George Matthews Bennett

“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.

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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.

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:—

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.”