_WHAT BONE-SETTERS CURE._
“Man’s life, Sir, being so short, and then the way that
leads unto the knowledge of ourselves, so long and tedious;
each minute should be precious.”—_Beaumont and Fletcher._
Throughout the many references to the Bone-setter and his art, which
I have quoted in the foregoing pages, the Bone-setter is constantly
misrepresented. He is described as a man of one idea, one formula, and
one mode of operation. His ruling idea is said to be that a “bone is
out” in all cases submitted to him. His formula to wrench the joint
so as to break adhesions, and to replace the bones in their normal
conditions. His mode of operation is said to be brute-force suddenly
applied. Nothing can be further from the truth. It is an offhand
generalization from a few cases out of thousands, and therefore
misleading. If these statements were true there would be but few who
would trust themselves and their painful limbs to the Bone-setter’s
care lest his force should be applied in the wrong direction. A
brother Bone-setter (Mr. J. M. Jackson, of Boston), has pointed out
how irrational and absurd Mr. Hood’s statements on the one hand and
admissions on the other necessarily are. Bonesetters, as a rule, are
as regular and legitimate in their practice as any medical man can be,
though they are not recognised by law. As Mr. Jackson truly says: “All
kinds of fractures and dislocations, and other injuries are constantly
being placed under their care and treatment, with the utmost confidence
on the part of the patients and their friends; a confidence inspired by
indisputable success on the part of a practitioner in a given locality
and district, for a series of years—it may be for a lifetime.” Mr.
Jackson, in his timely little pamphlet, very truly points out that
“living reasons” for this confidence can be found in town and country
where the practice has been carried on, or who have experienced the
greatest benefits under the skilful treatment of the Bone-setter, even
after the wisdom of the faculty had declared there was nothing wrong.
That such men are ignorant of anatomy, and but seldom have dislocations
under their care, and, that when they have, and succeed in replacing
the joint, that it is done unconsciously, and what they do is the
result of blind chance and ‘sudden movement’ without any knowledge of
how, or why such results are brought about; the idea is ridiculous
in the extreme; upon this hypothesis the practitioner would nearly
approach the “supernatural!” I am glad to record this opinion, because
it not only reflects the opinion of the public, but shows that the
faculty have tried to prove too much. The position of the Bone-setter
may be clearly defined, thus:—“_We lay no claim to skill beyond what
is the result of sound original teaching, thoughtful consideration, and
common sense_,” and we possess well-earned reputations won in proof
that we have succeeded in our special practice.
[Illustration: PLATE VIII.—FRACTURES, ETC.
36. Displacement of bones of foot in Pott’s fracture. 37. Badly
set Pott’s fracture (curable). 38. Rupture of rectus femoris. 39.
Dislocation of metatarsus. 40. Dislocation of metatarsal bones.]
Even at the risk of being classed by the present, or some future Dr.
Howard Marsh, as being amongst those sophisticated Bone-setters,
“who keep a skeleton in the cupboard,” or a few bones to amuse the
credulous, I cannot close this little manual without saying something
about the bones of the human skeleton. Throughout the extracts I have
quoted from surgical and other writers, reference is made to the
various parts of the body, where bones are fractured, or “put out.”
These bones are mentioned by their scientific names, and may be as
_caviare to the million_. I have therefore inserted a rough engraving
of a skeleton, plate I., pp. 1 which cannot offend the susceptibilities
of surgeons, for it is one which is placed in the hands of the students
of the ambulance classes of the Order of St. John of Jerusalem, in
England. It will be observed that the skeleton is divided into three
parts. 1. The Head; 2. The Trunk; and 3. The Limbs, i.—The _Head_ has
the skull-cap and face. ii.—The _Trunk_, the back-bone, breast-bone,
with the ribs. iii.—The Limbs; the shoulders and arms; the haunches
and legs. The shoulders and arms are the origin of prehension, whilst
the haunches and legs form the origin of support and progression. The
skull is composed of eight and the face of fourteen bones. The facial
bones, except the lower jaw, are firmly pressed together. The latter is
the one subject to dislocation.
The Trunk is divided into 1.—The thorax, or chest. 2.—The abdomen, or
belly. 3.—The pelvis.
The bones of the Thorax, are i.—The spine (behind). ii.—The sternum,
or breast-bone (in front); and iii.—The ribs and the cartilages (at
sides). The _Spine_ is divided into five parts. There are seven bones
in the _Cervical_ or neck portion. Twelve bones in the _Dorsal_ or back
portion. Five bones in the _Lumbar_ or lower portion. There are five
bones fixed into one in the _Sacrum_ or rump bone. The incipient tail,
this _Os Coccyx_ terminates the column.
The STERNUM, or breast-bone, forms the front of the chest; it has
attached to either side a collar-bone and the cartilages of seven upper
ribs.
The RIBS are twelve pairs of bony arches forming the walls of the
chest. They are all attached behind to the spine. The upper seven are
termed _true_ ribs, being fixed to the breast-bone by their cartilages:
the lower five are termed _floating_ or _false_ ribs, having no
attachment in front.
The ABDOMEN is supported behind by the lumbar spine, and below by the
bones of the pelvis.
The PELVIS is the basin-shaped cavity which forms the lowest portion of
the trunk; and contains the bladder, the internal organs of generation,
part of the intestines, and several great blood-vessels and nerves. The
pelvis is composed of four bones—_2 Innominate or haunch-bones._ _1
Sacrum or rump-bone._ _1 Coccyx._
The INNOMINATE or haunch-bones, with the lower portion of spine (sacrum
and coccyx), form the lowest portion of the trunk. The innominate bones
on their outer surfaces have cup-like depressions for the reception of
the heads of the thigh-bones.
The SHOULDER is formed by the _clavicle_ or _collar-bone_ and _scapula_
or _blade-bone_.
The CLAVICLE, or collar-bone, has a double curve; it marks the line
dividing the neck and chest.
The SCAPULA, or blade-bone, lies on the back of the chest, is of a
triangular shape, and forms the socket for the humerus or arm-bone.
The UPPER LIMB comprises—1 _Humerus_, arm-bone. 2 _Radius and
Ulna_, fore-arm. 8 _Carpus_, wrist. _Metacarpus_, palm. _Phalanges_,
finger-bones.
The HUMERUS, or bone of upper arm, extends from the shoulder to the
elbow; above, it is joined to the scapula, and below to the bones of
fore-arm.
The ULNA is the larger bone of the fore-arm, lies on the inside, and
extends from elbow to wrist.
The RADIUS lies on the outside of the fore-arm.
The CARPUS is a double row of small bones which help to form the
wrist-joint.
The METACARPUS consists of five bones, and forms the body of the hand.
The PHALANGES are the fourteen finger-bones.
The LOWER LIMB is composed as follows:—1 _Femur_, thigh-bone. 1
_Patella_, knee-cap. 2 _Tibia and Fibula_, leg-bones. 7 _Tarsus_,
ankle-bones. 5 _Metatarsus_, instep-bones. 14 _Phalanges_, toe-bones.
The HIP joint is a ball-socket joint, and is somewhat similar to the
joint at the shoulder.
The FEMUR, or thigh-bone, extends from hip to knee joint, both of which
joins it helps to form.
The PATELLA (_knee-cap_) is the small oval bone which forms the
prominent point of knee.
The KNEE JOINT is formed by the lower end of femur, the patella, and
the upper end of the tibia.
The TIBIA is the main bone of the leg, and extends from knee to ankle,
on the inside of the limb.
The FIBULA is the small bone on the outside of the limb: the lower ends
of the tibia and fibula form prominent projections at the sides of
the ankle.
The TARSUS, ankle-bones, are seven irregular shaped bones, firmly
united together; above they are attached to the tibia and fibula, and
in front to the metatarsus.
The METATARSUS forms the instep, and together with the tarsus the arch
of the foot.
The PHALANGES, bones of the toes, are fourteen in number, two for the
great toe, and three for each of the others.
These bones are liable to be broken, dislocated, or fractured by
violence. Fractures or broken bones, they are usually divided into four
classes, which are termed—
1.—Simple fracture, a simple break.
2.—Compound fracture, a flesh wound commencing with the
broken ends of the bone.
3.—Complicated fracture, injuries to soft parts, blood
vessels, nerves, or internal organs.
4.—Comminuted fracture, smashing of bones into pieces.
They vary very much in extent and form. Some are very simple indeed,
and there is but little perceptible looseness of the ends of the
fractured part or sign of fracture. A case of this kind might easily
be mistaken for a mere contusion, which has often been done. Bones are
often broken obliquely, and with sharp points, and require skilful
treatment both in reduction and the application of splints. Compound
fractures, of course, require care and skill, but many fractures are
so easy to understand and rectify, that all is required is a little
common sense treatment.
The SYMPTOMS of fracture are:—1. Alterations in shape and general
appearance (plate V., fig. 88., pp. xix).—2. Unusual mobility at seat
of fracture.—3. Crepitus or crackling in placing hand over the broken
part and creating motion with the other.—4. Shortening of limb.—5.
Some inequality felt on moving the fingers along the surface of the
injured bone.
These have to be distinguished from dislocations, and in doing so, the
following facts must be remembered:—
_Fractures._ _Dislocations._
Crepitus. No crepitus.
Unnaturally movable. More or less fixed.
Easily replaced. Replaced with difficulty.
Limb often shortened. Limb may be shortened
Seat of injury in the shaft or lengthened.
or body of the bone. Seat of injury at a joint.
DISLOCATIONS are partial or complete. Partial dislocations are most
common and most difficult to understand, as the ordinary signs are
not so clear as in complete dislocations, and may be overlooked or
misunderstood, but as Mr. Jackson has before pointed out to the
experienced Bone-setter, symptoms, which cannot be described appear;
and motions, or want of motions equally unexplainable, are felt, so
that he has very little difficulty in determining the nature of the
injury.
Partial dislocations, displacements of tendons, and other injuries of a
similar character, may sometimes be rectified a considerable time after
the injury has been sustained, but should be attended to within a short
time after the accident—at least, within a few days. Much, however,
depends upon the nature of the injury, that no definite time can be
given which the patient may take before seeking proper advice.
Many of the cases so graphically described in “Chambers’ Journal” and
Dr. Hood’s book were evidently not complete dislocations, but partial
dislocations of joints or displaced ligaments, etc., which admitted of
being rectified by dexterous manipulation.
In plate II., figs. 1 and 2, I have given the appearances of a
dislocated thumb and a dislocated finger (2) a very common form of
accident; fig. 3 shows the radius of the arm fixed forward; fig. 4
shows the dislocation of the radius at the elbow-joint; and fig. 5 the
dislocation of the humerus or upper arm-bone at the shoulder joint;
figs. 6 and 7 the appearances of a dislocated shoulder-joint; fig. 8
shows the radius dislocated forward a dislocated elbow; fig. 9 is a
painful and yet not uncommon accident, and one that frequently comes
under the Bone-setter’s care, whilst fig. 8 shows the dislocation of
the radius forward; fig. 10, plate III, page 35, shows its appearance
backward.
The dislocation of the jaw is a laughable accident to all but the
sufferer (fig. 11), unfortunately it is liable to recur at any time
when the patient is laughing or gaping.
The hip is likely to be dislocated by the jerking of the body. Figs.
12 and 13 show two modes in which this accident may present itself
when the “hip is out.” It is as well to lay the patient on the bed and
pack the knee with cushions or pillows so as to relieve the pain. The
manner of packing will depend upon the form of dislocation or injury,
but the position in which the patient lies the easiest is best, and in
that position it should be supported. Bran poultices should be applied;
scald the bran in hot water, or steam it, then put it into a bag and
lay it upon the hip as warm as it can be borne, and repeat it until
advice can be procured.
Plate IV, page 68, gives representations of five varieties of
dislocation. The dislocated shoulder joint is shown at fig. 14. If
the elbow hangs off from the side, which will be the case if the
dislocation is downwards, it is well to place a small cushion between
the elbows and the sides and place the arm in a sling. The dislocations
of the first, inwards or outwards (figures 15 and 16), are very painful
and are frequently accompanied with sprains. Figs. 17 and 18 show
the dislocation of the knee and elbow joint and fig. 29, a curious
dislocation of the vertebræ of the neck and arm.
In treating of fractures, two points have to be considered; 1.—To
reduce the fractured ends or portions to their natural positions;
secondly, to retain them there immovable till nature has effected
a permanent cure, or otherwise the result will be similar to fig.
19, plate V. It should be borne in mind that there is no urgency in
treating a broken limb, provided no attempt is made to remove the
person, but if the patient must be moved in the absence of a skilled
“Bone-setter,” it is an absolute necessity to secure the limb by
putting it in splints, which can be easily extemporised in the manner
taught in the ambulance classes of the Order of St. John of Jerusalem.
A stretcher is the only safe means of conveyance for cases of fracture.
Unskilful handling may cause either serious mischief or even loss
of life; the dangers are pressing the sharp ends through the flesh,
blood-vessels, nerves, or into some internal organ, such as the lungs.
SPECIAL FRACTURES.
FRACTURE OF THE SKULL is caused by blows or falls. The external signs
are not always present. In fracture of the base there may be hæmorrhage
from ear, mouth, or nose; red patches of blood under conjuctivæ of
eyes; and oozing of watery fluid from the ears. Accompanying these
there may be symptoms of concussion, or symptoms of compression.
_Treatment._ Place the patient in a dark and quiet room on his back,
with head slightly raised. Apply cold to head as soon as reaction sets
in and patient gets hot and feverish, and send for a surgeon.
FRACTURE OF LOWER JAW (Fig. 23, plate V.), is caused by direct blows;
falls on chin. The symptoms are irregularity in the line of the teeth
and the outline of the lower margin of bone; inability to move jaw. The
treatment is simple. First fix lower jaw to upper jaw by a bandage,
until the Bone-setter or surgeon connects the fractured parts.
FRACTURE OF COLLAR-BONE is caused by blows on shoulder; falls on elbow
or hand. It is a frequent accident, and when it occurs the shoulder
sometimes drops; finger along the arm is helpless, and there is an
irregularity on drawing surface of bone; a pad should be placed in
arm-pit, bind the arm to side just above elbow, and sling forearm, as
when a “shoulder is out.”
FRACTURES OF RIBS are variously caused by blows, falls, weight passing
over chest or back; there is pain and difficulty in breathing, and the
usual signs of fracture. All that can be done at first is to apply a
broad roller bandage firmly round chest, so as to prevent all movement;
or strap the injured side with adhesive plaster.
FRACTURE OF THE HUMERUS (Fig. 21). It is caused by direct falls on
elbow (fig. 26). The symptoms are mobility at seat of fracture,
crepitus, or crackling, shortening, usually present when fracture is
oblique, as in fig. 25. Apply first a roller bandage from hand to
elbow, abduct arm and apply three or four splints from shoulder to
elbow. Support arm in a sling. If there is looseness about the part
apply a splint; if the flesh is broken stop the bleeding as directed
elsewhere; if, however (as is often the case in a fracture of the
forearm), there is no particular looseness of the bones, the case may
be treated as dislocations and injuries to muscles, ligaments, &c. (see
page 36.)
FRACTURE OF THE FOREARM is variously caused by direct violent blows,
falls, &c. The symptoms are crepitus, mobility, alteration in shape of
arm (fig. 27), and in treating it, semiflex forearm with thumb pointing
outwards. Apply two splints, one in front from bend of elbow to the
tips of the fingers, and one behind from elbow to knuckles. The splints
should be well padded. Place arm in sling.
FRACTURES ABOUT WRIST AND HAND are caused by blows or other injuries.
There is pain, swelling, irregularity in the outline of the bones and
crepitus. The limb must be bandaged to a flat board or splint, and
supported by sling.
FRACTURES OF FEMUR OR THIGH-BONE (fig. 24) are caused by blows or
falls, and pain and loss of power is instantly felt with crepitus,
shortening, or the broken ends may be felt and the foot turned out.
FRACTURES (both of the leg or thigh).—First straighten the limb if
bent, then tie a handkerchief round the fractured part, after which
place a splint made of a broad lath, or something like it, from one
joint to the other—say from the knee to the hip, if it is a broken
thigh—and then tie handkerchiefs above and below the fracture, near
the ends of the splint, tie the limbs together at the ankles, knees,
and elsewhere, so that one supports the other. The object is to prevent
motion of the fracture while the injured person is being moved, either
to home or hospital. In doing this care should be taken to avoid
jolting or shaking, as far as possible.
FRACTURE OF PATELLA OR KNEE-CAP (fig. 33) may be caused by blows, or
excessive muscular action, and the person is made to stand upon leg
first. Fragments can also be felt. Raise limb to a position at right
angles to body, and apply a figure-of-eight bandage around the knee,
including the fragments.
FRACTURES OF BONES OF THE LEG (fig. 28), are frequent from blows,
falls, crushing weight, such as wheels passing over the limb. There is
pain and loss of power; alteration in shape; crepitus, and the broken
ends may be felt. Apply two splints, one inside and one outside the
limb, as directed above, and elevate limb.
FRACTURES ABOUT FOOT AND ANKLE. These are various results of blows
or other injuries—(see figs. 30, 31, 36, and 37)—pain, swelling;
alteration in outline of bones; crepitus. _Treatment._—Elevate foot;
apply cold water.
It must be remembered that the treatment for fractures here given is
only temporary, to enable the patient to be moved without further
injury, which might result in the loss of the limb or even life, till
advice can be had.
When the fractured bone protrudes through the flesh, and there is much
bleeding, first straighten the limb and close the wound, and tie a
handkerchief tightly round over the wound, until a pad can be made,
then as quickly as possible make a pad by folding old rags or cloth,
or anything of the kind to be got closely together, of some thickness,
and broad enough to cover the wound well, then remove the handkerchief
already tied on, and place the pad over the wound and tie it lightly,
so that the pad presses hard upon the wound and stops the bleeding; the
bandage or handkerchief cannot well be too tight. Many a life might
be saved, which is now lost if this or a similar method were adopted
promptly. The materials are almost always at hand, and the application
of them easy and simple. Immediately after the bleeding is stopped
remove the sufferer, and call in professional advice without delay.
The stoppage of bleeding from arteries is taught practically in the
ambulance classes, and though it forms no part of the Bone-setter’s
art, yet many a life may be, and has been saved by this little
knowledge, so I subjoin the directions given in the hand-book of the
order of St. John, by the lamented Surgeon-Major Sheppard, whose
humanity cost him his life after the battle of Isandula.
“_The following situation of the main arteries in the
different regions of the body, and their treatment when
wounded._”
IN THE REGION OF THE HEAD there is the _Temporal Artery_ in front of
ear, one _P. Auricular_ at the back of ear at the _Occipital_, back of
head. Compress over the wound, and bandage.
IN THE NECK the _Carotid Arteries_ ascend in a line from inner ends of
collar-bones to angles of jaw. Digital compression in line of vessels
above and below the wound, or directly into wound on the mouths of the
bleeding vessels.
IN THE ARMPIT, the _Auxiliary Artery_ lies across hollow space of
armpit. Compress subclavian artery behind middle of collar-bone, or
digital pressure into the wound.
IN THE UPPER ARM, the _Brachial Artery_ lies on inner side of arm, in
a line with seam on coat sleeve—from inner fold of armpit to middle of
bend of elbow. Compress artery by a tourniquet above wound.
IN THE FORE-ARM the _Radial and Ulnar Arteries_ begin below the
middle of bend of elbow, and descend one on each side of the front of
the arm to the wrist. Compress Brachial artery in the upper arm by
a tourniquet, _or_ place a pad in hollow of elbow and bend fore-arm
against arm.
IN THE PALM OF THE HAND, the _Radial and Ulnar Arteries_ give a number
of branches, which spread out and supply the palm. Apply two small firm
pads to arteries at wrist, or forcibly close and fix hand over a piece
of stick or hard substance, and bandage.
IN THE THIGH, the _Femoral Artery_, from middle of fold of groin runs
down the inside of thigh in its upper two-thirds. Pressure at middle of
fold of groin, with fingers or by tourniquet above wound.
IN THE HAM, the _Popliteal Artery_ lies along the middle of ham.
Compress popliteal artery above wound, or compress femoral artery in
front of thigh by tourniquet.
In the BACK OF THE LEG are the _Post_, _Tibial_ and _Peroneal
Arteries_ descend the back and outside of leg from below ham, passing
behind ankle-bones. Compress at ham or in front of thigh or double leg
on thigh with a pad in the ham.
In FRONT OF THE LEG AND INSTEP the _Anter. Tibial Artery_ descends
along middle of front of leg and instep. Compress artery above wound.
In the SOLE OF THE FOOT the _Post. Tibial and Peroneal Arteries_
descend behind ankle-bones; the former supplies branches, which spread
out on sole of foot. Compress by a pad behind inner ankle-bone; if this
fails, place pads behind outer ankle-bone and on middle of front of the
ankle.
In dislocations generally, and displacement of cartilage, tendons &c.,
and also sprains and bruises, flannels soaked in warm water may be
applied frequently, or warm bran poultices. This kind of treatment will
almost always be suitable in the first instance. After some time has
elapsed, when a little inflammation sets in, which mostly occurs some
hours after the injury has been sustained, apply cloths soaked in cold
water or cooling lotion, and repeat them as often as they get dry; if
they are pleasant when applied, that will be an indication that they
are suitable.
Displacement of cartilage, tendons, and similar injuries as Mr.
Jackson points out are of frequent occurrence, and require very close
attention and considerable experience to understand them. Theory is
quite insufficient of itself to enable an operator to ascertain the
nature of, and rectify the displacement. Such cases may be remedied
by a simple manipulation, but it must be a carefully studied one, and
acquired by constant practice.
Another form of accident is that of ruptured muscles which frequently
come under the Bone-setter’s care; an illustration of a ruptured biceps
is given in fig. 35 and fig. 38, shows the _rectus femioris_ rupture.
These useful hints can hardly be called superfluous in a manual on the
art of the Bone-setter, which is admittedly “a neglected corner of the
domain of surgery.”