MODERN BONE-SETTING

Bone-setting and the medical profession

In Britain, following the Medical Act of 1858, the social distance between registered medical doctors and bone-setters increased. Technological advances in medicine made treatment by hand appear old fashioned. Bone-setting was seen to be unscientific, its practitioners lacking in proper education and professionalism. Bone-setting, as the surgeon Dacre Fox saw it, was “almost exclusively employed by a class of persons who are without our pale” (Fox 1882, p. 843). Registered medical doctors were permitted to use manipulation themselves, but were discouraged from interacting with others who legally applied manual therapies under the provision of common law, rather than through specific state sanction. Bone-setting had a stigma about it and the practice of manipulation was tarnished by association.

Even so, there were registered medical practitioners who saw value in the bone-setters’ art. James Paget was one. Accepting that few of his colleagues were “likely to practice without having a bone-setter for an enemy”, he called upon them to “imitate what is good and avoid what is bad in the practice of bone-setters” (Paget, 1867). According to Paget, bone-setters had cured cases that good surgeons had failed to cure. They reduced fractures and dislocations, they treated locked, stiff and sprained joints, and they replaced dislodged tendons. That said, if Paget is to be believed, they saw every injured joint as “put out” and had a single method of cure, to “wrench” or manipulate the joint, so that what was thought to be “out” was “put in” again.

Wharton Hood was another medical practitioner who sought to understand and apply what he saw as good in bone-setting. His father, Peter Hood, also a medical doctor, had helped a bone-setter named Richard Hutton through a serious illness, but had refused to take a fee because of the benefit he saw in Hutton’s work for the poor (Wharton Hood, 1871a, v). To show his gratitude, Hutton offered to teach him bone-setting. Although that did not happen, the offer was extended to his son, which was accepted. Wharton Hood studied bone-setting and wrote a series of articles about it for the Lancet (1871b, 1871c, 1871d & 1871e), afterwards compiling the material into a book (1871a).

Paget and Hood are examples of medical practitioners who aided the absorption of ideas from bone-setting into regulated medicine. There were also persons from bone-setting families who became registered medical doctors. The name of James Eastwood Taylor, who came from a family of Lancashire bone-setters, was included in the first medical register to be published after the Medical Act (General Council of Medical Education and Registration of the United Kingdom, 1859). So also was the name of Hugh Owen Thomas, whose forebears had been bone-setters on the Isle of Anglesey. As it happened, Thomas came to be critical of bone-setting. His experiences, as described is his Principles of the Treatment of Diseased Joints, led him to the conclusion that manipulation could often be more harmful than beneficial. He wrote (Thomas, 1883, pp. 74-75):

“During the last twenty-six years I have repeatedly tried manipulations to loosen joints crippled in their action, and have watched the practice of qualified and unqualified practitioners, famed for their skill as manipulators of diseased and injured joints; and, again, I have been educated with a bias in favour of such treatment yet, notwithstanding all this, unmistakable evidence of its evils has led me to discard it myself, and to advise others to avoid the adventurous treatment recommended by the author of the lecture ‘On Cases that Bone-setters Cure’ [James Paget].”

Herbert Barker

Bone-setting was discussed at the fiftieth annual meeting of the British Medical Association in 1882. Howard Marsh, of St. Bartholomew’s Hospital, London, described two groups of bone-setters. On the one hand, at one end of the scale, there were those who worked in remote areas, who, according to Marsh, had little concern for anatomical knowledge (Marsh, 1882):

“Some are blacksmiths on the Cumberland hills, or shepherds in the sequestered valleys of Wales. Practitioners of this kind, standing in the same relation to surgery that herbalists bear to medicine, have existed, in these remote districts, from immemorial times. They belong to the same order which in bygone days included fortune-tellers, ring-charmers, and the workers of all kinds of village miracles.”

On the other hand, at the other end of the scale, there were those who resided in large towns, individuals Marsh described as being “less unsophisticated”, for they, at least, equipped themselves with the names of the principal bones and muscles and with a few medical phrases.

Herbert Barker was a city bone-setter. He studied bone-setting in London under the guidance of his cousin John Atkinson, who in turn had studied under Robert Hutton, the nephew of Richard Hutton (Barker, 1927, p. 29). Following his apprenticeship, in 1889 Barker set up practice in Manchester, and later worked in Glasgow, but it was in London, following his return in 1905, that he became a focus of particular notoriety and controversy.

Barker encouraged registered medical doctors to observe his work. One of those invited to his practice was a man named Fredrick William Axham, who came to be so impressed with what he saw that he agreed to assist Barker in treating patients where anaesthesia could usefully be used. While Axham saw value in Barker’s methods, others were more sceptical. Embittered by the criticism of his work by certain members of the medical profession, in 1906 Barker made the decision to have his skills tested (Barker, 1927, p. 62). He wrote to the editor of the Daily Express and proposed that he treat a small group of patients with joint injuries that had not responded effectively to therapy at London hospitals and by private practitioners. He offered a thousand pounds, which he agreed to forfeit to a charity of the editor’s choice, should his methods fail to achieve better results than those which had gone before. Two medical doctors were to act as arbiters. In the event, both they and the newspaper judged Barker’s methods successful, but rather than leading to further examination of his approach, as Barker had hoped, the results divided opinion and led to new criticism. In his autobiography Barker wrote (Barker, 1927, p. 63):

“My fond illusions that I had only to show that the work I was doing was beneficent to have it acknowledged were quickly being shattered, and I found to my disappointment that the fact that I was beginning to come into serious competition with surgeons and others, was an unforgivable offence, and success in relieving suffering as nothing in comparison.”

There can be little doubt that Barker courted publicity and openly challenged medical authority. He chose to describe himself as a manipulative surgeon even though he was not registered with the General Medical Council and in an open letter to the President of the Royal College of Surgeons of England he wrote (Barker, 1927, pp. 66-67):

“The qualified surgeon inflicts lameness, perpetuates lameness, or leaves lameness lame. The manipulative surgeon cures it. Science denounces him as a quack, but a word of abuse is of little consequence either to patient or to healer.”

Perhaps the most serious consequence of Barker’s tussle with medical authorities did not involve him directly, but his anaesthetist. Axham’s name was removed from the medical register in 1911 in view of the fact that he had acted as anaesthetist to an unregistered practitioner. Paradoxically, following distinguished service to patients during World War I and support from friends in high places, Barker was knighted in 1922. In 1936 he was invited to present his methods at a special meeting of the British Orthopaedic Association held at St. Thomas’s Hospital, London (British Medical Journal, 1936).

The decline of bone-setting

In spite of Barker’s renown, during the interwar period bone-setting was in decline in Britain. In its place, Henry Jones wrote of new manipulative practitioners who increasingly described themselves as osteopaths and chiropractors (Jones, 1926, pp. 9-10). In Europe and the United States the methods of bone-setters were incorporated into osteopathy and chiropractic, into emergency medicine, trauma and orthopaedic surgery, general practice and physiotherapy. Even so, folk healers continued to practise and to this day there are those who describe themselves as bone-setters, or by another similar name, the Karelian bone-setters of Finland and the endireitas of Portugal being examples. Across the world, especially in countries where the reach of biomedicine is less apparent, notably in developing nations, bone-setters continue to be utilized.

References

Barker H.A. (1927). Leaves from my Life. Hutchinson & Company, London.

British Medical Journal (1936). Manipulative surgery. Sir Herbert Barker’s demonstration. British Medical Journal 2 (3943), 255-256.

Fox R.D. (1882). On bone-setting (so called). Lancet 120 (3090), 843-845.

General Council of Medical Education and Registration of the United Kingdom (1859). Medical Register. General Council of Medical Education and Registration of the United Kingdom, London.

Hood W. (1871a). On Bone-setting (So Called), and its Relation to the Treatment of Joints Crippled by Injury, Rheumatism, &c &c. Macmillan and Co., London.

Hood W. (1871b). On the so-called “bone-setting,” its nature and results. Lancet 97 (2480), 336-338.

Hood W. (1871c). On the so-called “bone-setting,” its nature and results. Lancet 97 (2481), 372-374.

Hood W. (1871d). On the so-called “bone-setting,” its nature and results. Lancet 97 (2483), 441-443.

Hood W. (1871e). On the so-called “bone-setting,” its nature and results. Lancet 97 (2485), 499-501.

Jones J.H. (1926). Healing by Manipulation (Bone-Setting). Watts & Co., London.

Marsh H. (1882). On bone-setting. Being an introduction to a discussion in the section on surgery at the annual meeting of the British Medical Association in Worcester, August 9th, 1882. British Medical Journal 2 (1136), 663-666.

Paget J. (1867). Clinical lecture on cases that bone-setters cure. Delivered at St. Bartholomew’s Hospital. British Medical Journal 1 (314), 1-4.

Thomas H.O. (1883). Contributions to Surgery and Medicine. Part II. Principles of the Treatment of Diseased Joints. H.K. Lewis, London.

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