_THE FACULTY IN DOUBT._
“Why, what have you observed, sir, seems so impossible.”—_Ben
Jonson._
Like the Royal Society, when Charles II. asked that learned body the
answer to certain propositions, the medical profession continued for
years to “hum and haw” over the self-evident fact that Bone-setting
was not only an institution, but a successful profession. I have taken
somewhat at random from my voluminous collection of notes on the
subject, a few of the printed opinions of those “who were convinced
against their will,” but could _not_ “be of the same opinion still,”
but wished to modify the self-evident facts or gloss them over to
harmonise with previously expressed declarations.
[Illustration: PLATE V.—FRACTURES.
19. Disunited fracture. 20. Fracture of pelvis. 21. Extra capsular
fracture of humerus. 22. Fracture of scapula. 23. Fracture of jaw. 24.
Fracture of femur.]
In 1880, the Clinical Society, at their meeting, held on April 9, had
the subject of “Bone-setting” under discussion. Mr. Howard Marsh, whose
experience is elsewhere given (page 95) gave instances of a number of
cases he had treated after the Bone-setter’s manner, and which had
been quite successful. He gave his testimony to the great service Sir
James Paget had rendered to the profession by drawing attention to
the subject in his clinical lectures which had since been republished
with others (see pp. 69-74). He further said that _displacements of
cartilages, and slipped tendons might be, and doubtless sometimes
were, put right by Bone-setters; but he believed the cases of
adhesions—especially such as occurred after an injury outside a
joint_, which itself was healthy, afforded by far the most numerous
instances of improvement after forcible movement, and he expressed
his conviction that they were much more frequent in practice than
was generally supposed. He gave other several instances where he had
followed the Bone-setter’s treatment as given by Dr. Wharton Hood.
He, of course, was silent as to the practice of the Bone-setters in
reducing fractures, and their treatment of cases which never came under
the care of the faculty at all, and which were satisfactory to the
patients.
Mr. Hulke thought it was an approbrium to surgery that so many
persons sought advice from Bone-setters, and he mentioned that “even
intelligent people are blinded by these men!” Many alleged instances
of injury following the treatment of the Bone-setter, but there was a
little contemptuous tone with respect to country surgeons, which ere
long evoked a reply.
In the next number of the _Lancet_, there appeared a letter from Dr.
D. H. Monckton, of Rugeley, pointing out that it would seem “that the
chief object sought in the debate was to prove to country surgeons that
their metropolitan brethren understand, and can cure such conditions
of the joints if only they are sent up to them.” In other words,
they want to occupy the place and receive the fees of the ousted
Bone-setters, whose secrets they had appropriated, after covering them
with approbrium as quacks and empirics.
At another meeting of the profession there was the same _pro_ and _con_
argumentation. The obvious “willingness to wound,” but yet “afraid to
strike” in the face of the overwhelming testimony in favour of the
_bete noir_ of the profession:—the healer outside the fold “who in the
wilderness doth stray.” At this meeting Dr. Bruce Clarke read a paper
on the practice of the Bone-setter, in which after briefly alluding
to the variety of cases that found their way to the Bone-setter, and
derived benefits from his treatment, he adverted to the pathology of
stiff joints, and showed from observations of several cases which he
had been able to examine after removal of the limb, that adhesions
were usually found outside joints and tendon sheaths, and were due
to contractions of the connective tissue of the limb. Adhesions were
rarely formed inside the tendon sheaths or joints, and when they were,
the disease was far more serious and rarely yielded to treatment. In
cases of old stiff joints, the skin, and probably the subcutaneous
tissues, became weakened and atrophied by disease, and were so rendered
more liable to injury—in proof of which he cited several examples of
tearing and lacerating the skin without the employment of due violence.
The usual history, he tells us, of the class of cases that came under
the hands of the Bone-setter was this:—
The patient met with an injury resulting in a dislocation, or fracture,
or perhaps, only a severe bruise, or a sprain. He readily recovered
up to a certain point; but when all inflammation had subsided, there
remained a stiffness accompanied by pain on movement. In other cases
there were periodical attacks of synotictus. The treatment in all
such cases was active movement, with or without chloroform, which was
usually accompanied by a click or crack, ascribed by the Bone-setter
to the replacement of a bone, but which was due to the freeing of the
connective tissue bands. In slight cases, one violent flexion might
cure the trouble of months: in severe cases, the treatment might be
measured by months rather than minutes. The pathology of such cases
was as well marked as that of iritis, where there was the advantage
of seeing the adhesions not only form but rupture and disappear. He
expressed his obligation to Mr. Wharton Hood’s lecture which had
induced him to study the subject. The difficulty of these cases was
the selection of time for rupture, and for rest. Signs of inflammation
were their guides in that matter. Rest should be regulated to its
proper position in surgery, and should not be kept up when it increased
instead of abating the patients’ troubles.
Dr. Keetley thought Dr. Clarke could hardly have chosen a more
interesting subject, undoubtedly, the Bone-setter frequently earned
great credit by the manipulations which broke down adhesions outside
a joint, and at the same time, removed the cause of inflammation, for
in these cases there was no contraction of membrane. When there was an
osseous fibrous hand the case was of a strumous origin, it was due to
the presence of organisms. In such cases the joints became altered,
and there was great danger from the rough usage of the Bone-setter.
In the treatment of such joints he had put on ice for several days
with great advantage, and had repeatedly put them straight. When
once convalescent, a joint very rarely became strumous. There was
much bewilderment with regard to the value of rest, which was only a
negative factor. It was the natural tendency of a column of germs to
die as the joint became healthy.
Dr. Alderson related the case of a knee which became enlarged fourteen
days after confinement, but without pain. He called in Dr. Hewitt who
ordered rest, and the knee to be rubbed with salad oil. He also used
Scott’s dressing. Subsequently, at Brighton, a sea-weed poultice was
used. The treatment was successful.
Dr. Alden Owles had seen several cases confirmatory of the opinions
advanced in the paper. Once was a shoulder, the manipulation of which
caused agony to the patient, but in which motion was regained. Another
regarded at first as a strumous joint was eventually cured by somewhat
violent manipulation.
Dr. Vinen referred to the case of an officer of the 60th Regiment, who
sustained a compound fracture below the knee whilst playing at football
in India. The bones were set by some naval surgeons who were watching
the game; but in consequence of the leg being deformed, the adhesions
were broken and the limb reset. The ankle then remained fixed, and the
patient’s health suffered. However, Mr. Erichsen was called in, broke
the adhesion, and the patient recovered so thoroughly, that he was
enabled to rejoin his battalion in the Transvaal. Dr. Bruce Clarke in
reply, pointed out the necessity of distinguishing chronic cases, as
such were usually made worse by movement.
In the course of this discussion only one point of the Bone-setter’s
practice was alluded to—that of rigid or strumous joints, as if the
renown of the Bone-setters art rested on these alone. “There are none
so blind as those who will not see.”
[Illustration: PLATE VI.—FRACTURES.
25. Fracture of humerus. 26. Fracture of ulna. 27. Colles’ fracture.
28. Compound fracture of leg (tibia and fibula).]