MANIPULATIVE SURGERY. The earliest practitioners of "bone-setting"—the old name for what is now described as manipulative surgery—date back into very remote times, and Hippocrates was the author of a treatise on dislocations. The history of the Roman Republic tells of successful practitioners of this ancient craft.
During the years when surgery was gradually being regularised and its seats of learning were being established, "bone setters" were the only orthopaedic surgeons of those days, and the doctors apparently countenanced them as legitimate exponents of that section of therapeutics. The famous surgeon, William Cheselden, in the middle of the 18th century, used to send cases to the bone setters for treatment, and frankly admitted that he did so because he was not competent to treat them himself.
The renowned surgeon, John Hunter, was amongst the first of eminent surgeons to realize the value of early movements in cases of sprains and joint injuries. He wrote: "Nothing can pro mote contraction of a joint as much as motion before the disease is removed, but when all inflammation is gone off . . . a little motion and frequently repeated is necessary to prevent healing taking place with the parts fixed in one position." The world of conservative surgery owes an unpayable debt of gratitude to Sir James Paget who, in his desire for the public weal and the true interests of science, wrote to The British Medical Journal in Jan. 1867, urging his professional brethren to "learn what was good in the methods of the bone-setter, and eschew what was harmful." Paget stood on firm ground when he declared that "too long rest is by far the most frequent cause of delayed recovery after the injuries of joints, and not only to in jured joints but to those that are kept at rest because parts near them have been injured." Later, Dr. Wharton Hood, who had conceived the greatest ad miration and respect for Robert Hutton, the bone-setter, and who recognized the false teaching of his profession in regard to many forms of joint injuries and derangements, made a thorough investigation of Hutton's methods, and after the bone-setter's death published a description of them in The Lancet.
It is difficult to assign with certainty the predisposing factor in such cases, though heredity probably plays some part in its origin. As many as four members of one family have been known to suffer from the complaint. The hands of the operator—if sufficiently powerful—constitute a much more effective instru ment for forcing the foot and ankle into their normal positions than the Thomas wrench which is largely used even now. Several corrections should be made at short intervals, followed im mediately by certain exercises in place of the one or two adjust ments which used to be considered sufficient. The encasement of the joint in plaster of paris is secure immobilization and rest in bed must on no account be recommended. The anatomical con tour of the foot is palpably bettered even after the first manipula tion, and each operation brings the patient nearer full recovery. Almost all cases of adhesive and acquired flat-foot should re cover. Congenital cases are much less satisfactory, though even in these improvement can generally be looked for. The technique is difficult and should be taught by cinematographic pictures so slowly reproduced that students can follow each manipulation carefully.