Physician and patient

by Worthington Hooker

A gentleman, esteemed to be very shrewd by all his friends, received an injury of the first joint of his forefinger, which resulted in inflammation. After commencing medical treatment, he was persuaded to consult a bone-setter. He returned with a poor idea of the knowledge of regular physicians, because ‘they could not even set a dislocated finger,’ and loudly praised the skill of the bone-setter. He soon found, however, that the finger was no better, and, openly declaring that he had been deceived, submitted the finger to proper treatment, which in a little time removed the inflammation.

These two cases, taken from the two extremes of rank and intelligence in society, are fair examples of the imposition which is so frequently practised by the bone-setter upon all classes of his patients.

In this connexion I will notice another class of cases not so numerous, in which the bone-setter either imagines or pretends there is fracture, when there is nothing but a sprain, or an injury of the nerves of the limb, producing inability of motion. Such cases, at least in old persons, recover slowly. If the bone-setter puts on his splints, he commits a great error, but it is an error that may not be detected. The splints are taken off in due time, and the limb has recovered through the influence of rest alone.

There is another small class of cases from which bone-setters get much credit, and in which their bold practice, I will candidly allow, sometimes really does good. In the recovery of injured joints there sometimes form adhesions, which seriously impair their power of motion. I have said that the bone-setter operates on almost every case that presents, and he takes hold of these cases with a strong hand. He breaks up the adhesions, and sets the joint free. A regular surgeon would hesitate to do it, from the fear of inflicting an injury upon his patient greater than he would suffer if the joint were to remain with its limited power of motion. The bone-setter fearlessly runs this risk, for he has no very delicate sense of responsibility to prevent him from doing it; and if he does harm, he knows that a large portion of the community have so high an idea of his ‘gift,’ that they will absolve him from all blame. He may do great violence at times, and make some very bad cases; but there is little said about these, while the cases in which he has the good fortune to be successful are in everybody’s mouth.

The bone-setter sometimes acquires considerable reputation from some cases of stiff joints and contracted tendons, which are benefitted by a persevering course of friction, fomentation, &c. Physicians often prescribe such a course in such cases, but they do not, like the bone-setter, make the applications themselves, nor perhaps see that they are made. In the one case the course is faithfully pursued, and in the other it is not. A gentleman who had a stiff knee cured by a quack principally by friction, detailed the treatment to a medical friend. ‘I often prescribe just such a course for similar cases,’ said the physician. ‘Yes,’ replied the gentleman, ‘but you do not take hold and rub yourself. If I came to you with an aching tooth you would pull it, and not tell me or my friends to do it.’ There was much truth in this reply. Physicians often give directions of this kind, but do not see that they are followed up by the patient. I do not mean to say that they should do all the rubbing themselves. But they should show others how it is done, and then see that they do it. All the credit which bone-setters get from neglect of duty on the part of physicians, they have a perfect right to.

Another class of cases may properly be noticed here, of which I will cite but two examples. A lady sprained her ankle. Instead of the gradual recovery usual in such cases, the joint continued for a long time to be excessively tender—she could not bear to have it moved or touched without the most extreme care. The celebrated Professor Smith, of New Haven, on being called in to see the patient, recommended that all this caution in moving and touching the joint be discontinued, and that it at once be put to use. The prescription seemed to the patient to be a cruel one; but it was obeyed, and the recovery was rapid and perfect. The extreme sensitiveness of the joint in such cases is dependent upon two causes, the imagination and nervous irritability—sometimes almost wholly upon the former. If this case had chanced, like the one about to be mentioned, to pass into the hands of a natural bone-setter, his rubbing and other manœuvres would have accomplished the same object, and a great cure would have been proclaimed.

The other case was that of a lady, who had been long confined to her bed with a spinal disease. She supposed, and her friends did also, that it was not possible for her to move her back at all. A physician, to whom one of her friends described the case, said that he had no doubt that the disease had all been removed by the treatment which had been pursued, and that the patient could move about, and ought in some way to be made to do so. He saw that, as in the case just related, the sensitiveness and inability of motion were chiefly or wholly imaginary. And he predicted, that if she should be put under the care of a bone-setter, as her friends had contemplated, he would get her up and rub her back with his medicated applications, and she would be able to walk about in a very short time. She was carried to the bone-setter, the prediction was verified, and her father, a distinguished clergyman, gave the quack a certificate of the wonderful cure.

I remark upon these two cases—that, while Dr. Smith prescribed intelligently, the bone-setter only chanced to hit right—that while the discrimination of Dr. S. saved him from applying a similar treatment to cases to which it would be inapplicable, the bone-setter does much, sometimes fatal, harm to many cases by his lack of this discrimination, (cases which somehow fail to be reported)—and lastly, that while Dr. S. had no public testimony paid to the success of his discriminating skill, the lucky hit of the quack has been proclaimed, by the certificate of the clergyman, as the result of pre-eminent skill, throughout the length and breadth of the land.

There is still another class of cases to be noticed. Sometimes the motions of a joint are impeded, while there is no obvious deformity; and yet the case may be something more than a mere sprain, and often turns out to be so, when the subsidence of the swelling reveals the true nature of the case. It is a sub-luxation. That is, the bone is partially thrown out of place, but is not fairly out of joint. In such cases merely pulling upon the joint is commonly enough to set it. As soon as the bones are sufficiently separated to allow of it, the dislocated one slips into its place, or rather is drawn into it by the muscles. I have no doubt that many such cases, pronounced by physicians to be sprains, are remedied by the bone-setter, not from any superior skill on his part, but from the fact that he makes it a practice to pull the joint in every case.

One great source of the reputation of bone-setters is to be found in the flaming reports of their cases, made by themselves and their friends, most of which are either partly or wholly false. These reports are got up precisely in the same way that the reports of the great cures of other quacks are, and they have the same influence.