NATURAL BONE-SETTERS.
The setting of bones is wholly a mechanical operation; and there
cannot be a natural innate skill in this particular kind of
mechanics, any more than there can be in any other kind. It would
be as proper to say that a man is a natural watch maker, steamboat
builder, carpenter, &c., as to say that he is a natural bone-setter.
A man may be born with a taste for mechanics in general, but not with
a taste for any particular kind of mechanics. This innate mechanical
taste shows itself in various ways, as the child grows up into the
man; and it is governed altogether by circumstances, in selecting
the particular branches of mechanics, from which it will seek its
gratification.
Every one applies these plain principles almost instinctively to
every subject but the sciences of medicine and surgery. An exception
is made of these, not only by the ignorant, but often also by the
well-informed and the learned. The healing art seems to be cast out
of the common pale of reason; and learning, as well as ignorance,
often refuses it the plainest and most established principles both of
science and of common sense. There has always been a disposition to
mysticism on this subject, and the idea of a mysterious bestowment
of natural gifts has been an error of all ages, and, I may add, of
all conditions in life.
I have said that bone-setting is a perfectly mechanical operation.
The bones of the body are united together on simple mechanical
principles by ligaments and muscles. When a bone is put out of joint,
it is generally done by the action of the muscles, perhaps we may
say that it always is so, when there is dislocation alone without
any fracture. A man falls from a house—when he comes to the ground
he puts out his hand, and the wrist, or elbow, or shoulder, is
dislocated. If he were dead when he fell, no dislocation would occur,
though there might be fracture; for the muscles would fix none of the
bones upon any point of support, so as to give the head of one bone a
different direction from the head of its neighboring bone. It is for
the same reason that a man, whose muscles are relaxed and powerless
from intoxication, is not apt to have his bones dislocated in a fall,
though they may be fractured.
After a bone is put out of joint, it is the muscles and ligaments
which hold it there. In order to replace it then, the resistance
of these muscles must be overcome by force gradually and steadily
applied, so that the head of the bone which is thrown past the head
of the other may be brought opposite to its proper place. When
brought to this point it is to be pressed into its place, which is
commonly very easily done—sometimes the muscles themselves do it.
The requisites for skill in performing this operation are very
obvious. It is plain that the man who knows the most about the
relations of the parts, will best know how to adjust those parts when
they get out of place; just as one who understands most thoroughly
a machine is the best fitted to repair it when it is out of order.
And there is no such thing as an innate instinctive knowledge of a
machine made of bones, muscles, and ligaments, any more than there
is such a knowledge of a machine made of wood and iron. In both cases
the knowledge is _acquired_ knowledge—acquired by observation and
study. In order that the knowledge which one has, even of the most
common machine, shall be accurate and complete, he must be familiar
with the parts of it when separated, and then with their connection
as a whole. For the same reason, in order that the surgeon may
understand so compound a machine as a human joint, he should become
familiar with the several bones and muscles, and ligaments, and
tendons, of that joint separately, and then with their connection as
they make up the whole machine.
And by familiarity with the machine as a whole, I do not mean merely
that the surgeon should be familiar with the parts of the joint in
their connection, as they are seen when the skin is removed with the
fat and the cellular membrane. In order to perfect his knowledge
of the joint as a whole, he must be familiar with it as it appears
covered with the skin, and observe it in all its various attitudes
and motions. This is quite as important a part of the knowledge of
the joints, as that which is revealed by the dissecting knife. For
the surgeon in his practice has to do with them in this covered
state; and if he be familiar with them only in their uncovered
condition, he will often find himself much puzzled, and may commit
some unfortunate errors. A musician, who had always played upon a
piano with the keys open to the eye, would hardly venture to play a
tune with the keys covered for the first time at a public concert;
but I apprehend that there is many a surgeon who makes his first
real study of a joint as a whole in its covered state, when he is
called upon to determine whether some part of that joint is out of
place. This external geography of the joints, as it may be termed,
is not sufficiently attended to, nor is the importance of studying it
properly urged upon the students of medicine.
The above considerations, I trust, make it clear to the reader,
what are the kind and the extent of the knowledge of the empirical
bone-setter. I am not disposed to say that he has no knowledge at
all. He has power to observe, though his means of observation are
limited, and therefore his knowledge is limited, and of consequence
inaccurate. He acquires all the knowledge which he has by observing
(and that is studying) the external geography of the joints to which
I have alluded. He may perhaps have an accurate eye in such matters,
or, as a phrenologist would express it, he may have the organ of form
well developed. If this be true of him, in many cases of dislocation
he will readily see where the irregularity is. He will see an undue
prominence at one point and a consequent depression at another. The
knowledge thus acquired by the eye guides him in his practice. He
pulls the bones apart, and then applies pressure in such a direction,
as to force in the prominence, and remove the depression. This is the
sum and substance of all that an uneducated bone-setter can know, and
his knowledge all comes from observation, and is not the result of
any mysterious gift.
It is folly to pretend that the empirical bone-setter cannot, by the
study of the internal structure of the joints, add to his knowledge
and skill thus acquired from observation of their external forms. And
yet he assumes, and a large portion of the public believe it, that
not only does his skill, unlike skill in anything else in the wide
world, need no adding to it, but that it would be actually impaired
by anything like scientific study. That his _reputation_ would be
impaired very seriously, if it were publicly known that he in any
measure acknowledged the necessity of study, is certain; for his
skill would then be stripped of the charm, which is given to it by
the idea of its being an innate power. It is for this reason only
that he adheres so pertinaciously to this false and ridiculous notion.
I have thus far gone upon the supposition, that the natural
bone-setter learns all that he knows by his own observation alone,
without any assistance from others. This is far from being true. He
is indebted to physicians themselves for some of his knowledge. For
example, the fact that extension and counter-extension[22] must be
made to enable us to put the dislocated bone into its place, is not
a fact that he discovered. Somebody, (we know not who, but it was
somebody,) discovered it a long time ago, and the knowledge of it has
descended in the medical profession from time immemorial. It is in
this channel that the knowledge of it comes to the bone-setter. He
might as well say that it was an innate idea with him, that knives
and forks are the appropriate instruments to eat with, as that he was
born with the knowledge of the fact, that the expedient which I have
mentioned is necessary in setting dislocated bones.
Perhaps it will be said that the idea of pulling the bones apart is
a very simple idea, and that almost anybody would think of that.
So was the invention of knives and forks a simple idea. But it
was come at rather slowly. The transition from the use of fingers
and teeth, to that of knives and forks in their present state of
perfection, was not a sudden one. Improvement, in this instance, as
well as in every other, had its _march_, step by step—it was not
effected by a leap. So it has been with improvements in the setting
of bones. It is probable that at first many a bone was pushed and
twisted about, and then left in its dislocated state; but at length
it was discovered, either by accident, or by a scientific view of
the subject, that this pushing and twisting could be made to answer
the purpose, by first overcoming the resistance of the muscles by
extension and counter-extension. The man who first knew this fact was
a real discoverer. And further, as the first knives and forks were
made in a very bungling manner, so the setting of bones was at first
done awkwardly and unskillfully. The bones were probably pulled in a
jerking manner, till a second discoverer found out the fact, that it
was best to make the extension very gradually and steadily.
Here then are two very material facts in regard to one part of the
operation of setting bones, which are furnished to the natural
bone-setter from the experience of those who have gone before him;
and I think no one can doubt that he learns them in the same vulgar
way that the educated surgeon does. Though they were new facts once,
they are now familiar to every one who has seen a bone set, or heard
a description of the operation. And I would give no bone-setter the
credit of having been born with these facts in his head, unless he
had been shut up from the world till he was strong enough to set a
bone, and then, on being brought forth had set a dislocated limb,
making the extension and counter-extension in the proper manner. This
would be the only positive proof that he did not learn these facts
from some one else. Many familiar ideas, which we suppose that we
thought of ourselves, unaided by others, if brought to such a test,
would be found to have descended to us from our predecessors.
Bone-setters have not so much confidence in their innate skill, as
to refuse to learn anything from physicians. I suspect that they do
not object to reading a surgical book, or looking upon a skeleton, if
they can do it without its being known. I heard one once utter the
scientific names of bones and their parts, such as humerus, radius,
trochanter, astragalus, &c. He must have got these words from some
of the educated surgeons, whom he professes to despise, or from some
book upon surgery. It is hardly to be supposed, that he was born with
them packed away, in his head, along side of his skill, ready for
use, though perhaps his admirers and patrons may think so.
I have said that the knowledge of the ‘natural’ bone-setter must be
both limited and inaccurate. Hence, though in those cases, in which
the dislocation or fracture is so plain as to be readily seen, he may
perhaps get along without any serious difficulty, he is exceedingly
liable to make mistakes in cases which require nice discrimination.
His mistakes may be arranged chiefly under four classes, which I will
notice separately.
First. A common error is supposing a fracture to be a dislocation.
Generally there is no difficulty in deciding which of these accidents
has taken place. In cases of fracture a crepitus (or grating of the
broken ends of the bone upon each other) can be perceived on moving
the limb in different directions. But sometimes it is difficult to
perceive this, and it can only be done by executing some particular
motions. In such cases the uneducated bone-setter is very liable to
make a mistake and often does. I will relate but three out of many
examples of this error which I have in my possession.
The first case I take from Ticknor’s Medical Philosophy. A young
lad in the city of New York received an injury of the elbow joint,
which, under the most judicious surgical treatment, terminated in
permanent stiffness. The parents of the lad took him soon after
to a bone-setter who had acquired considerable celebrity. He at
once pronounced the elbow to be out of joint, and attempted to set
it. After repeated attempts, he at length by an extreme degree of
violence, which was attended with excruciating pain, succeeded in
straightening the limb. The bone-setter triumphed in the achievement,
and the parents were delighted with the result. But the force
employed to reduce the pretended dislocation did such violence
to tendons, ligaments, and nerves, that the child’s life was in
jeopardy, and was saved only by the timely amputation of the arm.
The second case which I shall mention occurred in the practice of
Professor Hooker in New Haven. A man fell from a canal bridge and
fractured the neck of the scapula, the bone which is commonly called
the shoulder-blade. There was depression of the arm similar to that
which occurs in common dislocation of the shoulder; but the crepitus
and other symptoms obviously distinguished the case from simple
dislocation. Professor H. dressed the shoulder in such a way as to
secure a perfect apposition of the two surfaces of the fracture;
and, if the man had continued under his care, a complete union would
undoubtedly have taken place, and he would have had a good shoulder.
But at the end of a week Professor H. found the apparatus removed
and the arm simply supported in a sling. The patient had been to
see a natural bone-setter, who convinced him that the Professor
had mistaken the case—that there was no fracture, but a simple
dislocation. He accordingly ‘set’ the shoulder. The patient was much
easier than he was with the confinement of Professor H.’s apparatus,
and he was gratified with the bone-setter’s assurance that the
shoulder would soon be well. He continued to have confidence in the
opinion of the bone-setter for about six weeks. Then, as the shoulder
was no better, he went again to Professor H. It was now of course too
late to remedy the fracture, and the poor man has a crippled shoulder
for life, as the result of his foolish reliance upon the ‘natural’
skill of a bone-setter.
The third case was related to me by Dr. Mercer, of New London in this
State. It was a case of oblique fracture of the thigh. The evidence
that it was a fracture was of the most palpable character; and yet
the most famous ‘natural’ bone-setter in this part of the country,
who has imparted his ‘gift’ to his descendants, and even to those
who are connected with them by marriage, stripped off the dressings
of Dr. M., pronounced the case a dislocation, and proceeded to ‘set’
it. The patient supposed that all was right, for the bone-setter was
considered infallible. But many of the inhabitants of New London well
remember the poor old man Bolton, who for so many years with his
crooked thigh, which was pronounced so confidently by the bone-setter
to be ‘set,’ literally crawled about the streets.
Secondly. The uneducated bone-setter is very liable to make a mistake
in those cases in which, though there may be much tumefaction and
pain, and the motion of the joint may be much impeded, there is
neither dislocation nor fracture. Of all the cases of injury of
the joints a very large proportion are of this character. There
is simply a sprain or a bruise, or both together. Such cases the
bone-setter almost invariably treats as dislocations. I will not
at present dwell upon this class of cases, as I shall speak of them
more particularly in another connexion. I will only remark here, that
if the bone-setter does but little in such cases, no real harm may
be done; but he may use so much violence, in reducing the supposed
dislocation, as to inflict a serious injury upon the joint.
Thirdly. Another class of mistakes, to which the uneducated
bone-setter is liable, have relation not to the mechanical
principles of bone setting, but to what may be called the _medical_
in distinction from the _surgical_, or operative part of the
treatment. The mere operator, however skillful he may be, is not a
finished surgeon. Very far from it. In order to be able to do his
_whole_ duty to his patients, the surgeon must in addition to his
skill in operating, understand well the principles of inflammation
and irritation, and must be in fact familiar with the whole range
of disease. The bone-setter is entirely destitute of any such
qualification for his department of surgery. He looks upon every case
as a mere mechanical matter, and operates upon it without any regard
to the state of the patient’s health, or to any of the circumstances
of the case. He therefore operates upon many cases that ought not
to be operated upon, and does to them a serious injury, sometimes
a fatal one. In some cases he neglects to do what is necessary for
the relief of the patient, and prevents any one else from doing it.
It may be that inflammation needs to be guarded against, or to be
overcome. This he neglects to do; and not only so, but perhaps, by
the violence which he does to the affected part, he aggravates, or
creates inflammation. The same may also be said of his neglecting the
prevention and cure of spasmodic affections.
I will cite but a few cases illustrative of the above remarks.
A man had a bad fracture of the wrist, which was taken care of by
a regular physician. After the fracture united, the joint he said
continued to be very weak, but it did not prevent him from getting a
livelihood by doing light work in a factory. More than a year after
the accident, the wrist became quite sore. Rest and some appropriate
applications would probably have restored it to its usual condition
in a short time. But he was persuaded to show it to a famous
bone-setter, who lived a few miles distant. The bone-setter said at
once that it was not set right in the beginning, and that it must be
broken over again, in order to set it as it should be done. The great
violence he did to the joint produced a severe inflammation. It was
in this state that I first saw it. Abscesses formed in consequence of
the inflammation, and the final result was that the arm was rendered
useless for life. If this man had been thus treated by an educated
surgeon, instead of an _infallible_ bone-setter, he could undoubtedly
have recovered large damages for such mal-practice.
The second case which I shall relate is that of a young man who had a
chronic disease of the shoulder, which came on gradually, without any
evidence that the joint had ever received any injury. A bone-setter,
whom he accidentally met, assured him that he could remove the
difficulty, and give him a good arm. He told him that the bone of
the arm had ‘dropped down out of the socket,’ that there was ‘callus
in the socket,’ and talked about ‘squeezing it out.’ This opinion he
gave without any examination of the shoulder. He did not even remove
a thick overcoat which the young man had on. He directed a liniment,
which was to be used for some time previous to the operation of
setting the shoulder. After using the liniment for six weeks, he
went to the bone-setter’s residence to be operated upon. Three stout
assistants held the patient, while the bone-setter _squeezed out the
callus_, and set the joint. The pain produced by this operation was
so severe that the young man fainted. The bone-setter, thinking that
the joint was not yet quite right, repeated the operation the next
day. The consequence of all this violence was an increase of the
inflammation. There was much soreness and pain, and at length several
abscesses appeared in succession, which discharged abundantly, and
the arm became exceedingly weak, very limited in its motions, and
much emaciated.
Cases of hip-disease, as it is commonly called, are often supposed
by bone-setters to be cases of dislocation, and sometimes are
unfortunately treated as such. I might relate many instances of
this kind, but I will detain the reader with but one, which I take
from Ticknor’s Medical Philosophy. In this case “the complaint had
existed for some time and produced a great degree of emaciation of
the affected limb, which gave to the joints an unusual prominence;
and, as is common in this disease, the limb was in a flexed position.
This patient had been attended by a respectable practitioner, who
understood the disease, and who had done all that the art can do in
this much dreaded complaint. But the natural bone-setter was sent
for. He pronounced _the hip, the knee, and the ankle dislocated_; and
straightway commenced furiously pulling at all these joints to get
them in place. The boy shrieked, and entreated him to desist. The
diseased parts being exceedingly tender and painful on the slightest
motion, the complaints of the boy only made his tormentor the more
confirmed in his opinion and the more persevering in his efforts to
‘set the bones.’ He did persevere till the child repeatedly fainted;
and being fearful that he had _cured the patient to death_, or
killed him outright, at length concluded his manipulations, by saying
that he had _got the bones all in their places_. The disease was so
aggravated by this cruelty, that in a few days the child’s sufferings
were at an end.”
The last case which I shall relate under this head, is a case of
tetanus or locked-jaw. The patient had his foot crushed. He was for
four days under the care of a regular surgeon. During this time such
a course was pursued as was calculated to prevent the occurrence of
tetanus, and the patient was in a very promising condition. But the
bone-setter was sent for. He discontinued the remedies which had been
used, and simply dressed the foot with a salve, which was of course
of an _all-healing_ character. The foot soon became very offensive,
and symptoms of locked-jaw came on, and in a few days the patient
died. The bone-setter within twelve hours of his death assured him
that he would get well.
Fourthly. Uneducated bone-setters fail most signally in their
treatment of _fractures_. In the case of a _dislocation_, when the
bone is once put into joint it is generally done with. The joints
are so aptly and closely fitted, that the reduced bone is not liable
to slip out of joint again from any slight cause. But in the case
of a _fracture_ on the other hand, after the bones are put into
place, some care and skill are required to keep them so. The pressure
which is brought to bear upon different points of the limb is to
be skillfully regulated, and motion of the two parts of the broken
bone is to be carefully prevented, in order that they may grow
together without irregularity, and with as little amount of callus
as possible. The bone-setter for obvious reasons, fails in these
particulars, and there may, therefore, be found among his patients a
great many crooked and shortened limbs, with a large and irregular
callus. One of the most deformed limbs that I ever saw was an arm
which had been under the care of one of the most famous bone-setters
in the country. The case was a simple fracture of the two bones of
the fore-arm, about midway between the wrist and the elbow. Any
ordinary surgical care would have secured to the patient a sound arm
without any deformity. But when she showed me her arm, after the
bone-setter had dismissed it from his care as _cured_, I found that
one bone had its two parts united at quite an angle, with a large
callus; and in the case of the other bone no union at all had taken
place, but the ends of the fracture could be still made to rub upon
each other by executing certain motions of the arm. Such mal-practice
as this, in the case of a young woman, who is dependent upon her
labor for a livelihood, ought to be punished with exemplary damages.
The remarks which I have made refer to ordinary fractures merely. But
there are some cases of fracture which require a peculiar and nice
application of mechanical principles in their treatment. In these the
bone-setter generally makes an utter failure. For example, there are
some fractures of the elbow-joint that require a particular position
of the arm, and a nice adjustment of the apparatus applied to it;
and, in order to prevent stiffness of the joint it is necessary that
the surgeon should, as soon as it will answer, begin to execute the
motions of the limb, gradually extending their range, till the joint
become entirely free. Such cases under the care of a bone-setter have
always resulted, so far as my observation has extended, in permanent
stiffness of the joint.
In the remarks that I have made upon the mistakes of uneducated
bone-setters, I wish not to be understood to claim that educated
surgeons never make any mistakes in their treatment of fractured
and dislocated limbs. They are not infallible, and some of them, I
am free to say, know very little about bone-setting, and have very
little skill in it. There is a mechanical tact which is necessary to
make a physician a good bone-setter, and some are so destitute of
this tact, that they are not even able to extract a tooth decently
well. But I do claim, that educated medical men, generally, do have
vastly more skill in this department of surgery, than the herd of
uneducated bone-setters.
If the claims of natural bone-setters be just—if it be true, as
they say it is, that surgeons are constantly making mistakes, which
_their_ innate skill is as constantly taxed to correct, then we
should expect, that in those parts of the country, which are not
blessed with bone-setters, there would be cripples in abundance, the
victims of educated unskillfulness. But I have never heard that it is
so. There has been no complaint that it is. And I have not a doubt
that in the neighborhood of every natural bone-setter, there can be
found more deformed and crippled limbs, than can be found in any
similar neighborhood, where educated surgeons are not so fortunate as
to have infallible possessors of the gift of bone-setting standing
ready to correct their errors.
If the bad cases which occur in the practice of natural bone-setters
could be found in the practice of regular physicians, they would
be frequently prosecuted for mal-practice, and damages would be
recovered of them by the sufferers. But I doubt very much whether
anything would be gained by prosecuting a bone-setter for the
grossest mal-practice. People are generally more willing to make
allowances for the uneducated bone-setter, than for an educated
surgeon; though, at the same time, inconsistent as it may appear,
they may claim that by virtue of a divine gift he is infallible.
One would suppose that cases resulting badly would lead them to
doubt his boasted infallibility. But no. They infer that these cases
were beyond the reach of the highest skill in the world, and that
it was impossible that they should have come to any better result.
They seem to regard it almost as a sin to express the least doubt
to the contrary. With this state of feeling, existing to such an
extent as it does in some parts of the country, no jury could be
found sufficiently unprejudiced to inflict any just penalty upon a
bone-setter for mal-practice; though they would inflict it to the
full, if the same facts were proved to them in regard to any educated
surgeon.
The testimony of physicians in such cases would be very apt to be
disregarded, however rational and clear it might be, unless it could
be brought to confront the testimony of the bone-setter himself.
Whenever this is done, educated skill always comes off victorious
over quackery. Nothing so exposes and demolishes quackery, as a
well-directed examination of the quack himself. It dispels from
the minds of the jury the false notion of a natural gift that
needs no teaching; a notion, which, so long as it remains in the
mind, effectually prevents any candid examination of the facts.
They are made to see by such a course, that the joints of the body
are constructed upon mechanical principles, and that they are to
be understood just like any other machine; and the ignorance and
consequent want of skill of the bone-setter become even ridiculously
palpable. Some few years ago a physician in Springfield, Mass., was
prosecuted by a patient for mal-practice. The case had fallen from
his hands into those of a celebrated bone-setter, who appeared as a
witness at the trial. The physician was triumphantly acquitted, and
the exposed ignorance of the bone-setter had more influence with the
jury, than all the display of surgical knowledge on the part of the
faculty, drawn out by the learned counsel.
It now remains for me to show why it is that natural bone-setters,
in spite of all their ignorance and their mistakes, acquire such a
reputation for success, as they often do. I deem it a very easy task
to do this to the satisfaction of any reasonable person.
I have already alluded to those cases in which the bone is not
dislocated, but the patient supposes, and the bone-setter supposes,
or, as is more often the case, _pretends_, that there is a
dislocation. These are the cases which are the principal source of
the bone-setter’s reputation. He pulls upon the affected limb and
performs various manœuvres with it, and then thinks, or pretends,
that he has ‘set’ the bone. In time the limb of course in most
instances gets well, and thus in a case of mere sprain he gains the
credit of having performed a wonderful operation. Especially is this
so, when the patient has been first examined by a regular physician.
_Probably more than half of the reputed cases of dislocation which
come under the care of bone-setters are nothing but sprains._
It is easy to see how the credulity of the patient can be imposed
upon in such cases. He supposes that there must be something out
of place, and is not satisfied with being told that there is not.
Rest, the principal remedy in such a case, seems to him to be a
very ineffectual remedy at least, and he gets out of patience. His
imagination, with the aid of friends, and neighbors, at length
conjures up before him the idea of a limb forever crippled. The
bone-setter is now consulted, and he says, of course, that there _is_
something wrong. No bone-setter was ever known to say otherwise under
such circumstances. After executing certain manœuvres, he pronounces
all now to be right. The patient is now satisfied, although the limb
improves no faster than it did before, perhaps not so fast. He is
satisfied, because he feels now that _something has been done_. If
the surgeon who first saw the case had gone through with the same
pretended setting of the joint, the patient probably would have been
equally well satisfied. A surgeon of some note once remarked, that he
pulled nearly all the sprained joints that came under his care and
pretended to set something right; ‘for,’ said he, ‘if I did not do
this, such patients would go to a bone-setter to have it done, and he
would do them some harm, which I am careful not to do.’
But it may be said, that in many cases the testimony of the patients
in regard to the setting of the bone is of the most positive
character, and even that decided relief is at once experienced. That
it is often imagined, I know. I have seen many cases of this kind,
in which there was the most undoubted evidence that the relief was
wholly imaginary.
As the deception of the bone-setter in such cases is so common, and
so successful, even with persons of shrewdness and discernment, I
will mention two cases in illustration.
A stout Irish girl had an inflammation of the ankle, which had come
on gradually. She in some way imbibed the idea that the ankle was
out of joint, though she did not remember to have hurt it in any
way. I told her that it was not possible to put the ankle out of
joint without knowing when it was done. But she chose to send for the
bone-setter. He came and pretended to set the ankle, and she declared
that he relieved her at once. The inflammation however was still
there, and was gradually dissipated by appropriate remedies.
A gentleman, esteemed to be very shrewd by all his friends, received
an injury of the first joint of his forefinger, which resulted in
inflammation. After commencing medical treatment, he was persuaded to
consult a bone-setter. He returned with a poor idea of the knowledge
of regular physicians, because ‘_they could not even set a dislocated
finger_,’ and loudly praised the skill of the bone-setter. He soon
found, however, that the finger was no better, and, openly declaring
that he had been deceived, submitted the finger to proper treatment,
which in a little time removed the inflammation.
These two cases, taken from the two extremes of rank and intelligence
in society, are fair examples of the imposition which is so
frequently practised by the bone-setter upon all classes of his
patients.
In this connexion I will notice another class of cases not so
numerous, in which the bone-setter either imagines or pretends there
is fracture, when there is nothing but a sprain, or an injury of the
nerves of the limb, producing inability of motion. Such cases, at
least in old persons, recover slowly. If the bone-setter puts on his
splints, he commits a great error, but it is an error that may not
be detected. The splints are taken off in due time, and the limb has
recovered through the influence of rest alone.
There is another small class of cases from which bone-setters get
much credit, and in which their bold practice, I will candidly allow,
sometimes really does good. In the recovery of injured joints there
sometimes form adhesions, which seriously impair their power of
motion. I have said that the bone-setter operates on almost every
case that presents, and he takes hold of these cases with a strong
hand. He breaks up the adhesions, and sets the joint free. A regular
surgeon would hesitate to do it, from the fear of inflicting an
injury upon his patient greater than he would suffer if the joint
were to remain with its limited power of motion. The bone-setter
fearlessly runs this risk, for he has no very delicate sense of
responsibility to prevent him from doing it; and if he does harm,
he knows that a large portion of the community have so high an idea
of his ‘gift,’ that they will absolve him from all blame. He may do
great violence at times, and make some very bad cases; but there is
little said about these, while the cases in which he has the good
fortune to be successful are in everybody’s mouth.
The bone-setter sometimes acquires considerable reputation from some
cases of stiff joints and contracted tendons, which are benefitted by
a persevering course of friction, fomentation, &c. Physicians often
prescribe such a course in such cases, but they do not, like the
bone-setter, make the applications themselves, nor perhaps see that
they are made. In the one case the course is faithfully pursued, and
in the other it is not. A gentleman who had a stiff knee cured by a
quack principally by friction, detailed the treatment to a medical
friend. ‘I often prescribe just such a course for similar cases,’
said the physician. ‘Yes,’ replied the gentleman, ‘but you do not
take hold and rub yourself. If I came to you with an aching tooth you
would pull it, and not tell me or my friends to do it.’ There was
much truth in this reply. Physicians often give directions of this
kind, but do not see that they are followed up by the patient. I do
not mean to say that they should do all the rubbing themselves. But
they should show others how it is done, and then see that they do it.
All the credit which bone-setters get from neglect of duty on the
part of physicians, they have a perfect right to.
Another class of cases may properly be noticed here, of which I
will cite but two examples. A lady sprained her ankle. Instead of
the gradual recovery usual in such cases, the joint continued for
a long time to be excessively tender—she could not bear to have
it moved or touched without the most extreme care. The celebrated
Professor Smith, of New Haven, on being called in to see the patient,
recommended that all this caution in moving and touching the joint
be discontinued, and that it at once be put to use. The prescription
seemed to the patient to be a cruel one; but it was obeyed, and the
recovery was rapid and perfect. The extreme sensitiveness of the
joint in such cases is dependent upon two causes, the imagination and
nervous irritability—sometimes almost wholly upon the former. If this
case had chanced, like the one about to be mentioned, to pass into
the hands of a natural bone-setter, his rubbing and other manœuvres
would have accomplished the same object, and a great cure would have
been proclaimed.
The other case was that of a lady, who had been long confined to
her bed with a spinal disease. She supposed, and her friends did
also, that it was not possible for her to move her back at all.
A physician, to whom one of her friends described the case, said
that he had no doubt that the disease had all been removed by the
treatment which had been pursued, and that the patient could move
about, and ought in some way to be made to do so. He saw that, as in
the case just related, the sensitiveness and inability of motion were
chiefly or wholly imaginary. And he predicted, that if she should be
put under the care of a bone-setter, as her friends had contemplated,
he would get her up and rub her back with his medicated applications,
and she would be able to walk about in a very short time. She was
carried to the bone-setter, the prediction was verified, and her
father, a distinguished clergyman, gave the quack a certificate of
the wonderful cure.
I remark upon these two cases—that, while Dr. Smith prescribed
intelligently, the bone-setter only _chanced_ to hit right—that
while the discrimination of Dr. S. saved him from applying a similar
treatment to cases to which it would be inapplicable, the bone-setter
does much, sometimes fatal, harm to many cases by his lack of this
discrimination, (cases which somehow fail to be reported)—and lastly,
that while Dr. S. had no public testimony paid to the success of
his discriminating skill, the _lucky hit_ of the quack has been
proclaimed, by the certificate of the clergyman, as the result of
pre-eminent skill, throughout the length and breadth of the land.
There is still another class of cases to be noticed. Sometimes the
motions of a joint are impeded, while there is no obvious deformity;
and yet the case may be something more than a mere sprain, and often
turns out to be so, when the subsidence of the swelling reveals the
true nature of the case. It is a sub-luxation. That is, the bone is
_partially_ thrown out of place, but is not fairly out of joint. In
such cases merely pulling upon the joint is commonly enough to set
it. As soon as the bones are sufficiently separated to allow of it,
the dislocated one slips into its place, or rather is drawn into it
by the muscles. I have no doubt that many such cases, pronounced by
physicians to be sprains, are remedied by the bone-setter, not from
any superior skill on his part, but from the fact that he makes it a
practice to pull the joint in every case.
One great source of the reputation of bone-setters is to be found
in the flaming reports of their cases, made by themselves and their
friends, _most of which are either partly or wholly false_. These
reports are got up precisely in the same way that the reports of the
great cures of other quacks are, and they have the same influence.
I will give two cases in illustration. These cases appeared in a
letter in a newspaper correspondence, in which a self-styled reformer
of some note undertakes to abuse the regular clergy, and regular
doctors, and laud Thompsonism, and natural bone-setting.
One of these cases is that of a boy who was born with a club foot.
He states in regard to him, that, after the best surgical skill of
Philadelphia and New York had been tried upon him in vain, he was
brought to the bone-setter, and in the course of a few weeks the boy
(then six years old), was perfectly cured. This statement I know to
be false. The bone-setter, so far from curing the boy, did him no
good. And further, the deformity of the foot has since been relieved,
so far as it can be, by the skill of one of those regular surgeons,
of whom the bone-setter so modestly said to our wise reformer, “that
during a constant practice of more than thirty years he has scarcely
found one who understood his business,” while he himself had “not in
a single instance,” among all his cases, committed any error.
The other case was that of a man of whom it is said that he
“was caught by one of his arms by the belt of the picker, and
carried over the drum [shaft?] upwards of one hundred times.” The
bone-setter “found that his shoulders, ribs and breast, were all
badly lacerated—his left arm broken near the shoulder—his right
arm broken in three places between the shoulder and elbow, much
hemorrhage having taken place—his right knee broken in pieces, and
partially dislocated—two of the bones of the toes of his right foot
loose in his stockings—a compound fracture of the left leg—one of the
condyles of the pelvis, near the back knocked off—his skull fractured
above his left eye—his scalp cut to the skull, and rolled up some
distance—and his whole body covered with bruises and lacerations.” It
is also stated that “the physicians who were summoned, said he could
not live an hour, and declined attempting to relieve him.” Perhaps
they would have taken this view of the case if the facts had been
as our reporter has stated them. But they were not. _Nearly all_ of
this statement is false. That the man was carried over that shaft
“upwards of one hundred times,” none but a stark-mad reformer is
foolish enough to believe—the man’s shoulders, ribs and breast were
_not_ “badly lacerated”—his right arm was _not_ “broken in three
places,” but only in one, and that not badly—there was _not_ “much
hemorrhage,” but almost none—his right knee was _not_ “broken in
pieces,” and was _not_ “partially dislocated,” but there was merely
a small abrasion of the knee-pan—there were _not_ “two bones in his
stockings,” but one small piece of bone in one stocking—there was
_not_ “a compound fracture of the left leg,” but a simple one—“one
of the _condyles_ of the pelvis near the back” was _not_ “knocked
off,” for there is no such thing in the body, and besides, the man
himself says that there was no injury of the back, and so says his
wife who took care of him—his skull was _not_ “fractured above the
left eye,” nor anywhere else—his scalp, instead of being “cut to
the skull and rolled up some distance,” was not enough injured to
leave any scar—“his whole body” was _not_ “covered with bruises and
lacerations”—and finally, the physicians did _not_ say that “he
could not live an hour,” for they saw no _mortal_ injury in three
simple fractures. But not only is this statement false in almost
every particular, but there are some facts in regard to this case
which are omitted. Under the care of the bone-setter the right arm
united in bad shape, though the fracture was simple and perfectly
manageable; and the leg, before it became firmly united, was broken
again by the bone-setter in an attempt to ‘stretch down the cords,’
as he expressed it, and finally came under the care of one of those
regular ‘scientific’ physicians, of whom our reformer says that
“probably not one in a hundred knows how to manage such cases.” If it
had been under his care from the beginning, the leg would undoubtedly
have healed in good shape, but now there is a large irregular callus,
which was produced by the violence done to it by the ignorant
bone-setter in ‘stretching down the cords.’[23]
No wonder that such a collector of facts as this reformer has proved
himself to be, should make the sweeping remark, that “there is
incomparably more of quackery in the schools of law, physic, and
divinity, than there is out of them.” The other cases, which he gives
in his letter, are probably about as worthy of belief as the two
which I have extracted. And these two are a fair sample of the degree
of truth in the wonderful stories which are told in relation to the
feats of bone-setters.[24]
I flatter myself that I have made it clear to the reader, that it
is no difficult matter for the natural bone-setter, in spite of
his ignorance of the structure of the joints, and his consequent
mistakes in managing injuries of them, to acquire a reputation for
skill, especially if he have some mechanical tact, a good share of
shrewdness, a plausible way of _embellishing_ his narratives of
cases, and impudence withal. I have said that a very large proportion
(probably more than half) of his reputed cases of dislocations are
mere sprains. All these he gets the credit of setting, and many of
them after they have been seen by some physician. Add to these his
occasional lucky hits in breaking up old adhesions, and in setting by
his random pulling some sub-luxations, and here is material enough,
with a loose veracity, to make up a reputation in this credulous and
marvel-loving world.
FOOTNOTES:
[22] Some of my readers will require an explanation of these terms.
In a case of fracture the broken ends often slip by each other. We
draw therefore upon the two portions to bring them into their proper
position. The traction exerted upon the portion the farthest from the
body is called extension, while that which is exerted upon the other
portion is called counter-extension. So when a bone is dislocated the
force exerted in drawing the head of it from its position is called
extension, while the force by which its fellow bone is drawn in the
opposite direction is called counter-extension.
[23] It will be proper for me to state that I had no personal
interest in this case, and I became acquainted with the facts in an
accidental call upon the family of the patient some time after the
accident.
[24] Some of the certificates of the bone-setter, like those of other
quacks, are of the most unwarrantable character.
A physician of great eminence was once called to see a clergyman
who had sprained his wrist. The sprain was a bad one, and produced
considerable inflammation, and therefore gave him great pain. The
treatment which my friend pursued relieved the patient, and nothing
was wanting but rest to complete the cure. But he very imprudently
and in direct disobedience to his physician’s injunctions, drove
a spirited horse on quite a long ride with his lame wrist, and of
course renewed in some degree the soreness and inflammation. He now
put himself under the care of a bone-setter, and after his wrist got
well, forgetting the _gratuitous_ as well as successful services of
his physician, this clergyman gave the quack a laudatory puff in one
of the public papers.