Physician and patient

by Worthington Hooker

The third case was related to me by Dr. Mercer, of New London in this State. It was a case of oblique fracture of the thigh. The evidence that it was a fracture was of the most palpable character; and yet the most famous ‘natural’ bone-setter in this part of the country, who has imparted his ‘gift’ to his descendants, and even to those who are connected with them by marriage, stripped off the dressings of Dr. M., pronounced the case a dislocation, and proceeded to ‘set’ it. The patient supposed that all was right, for the bone-setter was considered infallible. But many of the inhabitants of New London well remember the poor old man Bolton, who for so many years with his crooked thigh, which was pronounced so confidently by the bone-setter to be ‘set,’ literally crawled about the streets.

Secondly. The uneducated bone-setter is very liable to make a mistake in those cases in which, though there may be much tumefaction and pain, and the motion of the joint may be much impeded, there is neither dislocation nor fracture. Of all the cases of injury of the joints a very large proportion are of this character. There is simply a sprain or a bruise, or both together. Such cases the bone-setter almost invariably treats as dislocations. I will not at present dwell upon this class of cases, as I shall speak of them more particularly in another connexion. I will only remark here, that if the bone-setter does but little in such cases, no real harm may be done; but he may use so much violence, in reducing the supposed dislocation, as to inflict a serious injury upon the joint.

Thirdly. Another class of mistakes, to which the uneducated bone-setter is liable, have relation not to the mechanical principles of bone setting, but to what may be called the medical in distinction from the surgical, or operative part of the treatment. The mere operator, however skillful he may be, is not a finished surgeon. Very far from it. In order to be able to do his whole duty to his patients, the surgeon must in addition to his skill in operating, understand well the principles of inflammation and irritation, and must be in fact familiar with the whole range of disease. The bone-setter is entirely destitute of any such qualification for his department of surgery. He looks upon every case as a mere mechanical matter, and operates upon it without any regard to the state of the patient’s health, or to any of the circumstances of the case. He therefore operates upon many cases that ought not to be operated upon, and does to them a serious injury, sometimes a fatal one. In some cases he neglects to do what is necessary for the relief of the patient, and prevents any one else from doing it. It may be that inflammation needs to be guarded against, or to be overcome. This he neglects to do; and not only so, but perhaps, by the violence which he does to the affected part, he aggravates, or creates inflammation. The same may also be said of his neglecting the prevention and cure of spasmodic affections.

I will cite but a few cases illustrative of the above remarks.

A man had a bad fracture of the wrist, which was taken care of by a regular physician. After the fracture united, the joint he said continued to be very weak, but it did not prevent him from getting a livelihood by doing light work in a factory. More than a year after the accident, the wrist became quite sore. Rest and some appropriate applications would probably have restored it to its usual condition in a short time. But he was persuaded to show it to a famous bone-setter, who lived a few miles distant. The bone-setter said at once that it was not set right in the beginning, and that it must be broken over again, in order to set it as it should be done. The great violence he did to the joint produced a severe inflammation. It was in this state that I first saw it. Abscesses formed in consequence of the inflammation, and the final result was that the arm was rendered useless for life. If this man had been thus treated by an educated surgeon, instead of an infallible bone-setter, he could undoubtedly have recovered large damages for such mal-practice.

The second case which I shall relate is that of a young man who had a chronic disease of the shoulder, which came on gradually, without any evidence that the joint had ever received any injury. A bone-setter, whom he accidentally met, assured him that he could remove the difficulty, and give him a good arm. He told him that the bone of the arm had ‘dropped down out of the socket,’ that there was ‘callus in the socket,’ and talked about ‘squeezing it out.’ This opinion he gave without any examination of the shoulder. He did not even remove a thick overcoat which the young man had on. He directed a liniment, which was to be used for some time previous to the operation of setting the shoulder. After using the liniment for six weeks, he went to the bone-setter’s residence to be operated upon. Three stout assistants held the patient, while the bone-setter squeezed out the callus, and set the joint. The pain produced by this operation was so severe that the young man fainted. The bone-setter, thinking that the joint was not yet quite right, repeated the operation the next day. The consequence of all this violence was an increase of the inflammation. There was much soreness and pain, and at length several abscesses appeared in succession, which discharged abundantly, and the arm became exceedingly weak, very limited in its motions, and much emaciated.

Cases of hip-disease, as it is commonly called, are often supposed by bone-setters to be cases of dislocation, and sometimes are unfortunately treated as such. I might relate many instances of this kind, but I will detain the reader with but one, which I take from Ticknor’s Medical Philosophy. In this case “the complaint had existed for some time and produced a great degree of emaciation of the affected limb, which gave to the joints an unusual prominence; and, as is common in this disease, the limb was in a flexed position. This patient had been attended by a respectable practitioner, who understood the disease, and who had done all that the art can do in this much dreaded complaint. But the natural bone-setter was sent for. He pronounced the hip, the knee, and the ankle dislocated; and straightway commenced furiously pulling at all these joints to get them in place. The boy shrieked, and entreated him to desist. The diseased parts being exceedingly tender and painful on the slightest motion, the complaints of the boy only made his tormentor the more confirmed in his opinion and the more persevering in his efforts to ‘set the bones.’ He did persevere till the child repeatedly fainted; and being fearful that he had cured the patient to death, or killed him outright, at length concluded his manipulations, by saying that he had got the bones all in their places. The disease was so aggravated by this cruelty, that in a few days the child’s sufferings were at an end.”

The last case which I shall relate under this head, is a case of tetanus or locked-jaw. The patient had his foot crushed. He was for four days under the care of a regular surgeon. During this time such a course was pursued as was calculated to prevent the occurrence of tetanus, and the patient was in a very promising condition. But the bone-setter was sent for. He discontinued the remedies which had been used, and simply dressed the foot with a salve, which was of course of an all-healing character. The foot soon became very offensive, and symptoms of locked-jaw came on, and in a few days the patient died. The bone-setter within twelve hours of his death assured him that he would get well.

Fourthly. Uneducated bone-setters fail most signally in their treatment of fractures. In the case of a dislocation, when the bone is once put into joint it is generally done with. The joints are so aptly and closely fitted, that the reduced bone is not liable to slip out of joint again from any slight cause. But in the case of a fracture on the other hand, after the bones are put into place, some care and skill are required to keep them so. The pressure which is brought to bear upon different points of the limb is to be skillfully regulated, and motion of the two parts of the broken bone is to be carefully prevented, in order that they may grow together without irregularity, and with as little amount of callus as possible. The bone-setter for obvious reasons, fails in these particulars, and there may, therefore, be found among his patients a great many crooked and shortened limbs, with a large and irregular callus. One of the most deformed limbs that I ever saw was an arm which had been under the care of one of the most famous bone-setters in the country. The case was a simple fracture of the two bones of the fore-arm, about midway between the wrist and the elbow. Any ordinary surgical care would have secured to the patient a sound arm without any deformity. But when she showed me her arm, after the bone-setter had dismissed it from his care as cured, I found that one bone had its two parts united at quite an angle, with a large callus; and in the case of the other bone no union at all had taken place, but the ends of the fracture could be still made to rub upon each other by executing certain motions of the arm. Such mal-practice as this, in the case of a young woman, who is dependent upon her labor for a livelihood, ought to be punished with exemplary damages.

The remarks which I have made refer to ordinary fractures merely. But there are some cases of fracture which require a peculiar and nice application of mechanical principles in their treatment. In these the bone-setter generally makes an utter failure. For example, there are some fractures of the elbow-joint that require a particular position of the arm, and a nice adjustment of the apparatus applied to it; and, in order to prevent stiffness of the joint it is necessary that the surgeon should, as soon as it will answer, begin to execute the motions of the limb, gradually extending their range, till the joint become entirely free. Such cases under the care of a bone-setter have always resulted, so far as my observation has extended, in permanent stiffness of the joint.