Physician and patient

by Worthington Hooker

The above considerations, I trust, make it clear to the reader, what are the kind and the extent of the knowledge of the empirical bone-setter. I am not disposed to say that he has no knowledge at all. He has power to observe, though his means of observation are limited, and therefore his knowledge is limited, and of consequence inaccurate. He acquires all the knowledge which he has by observing (and that is studying) the external geography of the joints to which I have alluded. He may perhaps have an accurate eye in such matters, or, as a phrenologist would express it, he may have the organ of form well developed. If this be true of him, in many cases of dislocation he will readily see where the irregularity is. He will see an undue prominence at one point and a consequent depression at another. The knowledge thus acquired by the eye guides him in his practice. He pulls the bones apart, and then applies pressure in such a direction, as to force in the prominence, and remove the depression. This is the sum and substance of all that an uneducated bone-setter can know, and his knowledge all comes from observation, and is not the result of any mysterious gift.

It is folly to pretend that the empirical bone-setter cannot, by the study of the internal structure of the joints, add to his knowledge and skill thus acquired from observation of their external forms. And yet he assumes, and a large portion of the public believe it, that not only does his skill, unlike skill in anything else in the wide world, need no adding to it, but that it would be actually impaired by anything like scientific study. That his reputation would be impaired very seriously, if it were publicly known that he in any measure acknowledged the necessity of study, is certain; for his skill would then be stripped of the charm, which is given to it by the idea of its being an innate power. It is for this reason only that he adheres so pertinaciously to this false and ridiculous notion.

I have thus far gone upon the supposition, that the natural bone-setter learns all that he knows by his own observation alone, without any assistance from others. This is far from being true. He is indebted to physicians themselves for some of his knowledge. For example, the fact that extension and counter-extension[22] must be made to enable us to put the dislocated bone into its place, is not a fact that he discovered. Somebody, (we know not who, but it was somebody,) discovered it a long time ago, and the knowledge of it has descended in the medical profession from time immemorial. It is in this channel that the knowledge of it comes to the bone-setter. He might as well say that it was an innate idea with him, that knives and forks are the appropriate instruments to eat with, as that he was born with the knowledge of the fact, that the expedient which I have mentioned is necessary in setting dislocated bones.

Perhaps it will be said that the idea of pulling the bones apart is a very simple idea, and that almost anybody would think of that. So was the invention of knives and forks a simple idea. But it was come at rather slowly. The transition from the use of fingers and teeth, to that of knives and forks in their present state of perfection, was not a sudden one. Improvement, in this instance, as well as in every other, had its march, step by step—it was not effected by a leap. So it has been with improvements in the setting of bones. It is probable that at first many a bone was pushed and twisted about, and then left in its dislocated state; but at length it was discovered, either by accident, or by a scientific view of the subject, that this pushing and twisting could be made to answer the purpose, by first overcoming the resistance of the muscles by extension and counter-extension. The man who first knew this fact was a real discoverer. And further, as the first knives and forks were made in a very bungling manner, so the setting of bones was at first done awkwardly and unskillfully. The bones were probably pulled in a jerking manner, till a second discoverer found out the fact, that it was best to make the extension very gradually and steadily.

Here then are two very material facts in regard to one part of the operation of setting bones, which are furnished to the natural bone-setter from the experience of those who have gone before him; and I think no one can doubt that he learns them in the same vulgar way that the educated surgeon does. Though they were new facts once, they are now familiar to every one who has seen a bone set, or heard a description of the operation. And I would give no bone-setter the credit of having been born with these facts in his head, unless he had been shut up from the world till he was strong enough to set a bone, and then, on being brought forth had set a dislocated limb, making the extension and counter-extension in the proper manner. This would be the only positive proof that he did not learn these facts from some one else. Many familiar ideas, which we suppose that we thought of ourselves, unaided by others, if brought to such a test, would be found to have descended to us from our predecessors.

Bone-setters have not so much confidence in their innate skill, as to refuse to learn anything from physicians. I suspect that they do not object to reading a surgical book, or looking upon a skeleton, if they can do it without its being known. I heard one once utter the scientific names of bones and their parts, such as humerus, radius, trochanter, astragalus, &c. He must have got these words from some of the educated surgeons, whom he professes to despise, or from some book upon surgery. It is hardly to be supposed, that he was born with them packed away, in his head, along side of his skill, ready for use, though perhaps his admirers and patrons may think so.

I have said that the knowledge of the ‘natural’ bone-setter must be both limited and inaccurate. Hence, though in those cases, in which the dislocation or fracture is so plain as to be readily seen, he may perhaps get along without any serious difficulty, he is exceedingly liable to make mistakes in cases which require nice discrimination. His mistakes may be arranged chiefly under four classes, which I will notice separately.

First. A common error is supposing a fracture to be a dislocation. Generally there is no difficulty in deciding which of these accidents has taken place. In cases of fracture a crepitus (or grating of the broken ends of the bone upon each other) can be perceived on moving the limb in different directions. But sometimes it is difficult to perceive this, and it can only be done by executing some particular motions. In such cases the uneducated bone-setter is very liable to make a mistake and often does. I will relate but three out of many examples of this error which I have in my possession.

The first case I take from Ticknor’s Medical Philosophy. A young lad in the city of New York received an injury of the elbow joint, which, under the most judicious surgical treatment, terminated in permanent stiffness. The parents of the lad took him soon after to a bone-setter who had acquired considerable celebrity. He at once pronounced the elbow to be out of joint, and attempted to set it. After repeated attempts, he at length by an extreme degree of violence, which was attended with excruciating pain, succeeded in straightening the limb. The bone-setter triumphed in the achievement, and the parents were delighted with the result. But the force employed to reduce the pretended dislocation did such violence to tendons, ligaments, and nerves, that the child’s life was in jeopardy, and was saved only by the timely amputation of the arm.

The second case which I shall mention occurred in the practice of Professor Hooker in New Haven. A man fell from a canal bridge and fractured the neck of the scapula, the bone which is commonly called the shoulder-blade. There was depression of the arm similar to that which occurs in common dislocation of the shoulder; but the crepitus and other symptoms obviously distinguished the case from simple dislocation. Professor H. dressed the shoulder in such a way as to secure a perfect apposition of the two surfaces of the fracture; and, if the man had continued under his care, a complete union would undoubtedly have taken place, and he would have had a good shoulder. But at the end of a week Professor H. found the apparatus removed and the arm simply supported in a sling. The patient had been to see a natural bone-setter, who convinced him that the Professor had mistaken the case—that there was no fracture, but a simple dislocation. He accordingly ‘set’ the shoulder. The patient was much easier than he was with the confinement of Professor H.’s apparatus, and he was gratified with the bone-setter’s assurance that the shoulder would soon be well. He continued to have confidence in the opinion of the bone-setter for about six weeks. Then, as the shoulder was no better, he went again to Professor H. It was now of course too late to remedy the fracture, and the poor man has a crippled shoulder for life, as the result of his foolish reliance upon the ‘natural’ skill of a bone-setter.