“What in the captain but a choleric word is in the soldier rank blasphemy.”
The first volume of the British Medical Journal for 1867 opens with a report of a Lecture delivered by Mr., now Sir James Paget, Bart., on “Cases that Bone-setters cure.” The Lecture is the first recognition as far as I am aware that the profession of the Bone-setters received at the hands of a professional surgeon, or qualified medical man, anything more than the opprobrium of being a “quack,” an empiric, or a charlatan. Ignorance, presumption, want of skill and knowledge were laid to the charge of the Bone-setter. His success, if success, as it admittedly did, attend his efforts to alleviate the anguish of a sprain, to reduce a fracture or a dislocation, was attributed to a happy accident, or “luck,” whilst any failure, or any mistake, as if failures and mistakes were never made by those whose names were duly printed in the Medical Register, was trumpeted always in the medical journals and in the private coteries frequented by the local doctors who happened to hear of the case. The many cures were pooh-poohed, only the failures were deemed worthy of publicity. It appears to have been forgotten that not many years have elapsed since the barber-chirurgeons were the only recognised professors of surgery. That the present scientific system of surgery is of comparatively recent date. That there are instances on record of both physicians and surgeons being tabooed and denounced because they had wandered from the beaten path and had found out modes of curing disease and alleviating suffering which were not known before, or at least only to a few. The host of appliances and new methods of treatment are in the opinion of many old and experienced medical men decidedly unnecessary. They lead the student and the practitioner to disregard the empirical—the practical—manual part of his art—to trust to a mechanical system and not to himself, or to his personal skill and his experience. No one can read Sir James Paget’s lecture without feeling that throughout his address he was touching a subject that had only been brought under his notice in the course of his professional career, and that only in a partial manner. If anyone dissents from this view he has only to compare the original report of the lecture in the journal I have mentioned with the revised lecture and notes, edited by Mr. Howard Marsh, and published more than twelve years after the lecture had been first delivered. During that period, a great change had come over the surgical world with respect to the much despised Bone-setters. The greater publicity given to the cures of the Bone-setters by independent men of mark, who had found their pains alleviated and their afflictions cured by the professional Bone-setter, boldly stating their experiences, told the faculty there must be something more in this system of “quackery,” than was “dreamt of in their philosophy.” It was evident, that however distasteful it might be, it must be treated with respect, even if it jarred with their previously expressed opinions and shocked their ideas of strict professional etiquette.
PLATE IV.—DISLOCATIONS.
14. Dislocation of shoulder joint. 15. Dislocation of foot inwards. 16. Dislocation of foot backwards. 17. Dislocation of tibia and fibula forwards. 18. Dislocation of ulna and radius backwards.
No Bone-setter can find fault with Sir James Paget’s lecture beyond his vulgarising, if I may so term it, his opening illustration. Such an instance might occur, for there are “Bone-setters and Bone-setters.” The term is doubtless assumed by many whose practice brings disgrace upon those who pursue an honorable calling, even if they do not belong to a chartered society, or are recognised by Act of Parliament and therefore not “legally qualified practitioners,” it is true that they are qualified by long experience, by early training, and the skill gained by the constant practice of many years, but the law does not recognise them.
Sir James Paget appears to imagine that all the formula of a Bone-setter is to say that “a bone is out,” and to use a wrench to put it in again, which wrench he admits does good in some cases. He admits “of course they have a certain number of real fractures and dislocations which they reduce, and of old ankylosis which they loosen.” “Of these,” he adds, “I need say nothing; for I believe there is nothing in their practice in these cases which is not as well or better done by regular surgical men.”
He instances what he calls the “rare accident” of the slipping of a tendon which a wrench may cure, and he is polite enough to say “I can hardly doubt that a Bone-setter has occasionally done unwittingly, a lucky trick, when, with wrenchings and twistings of a joint, he has made some dislodged tendon slip back into its place.” Sir James further enumerates a series of cases of injuries to joints, which may, and indeed are, daily cured by Bone-setters, and he shows how sometimes patients themselves may unlock a stiff knee whether caused by loose cartilages, a stiffness of the muscles, or from other causes. “It may be admitted generally,” he tells his audience, “that from paying particular attention to this class of cases, which are constantly occuring, that the Bone-setters have achieved their great reputation where eminent surgeons have failed.” Sir James too dwells on suppositious cases, which if treated by the Bone-setter’s wrench would certainly end in mischief, and alludes to bad boys who simulate stiff joints who often “escape disgrace by lying and letting the Bone-setter be believed when he professes that he has ‘put in’ their dislocations.” “Amongst all these cases of muscular difficulty,” Sir James says, “there is a good harvest for Bone-setters and without doubt their remedy is rough as it is real.” “But,” he continues, “there is yet a larger class of cases which Bone-setters sometimes succeed in curing very quickly, namely, ordinary sprains.” “I cannot doubt,” he says, “that some recently sprained joints may be quickly cured, freed from pain, and restored to useful power, by gradually increased violence of rubbing and moving.” He admits that this has sometimes been introduced into regular surgery, but, he goes on to state, that it is in cases where old sprains have remained long uncured that Bone-setters, and especially those who combine rubbing and shampooing with their setting, gain their chief repute. He, therefore, cautions the surgeons against giving too much rest, to avoid cold joints, excessive exercise, and try more gentle methods than are popularly attributed to the Bone-setter, as if the latter gloated over causing pain, which is not the case, though he often thinks that one sharp pang is better than days of agony, and, when over, his patient always coincides with him. The great Master-Surgeon also points out that what are called “hysterical joints” afford a rare opportunity for a victory for a Bone-setter, which may be cured by sheer audacity of being pulled about.
“From this you may see,” says Sir James, “that the cases that the Bone-setters may cure are not a few, but,” he continues, “the lessons which you may learn from their practice are plain and useful. Many more cases of injured joints than one commonly supposed to be thus curable may be successfully treated with rough movements.”
“Learn, then, to imitate what is good, and avoid what is bad in the practice of Bone-setters; and if you would still further observe the rule, Fas est ab hoste doceri, which in no calling is wiser than in ours, learn next what you can from the practice of rubbers and plasterers; for these know many clever tricks; and if they had but educated brains to guide their strong and pliant hands, they might be most skilful curers of bad joints, and of many other hindrances of locomotion.”
Such is in brief the testimony of the great Master-Surgeon of the age to the methods of practice adopted by the Bone-setters, who have practised their art as their fathers and grandfathers have done before them. His testimony at least shows that the Bone-setter works on truly scientific grounds, and that he is not a mere “lucky trickster,” a charlatan who works on the credulity of the public for the sake of gain, pretending to cure others by his own conceit. As I have before pointed out, Sir James Paget himself had occasion to modify his originally expressed opinion when the process and mode of cure practised by the late Mr. Richard Hutton was explained by Dr. Wharton Hood.
To this gentleman the profession and the public were indebted for the first published authoritative account of the Bone-setter’s art. There are but few Bone-setters who will say that Dr. Hood has exhausted the subject, for he has not; he has only indicated a few salient points, in which the practice of Mr. Hutton varied materially from that taught in surgical schools. He showed that more might be done in the surgical world by the leverage of the limbs, than by the employment of complicated and expensive apparatus. He bemoaned the “cost and loss” which the practitioners of surgery have sustained by the resort of patients, affected by impaired mobility or usefulness of limbs, after disease or injury to the Bone-setters, who so frequently give relief and speedily cure a patient by their manipulations and treatment. It is but just to Dr. Hood to say that he has given a number of cases illustrative of his statements, which the faculty have “condescended” to notice, and some of which, in my desire to give the widest illustrations of the usefulness of the Bone-setter’s art, I have embodied in this treatise. He dwells somewhat on the supposition that all Bone-setters declare that “a bone is out” in every case of thickened or stiff joint that is brought to them, but he seems to forget that these are only a fraction of the “cases which Bone-setters cure,” and on which our reputation so securely rests. The quarry men of North Wales, as detailed in the British Medical Journal, in 1875, preferred Mr. Thomas Evans, of Pen-y-groes, to their old regular medical practitioner in cases of external injury to body or limb, and though the profession were indignant at any medical men, being associated with a mere Bone-setter in the rules of Friendly Society or Sick Club, the connection is not unfrequent. The faculty have evidently much to learn ere they can successfully compete with Bone-setters in the special cases to which they devote their time, abilities and attention. The patients are the best judges of results, and by results the surgeon must be judged. Their case is not helped by detailing how a Chinese farrier killed a girl the Emperor desired to marry, by forcibly straightening her hump-back, as recorded in page 900 of the Lancet for 1872. It is far better for them to admit as Dr. G. Reed admitted in the same journal that he “had his eye wiped” by a Bone-setter, at Liverpool, who cured a sailor whom he failed to relieve.
Throughout the medical publications from 1871 to 1880, there are frequent allusions to the bone-setter and several admissions by surgical practitioners,5 that they have followed the method of the bone-setter with success, and discarded therefore the teaching of the schools; for though the Lancet itself welcomed Dr. Wharton Hood’s exposition of the art of the Bone-setter, as tending “to afford the means for the suppression of a widely prevalent and very mischievous form of quackery which has been based, as every success of the kind must be upon some neglected or forgotten truth. The late Mr. Hutton, on whose practise, Dr. Wharton Hood’s papers are founded, was for many years a sort of bugbear to not a few of the most distinguished surgeons of London, and every few months some fresh case was heard of in which he had given immediate relief and speedy cure to a patient who seemed vainly to have exhausted the legitimate skill of the metropolis.” This is an admission somewhat at variance with its previous utterances, and not as frank as the organ of a boasted liberal profession should be, and is far from generous, for its tone is embittered.
It however goes on to say, that “in some country places and especially in mining districts, in which large labouring populations are much exposed to chances of injury, bone-setters become formidable opponents to regular practitioners, and, like their London representative, have their surprising cures to boast. It is true that they often inflict injury; but this is not the aspect of the case to which our attention should be first directed. They are not valued because they do harm, but because they do a certain amount of good; and the way in which this good is brought about is the matter of chief interest to the profession.” The Lancet goes on to say “that quackery is only an expression of the extent to which legitimate practitioners fail to meet the desires of the sick,” and then somewhat unfairly and unjustly introduces the quack who pretends to cure phthisis or other mortal illness, as if Bone-setters professed impossibilities. After this inconsistent divergence it points out “that in the particular in question (the art of the Bone-setter) it is incontestible that a large number of irritable and useless joints have been restored to a natural condition by Bone-setters after a long period of unavailing surgical treatment, and that the profession has not known how this desirable result has been produced, or what has been the true nature of the lesion treated. The quack always said that a bone was “out” and that he had replaced it, and the doctor knew quite well that these statements were not correct. The doctor would not meet the quack; and the quack kept his methods secret, and would not show them to the doctor. The quack obtained more credit for a cure after the doctor had failed, than the doctor for a hundred cures in an ordinary course; and the Bone-setter, of all quacks was the one who did most to injure the reputation of the profession.
We once heard a military man of considerable distinction describe how his son was instantly cured of a sprained knee by Hutton, after a distinguished hospital surgeon had treated him to no purpose; and the speaker wound up with the remark ‘you doctors are all duffers.’
******
“At all events, for good or evil, the treatment pursued by Bone-setters will now be fairly before the profession and scientifically educated surgeons will soon be in a position to define accurately its merits, its dangers, and the limitations of its usefulness. Its application by ignorant men to unsuitable cases has often been followed by injurious consequences; but no such consequences ought to occur in the hands of the profession. We have little doubt that Dr. Wharton Hood has really called attention to a neglected corner of the domain of surgery, to morbid conditions that have been only very faintly described in books, and scarcely at all recognised in practice, to precautions that have been either unfounded or exaggerated, and to a method of cure at once simple and intelligible. We hope to see as the result of his labour, that the art of the Bone-setters will become extinct, after having been for a time exercised only upon those cases for which treatment by movement would be really unsuitable, and, as a necessary consequence, hurtful instead of curative.
“There may be other forms of quackery also under which some valuable knowledge may lie concealed; and no better service can be rendered to the profession or the public than to bring quack knowledge to the light of day, and to make it available for the general good.”
The publication of Dr. Wharton Hood’s book had however a different effect on the public mind than what was intended. There was previously a sort of general belief that the doctors might be right in dubbing Bone-setters “quacks” without much discrimination as to who the bone-setter was. Some of the complaints which appeared in the Lancet prior to this, were like the petulant utterances of a child deprived of its plaything, rather than the opinions of a scientific inquirer, for it must have struck the thinking part of the faculty, as it subsequently did Sir James Paget, and gleamed on the writer in the Lancet, that the fame of the many cures could not have been the effect of chance, or the “luck” of ignorant charlatans. Mr. Archibald Maclaren, who noticed Dr. Hood’s book in Nature, seems to have been aware of this. He pertinently says with reference to his work On Bone-setting, “It will be asked, What is Bone-setting, who are the Bone-setters, and who are their patients? And it will be readily answered Why, of course, Bone-setting is the art of setting bones that have been broken, or joints that have been dislocated, and this is done doubtless by surgeons; and equally doubtless, and of course their patients are persons whose bones are fractured, or whose joints are dislocated—
“There needs no ghost come from
The grave to tell us that.”
Perhaps not, but the answer is quite wrong for all that; quite the reverse, indeed, of what is actually the case, for Bone-setting is NOT the art of re-setting broken bones or dislocated joints; Bone-setters are NOT surgeons, or regular practitioners in any sense of the title; and then patients, even when they have suffered injury to joint or bone, have been pronounced by the regular practitioner cured before seeking the help of the Bone-setter.”
The writer very properly calls this “a triple paradox,” and quotes what Dr. Hood has to say in explanation:—
“A healthy man sustains a fracture of one or both bones of the forearm, and applies at a hospital, where splints are adapted in the usual way. He is made an out-patient, and the splints are occasionally taken off and replaced.
“After the lapse of a certain number of weeks the fracture becomes firmly united, the splints are laid aside, and the man is discharged cured. He is still unable to use either his hand or his forearm, but is assured that his difficulty arises only from the stiffness incidental to long rest of them, and that it will soon disappear. Instead of disappearing, it rather increases, and in due time he seeks the aid of the Bone-setter. The arm and forearm are then bent nearly at a right angle to each other; the forearm is intermediate between pronation and supenation; the hand in a line with it; and the fingers straight and rigid, the patient being unable to move them, and also unable to move either the wrist or elbow. Passive motion can be accomplished within narrow limits, thus produces sharp pain, distinctly localised in some single spot about each joint, in which spot there will be also tenderness in pressure.
“The Bone-setter will tell the man that his wrist and his elbow are “out.” The man may object that the injury has been in the middle of the forearm, perhaps from a blow or other direct violence. The reply be then; perhaps the arm had indeed been broken as alleged, but that the wrist and the elbow had been put out at the same time, and that these injuries had been overlooked by the doctors. The Bone-setters would then, by a rapid manipulation hereafter to be described, at once overcome the stiffness of the fingers, and enabled the patient to move them to and fro. The instant benefit received would dispel all scruples about submitting the wrist and elbow to manipulation, and these also would be set free in their turn. The man would go away easily flexing and extending his lately rigid joints, and fully convinced that he had sustained grievous harm at the hands of his legitimate doctors.”
“The art of Bone-setting, then, is the art of overcoming these impediments in joints, these conditions or impaired freedom which not unfrequently supervene on the curative processes of treatment in use by surgeons in case of fracture or dislocation, or which may arise from and be observed only after the subsidence of active rheumatism, gout, gangrene swellings, or other local affections; and this brings us to the question—How is it done? how are these stiffened joints set free? how are these impediments to healthy action overcome? The answer of the regular practitioner is that which has been already quoted, namely—‘to rest it’—advice which usually entails a distressing failure; the answer of the irregular practitioner, i.e., the Bone-setter, is precisely the opposite, namely—that freedom can only be restored to the stiffened joint by movement, by manipulation, and manipulation, too, of the most formidable kind, nothing less than suddenly and forcibly rupturing, tearing asunder the adhesions formed between the articulating surfaces of the affected joint, an operation which is so frequently successful that it forms the very basis of the Bone-setter’s craft.”
This is very forcibly and clearly expressed, but its verbiage tends somewhat to place the Bone-setter in a formidable and forbidding light, as opposed to the regular practitioner, but as a matter of every-day experience such is not the case. It is true, that the injury of years cannot be removed in a twinkle of an eye, without the patient suffering any pain or inconvenience. No bone-setter pretends to do that, but his mode of procedure is not of that violent and repellant character which Mr. Maclaren’s words would seem to imply:—
“It is here,” continues Mr. Maclaren, “that the Bone-setter steps in front of the scientific surgeon, and we must confess to a feeling of disappointment that their relative positions are not reversed, that the surgeon is not called in to rectify the malpractices of the quack, instead of the latter being sought out to complete the shortcomings of the former.” These are not our words, but the words of an independent reviewer in a scientific periodical. He tells his readers that the Bone-setter is not a man with only one remedy and one resource, but that “he has a clearly defined system of treatment for each separate joint, if not for each specific affection to which each joint is subject.” What qualified surgeon, what regular practitioner has more than that? He follows the dogma and doctrine of the schools. The Bone-setter that of experience, practice and the traditions of generations of practitioners. The one is recognised by law, and the other is not.
Mr. Maclaren seems to have seen that there was something which required explanation in all this. With the facts in Dr. Hood’s book before him, he says “Bone-setters, we are told, are for the most part uneducated men, wholely ignorant of anatomy and pathology.” In the anecdotes of Mr. Hutton, this is always accentuated in the professional accounts of his proceedings, for he made a little boast of his ignorance, but the writer continues, “we are not told what we greatly wish to know, and that is, the manner and method in which the secrets, the mysteries, and the other traditions of the craft, are communicated to each other.6 No doubt there exists a freemasonry in the craft, so that when individual members meet, revelations are made and notes compared, but we are not informed of any regular or organised system of instruction, either for the maintenance and extension of the craft, as a craft, or for the enlightenment of the separate and detached members of the fraternity. The most celebrated, we may even say distinguished,7 Bone-setter of our day, was the late Mr. Hutton, whose successful treatment of cases which had baffled the skill of the foremost surgeons now living, as related in detail by Dr. Hood, and about the accuracy of which there can be no question or doubt, is little short of marvellous; and the question is ever recurrent, while we read ‘How and where was this skill acquired?’ for a Bone-setter of Mr. Hutton’s calibre could put his finger on the spot, where lurked the seat of an affection that had crippled a patient for half a dozen years, and had defied the scientific treatment of the ablest surgeons of our time; nay, he could point to this spot without ever seeing the limb affected, guided merely by observing the attitude, gait, or action of the patient. Now whence comes this skill of these illiterate men? It appears to have been gained solely by observation of symptoms and results of treatment, the accumulated knowledge of from day-to-day experience; and, as we often see that one sense is quickened and functional power increased by the loss or impairment of some other sense; so, perhaps, the narrowing of the field of instruction and counting of the sources of information, may have intensified the powers of observation of the Bone-setters, allowing in a measure for the absence of the revelations of science.”
Is not this equally applicable to the oculist, the aurist, the dentist, and to the “specialist” of every description. The Bone-setter keeps within his special knowledge, and though he may be called “a quack,” he can point to the results of his skill and experience, and ask if these are quackery? The patients, whose sufferings have been alleviated, must answer, “If this is quackery, we wish there was more of it in the world.”
