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 MANUAL
PHYSICAL
THERAPY
OF THE SPINE
2nd Edition

Kenneth A. Olson
PT, DHSc, OCS, FAAOMPT
Private Practitioner
Northern Rehabilitation and Sports Medicine Associates
DeKalb, Illinois
Adjunct Assistant Professor
Marquette University
Milwaukee, Wisconsin
2 CHAPTER 1 Introduction

HISTORY OF MANIPULATION the techniques were often learned from family members and
Manipulation in recorded history can be traced to the days of passed down from one generation to the next. The clicking
Hippocrates, the father of medicine (460–370 bc). Evidence sounds that occurred with manipulation were thought to be
is seen in ancient writings that Hippocrates used spinal trac- the result of bones moving back into place.4
tion methods. In the paper “On Setting Joints by Leverage,” In 1871, Wharton Hood published On Bone-Setting,
Hippocrates describes the techniques used to manipulate a the first such book by an orthodox medical practitioner.5
dislocated shoulder of a wrestler.3 Succussion was also prac- Hood learned about bonesetting after his father had treated
ticed in the days of Hippocrates. The patient was strapped in a bonesetter, Richard Hutton. Hutton was grateful for the
an inverted position to a rack that was attached to ropes and medical care and offered to teach his practitioner about
pulleys along the side of a building. The ropes were pulled to bonesetting. Instead, it was the practitioner’s son, Wharton
elevate the patient and the rack as much as 75 feet, at which Hood, who accepted the offer. Hood thought that the snap-
time the ropes were released and the patient crashed to the ping sound with manipulation was the result of breaking
ground to receive a distractive thrust as the rack hit the ground4 joint adhesions.5 Paget6 believed that orthodox medicine
(Figure 1-1). Six hundred years later, Galen (130–200 ad) should consider the adoption of what was good and useful
wrote extensively on exercise and manipulation procedures in about bonesetting but should avoid what was potentially
medicine.3 dangerous and useless.
Hippocrates’ methods continued to be used through- Osteopathy was founded by Andrew Still (1826–1917)
out the Middle Ages, with little advance in the practice in 1874. In 1896, the first school of osteopathy was formed
of medicine and manipulation because of the reliance on in Kirksville, Missouri.4 Still developed osteopathy based on
the church for most healing throughout Europe.3 In the the “rule of the artery,” with the premise that the body has an
Renaissance era, Ambroise Paré (1510–1590) emerged as innate ability to heal and that with spinal manipulation to cor-
a famous French physician and surgeon3 who used armor rect the structural alignment of the spine, the blood can flow
to stabilize the spine in patients with tuberculosis4 (Fig- to various regions of the body to restore the body’s homeosta-
ure 1-2). His manipulation and traction techniques were sis and natural healing abilities. Still’s philosophy placed an
similar to those of Hippocrates, but he opposed the use of emphasis on the relationship of structure to function and used
succussion.4 manipulation to improve the spinal structure to promote opti-
The bonesetters flourished in Europe from the 1600s mal health.7 The osteopathic profession continues to include
through the late 1800s. In 1656, Friar Moulton published The manipulation in the course curriculum but does not adhere
Complete Bone-Setter. The book was later revised by Robert to Still’s original treatment philosophy. Many osteopathic
Turner.4 No formal training was required for bonesetters; physicians in the United States do not practice manipulation
regularly because they are focused on other specialty areas, such
as internal medicine or emergency medicine. Osteopathy in
many European countries remains primarily a manual therapy
profession.
Chiropractic was founded in 1895 by Daniel David Palmer
(1845–1913). One of the first graduates of the Palmer School
of Chiropractic in Davenport, Iowa, was Palmer’s son Bartlett
Joshua Palmer (1882–1961), who later ran the school and

FIGURE 1-2 Ambroise Paré applied manual therapy to the spine

in conjunction with spinal traction, similar to Hippocrates’ meth-
ods described over 1000 years earlier. (From Paré, Ambroise.
FIGURE 1-1 Falling ladder (a.k.a. succession). (From Schoitz.) Opera. Liber XV, Cap. XVI, pp. 440-441, Paris, 1582.)
 CHAPTER 1 Introduction 3

promoted the growth of the profession. D. D. Palmer was a with a scientific rationale, based on contemporary knowledge
storekeeper and a “magnetic healer.” According to legend, in of anatomy and physiology, for the benefits of combining spe-
1895 he used a manual adjustment directed to the fourth tho- cific active, resistive, and passive movements and exercises,
racic vertebra that resulted in the restoration of a man’s hear- including variations of spinal manipulation, traction, and mas-
ing.8 The original chiropractic philosophy is based on the “law sage.9 “Ling’s doctrine of harmony” purported that the health
of the nerve,” which states that adjustment of a subluxed ver- of the body depended on the balance between three primary
tebra removes impingement on the nerve and restores innerva- forms: mechanics (movement/exercise/manipulation), chem-
tion and promotes healing of disease processes.3 The “straight” istry (food/medicine), and dynamics (psychiatry), and the
chiropractors continue to adhere to Palmer’s original sublux- Ling physical therapists were trained to restore this harmony
ation theories and use spinal adjustments as the primary means through use of manual therapy.
of treatment. The “mixers” incorporate other rehabilitative Graduates of RCIG immigrated to almost every major
interventions into the treatment options, including physical European city, Russia, and North America through the mid
modalities, such as therapeutic ultrasound and exercise. to late 1800s to establish centers of medical gymnastics and
The origins of physical therapy can be traced to the mechanical treatments.9 Jonas Henrik Kellgren (1837–1916)
Royal Central Institute of Gymnastics (RCIG), founded graduated from the RCIG in 1865, eventually opened clinics in
in 1813 by Pehr Henrik Ling (1776–1839) in Stockholm, Sweden, Germany, France, and London, and is credited with
Sweden9,10 (Figure 1-3). Ling’s educational system included development of many specific spinal and nerve manipulation
four branches: pedagogical gymnastics (physical education), techniques.9 In addition, medical doctors from throughout
military gymnastics (mostly fencing), medical gymnastics Europe enrolled in the RCIG to add physical therapy meth-
(physical therapy), and esthetic gymnastics (philosophy). ods to their treatment of human ailments and attained joint
Ling systematized medical gymnastics into two divisions, credentials as physician/physical therapist. Edgar F. Cyriax
massage and exercise, with massage defined as movements (1874–1955), the son-in-law of Kellgren and a graduate of
done on the body and exercise being movements done RCIG before becoming a medical doctor, published more
with a part of the body.11,12 Ling may not have been the than 50 articles on Ling’s and Kellgren’s methods of physi-
originator of medical gymnastics or massage, but he system- cal therapy in international journals and advocated to include
atized these methods and attempted to add contemporary “mechano-therapeutics” in the curriculum and training of
knowledge of anatomy and physiology to support medical medical doctors in Britain.9 In 1899, the Chartered Society of
gymnastics.11,12 Physiotherapy was founded in England.3 The first professional
Graduates of the RCIG earned the title “director of gym- physical therapy association in the United States, which was
nastics” and in 1887 were licensed by Sweden’s National Board the forerunner to the American Physical Therapy Association
of Health and Welfare, where physical therapists continue to (APTA), was formed in 1921.1
use the title sjukgymnast (“gymnast for the sick”).9,13 Through- Between 1921 and 1936, at least 21 articles and book
out the nineteenth century, the RCIG provided its graduates reviews on manipulation were found in the physical therapy
literature,14 including the 1921 textbook, Massage and Thera-
peutic Exercise, by the founder and first president of the APTA,
Mary McMillan. McMillan credits Ling and his followers with
development and refinement of the methods used to form the
physical therapy profession in the United States.11,12 In fact,
McMillan devotes a 15-page chapter of her book to specific
therapeutic exercise regimes developed by Ling referred to as “A
Day’s Order” and states that the term medical gymnastics is syn-
onymous with therapeutic exercise. In a subsequent editorial,11
she wrote of the four branches of physiotherapy, which she
identified as “manipulation of muscle and joints, therapeutic
exercise, electrotherapy, and hydrotherapy.”12 Titles of articles
during this period were quite explicit regarding manipulation,
such as “The Art of Mobilizing Joints”15 and “Manipulative
Treatment of Lumbosacral Derangement.”16 The articles used
phrases such as “adhesion . . . stretched or torn by this simple
manipulation”17 and “manipulation of the spine and sacroiliac
joint.”18 This usage helps illustrate that manipulation has been
part of physical therapy practice since the founding of the pro-
fession and through the 1930s.14
FIGURE 1-3 Thoracic traction as performed by graduates of the R
­ oyal
From 1940 to the mid-1970s, the word manipulation was
Central Institute of Gymnastics in the mid-1800s. (Reproduced not widely used in the American physical therapy literature.3
with permission from Dr. Ottosson, http://www.chronomedica.se.) This omission may have been due in part to the American
4 CHAPTER 1 Introduction

Medical Association’s Committee on Quackery, which was

formed in the 1960s and was active for the next 30 years in an
attempt to discredit the chiropractic profession. The commit-
tee was forced to dissolve in 1990 because of Wilk’s “restraint
of trade” case, which was upheld in the US Supreme Court.8
Because physical therapy remained within the mainstream
medical model, the terms mobilization and articulation were
used during this timeframe to separate physical therapy from
chiropractic. However, physical therapists continued to prac-
tice various forms of manipulation.
Through the early to mid 1900s, several prominent
European orthopaedic physicians influenced the practice of
manipulation and the evolution of the physical therapist’s
role as a manipulative therapist. Between 1912 and 1935,
James Mennell (1880–1957) provided advanced training in
manipulation technique for physiotherapist at St. Thomas’s
Hospital in London.19 In 1949, James Mennell published
his textbook titled the Science and Art of Joint Manipula-
tion. Mennell adapted knowledge of joint mechanics in
the practice of manipulation and coined the phrase “acces- FIGURE 1-4 Cyriax (left) and Stoddard (right) in Norway, 1965.
sory motion.”20 James H. Cyriax (1904–1985), son of Edgar (From Kaltenborn FM: Manual mobilization of the joints: volume II:
Cyriax and grandson of Jonas Henrik Kellgren, published his The spine, Oslo, Norway, 2012, Norli.)
classic Textbook of Orthopaedic Medicine in 1954. He made
great contributions to orthopaedic medicine with the devel-
opment of detailed systematic examination procedures for In the 1960s, several physical therapists emerged as interna-
extremity disorders, including refinement of isometric tissue tional leaders in the practice and instruction of manipulation.
tension signs, end feel assessment, and capsular patterns.21 Physical therapist Freddy Kaltenborn, originally from Norway,
Cyriax attributed most back pain to disorders of the inter- developed what is now known as the Nordic approach. He
vertebral disc and used aggressive general manipulation tech- published his first textbook on spinal manipulation in 1964
niques that included strong manual traction forces to “reduce and was the first to relate manipulation to arthrokinematics.25
the disc.”21 Cyriax, who also taught and practiced orthopae- His techniques were specific and perpetuated the importance
dic medicine at St. Thomas’s Hospital until 1969 and was of biomechanical principles, such as the concave/convex and
the successor of Mennell at St Thomas’s,22 influenced many arthrokinematic rules. Kaltenborn, in collaboration with
physiotherapists, including Stanley Paris and Freddy Kalten- physical therapist Olaf Evjenth, also developed extensive long-
born, to carry on the skills and techniques required to effec- term training programs for physical therapists to specialize in
tively use manipulation. manual therapy first in Norway and later throughout Europe,
Alan Stoddard7 (1915–2002) was a medical and osteopathic North America, and Asia.
physician in England who used skillful specific manipulation Australian physical therapist, Geoffrey Maitland (1924–2010),
technique and also mentored many physical therapists, includ- published the first edition of his book Vertebral Manipulation
ing Paris and Kaltenborn (Figure 1-4). Stoddard authored two in 1964.28 Maitland was also influenced by the work of Cyriax
textbooks, Manual of Osteopathic Technique (1959) and Man- and Stoddard but further refined the importance of a detailed
ual of Osteopathic Practice (1969), which became the corner- history and comprehensive physical examination. He also devel-
stone of osteopathic teaching in schools around the world.23 oped the concept of treatment of “reproducible signs” and inhi-
Physical therapists, Kaltenborn24 and Paris,25 both believed bition of joint pain with use of gentle oscillatory manipulation
that the Cyriax approach to extremity conditions was excellent, techniques. Maitland developed the I to IV grading system to
but they preferred Stoddard’s specific manipulation techniques further describe oscillatory manipulation techniques.28 Maitland
for the spine. also established long-term manual therapy educational programs
John Mennell (1916–1992), the son of James Mennell, first affiliated with universities in Australia, which subsequently
practiced orthopaedic medicine in England. In the 1960s, he facilitated the rapid growth of musculoskeletal physical therapy
immigrated to the United States, where he held many educa- research.
tional programs for physical therapists through the 1970s and Physical therapist, Stanley Paris, was originally from
1980s to promote manipulation within the physical therapy New Zealand. Early in his career, in 1961 and 1962, he was
profession. He published several textbooks, including Joint awarded a scholarship to study manipulation in Europe and
Pain, Foot Pain, and Back Pain and coined the phrase “joint the United States.14 He had the opportunity to study with
play.”27 Mennell brought attention to sources of back pain Cyriax, Stoddard, and Kaltenborn during this time and in
other than the intervertebral disc. 1965 published the textbook Spinal Lesion.26 In the late
 CHAPTER 1 Introduction 5

The Orthopaedic Section of the APTA represents all

aspects of musculoskeletal physical therapy and is open
to all members of the APTA, including physical therapist
assistants. Before formation of the AAOMPT, no organi-
zation in the United States could meet the IFOMPT cri-
teria because no recognized educational system in manual
therapy upheld standards of training and examination in
manual therapy for physical therapists in the United States.
However, by 1990 at least eight active manual therapy fel-
lowship programs were operating independently within the
United States.
In 1991, Freddy Kaltenborn invited representatives from
these eight manual therapy fellowship programs to meet at
Oakland University in Michigan to consider how the United
FIGURE 1-5 Photograph was taken in 1974 in Montreal, Canada, at States could develop educational standards in manual therapy
the successful formation of the International Federation of Ortho- and become a member organization of IFOMPT.29 These
paedic Manipulative Physical Therapists (IFOMPT). Dr. Paris was
Chair of the conference. The other three individuals were consul-
eight physical therapists, Stanley Paris, Mike Rogers, Michael
tants to the process and had served in that capacity for 6 years Moore, Kornelia Kulig, Bjorn Swensen, Dick Erhard, Joe
before this event. IFOMPT later became a subsection of the World Farrell, and Ola Grimsby, became the founding members of
Confederation for Physical Therapy (WCPT). From left: Geoffrey the AAOMPT. The AAOMPT developed a standards docu-
Maitland, Stanley Paris, Freddy Kaltenborn, and Gregory Grieve. ment, bylaws, and a recognition process for manual therapy
(From Paris SV: 37th Mary McMillan lecture: in the best interest of
the patient, Phys Ther 86[11]:1541-1553, 2006.)
fellowship programs. In 1992, the AAOMPT was accepted
as the member organization to represent the United States in
IFOMPT.
1960s, Paris immigrated to the United States, where he even- Although prominent individuals, such as Paris, Kalten-
tually completed his doctoral work in neuroanatomy of the born, and Maitland, played a large role in development and
lumbar spine and developed extensive educational programs advancement of manipulation and manual therapy within
for postprofessional physical therapy education in manual the physical therapy profession over the last half of the
physical therapy and manipulation that eventually resulted in twentieth century, the current practice and the future of the
the formation the University of St. Augustine for Health Sci- specialty area of OMPT are driven by evidence-based prac-
ences in St. Augustine, Florida. Paris also played key roles in tice and the promotion of OMPT practice through profes-
formation of professional organizations in the United States, sional associations, such as IFOMPT, AAOMPT, and the
including the APTA Orthopaedic Section and the Ameri- APTA.29 A large and growing body of research evidence
can Academy of Orthopaedic Manual Physical Therapists supports and guides the practice of manipulation within
(AAOMPT), two professional organizations that have played the scope of physical therapy practice and for other manual
roles in advocating for inclusion of manipulation within the therapy practitioners.
scope of physical therapy practice and that have promoted
education, practice, and research in manual physical therapy.
Paris worked with physical therapists Maitland, Kaltenborn, ORTHOPAEDIC MANUAL PHYSICAL THERAPY
and Gregory Grieve of the United Kingdom to form the TREATMENT PHILOSOPHY
International Federation of Orthopaedic Manipulative Physi- IFOMPT defines OMPT as a specialized area of physiotherapy/
cal Therapists (IFOMPT; Figure 1-5). physical therapy for the management of neuro-musculo-skele-
The IFOMPT was founded in 1974 and represents orga- tal conditions, based on clinical reasoning, using highly specific
nized groups of manual/manipulative physical therapists treatment approaches including manual techniques and thera-
around the world that have established stringent postgradu- peutic exercises. OMPT also encompasses, and is driven by, the
ation specialization educational programs in manual/manip- available scientific and clinical evidence and the biopsychosocial
ulative physical therapy. The federation sets educational and framework of each individual patient (see the IFOMPT Consti-
clinical standards and is a subgroup of the World Confed- tution 2012 at http://www.ifompt.com/site/ifompt/files/pdf//
eration of Physical Therapy (WCPT). One organization IFOMPT_Constitution.pdf).
of each WCPT country can be recognized by IFOMPT to IFOMPT considers the following terms as being inter-
represent that country if the organization meets IFOMPT changeable: orthopaedic manual therapy, orthopaedic manual
criteria. The IFOMPT educational standards and interna- physical therapy, orthopaedic manipulative therapy, and ortho-
tional monitoring system has allowed physical therapists paedic manipulative physical therapy (per IFOMPT Constitu-
to be recognized as orthopaedic manual physical therapy tion 2012).
(OMPT) specialists in countries beyond the country where Paris30 described a nine-point “Philosophy of Dysfunc-
they received their training. tion” that summarizes the components of a traditional OMPT
6 CHAPTER 1 Introduction

BOX 1-1    Philosophy of Dysfunction as Described by Paris

terminology, this is an “impairment-based approach,” which
is a foundation of physical therapy.
I. That joint injury, including such conditions referred to as Manual physical therapy approaches place an emphasis on
osteoarthritis, instability, and the after effects of sprains application of biomechanical principles in the examination and
and strains, are dysfunctions rather than diseases. treatment of spinal disorders. Motion is analyzed with active
II. That dysfunctions are manifest as either increases or
decreases of motion from the expected normal or by the
and passive motion testing with visualization of the spinal
presence of aberrant movements. Thus, dysfunctions mechanics; the motion is best described with standardized bio-
are represented by abnormal movements. mechanical terminology. Passive forces are applied, with pas-
III. That where the dysfunction is detected as limited sive accessory intervertebral motion testing and mobilization/
motion (hypomobility), the treatment of choice is
manipulation to joint structures, stretching to muscles manipulation techniques, along planes of movement parallel
and fascia and the promotion of activities that encour- or perpendicular to the anatomic planes of the joint surfaces.
age a full range of movement. Therefore, knowledge of spinal anatomy and biomechanics is
IV. That when the dysfunction is manifest as increased
a prerequisite to learning a manual physical therapy approach
movement (hypermobility), laxity or instability, the treat-
ment of the joint in question is not manipulation but sta- for examination and treatment of the spine.
bilization by instruction of correct posture, stabilization Orthopaedic manual physical therapists use a process of
exercises and correction of any limitations of movement clinical reasoning that includes continual assessment of the
in neighboring joints that may be contributing to the
patient, followed by application of a trail of manual therapy
hypermobility.
V. That the primary cause of degenerative joint disease is treatment or exercise, followed by further assessment of the
joint dysfunction. Therefore, it may be concluded that its patient’s response to the treatment. This intimate relationship
presence is due to the failure or lack of accessibility to between examination, treatment, and reexamination provides
physical therapy.
VI. That the physical therapist’s primary role is in the evalu-
useful clinical data for sound judgments regarding the patient’s
ation and treatment of dysfunction, whereas that of the response to treatment and the need to modify, progress, or
physician is the diagnosis and treatment of disease. maintain the applied interventions. Use of examination proce-
These are two separate but complementary roles in dures with proven reliability and validity further enhances the
health care.
VII. That since dysfunction is the cause of pain, the primary
clinical decision-making process.
goal of physical therapy should be to correct the dys- Physical therapists have embraced the principles of evi-
function rather than the pain. When, however, the nature dence-based practice. When research evidence is available
of the pain interferes with correcting the dysfunction, to guide clinical decisions, the physical therapist should
the pain will need to be addressed as part of the treat-
ment program. follow the evidence-based practice guidelines. However,
VIII. That the key to understanding dysfunction, and thus when research evidence is not clear, an impairment-based
being able to evaluate and treat it, is understanding approach that includes a thorough evaluation and sound
anatomy and biomechanics. It therefore behooves us in
clinical decision making should be used, with a focus on
physical therapy to develop our knowledge and skills in
these areas so that we may safely assume leadership in restoring function, reducing pain, and returning the patient
the non-operative management of neuromusculoskel- to functional activities. In fact, a growing body of research
etal disorders. evidence demonstrates the effectiveness of an impairment-
IX. That it is the patients’ responsibility to restore, maintain,
based orthopaedic manual physical therapy approach for
and enhance their health. In this context, the role of the
physical therapist is to serve as an educator, to be an the treatment of spine and extremity musculoskeletal condi-
example to the patient, and to reinforce a healthy and tions.31–39 This textbook attempts to incorporate the best
productive lifestyle. available evidence with an orthopaedic manual physical
therapy approach.
Adapted from Paris SV: Introduction to spinal evaluation and manipulation, Atlanta,
1986, Institute Press. The evidence supports use of a classification system to
guide the treatment of patients with spinal disorders.40-41 An
impairment-based classification system that is linked to the
treatment philosophy (Box 1-1). Paris defines “dysfunc- International Classification of Functioning, Disability, and
tion” as increases or decreases of motion from the expected Health (ICF) has been developed by the Orthopaedic Section
normal or as the presence of aberrant movements.4 There- of the APTA for low back and neck pain conditions.42-43 The
fore, the primary focus of the orthopaedic manual physical ICF impairment-based terminology is incorporated within this
therapist’s examination is the analysis of active and passive textbook where appropriate. The impairment-based classifica-
movement. If hypomobility is noted, joint mobilization and tion system recognizes that patients with spinal disorders are
stretching techniques are used; if hypermobility is noted, sta- a heterogeneous group. However, subgroups of patients can
bilization exercises, motor control, and postural correction be identified with common signs and symptoms that respond
are emphasized. If aberrant movements are noted, a motor to interventions that can be provided by physical therapists,
retraining exercise approach is appropriate. If localization of including manipulation, specific directional exercises, stabili-
tissue reactivity and pain are noted, gentle oscillatory tech- zation/neuromuscular control exercises, and traction. A clas-
niques as described by Maitland can be used to attempt to sification of common disorders is described in great detail for
inhibit pain.28 To use Guide to Physical Therapist Practice each anatomic region covered in this textbook.
 CHAPTER 1 Introduction 7

So, for effective treatment of patients with spinal disor- TABLE 1-1 Kappa Coefficient Interpretation
ders, physical therapists complete a comprehensive physical
examination that includes screening for red flags to ensure that KAPPA STATISTIC STRENGTH OF AGREEMENT

physical therapy is appropriate to the patient’s condition. The < 0.00 Poor
examination includes procedures with proven reliability and
validity, and the results of the examination are correlated with 0.00–0.20 Slight

patient questionnaire information and the patient’s history to 0.21–0.40 Fair

determine a diagnosis. The diagnosis places the patient in a
classification and includes a problem list of noted impairments 0.41–0.60 Moderate

that affect the patient’s condition. As treatment is imple- 0.61–0.80 Substantial

mented, the patient’s condition is continually reassessed to
determine the results of treatment and to determine whether 0.81–1.00 Almost perfect

modifications in diagnosis and treatment are necessary. The Data from Landis JR, Koch GG: The measurement of observer agreement for
categorical data,Biometrics 33:159-174, 1977.
primary emphasis of the treatment is integration of manual
therapy techniques and therapeutic exercise with principles
of patient education to ultimately allow the patient to self- Many of the examination tests presented in this textbook
manage the condition. have been tested for reliability and validity; this information
is reported when available. Reliability is defined as the extent
Evidence-Based Practice to which a measurement is consistent and free of error.45 If an
Evidence-based practice is defined as the integration of best examination test is reliable, it is reproducible and dependable
research evidence with clinical expertise and patient values.44 to provide consistent responses in a given condition.45 Validity
The research evidence considered in evidence-based practice is the ability of a test to measure what it is intended to mea-
is meant to be clinically relevant patient-centered research of sure.45 Both reliability and validity are essential considerations
the accuracy and precision of diagnostic tests, the power of in determination of what tests and measures to use in the clini-
prognostic markers, and the efficacy and safety of therapeutic, cal examination of a patient.
rehabilitative, and preventive regimens.44 Clinical experience, Reliability is often reported as both interrater and intra-
the ability to use clinical skills and past experience, should also rater reliability. Intrarater or intraexaminer reliability defines
be incorporated into evidence-based practice to identify each the stability or repeatability of data recorded by one individual
patient’s health state and diagnosis, risks and benefits of poten- across two or more trials.45 Interrater reliability defines the
tial interventions, and the patient’s values and expectations.44 amount of variability between two or more examiners who
Patient values include the unique preferences, concerns, and measure the same group of subjects.45 For the statistical analy-
expectations each patient brings to a clinical situation; these sis of interval or ratio data, the intraclass correlation coeffi-
values must be integrated into clinical decisions if the therapist cient (ICC) is the preferred statistical index, because it reflects
is to properly serve the patient.44 both correlation and agreement and determines the amount
Evidence-based principles are incorporated throughout of variance between two or more repeated measures.45,46 For
this textbook. When studies are identified to illustrate the ordinal, nominal, or categorical data, percent agreement can
accuracy and precision of diagnostic tests, this information is be determined and the kappa coefficient (k) statistic applied,
reported in the “notes” section of the examination technique which takes into account the effects of chance on the percent
description; when clinical outcome studies that use a specific agreement.46-47 Landis and Koch48 have established a gen-
intervention are identified, this information is included as eral guideline for interpretation of kappa scores (Table 1-1).
well. The examination and treatment procedures included Because the effect of chance is not affected by prevalence, the
in this textbook have been chosen based on the research evi- kappa coefficient can be deflated if the prevalence of a par-
dence to support their use, on my clinical experience, and on ticular outcome of the test or measure is either very high or
safety considerations. The decision to use the examination very low.44 “Acceptable reliability” must be determined by
and treatment techniques presented in this textbook should the clinician who uses the specific test or measure and should
be made based on the clinician’s knowledge of the evidence, be based on which variable is tested, why a particular test is
competence in application of the intervention, and clinical important, and on whom the test is to be used.49
experience combined with the patient’s values and expecta- Results of validity testing examination procedures are
tions. Although this textbook can establish a foundation for reported as sensitivity (Sens), specificity (Spec), positive likeli-
evidence-based practice for physical therapy management of hood ratio (+LR), and negative likelihood ratio (−LR). Sensitiv-
spinal and temporomandibular disorders, new evidence con- ity is the test’s ability to obtain positive test results when the
tinues to emerge regarding the best diagnostic and treatment target condition is really present, or a true positive.45 The 2 × 2
procedures. Therefore, the practitioner’s responsibility is to contingency table (Table 1-2) is used to calculate the sensitivity
stay abreast of new developments in research findings and and specificity. “SnNout” is a useful acronym to remember that
to make appropriate changes in practice to reflect these new tests with high sensitivity have few false negative results; there-
findings. fore, a negative result rules out the condition.44 Specificity is the
8 CHAPTER 1 Introduction

TABLE 1-2 2 × 2 Contingency Table* 0.1 99

0.2
DISEASE NO DISEASE
0.5 1000 95
Test positive True positive A False positive B
1 90
Test negative False negative C True negative D 500
2 200 80
100
Sensitivity Specificity 70
50
A/(A + C) D/(B + D) 5 60
20
10 50
Adapted from Sackett DL, Straus SE, Richardson WS, et al.: Evidence-based 10 5 40
medicine: how to practice and teach EBM, ed 2, Edinburgh, 2000, Churchill
Livingstone.
2 30
20
*Table is used to compare results of reference standard with results of test under 1 20
investigation; used to calculate sensitivity and specificity. 30 0.5
40 0.2 10
50 0.1
60 0.05 5
test’s ability to obtain negative test results when the condition is 70 0.02
really absent, or a true negative.45 “SpPin” is a useful acronym 80 0.01 2
0.005
to remember that tests with high specificity have few false posi- 90 0.002 1
tive results; therefore, a positive result rules in the condition.44
95 0.5
Likelihood ratios dictate the degree of the shift from the 0.001
pretest probability that a patient has or does not have a condi- 0.2
tion to the posttest probability. A positive likelihood ratio is
99 0.1
equal to Sensitivity/(1 − Specificity) and represents the amount
Pretest Likelihood Posttest
of increase in odds favoring the condition if the test results probability ratio probability
are positive.46 Positive likelihood ratios (+LR) of greater than FIGURE 1-6 Likelihood ratio monogram. (From Sackett DL, Straus
10 generate a large and often conclusive shift in probability; SE, Richardson WS, et al.: Evidence-based medicine: how
ratios of 5 to 10 generate moderate shifts in probability; and to practice and teach EBM, ed 2, Edinburgh, 2000, Churchill
ratios of 2 to 5 generate small but sometimes important shifts Livingstone.)
in probability.50 A likelihood ratio nomogram can be used to
draw a line from the pretest probability through the likelihood TABLE 1-3 Interpretation of Positive and Negative Likelihood Ratios
ratio score and continue in a straight line to end at the posttest
probability (Figure 1-6). POSITIVE NEGATIVE
LIKELIHOOD LIKELIHOOD
A negative likelihood ratio (−LR) is equal to (1 − ­Sensitivity)/ RATIO (+LR) EXPLANATION RATIO (−LR)
Specificity and represents the decrease in odds favoring the
condition if the test results are negative.46 Negative likelihood 2–5 Alters posttest probability 0.2–0.5
of a diagnosis by a small
ratios of less than 0.1 generate large and often conclusive shifts degree
in probability; ratios of 0.1 to 0.2 generate moderate shifts in
probability; and ratios of 0.2 to 0.5 generate small but some- 5–10 Alters posttest probability 0.1–0.2
of a diagnosis by a mod-
times important shifts in probability (Table 1-3).50 erate degree
The quality assessment of diagnostic accuracy studies
(QUADAS) tool is an evidence-based tool.51 It consists of a More than 10 Alters posttest probability Less than 0.1
of a diagnosis by a large
set of 14 items, phrased as questions, each of which should be
degree
scored as yes, no, or unclear (Table 1-4). The tool was devel-
oped for systematic reviews of research studies that assess the Adapted from Jaeschke R, Guyatt GH, Sackett DL: How to use an article about
a diagnostic test. B. What are the results and will they help me in caring for my
diagnostic accuracy of physical examination tests. The tool pri- patients? JAMA 271(9):703-707, 1994.
marily assesses the studies bias, which limits the validity of the
study results, and variability, which may affect the generaliz- that use the QUADAS tool must incorporate the judgment of
ability of study results; additional questions assess the quality at least two independent reviewers, and disagreements between
of reporting.51 The original intent of the QUADAS tool was reviewers must be resolved by a third qualified individual or by
to provide a qualitative assessment of the studies on diagnostic discussion and consensus between the reviewers.54 For this rea-
accuracy and not to provide a quality score.51 However, many son, only QUADAS scores that have been developed through
authors have interpreted use of the tool with QUADAS scores a published systematic review are reported in this textbook.
of 7 to 14 “yeses” to indicate a high-quality diagnostic accu- Clinical prediction rules (CPRs) may be used to enhance
racy study and a score of less than 7 as indicative of low qual- the clinician’s accuracy in predicting a diagnosis or in deter-
ity.52 Other authors have suggested that a score of 10 or more mining appropriate treatment strategies.46 The rule is devel-
“yeses” is required to consider a study design as one of high oped by applying an intervention to a group of patients
quality.53 Systematic reviews of diagnostic accuracy studies and then identifying common characteristics in the group
 CHAPTER 1 Introduction 9

TABLE 1-4 QUADAS Tool

ITEM YES NO UNCLEAR

1 Was the spectrum of patients representative of the patients who will receive the test
in practice?

2 Were selection criteria clearly described?

3 Is the reference standard likely to correctly classify the target condition?

4 Is the time period between reference standard and index test short enough to be
reasonably sure that the target condition did not change between the two tests?

5 Did the whole sample or a random selection of the sample, receive verification
using a reference standard of diagnosis?

6 Did patients receive the same reference standard regardless of the index test result?

7 Was the reference standard independent of the index test (i.e., the index test did not
form part of the reference standard)?

8 Was the execution of the index test described in sufficient detail to permit ­replication
of the test?

9 Was the execution of the reference standard described in sufficient detail to permit its
replication?

10 Were the index test results interpreted without knowledge of the results of the
reference standard?

11 Were the reference standard results interpreted without knowledge of the results of
the index test?

12 Were the same clinical data available when test results were interpreted as would
be available when the test is used in practice?

13 Were uninterpretable/intermediate test results reported?

14 Were withdrawals from the study explained?

Adapted from Whiting P, Rutjes AWS, Reitsma JB, et al.: The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic
reviews, BMC Med Res Methodol 3:25, 2003.
QUADAS, Quality assessment of diagnostic accuracy studies.

of patients who responded favorably to the intervention the interventions being studied. Sackett et al.44 describe the
through calculation of positive and negative likelihood ratios. essential questions to ask when reviewing the validity of RCTs:
After the CPR is developed, it must be validated with an 1. Was the assignment of patients to treatment randomized?
investigation of the accuracy of the CPR in a new group of Was the randomization list concealed?
patients with clinical tests or interventions performed by a 2. Was follow-up of patients sufficiently long and complete?
different group of clinicians other than those who developed 3. Were all patients analyzed in the groups to which they were
the rule.45,55 Validation should also occur in multiple settings randomized (even those who did not follow through on the
to enhance the rule’s generalizability, and an impact study prescribed treatment)?
should be completed to determine what effect the rule has 4. Were patients and clinicians kept blind to treatment?
had on changing clinical behaviors and to assess whether eco- 5. Were groups treated equally, apart from the experimental
nomic benefits have resulted.44,53 therapy?
The highest level of evidence to support interventions is 6. Were the groups similar at the start of the trial?
based on the recommendations of systematic reviews and clini- If these questions are answered favorably, the results of the
cal practice guidelines, and clinicians should start their search RCT can be used to assist with clinical decision making as long
to answer clinical management questions with identification of as the patient under consideration fits within the parameters of
applicable systematic reviews.44 A systematic review is a sum- the patient population studied in the RCT.
mary of the medical literature that uses explicit methods to sys- Lower levels of evidence, such as case reports or case series,
tematically search, critically appraise, and synthesize the world are useful for developing a hypothesis of the effect of a treat-
literature on a specific issue.44 The quality of systematic reviews ment approach, but a true cause and effect from the treatment
is dependent on the quality of the randomized controlled trials used in the case reports and case series cannot be assumed
(RCTs) that have been done to investigate the effectiveness of without a control group. Often case series studies are used to
10 CHAPTER 1 Introduction

support the need for an RCT and assist with development of spinal manipulation. The advantage of teaching students the
the RCT methodology. examination procedures before teaching manipulation tech-
The literature is reviewed in each chapter related to the classi- niques includes facilitation of safe application of the treatment
fication categories for subgrouping disorders commonly treated procedures, and many of the passive intervertebral motion
by physical therapists. One goal of this textbook is to promote (PIVM) tests used in the spinal examination are converted to
an increase in the number of physical therapists, physicians, manipulation techniques. Therefore, the process of learning
and other health professionals who follow the recommenda- the PIVM tests facilitates the motor skills required for proper
tions of high-quality clinical practice guidelines and systematic performance of the manipulation techniques. The more pro-
reviews for management of spinal disorders and to provide the ficient students become in the examination procedures, the
necessary background and instructional information to assist in easier the manipulation techniques are to learn.
skill development to effectively implement the treatment rec- The video clips can be used to assist the instructor in dem-
ommendations related to manual therapy and exercise. onstration of the examination and manipulation techniques.
Two or three cameras were used to film each technique, which
HOW TO USE THIS BOOK provides unique angles of perspective and viewing that an
The textbook has been organized by anatomic region as a use- individual viewing a demonstration in a large group of stu-
ful and easy to use reference resource for students and clini- dents cannot have. A live demonstration is still valuable, and
cians. However, when this textbook is used as a resource to the best use for the video clips may be for a second viewing
teach a course, students should be taught the principles and or review of the technique during practice sessions. In addi-
procedures of a detailed spinal examination and the clini- tion, because all students have access to the video clips with
cal decision making required to appropriately classify and the textbook, they can check the proper performance of the
diagnose spinal disorders before learning the motor skills of technique during practice sessions.

Definitions of Terms from the Guide to Physical Therapist Practice

Arthrokinematic: The accessory or joint play movements of a joint Joint mobility: The capacity of the joint to be moved passively,
that cannot be performed voluntarily and that are defined by taking into account the structure and shape of the joint sur-
the structure and shape of the joint surfaces, without regard to face in addition to characteristics of the tissue surrounding
the forces producing motion or resulting from motion. the joint.
Assessment: The measurement or quantification of a variable or Manual therapy techniques: Skilled hand movements intended
the placement of a value on something. Assessment should to improve tissue extensibility; increase range of motion;
not be confused with examination or evaluation. induce relaxation; mobilize or manipulate soft tissue and
Diagnosis: Diagnosis is both a process and a label. The diagnos- joints; modulate pain; and reduce soft tissue swelling,
tic process includes integrating and evaluating the data that inflammation, or restriction.
are obtained during the examination to describe the patient/ Mobilization/manipulation: A manual therapy technique com-
client condition in terms that will guide the prognosis, the prising a continuum of skilled passive movements to the
plan of care, and intervention strategies. Physical therapists joints and/or related soft tissues that are applied at varying
use diagnostic labels that identify the impact of a condition speeds and amplitudes, including a small-amplitude/high-
on function at the level of the system (especially the move- velocity therapeutic movement.
ment system) and at the level of the whole person. Osteokinematics: Gross angular motions of the shafts of bones
Evaluation: A dynamic process in which the physical therapist in sagittal, frontal, and transverse planes.
makes clinical judgments based on data gathered during the Passive accessory intervertebral motion (PAIVM) tests: A type
examination. of passive joint mobility assessment that uses passive joint
Examination: A comprehensive screening and specific testing play motions of the spine to induce spinal segment passive
process leading to diagnostic classification or, as appropri- motion. The therapist judges the degree of passive mobil-
ate, to a referral to another practitioner. The examination ity at the targeted spinal motion segment by sensing the
has three components: the patient/client history, the systems amount of resistance to the passive joint play movement.
review, and tests and measures. Joint mobility, irritability, and end feel can be assessed with
Functional limitation: The restriction of the ability to perform, at these procedures.
the level of the whole person, a physical action, task, or activ- Passive intervertebral motion (PIVM) tests: A type of passive
ity in an efficient, typically expected, or competent manner. segmental joint mobility assessment of the spine that might
Impairment: A loss or abnormality of anatomical, physiological, include either passive accessory intervertebral motion tests
mental, or psychological structure or function. Secondary or passive physiological intervertebral motion tests. The
impairment: Impairment that originates from other, preexist- therapist will make judgments of segmental passive motion,
ing impairments. end feel, and pain provocation (i.e., irritability) assessment
Intervention: The purposeful interaction of the physical therapist based on these procedures.
with the patient/client and, when appropriate, with other indi- Passive physiological intervertebral motion (PPIVM) tests: A
viduals involved in patient/client care, using various physical type of passive joint mobility assessment that uses passive
therapy procedures and techniques to produce changes in osteokinematic motions of the spine to induce spinal seg-
the condition. ment passive motion, which is palpated by the therapist to
Joint integrity: The intactness of the structure and shape of judge the degree of passive mobility at the targeted spinal
the joint, including its osteokinematic and arthrokinematic motion segment.
characteristics.

Adapted from American Physical Therapy Association: Guide to physical therapist practice, Phys Ther 81:9-746, 2001.
 CHAPTER 1 Introduction 11

Additional Definitions of Manual Therapy Terminology

Accessory motion: Those motions that are available in a joint Joint play: Movements not under voluntary control that occur
that may accompany the classical movements or be pas- only in response to an outside force.
sively produced isolated from the classical movement. Kinematics: The study of the geometry of motion independent
Accessory movements are essential to normal full range of of the kinetic influences that may be responsible for the
motion and painless function. motion. In biomechanics, the two divisions of kinematics are
Component motion: Motions that take place in a joint complex osteokinematics and arthrokinematics.
or related joint to facilitate a particular active motion. Loose-packed position: Position of a joint where the capsule and
Close-packed position: Position of maximum congruency of a ligaments are their most slack, which is unlocked, statically
joint that is locked and statically efficient for load bearing but inefficient for load bearing, and dynamically safe.
dynamically dangerous.
Joint dysfunction: A state of altered mechanics, either an
increase or decrease from the expected normal, or the
­presence of an aberrant motion.

Data from Paris SV, Loubert PV: Foundations of clinical orthopaedics, St Augustine, FL, 1990, Institute Press.
12 CHAPTER 1 Introduction

References

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 CHAPTER 1 Introduction 13

45. Portney LG, Watkins MP: Foundations of clinical research applica- 51. Whiting P, Rutjes AWS, Reitsma JB, et al.: The development
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46. Cleland JA: Orthopaedic clinical examination: an evidence-based agnostic accuracy included in systematic reviews, BMC Med Res
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caring for my patients? JAMA 271:703–707, 1994.
 CHAPTER 2

Spinal Examination and Diagnosis in

Orthopaedic Manual Physical Therapy
CHAPTER OVERVIEW
The purpose of this chapter is to provide a framework for completion of a comprehensive spinal
examination, including systems medical screening, patient interview, disability assessment, and tests
and measures. In addition, evaluation of the examination findings and principles involved in a diag-
nosis and plan of care are included. The tests and measures presented in this chapter are the basic
examination procedures used in screening the spine, or they are techniques used across anatomic
regions to complete a comprehensive spinal examination. Additional special tests and manual exami-
nation procedures, such as passive intervertebral motion tests, are presented in detail in subsequent
chapters that focus on each anatomic region of the spine.

OBJECTIVES
□ Describe the components of a comprehensive spinal examination.
□ Perform a medical screening as part of a spinal examination.
□ Describe common red flags and yellow flags that must be evaluated as part of a comprehensive
spinal examination.
□ Explain the components of a patient interview, and provide interpretation of common responses
to interview questions.
□ Use and interpret relevant questionnaires for pain, function, and disability.
□ Perform common tests and measures used in a spinal examination.
□ Explain the reliability and validity of common tests and measures used in a spinal examination.
□ Describe
the process used in the evaluation of clinical findings, diagnosis, and treatment planning for
common spinal disorders, utilizing the current best evidence with an impairment-based ­approach.

To view videos pertaining to this chapter, please visit www.olsonptspine.com.

physical therapist does not make a medical diagnosis, the

DIAGNOSIS IN PHYSICAL THERAPY physical therapist must determine whether the patient’s
PRACTICE condition is appropriate for physical therapy or whether the
Physical therapy diagnostic classifications are based on clusters patient should be immediately referred for further medi-
of patient signs and symptoms that guide treatment decisions. cal diagnostic assessment. The physical therapist may also
Because physical therapy interventions are designed for correc- identify signs of conditions that warrant further medical
tion of physical impairments such as hypomobility or instabil- consultation but that may not be severe or progressive in
ity, the physical therapy diagnostic classifications are based on nature so that physical therapy can still proceed while the
impairments that can be treated with physical therapy inter- patient seeks further medical assessment. The patient may
ventions. Other physical therapy diagnostic classifications may also have medical conditions that have been diagnosed and
describe symptom location and behavior if these are the pri- are being appropriately managed. In this situation, physical
mary focus of the physical therapy interventions. therapy can proceed, but the condition should be monitored
Medical diagnostic classifications focus on identification or taken into consideration as physical therapy treatment is
of disease and are determined by physicians. Although the implemented.

14
 CHAPTER 2 Spinal Examination and Diagnosis in Orthopaedic Manual Physical Therapy 15

BOX 2-1    Red Flags for the Cervical Spine TABLE 2-1 Red Flags for Low Back Region

CONDITION RED FLAGS

Cervical Myelopathy
• Sensory disturbance of hand
Back-related tumor • Age > 50 years
• Muscle wasting of hand intrinsic muscles
• History of cancer
• Unsteady gait
• Unexplained weight loss
• Hoffmann reflex
• Failure of conservative therapy
• Inverted supinator sign
• Babinski sign Back-related infection • Recent infection (e.g., urinary tract
• Hyperreflexia (spinal osteomyelitis) or skin)
• Bowel and bladder disturbances • Intravenous drug user/abuser
• Multisegmental weakness or sensory changes • Concurrent immunosuppressive
• Age > 45 years disorder

Neoplastic Conditions Cauda equine • Urine retention or incontinence

• Age > 50 years ­syndrome • Fecal incontinence
• History of cancer • Saddle anesthesia
• Unexplained weight loss • Global or progressive weakness in
• Constant pain; no relief with bed rest lower extremities
• Night pain • Sensory deficits in feet (i.e., L4, L5,
and S1 areas)
Upper Cervical Ligamentous Instability • Ankle dorsiflexion, toe extension,
• Occipital headache and numbness and ankle plantarflexion weakness
• Severe limitation during neck AROM in all directions
• Signs of cervical myelopathy Spinal fracture • History of trauma (including minor
falls or heavy lifts for individuals who
Inflammatory or Systemic Disease have osteoporosis or are elderly)
• Temperature > 37° C • Prolonged use of steroids
• Blood pressure > 160/95 mm Hg • Age > 70 years
• Resting pulse > 100 bpm
• Resting respiration > 25 bpm From Boissonnault WG: Primary care for the physical therapist: examination and
triage, Philadelphia, 2005, Saunders.
• Fatigue

Vertebral Artery Insufficiency

• Drop attacks
Evidence-based screening strategies for serious conditions
• Dizziness like cancer, fractures, and abdominal pain that is nonmuscu-
• Lightheadedness related to head movements loskeletal in nature are completed by identification of a cluster
• Dysphasia of history and physical examination findings.3 For example,
• Dysarthria
• Diplopia
low back pain (LBP), advanced age, corticosteroid use, or pain
• Cranial nerve signs caused by a traumatic incident may not be a concern when
each finding is considered in isolation, but when these factors
Adapted from Childs JD, Fritz JM, Piva SR, et al.: Proposal of a classification system are clustered in an individual with back pain, they are highly
for patients with neck pain, J Orthop Sports Phys Ther 34(11):686-696, 2004.
AROM, Active range of motion; bpm, beats per minute. predictive of a fracture.3,4 Life-threatening conditions, such
as fracture or malignant disease, are important conditions for
identification; if suspected, these conditions warrant an imme-
diate referral to the appropriate physician.
MEDICAL SCREENING The results of a systematic review for assessment of the accu-
Medical screening is the evaluation of patient examination racy of clinical features and tests used to screen for malignant
data to help determine whether a patient’s referral to a medical disease in patients with LBP found the prevalence rate of malig-
practitioner is warranted.1 Box 2-1 and Table 2-1 list common nant disease ranged from 0.1% to 3.5%.3 A history of cancer
red flags for which patients must be screened before initiation (positive likelihood ratio [+LR] = 23.7), an elevated erythro-
of physical therapy. With any signs or symptoms characteris- cyte sedimentation rate (ESR; +LR = 18.0), a reduced hemato-
tic of red flags, patients should be referred to the appropriate crit level (+LR = 18.2), and overall clinician judgment (+LR =
medical practitioner for further diagnostic tests. Some com- 12.1) increased the probability of identification of a malignant
prehensive resources can assist in training clinicians to screen disease.5 A combination of age of 50 years or more, history of
for medical conditions that need to be further assessed by a cancer, unexplained weight loss, and no improvement after 1
physician.1,2 Conditions such as gastrointestinal (GI) disease, month of conservative treatment showed a sensitivity of 100%
psychosocial issues, or cardiovascular disease are cause for cau- for identification of malignant disease.5 Therefore, cancer as
tion. If these conditions have not been diagnosed and treated the cause of LBP can be ruled out with 100% sensitivity if the
by a physician, a referral is warranted. If these conditions are patient is less than 50 years old, does not exhibit unexplained
being medically managed, the physical therapist can proceed weight loss, does not have a history of cancer, and is responding
with evaluation and treatment while continuing to monitor to conservative intervention.6 Malignant disease is a rare cause
these conditions. of LBP, and the most useful features and tests to evaluate for it
Exploring the Variety of Random
Documents with Different Content
with the Association. After Burr’s arrival, and under his influence, the
scheme of disunion was made a part of the Mexican plan; and these
projects soon became so well known in New Orleans as to reach the
ears of the Spanish agents and excite their suspicions, until Clark
two months later complained to Wilkinson that Burr’s indiscretion
was bringing them all into danger.[155] Clark’s letter was written as
though he were an innocent bystander annoyed at finding himself
included in an imaginary conspiracy against the Spanish
government. In truth it seemed also to be written as a warning to
Burr against trusting a certain “Minor of Natchez”:—
“Were I sufficiently intimate with Mr. Burr, and knew where to direct
a line to him, I should take the liberty of writing to him. Perhaps,
finding Minor in his way, he was endeavoring to extract something
from him,—he has amused himself at the blockhead’s expense,—and
then Minor has retailed the news to his employers. Inquire of Mr. Burr
about this and let me know on my return [from Vera Cruz], which will
be in three or four months. The tale is a horrid one if well told.
Kentucky, Tennessee, the State of Ohio, the four territories on the
Mississippi and Ohio, with part of Georgia and Carolina, are to be
bribed with the plunder of the Spanish countries west of us to
separate from the Union.”
This letter, written by Clark, Sept. 7, 1805, showed that Burr’s
plans were notorious at New Orleans, and that his indiscretion
greatly annoyed his friends. Two years afterward, Wilkinson
reminded Clark of the letter.[156]
“You will recollect,” wrote Wilkinson, “you desired me to write Burr
on the subject, which I did, and also gave his brother-in-law, Dr.
Brown, an extract of your letter to transmit him.”
Burr’s reply has been preserved:—
“Your letter of November,” he wrote to Wilkinson,[157] Jan. 6, 1806,
“which came, I believe, through J. Smith, has been received and
answered. Your friend [Clark] suspects without reason the person
[Minor] named in his letter to you. I love the society of that person; but
surely I could never be guilty of the folly of confiding to one of his
levity anything which I wished not to be repeated. Pray do not disturb
yourself with such nonsense.”
 Daniel Clark and Wilkinson were therefore assured, not that the
tale was untrue, but that Burr had not confided to Minor, or “to one of
his levity” anything which Burr “wished not to be repeated.”
Nevertheless Clark, whose abilities were far greater than those of
Burr, and whose motives for secrecy were stronger, knew that Burr
must have talked with extreme indiscretion, for his plans had already
come to the ears of the Spanish agents in Louisiana. Many residents
of New Orleans knew of the scheme,—“many absurd and wild
reports are circulated here,” wrote Clark; and whether they shared it
or not, they certainly did not denounce it.
No plea of ignorance could avail any of Burr’s friends. His
schemes were no secret. As early as Aug. 4, 1805, more than a
month before Daniel Clark sent his warning to General Wilkinson,
the British minister was so much alarmed at the publicity already
given to the plot that he wrote to Lord Mulgrave a panic-stricken
letter, evidently supposing that the scheme was ruined by Burr’s
indiscretion:[158]—
“He or some of his agents have either been indiscreet in their
communications, or have been betrayed by some person in whom
they considered that they had reason to confide; for the object of his
journey has now begun to be noticed in the public prints, where it is
said that a convention is to be called immediately from the States
bordering on the Ohio and Mississippi for the purpose of forming a
separate government. It is, however, possible that the business may
be so far advanced as, from the nature of it, to render any further
secrecy impossible.”
The French minister was hardly less well informed. Feb. 13,
1806, Turreau wrote to his government,[159] mentioning Miranda’s
departure, and adding,—
“The project of effecting a separation between the Western and
Atlantic States marches abreast with this one. Burr, though displeased
at first by the arrival of Miranda, who might reduce him to a secondary
rôle, has set off again for the South, after having had several
conferences with the British minister. It seems to me that the
Government does not penetrate Burr’s views, and that the difficult
circumstances in which it finds itself, and where it has placed itself,
force it to dissimulate. This division of the confederated States
 appears to me inevitable, and perhaps less remote than is commonly
supposed; but would this event, which England seems to favor, be
really contrary to the interests of France? And, assuming it to take
place, should we not have a better chance to withdraw, if not both
confederations, at least one of them, from the yoke of England?”
That Burr should have concealed from his principal allies—the
creoles of New Orleans—plans which he communicated so freely
elsewhere, was not to be imagined. Burr remained only about a
fortnight at New Orleans; then returned on horseback through
Natchez to Nashville, where he became again the guest of Andrew
Jackson. He passed the month of August in Tennessee and
Kentucky; then struck into the wilderness across the Indiana Territory
to St. Louis in order to pass a week more with General Wilkinson
and Secretary Brown. He found Wilkinson discouraged by the
rebuffs he had met in attempting to seduce his subordinate officers
and the people of the territory into the scheme. Although Wilkinson
afterward swore solemnly that he had no part or parcel in Burr’s
disunion project, his own evidence proved that the subject had been
discussed between them, and that his fears of failure had at the time
of their meeting at St. Louis checked his enthusiasm:[160]—
“Mr. Burr, speaking of the imbecility of the government, said it
would moulder to pieces, die a natural death,—or words to that effect;
adding that the people of the Western country were ready to revolt. To
this I recollect replying that if he had not profited more by his journey
in other respects, he had better have remained at Washington or
Philadelphia; for ‘surely,’ said I, ‘my friend, no person was ever more
mistaken. The Western people disaffected to the government! They
are bigoted to Jefferson and democracy.’”
Wilkinson afterward claimed to have written at that time a letter to
the Secretary of the Navy warning him against Burr; but the letter
never reached its supposed address. He certainly gave to Burr a
letter of introduction to Governor Harrison, of the Indiana Territory,
which suggested decline of sympathy with the conspiracy; for it
urged Harrison to return the bearer as the Territorial delegate to
Congress,—a boon on which the Union “may much depend.”[161]
Burr reached St. Louis Sept. 11, 1805; he left it September 19, for
Vincennes and the East. Two months afterward he arrived at
Washington and hurried to the British legation. His friend Dayton,
who had been detained by a long illness in the West, arrived and
made his report to Merry only two days before.
The conspiracy counted on the aid of Great Britain, which was to
be the pivot of the scheme; but Burr’s hopes were blasted by
learning from Merry that no answer had been received from the
British government in reply to the request for money and ships.
Merry explained that an accident had happened to the packet-boat,
but both had reason to know that hope of aid from the British
government had vanished.
“These disappointments gave him, he [Burr] said,[162] the deepest
concern, because his journey through the Western country and
Louisiana as far as New Orleans, as well as through a part of West
Florida, had been attended with so much more success than he had
even looked for, that everything was in fact completely prepared in
every quarter for the execution of his plan; and because he had
therefore been induced to enter into an engagement with his
associates and friends to return to them in the month of March next, in
order to commence the operations. He had been encouraged, he said,
to go such lengths by the communications he had received from
Colonel Williamson, which gave him some room to hope and expect
that his Majesty’s government were disposed to afford him their
assistance.... He was sensible that no complete understanding on the
subject could well take place without verbal communication; but he
flattered himself that enough might be explained in this way to give a
commencement to the business, and that any ulterior arrangements
might safely be left till the personal interviews he should have with the
persons properly authorized for the purpose, whom he recommended
to be sent with the ships of war, which it was necessary should cruise
off the mouth of the Mississippi at the latest by the 10th of April next,
and to continue there until the commanding officer should receive
information from him or from Mr. Daniel Clark of the country having
declared itself independent. He wished the naval force in question to
consist of two or three ships of the line, the same number of frigates,
and a proportionable number of smaller vessels.”
The British minister was curious to know precisely the result of
the Western tour; but on this subject Burr talked vaguely, and,
contrary to his usual custom, mentioned few names.
 “Throughout the Western country persons of the greatest property
and influence had engaged themselves to contribute very largely
toward the expense of the enterprise; at New Orleans he represented
the inhabitants to be so firmly resolved upon separating themselves
from their union with the United States, and every way to be so
completely prepared, that he was sure the revolution there would be
accomplished without a drop of blood being shed, the American force
in that country (should it not, as he had good reason to believe, enlist
with him) not being sufficiently strong to make any opposition. It was
accordingly there that the revolution would commence, at the end of
April or the beginning of May, provided his Majesty’s government
should consent to lend their assistance toward it, and the answer,
together with the pecuniary aid which would be wanted, arrived in time
to enable him to set out the beginning of March.”
From Pitt, besides the naval force, Burr wanted a credit for one
hundred and ten thousand pounds, to be given in the names of John
Barclay of Philadelphia, and Daniel Clark of New Orleans. In his
report to Merry on the results of the Western tour he said no more
than he had a right to say, without violent exaggeration. He barely
hinted at complicity on the part of Wilkinson, Smith, Adair, and
Andrew Jackson. He gave Merry clearly to understand that the heart
of his plot was not in the Ohio Valley, but at New Orleans. He laid
little weight on the action of Kentucky or Tennessee; with him, the
point of control was among the creoles.
“Mr. Burr stated to me—what I have reason to believe to be true
from the information I have received from other quarters—that when
he reached Louisiana he found the inhabitants so impatient under the
American government that they had actually prepared a
representation of their grievances, and that it was in agitation to send
deputies with it to Paris. The hope, however, of becoming completely
independent, and of forming a much more beneficial connection with
Great Britain, having been pointed out to them, and this having
already prevailed among many of the principal people who are
become his associates, they had found means to obtain a suspension
of the plan of having recourse to France.”
Burr impressed Merry with the idea that West Florida was also to
be taken within the scope of his scheme. “The overture which had
been made to him at New Orleans from a person of the greatest
influence in East and West Florida, and the information he had
otherwise acquired respecting the state of those countries,” were
among the reasons which he pressed upon the British government
as motives for aiding the conspiracy with a naval force. England was
then at war with Spain.
One more argument was pressed by Burr, for no one knew better
than he the use to which New England might be put.
“He observed—what I readily conceive may happen—that when
once Louisiana and the Western country became independent, the
Eastern States will separate themselves immediately from the
Southern; and that thus the immense power which is now risen up
with so much rapidity in the western hemisphere will, by such a
division, be rendered at once informidable.”
Whatever may have been Merry’s sympathies or wishes, he
could do no more than report Burr’s conversation to Lord Mulgrave
with as much approval as he dared give it. Meanwhile Burr was
thrown into extreme embarrassment by the silence of Mulgrave.
Burr’s report showed that the creoles in New Orleans, with Daniel
Clark as their financial ally, were induced to countenance the
conspiracy only because they believed it to be supported by
England. Without that support, Burr could not depend on creole
assistance. Had he been wise, he would have waited; and perhaps
he might in the end have brought the British government to accept
his terms. If Pitt intended to plunder American commerce and to
kidnap American citizens, he must be prepared to do more; and Burr
might calculate on seeing the British Tories placed by their own acts
in a position where they could not afford to neglect his offers.
Burr stayed a week in Washington; and although the object of his
Western journey was so notorious that even the newspapers talked
about it, his reception at the White House and at the departments
was as cordial as usual. About Dec. 1, 1805, he returned to
Philadelphia, where he began the effort to raise from new sources
the money which till then he hoped to provide by drafts on the British
treasury. The conspirators were driven to extraordinary shifts. Burr
undertook the task of drawing men like Blennerhassett into his toils,
and induced Dayton to try an experiment, resembling the plot of a
comic opera rather than the seriousness of historical drama.
 Dec. 5, 1805, as Miranda was leaving New York to entrap
Madison, three days after Burr had returned to Philadelphia from his
unsatisfactory interview with Merry, the Marquis of Casa Yrujo, as
yet innocent of conspiracy, and even flattering himself upon having
restored friendly relations with the Government, received a secret
visit at his house in Philadelphia from Jonathan Dayton, whom he
had known at Washington as the Federalist senator from New
Jersey. Dayton, in a mysterious manner, gave him to understand that
the Spanish government would do well to pay thirty or forty thousand
dollars for certain secrets; and finding the marquis disposed to listen,
Dayton recited a curious tale.
“This secret,” said he,[163] “is known at the present moment to only
three persons in this country. I am one of them; and I will tell you that
toward the end of the last session and near the end of last March
Colonel Burr had various very secret conferences with the British
minister, to whom he proposed a plan not only for taking the Floridas,
but also for effecting the separation and independence of the Western
States,—a part of this plan being that the Floridas should be
associated in this new federative republic; England to receive as the
price of her services a decisive preference in matters of commerce
and navigation, and to secure these advantages by means of a treaty
to be made as soon as she should recognize this new republic. This
plan obtained the approval of the British minister, who sent it and
recommended it to his Court. Meanwhile Colonel Burr has been in
New Orleans, in the Mississippi Territory, in the States of Tennessee,
Kentucky, and Ohio, to sound and prepare their minds for this
revolution. In all these States he has found the most favorable
disposition, not only for this emancipation, which the Western States
evidently desire, but also for making an expedition against the
kingdom of Mexico. This is an idea that occurred to us after sending
the first plan to London; and having given greater extension to the
project, Colonel Burr sent to London a despatch with his new ideas to
Colonel Williamson,—an English officer who has been many years in
this country, and whose return he expects within a month or six
weeks. The first project was very well received by the English Cabinet,
and more particularly by Mr. Dundas, or Lord Melville, who was the
person charged with this correspondence; but as he had reason to
fear dismission from office for causes well known through the debates
of Parliament, this plan has suffered some delay; but Mr. Pitt has
again turned his attention to it.”
 On the strength of this information Dayton seriously proposed to
terrify Yrujo and Don Carlos IV. into paying the expenses of Burr’s
expedition. An idea so fantastic could have sprung from no mind
except Burr’s; but, fantastic as it was, he pursued it obstinately,
although by doing so he betrayed to Spain the followers whom he
was striving to inveigle into an imaginary assault on Spanish empire.
Dayton asserted that the revolution would begin on the appearance
of the British squadron off the coast of West Florida in February or
March, 1806; that to make this revolution more popular, after the
Floridas were taken, the expedition against Mexico would be
attempted; that they feared no opposition from a government so
weak as the Federal; that the United States troops were all in the
West, and that Colonel Burr had caused them to be sounded in
regard to the expedition against Mexico; that they were all ready to
follow him, and he did not doubt that there existed in them the same
disposition to sustain the rights of the Western States, in which they
lived, against the impotent forces of the Federal government; that
Mexico was to be assailed, in co-operation with the English fleet, by
troops to be disembarked at Tampico or thereabout; and that the
revolutionized Spanish possessions would be made republics.
To reveal such a plan was to destroy its chance of success; and
in thus presenting himself before the Spanish minister Dayton
appeared as a traitor not only to the Union, but also to the
conspirators with whom he was engaged. Such a character was not
likely to create confidence. Yrujo instantly saw that Burr stood behind
Dayton; that England could not have encouraged the conspiracy, for,
had she done so, the conspirators would never come to beg a few
thousand dollars from Spain; and that the Mexican scheme, if it ever
existed, must have been already abandoned, or it would not have
been revealed. Dismissing the ex-senator with civility and a promise
to talk with him further, Yrujo wrote to his Government a long
account of the interview. He pointed at once to Clark as the person
through whom Burr drew his information about Mexico. Yrujo was
perplexed only by Jefferson’s apparent blindness to the doings in the
West. The marquis was a Spaniard; and for twenty years the people
of the United States had talked of Spaniards with contempt. Even
Jefferson freely assumed their faithlessness and paltriness; but
surely if Yrujo had cared to concentrate in a few words his opinion of
American political character, no American could have wondered if
these few words, like a flash of lightning, left no living thing where
they struck.
“I am sure,” he wrote to Cevallos, “that the Administration will not
let itself be deceived by Colonel Burr’s wiles; but I know that the
President, although penetrating and detesting as well as fearing him,
and for this reason, not only invites him to his table, but only about five
days ago had a secret conference with him which lasted more than
two hours, and in which I am confident there was as little good faith on
the one side as there was on the other.”
The assertion could not be denied. The White House rarely saw,
within a few days’ interval, two less creditable guests than Aaron
Burr, fresh from confiding his plans to Anthony Merry, and Francesco
de Miranda, openly engaged in a military attack from the port of New
York upon the dominions of Spain.
Yrujo was at first inclined to distrust Dayton; but Miranda’s
undertaking, which crossed Burr’s plans, gave to the ex-senator the
means of proving his good faith. Indeed, in a few days more, Dayton
made a clean breast, admitting that England had disappointed Burr’s
expectations, and that Burr had authorized the offer to sell his
services to Spain.
“I have had with him two very long conferences,” wrote Yrujo three
weeks later,[164] “in which he has told me that Colonel Burr will not
treat with Miranda, whom he considers imprudent, and wanting in
many qualities necessary for an undertaking of such magnitude as he
has on hand. Miranda has returned to New York, much piqued at
finding that Colonel Burr was very determined to have nothing to do
with him. He also told me that Colonel Williamson, who was sent to
London with the plan for the British ministry, not finding Mr. Pitt so
warm as Lord Melville for the project of raising the Western States,
had turned to plans in that capital, and showed, by the want of
exactness in his correspondence, that he was not following up the
object with the same zeal as at first he undertook it; that in
consequence they were disposed to despatch to London a New York
gentleman named Warton, well known for his intimacy with Burr, but
that on the verge of his departure another plan suggested itself to
Burr, which he seems rather inclined to execute. This plan, excepting
 the attack on the Floridas, has the same object, which he, as well as
his chief friends, hope may be put in execution even without foreign
aid. For one who does not know the country, its constitution, and,
above all, certain localities, this plan would appear almost insane; but
I confess, for my part, that in view of all the circumstances it seems to
me easy to execute, although it will irritate the Atlantic States,
especially those called central,—that is, Virginia, Maryland, Delaware,
Pennsylvania, New Jersey, and New York. It is beyond question that
there exists in this country an infinite number of adventurers, without
property, full of ambition, and ready to unite at once under the
standard of a revolution which promises to better their lot. Equally
certain is it that Burr and his friends, without discovering their true
object, have succeeded in getting the good-will of these men, and
inspiring the greatest confidence among them in favor of Burr.”
The “almost insane” plan which Dayton unfolded to the Spanish
minister was nothing less than to introduce by degrees into the city
of Washington a certain number of men in disguise, well armed, who,
at a signal from Burr, were to seize the President, Vice-President,
and the President of the Senate,—the substitute always named at
the beginning of each session, in case of the death, illness, or
absence of the two first. Having thus secured the heads of
government, the conspirators were to seize the public money
deposited in the Washington and Georgetown banks, and to take
possession of the arsenal on the Eastern Branch. Burr hoped by this
blow to delay or paralyze opposition, and perhaps to negotiate with
the individual States an arrangement favorable to himself; but in the
more probable case that he could not maintain himself at
Washington, he would burn all the national vessels at the Navy Yard,
except the two or three which were ready for service, and embarking
on these with his followers and the treasure, he would sail for New
Orleans and proclaim the emancipation of Louisiana and the
Western States.
Wild as this scheme was, it occupied Burr’s mind for the rest of
the winter, and he made many efforts to draw discontented officers
of the government into it. He sounded Commodore Truxton, without
revealing his whole object; but to William Eaton, the hero of Derne,
he opened himself with as much confidence as to Merry and Yrujo.
Eaton was at Washington in January and February, 1806, sore at the
manner in which his claims were treated by Congress, and
extravagant in ideas of his own importance. To him Burr laid open
the whole secret, even in regard to the plan for attacking
Washington. The story was the same which had been told to Merry
and Yrujo.[165] He spoke of Wilkinson as his second in command; of
his son-in-law, Allston, as engaged in the enterprise; and of New
Orleans as the capital of his Western empire, whence an expedition
would be sent for the conquest of Mexico. The line of demarcation
was to be the Alleghany Mountains; and although he expressed
some doubts about Ohio, he declared himself certain of Kentucky
and Tennessee.
“If he could gain over the marine corps and secure to his interests
the naval commanders Truxton, Preble, Decatur, and others, he would
turn Congress neck and heels out of doors, assassinate the President
(or what amounted to that), and declare himself the protector of an
energetic government.”
The scheme of attacking Washington was merely an episode due
to Burr’s despair of British or Spanish aid. Burr was reduced to many
devices in order to keep his conspiracy alive. December 12,
immediately after the disappointing interview with Merry, and
Dayton’s first advance to Casa Yrujo, Burr wrote to Wilkinson a letter
evidently intended to conceal his diplomatic disaster and to deceive
his friend. He said that there would be no war with Spain, and
foretold the peaceful course of Government.[166] “In case of such
warfare, Lee would have been commander-in-chief. Truth, I assure
you. He must you know come from Virginia.” As to the conspiracy, he
reserved it for a few short lines, intelligible enough to those who
knew that New Orleans was to declare its independence on the
arrival of a British squadron in February, and that the revolutionary
government would at once send a delegation to Natchez or St. Louis
to make a formal tender of military command to General Wilkinson.
“On the subject of a certain speculation it is not deemed material to
write till the whole can be communicated. The circumstance referred
to in a letter from Ohio remains in suspense. The auspices, however,
are favorable, and it is believed that Wilkinson will give audience to a
delegation, composed of Adair and Dayton, in February.”
 Meanwhile the Government asked no questions. Denunciation of
Burr and Wilkinson was dangerous; it was tried again and again with
disastrous results. Major Bruff, at St. Louis, who suspected the truth,
dared not bring such a charge against his superior officer:[167] but a
certain Judge Easton, to whom Burr confided at St. Louis, ventured
to write a letter to a senator of the United States charging Wilkinson
with being concerned in Miranda’s expedition; and was told in reply
that the letter was burned, and that the writer should mind his own
business, and take care how he meddled with men high in power
and office. So thick an atmosphere of intrigue, especially in Spanish
matters, was supposed to pervade the White House; men’s minds
were so befogged with public messages about a Spanish war and
secret messages about peace, with private encouragement to
Miranda and public punishment of Miranda’s friends, with John
Randolph’s furious charges of duplicity and Madison’s helpless
silence under these charges,—that until the President himself should
say the word, Burr, Wilkinson, Dayton, and their associates were
safe, and might hatch treason in the face of all the world.
President Jefferson had already too many feuds on his hands,
and Burr had still too many friends, to warrant rousing fresh reprisals
at a time when the difficulties of the Administration were extreme.
The President continued to countenance Burr in public, alleging in
private that the people could be trusted to defeat his schemes.
Doubtless the people could be trusted for that purpose, but they had
instituted a government in order to provide themselves with proper
machinery for such emergencies, and the President alone could set
it in action. General Eaton made an attempt to put the President on
his guard. He first consulted two leading Federalist Congressmen,—
John Cotton Smith and Samuel Dana,—who advised him to hold his
tongue, for his solitary word would not avail against the weight of
Burr’s character.[168] Nevertheless, in March, 1806, he called at the
White House and saw the President.
“After a desultory conversation, in which I aimed to draw his
attention to the West, I took the liberty of suggesting to the President
that I thought Colonel Burr ought to be removed from the country,
because I considered him dangerous in it. The President asked where
he should send him. I said to England or Madrid.... The President,
 without any positive expression, in such a matter of delicacy, seemed
to think the trust too important, and expressed something like a doubt
about the integrity of Mr. Burr. I frankly told the President that perhaps
no person had stronger grounds to suspect that integrity than I had;
but that I believed his pride of ambition had so predominated over his
other passions that when placed on an eminence and put on his
honor, a respect to himself would secure his fidelity. I perceived that
the subject was disagreeable to the President; and to bring him to my
point in the shortest mode, and in a manner which would point to the
danger, I said to him, if Colonel Burr was not disposed of, we should in
eighteen months have an insurrection, if not a revolution, on the
waters of the Mississippi. The President said he had too much
confidence in the information, the integrity, and attachment of the
people of that country to the Union, to admit any apprehensions of
that kind.”
If the President had confidence in the people of New Orleans, he
had not shown it in framing a form of government for them; and if he
admitted no apprehensions in March, 1806, he admitted many
before the year closed. In truth, he deceived himself. That he was
afraid of Burr and of the sympathy which Burr’s career had excited,
was the belief of Burr himself, who responded to Jefferson’s caution
by a contempt so impudent as to seem even then almost incredible.
Believing that the President dared not touch him, Burr never cared to
throw even a veil over his treason. He used the President’s name
and the names of his Cabinet officers as freely as though he were
President himself; and no one contradicted or disavowed him. So
matters remained at Washington down to the close of the session.
“I detailed,” said Eaton,[169] “the whole projects of Mr. Burr to
certain members of Congress. They believed Colonel Burr capable of
anything, and agreed that the fellow ought to be hanged, but thought
his projects too chimerical, and his circumstances too desperate, to
give the subject the merit of serious consideration.”
 CHAPTER XI.
The death of Pitt destroyed all immediate possibility of drawing
England into conspiracy with Burr,—if indeed a possibility had ever
existed. The attempt to obtain money from Spain was equally
hopeless. Except for Madison’s conduct in receiving Miranda and
refusing to receive Yrujo, Dayton would probably have obtained
nothing from Spain; but the information he was able to give Yrujo in
regard to Miranda’s plans and proceedings deserved reward, and
Dayton received at different times sums of money, amounting in all to
about three thousand dollars, from the Spanish treasury. Dayton’s
private necessities required much larger sums.
Burr was also ruined. He could not return to New York, where an
indictment hung over his head. Conspiracy was easier than poverty;
but conspiracy without foreign aid was too wild a scheme for other
men to join. Jefferson might at that moment have stopped Burr’s
activity by sending word privately to him and his friends that their
projects must be dropped; but Jefferson, while closing every other
path, left that of conspiracy open to Burr, who followed it only with
much difficulty. In order to retain any friends or followers he was
obliged to deceive them all, and entangle himself and them in an
elaborate network of falsehood. Dayton alone knew the truth, and
helped him to deceive.
April 16, 1806, a few days before the adjournment of Congress,
Burr wrote to Wilkinson a letter implying that Wilkinson had required
certain conditions and an enlargement of the scheme; Burr assured
him that his requirements, which probably concerned aid from
Truxton, Preble, Eaton, and Decatur, had been fully satisfied:—
“The execution of our project is postponed till December. Want of
water in Ohio rendered movement impracticable; other reasons
rendered delay expedient. The association is enlarged, and comprises
all that Wilkinson could wish. Confidence limited to a few. Though this
delay is irksome, it will enable us to move with more certainty and
dignity. Burr will be throughout the United States this summer.
Administration is damned which Randolph aids. Burr wrote you a long
 letter last December, replying to a short one deemed very silly.
Nothing has been heard from the Brigadier since October. Is Cushing
and Porter right? Address Burr at Washington.”[170]
Burr’s letters to Wilkinson were always in cipher, and
mysteriously worded; but in this despatch nothing was unintelligible.
Wilkinson afterward explained that he was himself the “Brigadier,”
and the two names were those of officers under his command.
The same western mail which carried this letter to Wilkinson
carried another to Blennerhassett, inviting him to join in a
“speculation,” which would “not be commenced before December, if
ever.” Probably Burr made many other efforts to obtain money from
petty sources; he certainly exerted himself to delude the Spanish
government into lending him assistance. Hitherto he had left this task
to Dayton, his secretary of state, but May 14, 1806, the Spanish
minister wrote to Don Pedro Cevallos,[171]—
“The principal [Burr] has opened himself to me; and the
communications I have had with him confirm me in the idea, not only
of the probability, but even of the facility, of his success, under certain
circumstances. To insure it, some pecuniary aid on our part and on
that of France is wanted. I have been careful to be very circumspect in
my answers, and have not compromised myself in any manner; but
when I return to Spain next spring I shall be bearer of the whole plan,
with the details that may be wanted. There will also arrive in Spain
before long, more or less simultaneously with me though by different
ways, two or three very respectable persons, both from Louisiana and
from Kentucky and Tennessee, with the same object. They all
consider the interests of these countries as united and in conformity
with those of Spain and France; but the principal, or more correctly the
principals, here do not wish to open themselves to the Emperor
Napoleon’s minister [Turreau], as they lack confidence in him.
Consequently, it will be proper either not to communicate the matter at
all to that government, or to do it with the intimation that its
representative here shall not have the least notice of it; for, I repeat,
they have no confidence in him, and this has been a condition
imposed on me in the communications I have received.”
Finding Yrujo obstinate in refusing to advance money, Burr tried
to alarm him by pretending to take up again the scheme of attacking
Florida and Mexico. June 9, 1806, Yrujo wrote another long
despatch on the subject. Burr, he said, had suddenly ceased to visit
him as frequently as usual, and Dayton had explained the coldness
as due to Burr’s belief that the new Administration in England would
be more liberal and zealous than that of Pitt. Dayton added that Burr
was drawing up new instructions for Williamson; that he had even
decided to send Bollman to London to invite co-operation from the
British government in an attack on the Spanish possessions. Dayton
professed to have acted as the protector of Spain from Burr’s
unprincipled ambition.
“Dayton told me[172] he had observed to Burr that although he
(Burr) was assuredly the principal, yet a plan of this nature ought to be
put in deliberation in the cabinet council which certain chiefs are to
hold in New Orleans in the month of December next, and that for his
own part he thought this idea unjust and impolitic; to which Burr
answered that they would always be able to alter the plan as
circumstances should require, and that in fact this point, or at least the
direction to be given to it, would be determined in New Orleans.
Dayton told me that he would oppose with all his strength measures of
this nature, and that he knew General Wilkinson, who was to be a
member of the Congress, would make the same opposition; and that
in order to drive the idea of such a temptation out of Burr’s head, and
of other people’s also, it would be well for us to reinforce our garrisons
at Pensacola and Mobile, and that then the circumstance of our
respectable condition of defence might be used as a weighty
argument for abandoning such a project. After holding this conference
with me, Dayton returned to his residence; and before starting, wrote
me a note to say that the night before Burr had read him the
instructions to be given to Bollman, and that they were of the tenor
indicated to me.”
Godoy and Cevallos were hardly so imbecile as to pay for
creating at New Orleans a new American empire more dangerous to
Spanish possessions than the peaceful republic over which
Jefferson presided at Washington. Don Pedro Cevallos read Yrujo’s
despatches with great interest. At first he even hinted that if the
United States were bent on forcing a war with Spain, these
adventurers, in case of actual hostilities, might be made useful;[173]
but this suggestion was accompanied by many warnings to Yrujo not
to commit himself or to contribute money, and at last by a flat
announcement that the King would not in any way encourage Burr’s
designs.[174]
The conspirators were in a worse position as regarded England.
By a fatal stroke of ill-luck, Merry’s despatch of Nov. 25, 1805, written
to be read in secrecy by the Tory Lord Mulgrave, was received at the
Foreign Office Feb. 2, 1806, ten days after Pitt’s death, and was
probably opened by Charles James Fox,—almost the last man in
England to whom Merry would have willingly shown it. The only
answer received by Merry reached Washington about June 1, 1806,
and consisted in the dry announcement that his Majesty had been
pleased to listen favorably to Mr. Merry’s request for a recall, and
had appointed the Hon. David Montague Erskine as his successor.
Merry complained piteously that he had never suggested a wish
to be recalled, that he had indeed the strongest desire to remain,
and felt himself greatly aggrieved at his treatment; but Fox was
remorseless, and Merry could only prepare for Erskine’s arrival.
Smarting under this sudden reproof, Merry held his parting interview
with Burr. Doubtless it was as little cheerful on one side as on the
other; but Merry did not think himself required to give an immediate
or a minute account of it to Fox. He waited until Erskine’s arrival, and
then, in one of his last despatches, Nov. 2, 1806, after Burr had
begun his operations in the West, Merry wrote,[175]—
“I saw this gentleman [Burr] for the last time at this place
[Washington] in the month of June last, when he made particular
inquiry whether I had received any answer from my Government to
the propositions he had requested me to transmit to them, and
lamented exceedingly that I had not, because he, and the persons
connected with him at New Orleans, would now, though very
reluctantly, be under the necessity of addressing themselves to the
French and Spanish governments. He added, however, that the
disposition of the inhabitants of the Western country, and particularly
Louisiana, to separate themselves from the American Union was so
strong that the attempt might be made with every prospect of success
without any foreign assistance whatever; and his last words to me
were that, with or without such support, it certainly would be made
very shortly.”
 After receiving this rebuff from England, Burr and Dayton needed
singular impudence to threaten Yrujo with the terror of Charles
James Fox; but impudence had become their only resource. Every
step taken thenceforward by the conspirators was taken by means of
a new imposture; until at last they became petty swindlers who lived
from day to day by cheating each other. How flagrant their imposture
was, has been partly shown in their attempt to deceive Yrujo; but
their treatment of Wilkinson was far more dishonest.
Toward the end of July, 1806, Burr had accomplished all that
could be done in the East, and prepared to begin his campaign to
New Orleans. By strenuous efforts money had been raised to set the
subordinate adventurers in motion. Among these were Erick
Bollman, famous for an attempt to rescue Lafayette from
confinement at Olmütz; a French officer named De Pestre, or
Dupiester; Samuel Swartwout, a younger brother of Robert; and
finally young Peter V. Ogden, a nephew of Dayton. The time had
come when each actor must take his place, and must receive orders
as to the rôle he was to play.
Of all Burr’s intimates, Wilkinson was not only the most important,
but also the most doubtful. He had hung back and had made
conditions. Since October, 1805, nothing had been heard from him,
and his last letter had contained objections “deemed very silly.” At
last a letter, dated May 13, arrived. This letter never saw the light;
afterward, at the trial, Wilkinson challenged its production, and
accused Burr of falsehood in asserting that it had been destroyed at
Wilkinson’s request or with his knowledge. Only one conclusion
might be taken as certain in regard to its contents,—they did not suit
the situation of Dayton and Burr.
Dayton’s reply was dated July 24, 1806, and was sent by his
nephew, Peter V. Ogden, to Wilkinson.
“It is now well ascertained that you are to be displaced in next
session,” wrote Dayton, working on his old friend’s pride and fears.
“Jefferson will affect to yield reluctantly to the public sentiment, but
yield he will. Prepare yourself, therefore, for it. You know the rest. You
are not a man to despair, or even despond, especially when such
 prospects offer in another quarter. Are you ready? Are your numerous
associates ready? Wealth and glory! Louisiana and Mexico!”
Together with this exhortation from Dayton, Burr sent a cipher
despatch, afterward famous as the key to the whole conspiracy.
Published at different times with varying versions, as suited
Wilkinson’s momentary objects, the correct reading probably ran
very nearly as follows:—
“July 29, 1806. Your letter, postmarked 13th May, is received. At
length I have obtained funds, and have actually commenced. The
Eastern detachments, from different points and under different
pretences, will rendezvous on the Ohio 1st of November. Everything
internal and external favors our views. Naval protection of England is
secured. Truxton is going to Jamaica to arrange with the admiral on
that station. It will meet us at the Mississippi. England, a navy of the
United States, are ready to join, and final orders are given to my
friends and followers. It will be a host of choice spirits. Wilkinson shall
be second to Burr only; Wilkinson shall dictate the rank and promotion
of his officers. Burr will proceed westward 1st August, never to return.
With him goes his daughter; the husband will follow in October, with a
corps of worthies. Send forthwith an intelligent and confidential friend
with whom Burr may confer; he shall return immediately with further
interesting details; this is essential to concert and harmony of
movement. Send a list of all persons known to Wilkinson west of the
mountains who could be useful, with a note delineating their
characters. By your messenger send me four or five commissions of
your officers, which you can borrow under any pretence you please;
they shall be returned faithfully. Already are orders given to the
contractor to forward six months’ provisions to points Wilkinson may
name; this shall not be used until the last moment, and then under
proper injunctions. Our object, my dear friend, is brought to a point so
long desired. Burr guarantees the result with his life and honor, with
the lives and honor and the fortunes of hundreds, the best blood of
our country. Burr’s plan of operation is to move down rapidly from the
Falls, on the 15th of November, with the first five hundred or a
thousand men, in light boats now constructing for that purpose; to be
at Natchez between the 5th and 15th of December, there to meet you;
there to determine whether it will be expedient in the first instance to
seize on or pass by Baton Rouge. On receipt of this, send Burr an
answer. Draw on Burr for all expenses, etc. The people of the country
to which we are going are prepared to receive us; their agents, now
with Burr, say that if we will protect their religion, and will not subject
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