ANCIENT PRACTICES
Ancient cave art, Lascaux, France, circa 17,000 BCE
Credit: Greyscale of a photograph by Prof saxx. Wikimedia CC BY-SA 3.0
Origins of manipulation
Aches and pains are a part of the human condition. It is reasonable to assume that in early human societies, in times before written records, there were those who rubbed, mobilized and manipulated in order to restore function and provide relief from pain. We cannot say how far back into the past use of these methods go, but we can consider the potential advantages of joint manipulation in evolutionary terms and identify the physical, cognitive and behavioural characteristics necessary for the practice to begin.
Imagine we travel back in time 19,000 years to a forest in what today is south west France. A group of humans are hunting deer when during a chase one of the party falls and dislocates his shoulder. He is a man known for his hunting prowess and this is his throwing arm. If the shoulder remains dislocated he will not recover normal function in his arm and his hunting skill will be lost to the group. Fortunately one of his companions knows what to do. He reduces the dislocated shoulder. Over the weeks that follow the man recovers from his injury and is able to use his shoulder as before. His skill as a hunter is not lost to the tribe.
In this fictional example the use of manipulation can be seen to have survival value. As hunting skills were taught and learnt, so the skill to manipulate factures and joint dislocations would, we might reasonably assume, have been passed between people and between successive generations. Its use was dependent upon manual dexterity, which in humans was a product of bipedalism and the presence of opposable thumbs. It required intelligence and it required social skills.
Ancient writings about manipulation
It seems likely that the origins of joint manipulation predate organized medicine and that it began as a folk practice. Arguably, relevant knowledge and skills were communicated through observation and word of mouth, and so became oral tradition.
What is more certain is that as civilizations came into existence, as writing developed as a cultural practice, and as writing became a scholarly activity, manipulation was described. There is documentary evidence to support the idea that ancient physicians set broken bones and reduced joint dislocations more than 3,500 years ago. The Babylonian Code of Hammurabi, which was carved into stone and is thought to date from about 1,750 BCE, included details of the fees to be paid to physicians who set broken bones (Harper, 1904, p. 79). The Code of Hammurabi did not refer to joint manipulation, but the Edwin Smith Papyrus, an ancient Egyptian medical text, did. Dating from about 1,600 BCE, it described the treatment of a dislocated mandible by means of manipulation in sufficient detail for the practice to be reproduced (Breasted, 1930, p. 304):
“If thou examinest a man having a dislocation in his mandible, shouldst thou find his mouth open (and) his mouth cannot close for him, thou shouldst put thy thumb(s) upon the ends of the two rami of the mandible in the inside of his mouth, (and) thy two claws (meaning two groups of fingers) under his chin, (and) thou shouldst cause them to fall back so that they rest in their places.” (English translation by J.H. Breasted)
In Europe significant information about the early application of joint manipulation can be found from documents originating in ancient Greece (Vasiliadis, Grivas and Kaspiris, 2009). Hippocrates of Kos (circa 460-370 BCE) was one of the most influential thinkers of classical Greece and today is considered by many as the father of Western medicine. Within the Hippocratic corpus, which is to say the writings associated with Hippocrates and his followers, are various descriptions of manipulation. These were included in treatises On Fractures, On Joints and on Instruments of Reduction (Withington, 1928).
Hippocratic works were reproduced and developed by others, including the Greco-Roman physician Galen of Pergamon (circa 129-210 CE). He and his students promoted use of manipulation and produced commentaries on Hippocratic treatises (Iuntas, 1576). They encouraged use of the Hippocratic board, a device that could be utilized to treat spinal deformities through a combination of traction and physical pressure on the spine. Galenic ideas themselves came to influence both Christian and Islamic thinkers in subsequent centuries.
References
Breasted J.H. [translator] (1930). The Edwin Smith Surgical Papyrus. Volume 1. English translation by J.H. Breasted. University of Chicago Press, Chicago.
Harper R.F. [translator] (1904). The Code of Hammurabi. English translation by R.F. Harper. University of Chicago Press, Chicago.
Iuntas [printer] (1576). Galeni Librorum Septima Classis. Curativam Methodum. Latin translations of Galenic works on therapeutics. Fifth edition. Iuntas, Venice.
Vasiliadis E.S., Grivas T.B. and Kaspiris A. (2009). Historical overview of spinal deformities in ancient Greece. Scoliosis 4, article 6.
Withington E.T. [translator] (1928). Hippocrates. Volume 3. English translation by E.T. Withington. William Heinemann Ltd., London.