Physician and patient

by Worthington Hooker

In the remarks that I have made upon the mistakes of uneducated bone-setters, I wish not to be understood to claim that educated surgeons never make any mistakes in their treatment of fractured and dislocated limbs. They are not infallible, and some of them, I am free to say, know very little about bone-setting, and have very little skill in it. There is a mechanical tact which is necessary to make a physician a good bone-setter, and some are so destitute of this tact, that they are not even able to extract a tooth decently well. But I do claim, that educated medical men, generally, do have vastly more skill in this department of surgery, than the herd of uneducated bone-setters.

If the claims of natural bone-setters be just—if it be true, as they say it is, that surgeons are constantly making mistakes, which their innate skill is as constantly taxed to correct, then we should expect, that in those parts of the country, which are not blessed with bone-setters, there would be cripples in abundance, the victims of educated unskillfulness. But I have never heard that it is so. There has been no complaint that it is. And I have not a doubt that in the neighborhood of every natural bone-setter, there can be found more deformed and crippled limbs, than can be found in any similar neighborhood, where educated surgeons are not so fortunate as to have infallible possessors of the gift of bone-setting standing ready to correct their errors.

If the bad cases which occur in the practice of natural bone-setters could be found in the practice of regular physicians, they would be frequently prosecuted for mal-practice, and damages would be recovered of them by the sufferers. But I doubt very much whether anything would be gained by prosecuting a bone-setter for the grossest mal-practice. People are generally more willing to make allowances for the uneducated bone-setter, than for an educated surgeon; though, at the same time, inconsistent as it may appear, they may claim that by virtue of a divine gift he is infallible. One would suppose that cases resulting badly would lead them to doubt his boasted infallibility. But no. They infer that these cases were beyond the reach of the highest skill in the world, and that it was impossible that they should have come to any better result. They seem to regard it almost as a sin to express the least doubt to the contrary. With this state of feeling, existing to such an extent as it does in some parts of the country, no jury could be found sufficiently unprejudiced to inflict any just penalty upon a bone-setter for mal-practice; though they would inflict it to the full, if the same facts were proved to them in regard to any educated surgeon.

The testimony of physicians in such cases would be very apt to be disregarded, however rational and clear it might be, unless it could be brought to confront the testimony of the bone-setter himself. Whenever this is done, educated skill always comes off victorious over quackery. Nothing so exposes and demolishes quackery, as a well-directed examination of the quack himself. It dispels from the minds of the jury the false notion of a natural gift that needs no teaching; a notion, which, so long as it remains in the mind, effectually prevents any candid examination of the facts. They are made to see by such a course, that the joints of the body are constructed upon mechanical principles, and that they are to be understood just like any other machine; and the ignorance and consequent want of skill of the bone-setter become even ridiculously palpable. Some few years ago a physician in Springfield, Mass., was prosecuted by a patient for mal-practice. The case had fallen from his hands into those of a celebrated bone-setter, who appeared as a witness at the trial. The physician was triumphantly acquitted, and the exposed ignorance of the bone-setter had more influence with the jury, than all the display of surgical knowledge on the part of the faculty, drawn out by the learned counsel.

It now remains for me to show why it is that natural bone-setters, in spite of all their ignorance and their mistakes, acquire such a reputation for success, as they often do. I deem it a very easy task to do this to the satisfaction of any reasonable person.

I have already alluded to those cases in which the bone is not dislocated, but the patient supposes, and the bone-setter supposes, or, as is more often the case, pretends, that there is a dislocation. These are the cases which are the principal source of the bone-setter’s reputation. He pulls upon the affected limb and performs various manœuvres with it, and then thinks, or pretends, that he has ‘set’ the bone. In time the limb of course in most instances gets well, and thus in a case of mere sprain he gains the credit of having performed a wonderful operation. Especially is this so, when the patient has been first examined by a regular physician. Probably more than half of the reputed cases of dislocation which come under the care of bone-setters are nothing but sprains.

It is easy to see how the credulity of the patient can be imposed upon in such cases. He supposes that there must be something out of place, and is not satisfied with being told that there is not. Rest, the principal remedy in such a case, seems to him to be a very ineffectual remedy at least, and he gets out of patience. His imagination, with the aid of friends, and neighbors, at length conjures up before him the idea of a limb forever crippled. The bone-setter is now consulted, and he says, of course, that there is something wrong. No bone-setter was ever known to say otherwise under such circumstances. After executing certain manœuvres, he pronounces all now to be right. The patient is now satisfied, although the limb improves no faster than it did before, perhaps not so fast. He is satisfied, because he feels now that something has been done. If the surgeon who first saw the case had gone through with the same pretended setting of the joint, the patient probably would have been equally well satisfied. A surgeon of some note once remarked, that he pulled nearly all the sprained joints that came under his care and pretended to set something right; ‘for,’ said he, ‘if I did not do this, such patients would go to a bone-setter to have it done, and he would do them some harm, which I am careful not to do.’

But it may be said, that in many cases the testimony of the patients in regard to the setting of the bone is of the most positive character, and even that decided relief is at once experienced. That it is often imagined, I know. I have seen many cases of this kind, in which there was the most undoubted evidence that the relief was wholly imaginary.

As the deception of the bone-setter in such cases is so common, and so successful, even with persons of shrewdness and discernment, I will mention two cases in illustration.

A stout Irish girl had an inflammation of the ankle, which had come on gradually. She in some way imbibed the idea that the ankle was out of joint, though she did not remember to have hurt it in any way. I told her that it was not possible to put the ankle out of joint without knowing when it was done. But she chose to send for the bone-setter. He came and pretended to set the ankle, and she declared that he relieved her at once. The inflammation however was still there, and was gradually dissipated by appropriate remedies.