“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.

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.”