Lest it should be thought that I have only my own authority for calling in question Dr. Howard Marsh’s dogmatic assertions with respect to the method of practice by modern Bone-setters I find at the same medical jubilee, Mr. R. Dacre Fox, Fellow of the Royal College of Surgeons, of Edinburgh, the surgeon to the Southern Hospital, Manchester; surgeon to the Manchester police force, and whose other practice and official appointments entitle his opinion to some weight, gave his practical experience of the Bone-setter’s art, so entirely different and so much nearer the truth, that I shall content myself with merely quoting, whilst thanking him, for his remarks which appeared in the Lancet, for 1882 (vol. ii. pp. 844.) Speaking from three years’ experience with the late Mr. Taylor, a celebrated bone-setter at Whitworth, Lancashire, whose family have been bone-setters for more than two hundred years, he told the medical men in plain terms that, “Much misconception exists as to the practice of Bone-setters; many of the methods of treatment popularly attributed to them have no other existence than in the imagination of ignorant patients, whose stories we, as a profession, are perhaps rather too ready to believe. It is certain that some families—notably the Taylors, Huttons, and Masons—have by their manipulative and mechanical skill justly acquired a great reputation. In what has their practice consisted? First, in the treatment of fractures and correction of deformities. The general impression in the profession appears to be that the Bone-setter’s art consists of nothing more or less than the forcible “breaking up” of stiff joints, so as to make the same man walk as if by a miracle. The practice at Whitworth was a large one, furnishing constant employment for at least two active men, and consisting chiefly of the cases I have mentioned. Speaking from memory, I do not believe that fifty joints of all sorts were “cracked up” during the time I was there; but it was not an uncommon event to have to put up half a dozen fresh fractures and twice as many recent sprains in a single morning. In the North of England, the origin of nearly all the men who are fairly good at Bone-setting can be traced to the Whitworth surgery, and while, so far as I know, the Taylors, in their various settlements at Whitworth, Todmorden, Stock-wood, and Oldfield-lane, were the only qualified surgeons who practised Bone-setting; amongst the hills and dales of Lancashire, Yorkshire, and the Lake district, there were many who did so without being qualified, some of whom, I must in fairness say, put up fractures uncommonly well. But apart from the legitimate credit they have won by the skill displayed in their handicraft, they owe some of their success to the carelessness or indifference of the general body of practitioners, who are apt to overlook little injuries which often become very painful and troublesome. It sometimes seems to me that it is beneath the dignity of the ordinary practitioner to employ any active treatment whatever for a sprain. It is hardly fair then to guage the work of Bone-setters solely by their method of treating diseased joints (probably the most unsatisfactory class of cases in the whole realm of surgery), but we ought also to take into account the patience and skill they display in the treatment of injuries for which they are not unfrequently consulted by the patients of qualified practitioners. I have no desire to hold a brief for every idle fellow who calls himself a Bone-setter, but I am anxious to give credit where credit is due, and to explain that the art of Bone-setting is not what it is often thought to be a mere mixture of charlantanism and good luck.
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From my own experience, I should classify weak joints as follows:—
1.—Those that have become stiff from enforced rest.
2.—Those that have become stiff by chronic disease.
3.—Joints stiff from injury to the bones entering into their formation.
4.—Joints stiff and weak from sprains, including displacement of tendons and partial luxation.
Apart from the previous history of the case, and the evident existence of constitutional disease, there are some external appearances which help to distinguish cases and to afford indications of treatment, and of these the Bone-setters have learned by experience to avail themselves.
1.—In the first-class I have mentioned the stiffness of the structures about the joint impeding its movement is the result of purely mechanical causes, is in fact simply due to prolonged disuse. No cause for functional activity exists, and consequently the elasticity, the flexibility and power of adaptation to movement in the parts about the joints not being required they become stiff and rigid. No degenerative changes however taking place, and they are capable of being recalled into activity unimpaired. In such a joint, the bony points, and the outlines of the tendons and ligaments about it, seem unnaturally prominent, probably from absorption of the adipose and connective tissue; the rigid ligaments impart a sense of hardness, and if the limb be flexed to its utmost, it shows considerable resilliency, such joints may, I believe, be “cracked up” without fear of consequences, and this constitutes one of the successful operations of Bone-setters. My own recollection carries me back to some apparently almost miraculous results. I am convinced suddenness ought to be insisted on in doing this; the advantage derived from it being, I believe, mainly due to the fact, that it is less likely to set up any irritation in the joint than the “dragging” of gradual extension.