The Art of the Bone-Setter: A Testimony and a Vindication

by George Matthews Bennett

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.”