REGULAR AND IRREGULAR MEDICINE

Guilds

Roots of modern manipulative medicine are to be found in the practices of bone-setters. They are also to be found in surgery as well as in the work of barbers, for historically the functions of barbers and surgeons overlapped. In addition to cutting and dressing hair, from the Middle Ages to early modern times barbers employed surgical and dental practices, including use of joint manipulation.

Over time barbers and surgeons came to be distinguished from bone-setters in part because of the guild system. Guilds were associations of skilled workers and traders who organized themselves in order to protect what they saw as their area of expertise and standards of practice within it. In London, both barbers and surgeons had formed guilds as early as the twelfth century (Power, 1886, p. XXVI). In 1540, during the reign of King Henry VIII, the Barbers’ Company and the Guild of Surgeons were incorporated into the Company of Barbers and Surgeons. There was no equivalent organization for bone-setters.

It is of historical significance that bone-setters did not become effectively organized, but barbers and surgeons did, and also that the practices of barbers and surgeons came to be integrated. Guilds existed in Britain and also in other European nations. Their ability to wield power varied between countries and between occupations. During the eighteenth century, in spite of increasing organization, pluralism remained a feature of health care with regulars and irregulars vying for trade under systems of administration which applied either greater or lesser restrictions (Porter, 2000, pp. 34-39). Within this context, physicians (who diagnosed and offered remedies of various sorts), surgeons (who incised and manipulated) and apothecaries (who prepared and prescribed drugs) became increasingly established as regulars. Folk practitioners, including bone-setters, fell outside of the fold.

Comorbidity and risk

Joint manipulation was a part of irregular practice and that hindered its development. As medical education grew to be more academic, those practitioners without formal training who treated fractures and dislocations were frowned upon by the learned. With advances in medical knowledge, the risks and benefits of manipulation became more apparent. Educated medical practitioners recognized that there were circumstances in which the use of joint manipulation could be advantageous, but that in the presence of certain underlying diseases its application could be harmful. Regarding the treatment of spinal dislocations, Wiseman (1676, p. 498) wrote:

“Luxations of the spine, which are most usually from inward causes, as in rickety children, also in the King’s evil, and other tumours, happening upon those bones, require internal remedies, so are referable to a physician. The chirurgical part consisteth in the application of plasters … also in good bandage, which chiefly belongs to the bodice-maker. When it happens from force, a speedy re-position is required, about which Galen, Hippocrates, Oribasius, Celsus, &c. speak much, who all may be consulted.”

The King’s evil, also known as scrofula, was a condition which resulted in glandular swellings. It had been believed by some that the touch of the monarch could cure it. The King’s evil was in fact tuberculosis. In the spine it also came to be known as Pott’s disease following Percivall Pott’s description of it. Like Wiseman, Pott was forthright in his views regarding fractures and dislocations and on those he considered qualified to treat them. For him, learning, ability and integrity were the hallmarks of a good surgeon. He wrote of bone-setting (Pott, 1769, p. 1):

“No part of surgery is thought to be so easy to understand, as that which relates to fractures and dislocations. Every, the most inexpert, and least instructed practitioner, deems himself perfectly qualified to fulfil this part of the chirurgic art; and the majority, even of these, are affronted by the offer of instruction, on a subject with which they think themselves already so well acquainted.

This is also the opinion of a considerable part of the people. They regard bone-setting (as it is called) as no matter of science; as a thing which the most ignorant farrier may with the utmost ease become soon and perfectly master of; nay, that he may receive it from his father and family, as a kind of heritage. We all remember the great, though short-lived reputation, of the late Mrs. Mapp. We all remember, that even the absurdity and impracticability of her own promises and engagements were by no means equal to the expectations and credulity of those who ran after her, that is, of all ranks and degrees of people, from the lowest labourer or mechanic, up to those of the most exalted rank and station; several of whom not only did not hesitate to believe implicitly the most extravagant assertions of an ignorant, illiberal, drunken female savage, but even sollicited her company, and at least seemed to enjoy her conversation.”

References

Porter R. (2000). Quacks. Fakers and Charlatans in English Medicine. Tempus Publishing Ltd., Stroud.

Pott P. (1769). Some Few General Remarks on Fractures and Dislocations. Hawes, Clarke and Collins, London.

Power D. [editor] (1886). Memorials of the Craft of Surgery in England. From materials compiled by J.F. South. Cassell and Company Ltd., London.

Wiseman R. (1676). Severall Chirurgicall Treatises. Printed by E. Flesher and J. Macock, for R. Royston and B. Took, London.

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