Selected writings of A. Jackson Howe.
Dr. Howe recognized the fact that some individuals, wholly uneducated in other respects, may acquire wonderful dexterity in reducing luxations. It is customary for educated physicians to ridicule "natural bone setters," but Dr. Howe was willing "to give the devil his due." The advantages of a thorough knowledge of anatomy and the mechanism and action of joints makes the surgeon more than the equal of such rare bone-setters, while the latter may often succeed where the ill-prepared operator, though possessed of a diploma, may fail. In this article Dr. Howe shows the intricacies involved in the management of such injuries, a knowledge of which makes the physician master of the situation. Among the famous bone-setters of history are several members of the Sweet family, of Rhode Island, and Dr. Kittredge, of New York, all of whom reduced luxated bones by manipulation processes alone when physicians and surgeons were clinging to cumbersome methods and apparatus.—Ed. Gleaner.
NATURAL BONE-SETTERS.—At the November meeting of the Cincinnati Society of Eclectic Medicine, I took occasion to make some off-hand remarks on the alleged gift of adjusting luxated bones, saying, among other things, that I had seen the Christian healer, the Rev. Newton, manipulate the lame and make them walk away without canes or crutches; that the seeming cure came from the mobility imparted to stiffened joints, and to confidence impressed upon the feeble and the tottering. A wonderful degree of energy can be infused into a despairing wretch by a man of physical and mental vigor. I have been surprised at my own power to dissipate distrust and to impart confidence to the sick and lame.
Natural bone-setters are not without ability; they have not practiced their arts for years and learned nothing. But, to say that they can rival an experienced surgeon in the successful manipulation of dislocated, sprained, or anchylosed articulations, is to be ready to champion the marvelous upon a slight provocation. A regular practitioner of little experience in bone-setting, though he be a fair anatomist, can not handle a luxated limb as expertly or adroitly as a bone-setter of large experience; and here comes the opportunity for a contrast which exalts the specialist, and reflects upon the educated physician. The latter fails to reduce a luxation through lack of experience, and the bone-setter comes in and succeeds! Mirabile dictu!—the quack has beaten the skillful surgeon! Not so; the confident bone-setter has been victorious over an inexperienced practitioner. In ordinary life a graduate in medicine, obstetrics, and surgery passes as an expert in all these branches, yet may be a poor representative of either.
Once we did not know much about the manipulating plan of reducing dislocations, and hence there was an excellent opportunity for bone-setters to ply their arts. At present every practical surgeon knows all about a joint, and rarely, if ever, fails to reduce a luxated bone in a few minutes. The kinds of dislocations are now compared one with another, and each is known to yield to a definite manipulative effort. With a patient insensible from the effects of an anaesthetic, the average practitioner may, by varied trials, reduce a dislocation of the shoulder; but if the injury be displacement of the long heads of the biceps from the bicipital groove, the random pulling and hauling will fail, and the bone-setter will also fail; he is not up to the specialties of the case; he lacks diagnostic skill The experienced surgeon, however, sees by the peculiar outline of the limb what must be the matter; he recognizes the supine and flexed state of the forearm, the tense condition of the biceps, and the fact that the head of the humerus is not out of the socket, though the scapulohumeral articulation be somewhat restricted in its range of motion. By utilizing the method of exclusion the surgeon arrives at a conclusion—there is no fracture, no dislocation, and more than a sprain—what, then, is the trouble? Is the long head of the biceps displaced? It is possible; evidence of the lesion can not be excluded, and may be speculated upon—may be subjected to a test. While the forearm is flexed and the arm is forcibly revolved inwards and then outwards, the displaced tendon will be forced out of its new position, to fall into the groove it has left. But can not the surgeon determine whether he is to rotate the arm—the humerus—inwards or outwards? Not always; in a fleshy limb the point can not be determined by outward palpation, though the attitude of the limb may help in the differential diagnosis; yet if only two ways are to be tried, the second method will succeed, if the first fail.
The practitioner who talks about partial dislocations of the shoulder, as if the lesion were common, does not know what he is about; he is a man whom the "one-setter" will beat. The discoverer of partial dislocations has little confidence in his diagnostic powers, manipulates at random in a purposeless manner, and "hopes for the best." He uses a liniment, and advises rest—possibly with the injunction that the patient be careful not to undo the good work already accomplished!
Ilio-femoral arthritis is so common, and so difficult to cure, that cases treated well by regular physicians not infrequently drift into the hands of "natural bone-setters." But these alleged possessors of supernatural powers rarely do any substantial good. Occasionally a case is benefited by a thorough overhauling, yet damage is often done. Some years ago a little girl on East Fourth Street was thoroughly manipulated by a peripatetic bone-setter, and the patient died in a week. She died of the wasting disease, but the end was hurried by the untimely attempt to reduce a bone which was not out of joint—was not luxated.
In cases of partial anchylosis, say of the elbow, following fracture of a humeral condyle, the itinerant possessor of inborn skill will sometimes break the fortuitous bands which constitute the "false anchylosis" and give mobility to the restricted articulation. —HOWE, Eclectic Medical Journal, 1888.