anatomy and was familiar with contemporary medical literature, would have encountered these warnings. His early teaching practices are consistent with having taken them seriously.
It should be noted that DD Palmer’s restraint cannot be attributed to deference to the manipulative traditions from which he is often said to have drawn. The Bohemian bone-setting practice known as napravit, sometimes cited as a possible influence, routinely included cervical manipulation.13 Similarly, Andrew Taylor Still’s The Philosophy and Mechanical Principles of Osteopathy (1899) contains an entire chapter devoted to examination and adjustment of the neck, including the Atlas, presenting such work as both safe and therapeutically important.14 The Swedish movement cure of Per Henrik Ling also incorporated cervical techniques without special prohibitions.15 DD Palmer’s documented progression from dorsal to lumbar to lower cervical adjustments, and his delay in introducing upper cervical work, therefore appears to reflect his own clinical judgment rather than imitation of predecessor traditions.
During the 1903–1906 controversy with Solon Langworthy, Oakley Smith, and Minora Paxson, DD Palmer vigorously defended the originality of chiropractic and pressed his critics to identify any specific practitioner from whom he had supposedly learned the technique.16 While Langworthy and his associates accused Palmer of appropriating the method from the Bohemian practice of napravit, their published criticisms frequently focused on questioning Palmer’s limited formal education, intelligence, and character rather than identifying any specific individual who had taught him the technique.17
In summary, the contrast between DD Palmer’s 1910 writings and B.J. Palmer’s 1950 reinterpretation suggests that the Founder exercised early caution with respect to cervical manipulation. B.J. Palmer’s later account, rather than providing direct evidence of his father’s original reasoning, more clearly illuminates the institutional needs of the Palmer School decades afterward and must be read in light of his own well-documented tendency to embellish historical narrative. DD Palmer’s methodical progression along the spine and his delay in teaching cervical adjustments are best understood as reflecting prudent clinical judgment based on the anatomical knowledge and prevailing medical warnings of the late nineteenth century.
Lessons for Contemporary Practice
Although the modern understanding of vertebrobasilar insufficiency, cervical artery dissection, and stroke risk was not available in 1895, these concerns are now well established in chiropractic practice.18,19 Contemporary research, much of it by chiropractors, has proposed that cervical manipulation may dislodge a thrombus from an undiagnosed cervical artery dissection, potentially causing thromboembolic stroke.20 In light of these recognized risks, the deliberate clinical restraint demonstrated by DD Palmer during chiropractic’s formative years remains relevant. A cautious, stepwise approach to the application of cervical spine manipulation reflects sound clinical judgment and prioritizes patient safety.
Conclusion
A close reading of primary sources reveals a richer and more nuanced picture of chiropractic’s origins than is sometimes presented in popularized accounts. DD Palmer’s early caution regarding cervical adjustments should not be dismissed as medical-political expediency; the available evidence indicates it more likely reflected prudent clinical judgment exercised by the Founder at the inception of the profession.
Importantly, this historical re-examination does not advocate for the prohibition or abandonment of cervical spine manipulation in contemporary chiropractic practice. Rather, DD Palmer’s early restraint serves as a reminder of the value of clinical prudence and a patient-centered standard of care, principles that remain relevant more than a century later.
The chiropractic profession owes both its patients and its intellectual heritage a commitment to engaging primary sources rather than relying exclusively on later reinterpretations, particularly those offered by figures with institutional interests in reframing the past. Such scholarly attention honors the careful, experimental spirit of DD Palmer and strengthens the profession’s ongoing dialogue about safety, evidence, and historical integrity.
Use of AI
Grok (xAI) was utilized for assistance with manuscript review, editing and
literature synthesis.