Lecture+1+-+A+Brief+History+Of+Spinal+Manipulation+%26+Chiropractic.pdf

A Brief History Of Spinal Manipulation & Chiropractic Lecture 1 Dr. Paul Wanlass, D.C. Professor of Chiropractic Education Certified Strength & Conditioning Specialist (CSCS) Certified Specialist in Performance Nutrition (CSPN) Cox Technic ® Parts I, II, III, IV Certified Activator Methods ® Certifi...

A Brief History Of Spinal Manipulation & Chiropractic Lecture 1 Dr. Paul Wanlass, D.C. Professor of Chiropractic Education Certified Strength & Conditioning Specialist (CSCS) Certified Specialist in Performance Nutrition (CSPN) Cox Technic ® Parts I, II, III, IV Certified Activator Methods ® Certified Certification with Exemplary Badge in Teaching and Learning from the Boston University School of Medicine Rev. 1-17-2024 1 MODULE OBJECTIVES Upon completion of this lecture, you should understand the following: Early spinal manipulation in the eastern and western world A brief history of chiropractic including important people The persecution of chiropractors The growth of chiropractic Important events 2 READING ASSIGNMENT Please acquire a copy of the required textbook A.S.A.P. to start the required reading: Principles and Practice of Chiropractic, 3rd ed., by Scott Haldeman. ISBN13: 978-0071375344 Found on the Modules page on Canvas: Read the course syllabus Read Chapter 1 and 2 Read Lecture 1 notes Read the Course Testing Guide 3 INSTRUCTIONS This lecture is not intended to replace the required reading in your text. It is meant to highlight important concepts. Please do all of the required reading. In lecture, we will discuss key concepts and I will ask students to volunteer to answer questions that I pose to the group. Please complete all required reading prior to lecture and be prepared to participate. I look forward to discussing this topic with all of you. 4 EARLY SPINAL MANIPULATION IN THE EASTERN WORLD Practiced in China and India as early as 2700 BC 5 EARLY SPINAL MANIPULATION IN THE WESTERN WORLD The first physician to clearly describe spinal manipulation in the western world was Hippocrates Known for the Hippocratic Oath 6 HIPPOCRATES (460-377 B.C.) He authored the book “On Joints” Used gravity traction and rachiotherapy (spinal therapy) His famous quote – “Look well to the spine for the cause of disease” is still used today He said “man must be treated as a whole, that the ultimate curative forces are within” We “should study the entire patient and his environment” 7 U.S. HEALTH CARE IN THE 19TH CENTURY No governmental regulation for “medicines” or therapy Many trained and untrained providers No licensing laws Many “remedies” Medical Doctors (physicians) included: Homeopaths (1796- current day) Practitioners of botanical medicine (1840-1900) Heroic medicine practitioners (1780-1850) 8 OTHER PRACTITIONERS IN THE 19TH CENTURY INCLUDED Faith healers - Christian Scientists & Mormon Church, Magnetic healers, and others Bonesetters (lay people) (1552- current). Still in Asia, Africa, South America* Manual Therapists: Chiropractic Osteopathy *https://en.wikipedia.org/wiki/Edwin_Smith_Papyrus and https://en.wikipedia.org/wiki/Bonesetter 9 SPINAL MANIPULATION TODAY Still used by: Doctors of Osteopathy (D.O.) Medical Doctors (M.D.) Physical Therapists (P.T.) under the direction of a licensed doctor’s diagnosis and prescription. (M.D., D.O., or D.P.T.)* Naturopathic Doctors (N.D.) in 25 states and territories** Doctors of Chiropractic (D.C.) Bone setters (not licensed) Eastern medicine practitioners Traditional Chinese Medicine (TCM) Ayurvedic practitioners *https://www.fsbpt.org/Portals/0/documents/free-resources/JLRG_DirectAccessLawsAndRegs_201311.pdf **https://aanmc.org/licensure/ 10 CHIROPRACTIC Another form of manipulation was developed in 1895 by Daniel David(D.D.) Palmer, a magnetic healer in Davenport, Iowa. He termed his healing art “chiropractic”, from the Greek word's chiro and praktikos, meaning “done by hand”. Chiropractors are not physicians in the traditional sense of the term. They do not practice medicine (prescribing medications or performing surgery). Chiropractors treat misalignments, or subluxations, within the spinal column, that they believe cause problems within the nervous system, thereby leading to disease. Chiropractors may use adjunctive therapies such as exercise, lifestyle modification, nutrition, heat, cold, laser, electrical stimulation, and ultrasound. 11 DANIEL DAVID PALMER, D.C. (1845-1913) A.K.A. D.D. Palmer or “Old Dad Chiro” Known as the Founder of Chiropractic in 1895 Born in Ontario, Canada Died in Los Angeles 12 D.D. PALMER Farmer, beekeeper, and school teacher until the early 1880s Practiced as a magnetic healer (1886) Moved to Davenport, Iowa in 1887 Advertised widely that he could “cure disease without medicine” Distributed newspaper flyers called “The Magnetic Cure”, “The Chiropractor”, and “The Chiropractic” (Chap. 2) 13 PALMER PUBLICATIONS The Magnetic Cure, Jan 1896 14 PALMER PUBLICATIONS The Chiropractor, 1904 15 PALMER PUBLICATIONS The Chiropractic, 1897 16 “1ST CHIROPRACTIC PATIENT” 2, 20 Palmer performed the first chiropractic adjustment on Sept. 18, 1895. Palmer met Harvey Lillard, was the owner of a janitorial service in the building where D.D. worked. Lillard reported he had been deaf for 17 years. Palmer noticed a misalignment in the man’s spine and offered to treat it. Mr. Lillard agreed and became the first chiropractic patient. He was also the first African American patient. After 2 treatments he could hear well and after 8 months his hearing remained good. Lillard’s daughter recounted a slightly different version but confirmed that his hearing was restored. 17 MORE D.D. PALMER HISTORY In 1897, D.D. Palmer and his son, B.J. Palmer, opened the first chiropractic school in Davenport, Iowa. Also known as “The Fountainhead”. The fee was $500 for a 6-month graduate course. Extended to 18 months in the 1920’s. Around the turn of the century, the name changed from the Palmer School of Magnetic Cure (P.S.M.C.) to the Palmer School of Chiropractic (P.S.C.) 18 D.D.’S LATER YEARS 1906 – Sold the P.S.C. to his son B.J. 1910 D.D. opened the D.D. Palmer College of Chiropractic in Portland, OR. 1910/1911 – move to Los Angeles, CA to teach at the Ratledge System of Chiropractic Schools – which later became Cleveland Chiropractic College of Los Angeles 1913- D.D. died in L.A. from Typhoid Fever (the official cause of death). You can read the entire D.D. Palmer Life Timeline here: https://chiro.org/Plus/History/Persons/PalmerDD/PalmerDD's-Lifeline-chrono.pdf 19 BARTLETT JOSHUA PALMER, D.C. (1882 – 1961) He named himself “B.J.” at 20 years old Known as the Developer of Chiropractic, Hole in One Technique (HIO), vitalism, and the Neurocalometer Transitioned from full spine adjusting to HIO in 1924 Co founder, Palmer College of Chiropractic Co founder, The Meric System Author of over 39 “Green Books”* Born in What Cheer, Iowa Died in Sarasota, Florida * http://library.palmer.edu/greenbookslist 20 B.J. PALMER TEACHING ONE OF THE FIRST ADJUSTING CLASSES 21 B.J. PALMER 1906 – B.J. purchased the P.S.C. from his father. 1906 – The Universal Chiropractor's Association (UCA) was organized by the Palmer School of Chiropractic (PSC) to provide legal services to member D.C.’s charged with practicing medicine without a license. 17 22 B.J. PALMER 1907 – The UCA hired Attorney Tom Morris for the first case to successfully defend Shegatoro Morikubo, D.C. (the first AsianAmerican Chiropractor, Palmer grad in 1907). https://jacchiro.org/aboutChiroE.html To avoid legal prosecution of D.C.’s, B.J. Palmer insisted that chiropractors only analyze the spine for the presence of subluxation and were therefore not practicing medicine. Shegetaro Morikubo, D.C. (1877-1933) 23 B.J. PALMER 1907/08 - Shegetaro Morikubo, D.C. was found not guilty. 1908 – B.J. “delighted by the way that “chiropractic philosophy” had saved the day, had his faculty at the PSC award him the first ever Philosopher of Chiropractic (Ph.C.) degree.” [pg. 32 in the text]. The degree was also offered at other “straight” chiropractic schools until 1968, a few years after B.J. Palmer’s death.21 1911 – B.J. introduced the first Philosophy class in the curriculum Strongly promoted the emerging chiropractic philosophy, which helped defend chiropractors against unlicensed practice lawsuits. 24 WILLARD CARVER, D.C., LLB (1866-1943) Willard Carver also held a Bachelor of Law degree Known as the Constructor of Chiropractic and made Chiropractic legal in Oklahoma in 1921 Authored 18 books Was also an Indian Chief 25 WILLARD CARVER, D.C., LLB Presided over 4 schools in Oklahoma City, Washington D.C., New York, and Denver Introduced the first bill to legalize chiropractic in 1907 (in Oklahoma). Finalized in 1921. 26 R.W. STEPHENSON, D.C., PH.C. (1879 – 1936) Palmer graduate, 1921 Author of The 33 Principles Philosophy and technique teacher at PSC Author of the Chiropractic Textbook, 1927 Author of The Art of Chiropractic, 1927 https://www.institutechiro.com/gens/first-generation-chiropractors/rw-stephenson/ https://www.institutechiro.com/product-category/chiropractic-authors/ralph-stephenson/ 27 ANDREW TAYLOR STILL, D.O. (1828-1917) Opened the American School of Osteopathy in Missouri in 1892 There are now 25 osteopathic medical colleges & D.O.’s practice in all 50 states Curriculum included surgery (for emergencies) but not “pharmaceuticals” Early concepts included the “supremacy of blood flow” 28 ANDREW TAYLOR STILL Worked as a hospital orderly in the Civil War May have been a battlefield surgeon Rose to the rank of Major Following the war, lost several children to typhoid or spinal meningitis Wanted to find an alternative to heroic interventions used on his children 29 ANDREW TAYLOR STILL Practiced as a magnetic healer in 1875 Developed osteopathy in 1889 Known as a “lightning bonesetter” Believed that the brain manufactured the body’s own healing substances – turned out to be true as we will discuss later in the term. Health could be maintained by keeping channels (arteries, veins, nerves, lymph) from the brain to the end organs free of obstructions. 30 SOLON M. LANGWORTHY, D.C.9 1901 Palmer graduate at a cost of $500 1903 American School and Health Home of Chiropractic (Cedar Rapids, Iowa) 1904 patented a traction adjusting table 1905 1st scholarly journal “The Backbone” 1st to establish an organized chiropractic college curriculum 1906 Published the first textbook on Chiropractic “Modernized Chiropractic” along with Minora Paxson, D.C., and Oakley Smith, D.C. 31 SOLON M. LANGWORTHY, D.C. Defended DC’s in court and tried to pass legislation in Minnesota requiring all new DC’s to have 2 years of training to get licensed. This would have eliminated all Palmer graduates but would allow graduates of Langworthy’s school to get a license The Palmers met with the Governor and the legislation was defeated. 32 SOLON M. LANGWORTHY, D.C. 1902 B.J. rejects Solon Langworthy’s proposition of a joint teaching venture. Solon wanted to add hydrotherapy, osteopathy, and naturopathic remedies. This set the stage for B.J.’s lifelong stance against mixing chiropractic with other methods (the beginning of the “Straights vs. Mixers”) 33 SOLON M. LANGWORTHY, D.C. 34 SOLON M. LANGWORTHY, D.C. 1904: Langworthy patents the Langworthy Traction Table 35 JOHN A. HOWARD, D.C. (1876-1953)8 1906 Palmer graduate Founded the National School of Chiropractic in 1906 in Davenport, IA National relocated to Chicago in 1908 Offered physiological therapeutics courses by 1914 Renamed to the National College of Chiropractic in 1918. Now National Univ. of Health Sciences Diversified in its teaching approach, in contrast to the Palmer school 36 NATIONAL SCHOOL OF CHIROPRACTIC 1906 37 NATIONAL COLLEGE OF CHIROPRACTIC IN 1938 38 10 MINUTE BREAK 39 TULLIUS RATLEDGE, D.C. (1881-1967)7 Moved his Ratledge College of Chiropractic from Kansas to California in 1911 Sold the school to Carl Cleveland, Sr., in 1950’s Spent 75 days in jail for practicing medicine without a license rather than pay the fine Active in bringing the 1922 referendum to California voters to legalize chiropractic in CA. 40 FEMALE PIONEERS IN THE PROFESSION13 Women have traditionally faced obstacles in gaining equality in the workplace. In the medical field female physicians were not recognized until 1915. Women were a part of the chiropractic profession from the onset. In D.D. Palmer's first chiropractic class of 15 students, three of them were women. 41 MABEL HEATH PALMER, D.C. (1885-1949)6 The first female Doctor of Chiropractic, 1905 from the P.S.C. She was married to B.J. Palmer Known as the "First Lady of Chiropractic" She later went to Chicago to study anatomy and dissection. In 1918, she authored Anatomy*, the first anatomy textbook for chiropractic students. She returned to P.S.C where she taught anatomy for four decades and founded Sigma Phi Chi, the world's first chiropractic sorority. * Link to the book: https://centerforinquiry.org/wp-content/uploads/sites/33/quackwatch/anatomy.pdf 42 SYLVA ASHWORTH, D.C. (1874–1958)10, 18 Graduated from Palmer in 1910 at the age of 35 Known as the “Grand Old Lady Of Chiropractic” Served on the first chiropractic board in Nebraska In 1921, the Lincoln Herald credited her with the largest chiropractic practice in the state Daughter Ruth and son-in-law Carl Cleveland started the Central College of Chiropractic in Kansas City 43 SYLVA ASHWORTH, D.C.18 Which became the Cleveland Chiropractic College in 1924 Renamed the Ratledge College Then to the Cleveland Chiropractic College of Los Angeles in 1955 Matriarch of the first 5-generation family of chiropractors – the Cleveland’s Vice-President of the Universal Chiropractors Association (UCA) in 1918 Founder of the Chiropractic Research Foundation in 1944, known today as the Foundation for Chiropractic Education & Research (FCER). 44 FRED RUBEL, D.C.3,12 Fred Rubel, a 1913 graduate of the National School of Chiropractic, was the first African American Doctor of Chiropractic in the U.S. In 1914 Dr. Rubel founded the Rubel Chiropractic College in Alabama, and in Chicago in 1921, that accepted students of all races. 45 JULIAN DAWSON, M.D.12 Julian Dawson, MD was an anatomy teacher at the Rubel College of Chiropractic in 1925 and one of the first African American faculty at any Chiropractic College. 46 AFRICAN AMERICAN HISTORY IN CHIROPRACTIC You can read more about African American chiropractic leaders in the history of the profession at these links: https://harshechiropractic.com/2020/02/14/bla ck-history-month-in-chiropractic/ https://www.timetoast.com/timelines/theblack-history-of-chiropractic Timeline: https://www.timetoast.com/timelines/theblack-history-of-chiropractic A Study Group in PSC Library, Jan 1959. 47 SEGREGATION11 The Palmer School of Chiropractic restricted enrollment to members of the white race until 1950. Other segregated schools from the period included Central Chiropractic College (Washington, D.C.), and Booker T. Washington Institute (Kansas City, Missouri), as well as Cosmopolitan College of Chiropractic (New York City). 48 GEOFFREY DOUGLAS MAITLAND (1924-2010) Born in Australia in 1924. He trained as a physiotherapist from 1946 to 1949 In 1962 he differentiated some of the various mobilization procedures Maitland proposed four levels or grades of mobilization 49 JOSEPH JANSE (1909-1985) Helped create the National Chiropractic Association Council on Education in 1947 Received DC and ND degrees from National College of Chiropractic (NCC) in 1938 Was a faculty member at NCC, Dean, and president (in 1944) of NCC Presented the “Scientific Basis of Chiropractic” before the U.S. Congress in 1967 Helped create the first peer-reviewed, indexed, chiropractic research journal, the Journal of Manipulative and Physiological Therapeutics (JMPT) in 1978 50 THE FOUNDERS OF L.A.C.C. http://www.chiro.org/Plus/History/Persons/CaleChas/Cale-photos/Cale_&_Family.pdf 51 DRS. CHARLES AND LINNIE CALE 4 Founded Los Angeles College of Chiropractic (LACC) in 1911. 1st graduating class had 3 students Classes were taught in the Cale’s home with a nine-month course of study that included anatomy, chiropractic principles and technique By 1950, the course of study had expanded to four years and the College moved to Glendale, California, consolidating its basic science subjects and chiropractic sciences into one comprehensive curriculum taught in one modern facility. The school moved to Whittier, CA in 1981 First accredited in 1993, the only chiropractic college accredited by the Western Assoc. of Schools and Colleges (WASC) at the time. 52 THE PERSECUTION OF CHIROPRACTORS & THE GROWTH OF CHIROPRACTIC 53 PERSECUTION OF CHIROPRACTORS By 1930, an estimated 15,000 chiropractors had been charged with practicing medicine without a license Over 450 chiropractors went to jail in California rather than pay the fine Chiropractors prevailed in about 75% of the cases 54 GROWTH OF CHIROPRACTIC SCHOOLS Between 1903 and 1914, 23 chiropractic schools opened their doors, including: Parker School of Chiropractic (1905) National School of Chiropractic (1906) Texas Chiropractic College (1908) Los Angeles College of Chiropractic (1911) Canadian Chiropractic College (1914) Rubel College of Chiropractic (1914, 1921). First DC schools to admit people of all ethnicities, races, and backgrounds 55 GROWTH OF CHIROPRACTIC SCHOOLS The biggest surge in enrollment came following World War I and World War II The Veterans Bureau provided funds for vocational and professional training Enrollment at Palmer in 1922 was over 3,000 students 1974: Council on Chiropractic Education (CCE) was recognized by the US Office of Education as the accrediting agency for schools of chiropractic. This resulted in the development of affiliated agencies in Australia, Asia, Canada, Europe and most recently Latin America. Students could now be eligible for federally guaranteed student loans 56 GROWTH OF CHIROPRACTIC GLOBALLY14 The Chiropractic Workforce: A Global Review (2019): Total number of chiropractors worldwide was 103,469. Number of chiropractors per country ranged from 1 to 77,000. Chiropractic education was offered in 48 institutions in 19 countries. Direct access to chiropractic services was available in 81 countries, and services were partially or fully covered by government and/or private health schemes in 46 countries. The practice of chiropractic was legally recognized in 68 (75.6%) of the 90 countries. It was explicitly illegal in 12 (13.3%) countries. 57 IMPORTANT DATES & EVENTS 58 STRUGGLES FOR LICENSURE IN THE U.S. 60-year effort Kansas = first state (1913) Louisiana = last state (1974) 59 NUMBER OF STATES LICENSING CHIROPRACTIC 60 IMPORTANT DATES 17,19 1922: The original American Chiropractic Association (ACA) was founded to provide a broad scope alternative to BJ’s Universal Chiropractic Association (UCA). 1926: International Chiropractic Association (ICA) was founded by B.J. Palmer 1930: The original ACA and UCA combined to form the National Chiropractic Association (NCA) 61 IMPORTANT DATES 1963: The NCA was re-organized into today’s modern American Chiropractic Association (ACA) https://www.acatoday.org/ 1963: The National Board of Chiropractic Examiners (NBCE) was established in the U.S. to promote consistency and reciprocity between state examining boards. 1963: The American Medical Association (AMA) Committee on Quackery, goal to “contain and then eliminate chiropractic”. 1972: The U.S. Congress allowed authorizing payments for chiropractors through Medicare. 62 IMPORTANT DATES 1974: Council on Chiropractic Education (CCE) is founded as the accrediting agency for all chiropractic colleges in the U.S.A. 1975: National Institute for Neurological and Communicative Diseases and Stroke Conference Sponsored by Congress Interdisciplinary discussion panel, including chiropractors 63 1976 WILK ANTITRUST SUIT 15,16 1976: Wilk vs. American Medical Assoc. (AMA) lawsuit filed. Chester Wilk & 4 other chiropractors sued the AMA and 10 other medical organizations for engaging in a conspiracy to monopolize health care and restrain competition by making voluntary professional associations between MDs and DCs unethical. The suit also asserted that the AMA had conspired with insurance companies to exclude chiropractic coverage. AMA was found guilty in 1978 of violating the Sherman Antitrust Act (an act of Congress in 1890 prescribing the rule of free competition). 64 IMPORTANT DATES 1978: The Journal of Manipulative and Physiological Therapeutics (JMPT) published its first issue. 1982: The JMPT became the first chiropractic journal to be included in Index Medicus, published by the National Institutes of Health (NIH). 1988: Founding of the World Federation of Chiropractic (WFC). 65 IMPORTANT DATES 1995: Chiropractic was not yet available to U.S. military members. U.S. Congress directed the Department of Defense to test the feasibility of providing chiropractic services to military members through a demonstration project. 1996: The Association of Chiropractic Colleges (A.C.C.) published a position paper describing the nature of Chiropractic and its professional attributes. Adopted by the ACA, ICA, and WFC. 1997: The WFC was admitted into official relations with the World Health Organization (WHO) as a non-governmental organization (NGO). 66 IMPORTANT DATES 1999: The U.S. Congress authorized the Veterans’ Administration (VA) healthcare system to begin providing chiropractic care to American Veterans. 2000: The chiropractic demonstration project within the Military Health System was a success. Chiropractic care was made a permanent benefit for US uniformed service members (DOD). 67 IMPORTANT DATES 2018: The WFC launched a strategic plan 20192022 and began the WFC Evidence-based, People-centered, Interprofessional, Collaborative campaign, known as the EPIC campaign. 2020: WFC issued a statement that it “stands in solidarity with World Health Organization in its role of promoting health for all and in protecting population health in all nations”. 68 QUESTIONS ABOUT LECTURE 1 CONTENT? 69 REFERENCES Chapters 1 and 2 of the required text. 1. https://www.nbce.org/practice-analysis-of-chiropractic-2020/ 2. From The Chiropractic, Jan 1897, published by D.D. Palmer 3. Chiropractic’s Continued Legacy of Racism and its Affects on Minority Population Utilization Journal of Philosophy, Principles & Practice of Chiropractic, Volume 2016 https://www.researchgate.net/publication/323225702_Chiropractic's_Continued_Leg acy_of_Racism_and_its_Affect_on_Minority_Population_Utilization 4. https://www.scuhs.edu/about-scu/history/ 5. https://www.nuhs.edu/news/2019/2/nuhs-clubs-celebrate-medical-trailblazersduring-black-history-month/ 70 REFERENCES 6. 6. https://en.wikipedia.org/wiki/Mabel_Heath_Palmer 7. 7. https://chiro.org/Plus/History/Colleges/RatledgeSCS/Ratledge-bio-chrono.pdf 8. 8. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/210354 9. 9. https://chiro.org/Plus/History/Persons/PalmerDD/PalmerDD's-Lifeline-chrono.pdf 10. 10. https://en.wikipedia.org/wiki/Sylva_Ashworth 11. 11. Wiese, G. Beyond the Jim Crow experience: blacks in chiropractic education." Chiropractic History: the archives and journal of the Association for the History of Chiropractic 14.1 (1994): 14-21. 12. 12. https://harshechiropractic.com/2020/02/14/black-history-month-in-chiropractic/ 13. 13. https://library.palmer.edu/womenandchiropractic#:~:text=In%20D.D.,consider%20a%20 career%20in%20chiropractic. 14. 14. Stochkendahl, M.J., Rezai, M., Torres, P. et al. The chiropractic workforce: a global review. Chiropr Man Therap 27, 36 (2019). https://doi.org/10.1186/s12998-019-0255-x 71 REFERENCES 15. (http://betterspines.com/2009/09/25/the-wilk-antitrust-lawsuit-etc/) 16. https://en.wikipedia.org/wiki/Wilk_v._American_Medical_Ass%27n 17. Keating JC Jr, Rehm WS. The origins and early history of the National Chiropractic Association. J Can Chiropr Assoc. 1993 Mar;37(1):27–51. PMCID: PMC2484960. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2484960/ 18. https://chiro.org/Plus/History/Persons/AshworthSylviaL/Ashworth-article.pdf 19. Principles and Practice of Chiropractic, 3rd ed., by Scott Haldeman, editor; McGrawHill, 2005. ISBN-13: 978-0071375344, page 45 20. https://www.palmer.edu/wp-content/uploads/2022/02/biography-palmer-danieldavid.pdf 21. Stout RJ. The Ph.C. degree: an affirmation of chiropractic philosophy, 1908-1968. Chiropr Hist. 1988 Jul;8(1):11-2. PMID: 11621596. 72 Take QUIZ 1 73