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Not every poem's good because it's ancient,
Nor mayst thou blame it just because it's new,
Fair critics test, and prove, and so pass judgment;
Fools praise or blame as they hear others do
The origin of bonesetting -- treatment and replacement of joints -- is lost in the mist of antiquity. In the historical development of medicine, there are many references to the practice of bonesetting by both qualified and unqualified practitioners. (In using the term "unqualified," we refer to those who take up the practice of healing without having had any formal training in the accepted medical procedures of the day.)
In some of the early hospitals, bonesetting was the duty of a few members of certain religious orders. These manipulations were no doubt performed with various religious incantations to their respective Gods. One of these religious bonesetters, Friar Moulton, of the order of St. Augustine, wrote a book entitled the Compleat Bonesetter, which was revised in 1656 by Robert Turner and which is presently in the library of the Royal College of Surgeons of England. It is interesting to note that Turner, in his introduction to the book, mentioned that the book was intended to be a guide for "the use of those Godly Ladies and Gentlewomen, who are industrious for their talent God has given them, in helping their poor sick neighbors." This seems to indicate that bonesetting was a practice commonly employed in the homes of England in the 17th century, and, curiously enough, primarily by women. One of the most famous lay bonesetters in the history of bonesetting was a woman: Sally Mapp, the daughter of an English bonesetter of the 18th century.
In addition to the use of manipulation as a method of setting fractures, reducing dislocations, and restoring mobility to an injured or diseased joint, there is considerable evidence that many ancient cults and individuals attempted to treat disease by ceremoniously manipulating or popping the joints. This was especially true among those groups and civilizations that routinely employed massage in their treatment methods.
The ancient Chinese were experts at massage. (In China today, however, the practice of massage has been relegated to the duties of blind and old women.) During the Neolithic period (the latter part of the Stone Age), massage was part of the culture of coastal inhabitants of the Mediterranean races, of India, up the Pacific coast of China, and of the inhabitants along the coast of Mexico and Peru . The art of massage and bonesetting are too closely allied to assume that those who practiced massage did not apply forceful movement and pressure to the joints-especially when the joints seemed to be disturbed in their functions. We cannot, of course, attempt to give a complete history on the origin and ancient use of joint manipulation and massage, since such information in its entirety is not readily available and is not entirely within the scope of this book. Only a few examples will be necessary to demonstrate the ancient nature of a physical treatment that is obviously as old as the human race itself.
Some claim that the American Indians practiced a form of spinal manipulation (for centuries) that is similar to the ancient and present-day forms of spinal "bonesetting." It is well known that general bonesetting was skillfully practiced by Indian tribes all over the continent, particularly the Sioux Indians, the Winnebagos, the Creeks of the southeastern United States, groups of the north Pacific Coast, and certain Brazilian tribes. (3-G) One author relates the story of having witnessed an Indian hunter reduce a dislocation in his own hip after catching his leg in a tree. Since it would seem to be a natural tendency for man to attempt to "replace" a joint that was obviously out of its normal position, such has probably occurred from time immemorial notwithstanding man's ignorance.
Claudius Galen, in his 2nd-century work, On the Natural Faculties, wrote of Amazonian women who purposely dislocated the hips of some of their male children in order to compel them to undertake certain types of work that an able-bodied man would normally refuse to do.
When Spanish conqueror Hernando Cortez invaded Mexico in the 16th century, Aztec doctors were "concerting the bones," or manipulating the joints, as an essential requirement of the more qualified doctor's duties.
Trying to trace the origin of joint manipulation and massage would probably be quite impossible, for both have undoubtedly existed in one form or another since the beginning of man. It is a natural tendency for one to massage and manipulate an aching muscle or limb. Everyone, at some time or another, has felt the urge to throw back his shoulders and relieve the binding of spinal fatigue. It is not too much to assume that primitive man devised methods of accomplishing the instinctive tendency to massage and manipulate his fatigued and aching muscles and joints in order to maintain a desired flexibility. I can recall seeing pictures of a primitive native tribe giving exhibitions of one of their favorite sports whereby practiced natives climbed atop a high perch and then proceeded to dive head-first onto a padded area on the ground. If any of these daring sportsmen suffered ill-effects from their feat, they submitted to the manipulations of a female bonesetter who quickly "jerked out the kinks."
Most of us have known individuals who, without ever having seen a spinal manipulation performed, were able to "crack" their own spines. We have all had the experience of inadvertently snapping our joints while luxuriously stretching our fatigued frames. Although primitive man may have interpreted these sounds to be some mysterious spiritual phenomena, the more modern man began to assume that "little bones" were simply snapping back-into-place-or out-of place.
Ancient Babylonian healers stroked the patient seven times (a magic number) in order to rid the body of a demon of sickness. When pain was present, the healer placed the head of the patient lower than his feet and kneaded or struck the back while repeating the incantation "It shall be good." No doubt, this manipulation, employed to drive evil spirits out of the body, occasionally caused the spine to snap-a sound that was probably often interpreted as the sudden exit of an unwanted spirit.
The sense of well-being associated with mechanical treatment of the body's structures probably gave such treatment priority consideration in the limited armamentarium of ancient physicians who did not possess today's knowledge of specific treatment for disease. In modern medical care, massage and manipulation play important parts in the treatment and rehabilitation of crippled and bedridden patients. In keeping with ignorance and human nature, however, such treatment is still the "panacea" of various cults that have not changed their ancient methods of treatment in order to keep pace with the developments of medical science. The tremendous psychological influence of "popping bones back-into-place" has been a potent factor in maintaining such practice as a general treatment for disease-hiding the real value of such treatment under a fog of ignorance. In addition, the theory of a "bone-out-of-place," interfering with nerve or blood supply, was beautifully simple and logical to the uninitiated mind; so much so that an inadequate basis for placing limits upon the theory also served as a cover over any real reason why the theory should have any value at all.
Today, those who promote the use of spinal manipulation as a supreme treatment for disease confuse the picture by contending that medical science recognizes the claims of such treatment when a physician, or other practitioner, prescribes manipulation for a binding joint, a herniated intervertebral disc, or a selected condition that is actually related to a spinal disorder or a structural derangement. Actually, the treatment of joint conditions as specific entities, by scientific manipulation, does not, in any way, validate the use of such treatment as the most important treatment for disease. As we shall see, the use of scientific manipulation has been part of legitimate medical practice for centuries, while, likewise, many cults and laymen have used the treatment without recognizing or exercising any limitations in its application. In any event, the relationship of the body's structures to disease is being carefully studied and recorded in scientific publications-notwithstanding the extravagant claims of those who believe excessively in that approach to the treatment of disease, or the dubiousness of those who are confirmed skeptics.
My father, who grew up in Czechoslovakia, told me that, in his homeland, families had used spinal manipulation in the home for centuries. As a child, he was regularly commissioned to walk barefoot up and down the spine of his father. Following a day in the fields, laboring under the pull of the earth's gravity, this, no doubt, was a beneficial and relaxing form of treatment. Some "professional spinal manipulators" of that day trained small bears to walk up and down a man's spine, and offered such services for a fee. The additional weight of the bear no doubt "popped" the bones more readily than many were able to do by other means-although probably not without considerable risk to the patient.
In Hawaii today, in Japan, and in a few other countries, masseurs still practice a crude form of spinal manipulation-handed down from generation to generation-by walking over the patient's back while holding to an overhead bar.
In the Netherlands Indies, babies born feet-first on the island of Nias are still believed to have special talents for manipulating the joints.
The Ancient Egyptians left scrolls describing methods of treating fractures, dislocations, and injuries resulting from falls or blows. The Edwin Smith Papyrus, for example, described a method of setting the collarbone as follows:
If thou examinest a man having a break in his collarbone ... thou shouldst place him prostrate on his back, with something folded between his two shoulder blades; thou shouldst spread out his two shoulders in order to stretch apart his collarbone until that break falls into place .
While a joint that is only partially misplaced or subluxated can often recover without any special treatment, joints that have been dislocated obviously cannot always recover without special manipulative treatment. Recognizing this, ancient physicians have probably always attempted to replace those joints they thought were out of socket. This also resulted in the manipulation of many joints that were not actually dislocated. As the techniques of joint manipulation were passed down through the ages, however, the physician began to manipulate more specifically for the dislocated joint or fractured bone, while lay bonesetters began to employ the manipulations for a wide variety of conditions . . . thus obscuring the value of the treatment for specific conditions other than actual dislocations. The extreme and sharp division of the bonesetters' activities from those of the physician-and the value found between these extremes-is essentially the basis for this text.
German physicians report that some forms of manipulation resembling modern chiropractic manipulations still persist in the folk medicine of Germany. It was stated that, in addition, such treatment was once part of the official medicine of Germany, and that, although it was forgotten over the years, it is now being reclaimed by the physician-for what value it has-and incorporated into the practice of medicine.
Cato the elder, a Roman statesman (234-149 BCE) practiced bonesetting during the time of the Roman republic. In his De Re Rustica, we note that he reduced dislocations while reciting the following incantation:
"Haut hanat ista pista sista damiate damnaustra."
This fearful sounding invocation no doubt sounded like the last rites to many a frail individual submitting a painfully dislocated joint to Cato's manipulations.
During the time of Cato, Roman physicians were few and poorly trained. The practice of medicine for a fee was not a dignified profession in warlike Rome, and the head of each family was more or less compelled to look after his own. There was a God for every disease, and most Romans depended upon these Gods to help them through their illnesses.
The Greeks, on the other hand, were organizers of culture. There were many good physicians in Greece, the most notable of whom was to be Hippocrates. Modern medicine is said to have originated in Greek medicine. Some of the Greek physicians moved into the virgin territory of Rome and started a practice; many of them, however, were quacks who simply hung out signs and solicited patients -- treating them with any method at their disposal. Cato, the most tyrannically influential man in Rome, spoke out against the use of physicians, especially Greek physicians, advising his followers that they had "got on for six-hundred years without physicians" and that there was no need for them now. Thus, while Cato's advice may have saved some from the ministrations of the many quack physicians migrating to Rome from Greece, his advice also delayed the acceptance of high-quality Greek medicine so badly needed by the Roman citizens. No doubt Cato's influence had much to do with the manner of treatment used in the homes of Rome. One of his favorite treatments, in addition to bonesetting performed with incantations, was that of applying cabbage to the body, both internally and externally. Fearful of quack physicians, and under the influence of Cato "the bonesetter," many Roman families continued to employ their old methods of treatment "with the help of their Gods."
Eventually, however, Greek medicine came to be accepted in Rome, and physicians were appointed to fill positions in the cities under the auspices of the Roman government. But the advance of Greek medicine was soon halted; for after the Roman Empire fell and Greek medicine deteriorated, rational medicine was again replaced by superstition, and the influence of theology crushed all traces of the advanced medicine of ancient Greece. There were centuries of struggle between science and religion before the teachings of Hippocrates and other Greek physicians were resurrected.
Before the reign of Hippocrates, Aesculapius, an ancient Greek physician (often referred to as "the first physician"), supposedly employed methods of treatment such as bonesetting. Priests, under the direction of Aesculapius, conducted sleep cures in elaborately constructed temples. Aesculapius himself would advise patients under treatment as they lay with their eyes closed. This was probably a very powerful and effective form of autosuggestion. While the patients slept in the temple, the sacred serpents of healing were supposed to appear and lick their lesions, thus curing them of their diseases. Before patients left the temple, they read testimonials and accounts recorded on temple tablets by other patients who had supposedly suffered similar diseases but who had been cured of their afflictions by the temple treatment. This phase of Aesculapius' treatment was obviously a form of suggestion and hocus-pocus, but the treatment became very popular nevertheless. The very atmosphere of the beautiful temples undoubtedly had a beneficial effect upon the minds of those who went there for treatment. Not all of the intelligent Greeks were fooled by this type of ministration, however, for many recognized the falsehoods of the "sleep cure" and the "healing serpents." As a result, the temples of Aesculapius gradually began to include the use of special baths, exercises, and other forms of treatment, of which, it is suspected, bonesetting was a part.
Today, interestingly enough, more than 2,000 years after the time of Aesculapius, there are still some practitioners who are exercising unreasonable faith in the efficacy of single or obsolete methods of treatment, and who are being forced by time and consumer intelligence to add additional methods of treatment to their procedure. This is particularly true among those who practice spinal manipulation as a sovereign method of treating disease. Many of these practitioners still prescribe a "rest treatment" following "bone adjustment" -- placing the patient upon a couch in a quiet room and asking him to remain there half-an-hour or more so that the treatment "will be more effective." In many cases, especially with the nervous patient, the rest and suggestion of such a procedure are probably more beneficial than the actual treatment.
Much mythology surrounds the story of Aesculapius, so much so that some doubt that he actually existed. After his death he was made a God of Medicine and was worshipped in Grecian temples. The religious followers of Aesculapius continued to practice the .,sleep cure" and other forms of cult healing, while his more scientific descendants followed more progressive methods of healing -- culminating in modern medical science. Today, the symbol of Aesculapius -- two serpents twined on a staff (the caduceus) -- remains as the symbol of modern medicine.
It was not until the influence of Hippocrates prevailed, however, that religious superstition was separated from the practice of medicine. Hippocrates (460 B.C. - 375 BCE), the greatest of the Greek physicians, is known today as "the father of medicine." He left many volumes of work on the observation and treatment of disease. Many of his descriptions of disease have been changed but little. In the treatment of his patients, Hippocrates recommended such simple measures as rest, sunlight, exercise, and diet. Not using an excessive amount of drugs, he altered the environment contributing to sickness and treated the patient as a whole; he laid the foundation for the practice of modern, rational medicine.
Hippocrates completed at least three works on the bones and joints, these three of which were entitled: On Fractures; On the Articulations; and On Setting Joints by Leverage. The aphorism "look well to the spine for the cause of disease" was reported to have been written by Hippocrates. He apparently recognized the existence of symptoms that coursed over the spinal nerves making their exist near diseased vertebrae, as well as certain paralytic symptoms caused by severe injuries to the spinal column.
In spite of the fact that little was known of the correct anatomy in the time of Hippocrates, Hippocrates himself made amazingly accurate diagnoses and devised commendably skillful methods of manipulating- the joints. Many of his methods of reducing dislocated limbs are similar or much the same as methods used today. With practiced observation and clinical art, Hippocrates examined the joints in a manner that compensated for his imperfect understanding of the actual anatomy. "A dislocation may be recognized by the following symptoms," he wrote in his treatise, On the Articulations. "Since the parts of a man's body are proportionate to one another, as the arms and the legs, the sound should always be compared with the unsound, and the unsound with the sound, not paying regard to the joints of other individuals (for one person's joints are more prominent than another's) , but looking to those of the patient, to ascertain whether the sound joint be unlike the unsound." 
Although many early chiropractors claimed that the founder of chiropractic was the first to recognize the fact that subluxations (displacements that are not luxations or dislocations,) occur in the body's joints, especially in the spine, we note with considerable interest that Hippocrates himself recognized the difference between subluxated and luxated joints. In his work On the Articulations, for example, he advised fellow physicians that ". . . luxations and subluxations take place in different degrees, being sometimes greater and sometimes less . . . but when the bone has slipped, or been displaced to a less extent, it is easier to reduce such cases than the other."  Thus, we learn from Hippocratic writings that physicians more than 2,000 years ago recognized various degrees of displacement in the spinal joints and attempted correction accordingly.
In reading the work of Hippocrates, we gather that a good many physicians of his time were attempting to correct spinal disorders, many of whom apparently were ignorantly or intentionally taking credit for correction of "spinal dislocations" that were actually subluxations, strains, and other less serious conditions. In noting Hippocrates' impatience with such practitioners, many of whom, he said, "are ignorant, and profit by their ignorance, for they obtain credit from those about them," he might be astonished to learn that human nature has changed but little, or none, in this time remote from his own observations. For today, charlatans still falsely obtain credit from those about them in the eternal perpetuation of quackery. Strangely enough, Hippocrates' admonitions concerning improper interpretation of spinal treatment are as applicable today as they were when they were first spoken.
Although Hippocrates was quite unaware of the cause in most cases, he did note that "humps" in the spinal column, especially when they were accompanied with "tubercules in the lungs," were quite impossible to correct. "The vertebrae of the spine when contracted into a hump behind from disease, for the most part cannot be remedied, more especially when the gibbosity [hump] is above the attachment of the diaphragm to the spine." Today, of course, physicians recognize some of these "humps" as being tuberculous infection of the thoracic vertebrae, a condition that should not be treated forcefully under any circumstances. In fact, unrecognized tuberculous joint disease, ultimately resulting in a deterioration of the infected bone, has become the bugaboo of every conscientious joint manipulator, whose treatment, when applied in such conditions, could result in complete destruction of the forcefully moved joint.
It was also an opinion of Hippocrates that the sudden appearance of gross deviations in the spine, following severe injuries or falls, were also incorrectable in many instances, probably as a result of compression fracture of one or more vertebrae, or dislocation of a spinal articulation. "When the spine protrudes backward, in consequence of a fall," he advised, "it seldom happens that one succeeds in straightening it." Since most dislocations of the spine, with the possible exception of atlanto-occipital (the skull and Ist vertebra) or atlanto-axial (Ist and 2nd vertebrae) dislocation, are associated with bone -- fracture and tearing of the spinal ligaments, modern orthopedic surgery now plays an important role in the reduction of vertebral dislocations, thus removing pressure upon the spinal cord. In many types of spinal injury, however, even in compression fracture of a vertebra, spinal traction or spinal extension, and other conservative measures, often provide correction without resort to the use of surgery.
As far back as the latter part of the 12th century, Gilbertus Anglicus made practical suggestions for correction -- without the use of surgery -- of a "broken neck" when it involved dislocation of the atlas-axis articulation. He suggested that the patient be placed upon his back on the floor so that the surgeon, passing a strip of cloth under the patient's chin, could place his feet upon the patient's shoulders and reduce the dislocation by exerting heavy traction upon the patient's neck. His work, entitled Compendium, also prescribed treatment for many other types of dislocations, along with a description of conditions contemporary with his own lifetime -- approximately 1170 to 1230.
Since spinal surgery, as we know it today, was not part of the armamentarium of Hippocrates, this great physician was compelled to select for treatment only those cases he thought could benefit without further unnecessary injury to the patient. One of the most popular methods of treating spinal injuries among the contemporaries of Hippocrates was a method of "succussion," that is, tying the patient outstretched upon a ladder and shaking him vertically so that the weight of the body could stretch the spine in a corrective manner and reduce existing "dislocations." Although Hippocrates described this method of treatment in his writings he used it sparingly, probably because, as we shall see, there were better ways known to adjust the spine, and because "succussion" was a treatment routinely employed by the quacks of his time. In his treatise, On the Articulations, he explained:
Wherefore succussion on a ladder has never straightened anybody, as far as I know, but it is principally practiced by those physicians who seek to astonish the mob -- for to such persons, if they see a man suspended or thrown down, or the like; and they always extol such practices, and never give themselves any concern whatever bad or good. But the physicians who follow such practices, as far as I have known them, are all stupid. The device, however, is an old one, and I give great praise to him who first invented this, and any other mechanical contrivance which is according to nature. For neither would I despair, but that if succussion were properly gone about, the spine, in certain cases, might be thereby rectified. But, indeed, for my own part, I have been ashamed to treat all such cases in this way, because such modes of procedure are generally practiced by charlatans.
In this interesting statement by Hippocrates, we find an analogy more than 2,000 years old that might appropriately describe a situation existing today in regard to medical interpretation of chiropractic activity. For example, while there are a great many medical practitioners who see values in the use of spinal manipulation, when it is "properly gone about," many qualified physicians hesitate to prescribe or use certain manipulative procedures that have so long been employed by medically unqualified practitioners. This peculiar situation will be greatly clarified in the closing chapters of this book.
In spite of the fact that Hippocrates favored somewhat different methods in treatment of the spine (to be described later), writers often attribute ancient use and origin of succussion on a ladder to the originality of Hippocrates who, as we have shown, stated that the practice was in use many years before his own time. Misinterpretation of the Hippocratic writings is often brought about by the fact that these writings are among the oldest in medical literature, thus leading many persons to believe that everything Hippocrates wrote was quite original. Actually, much of what he wrote, regarding various treatment methods, was an accumulation of knowledge and ideas passed down through centuries of unrecorded medical practice. In any event, Hippocrates described the practice of succussion on a ladder as follows:
The ladder is to be padded with leather lined cushions, laid across, and well secured to one another, to a somewhat greater extent, both in length and breadth, than the space which the man's body will occupy; he is then to be laid on the ladder upon his back, and the feet, at the ankles, are to be fastened, at no great distance from one another, to the ladder, with some firm but soft band; and he is further to be secured, in like manner, both above and below the knee, and also at the nates [buttocks); and at the groins and chest loose shawls are to be put round in such a fashion as not to interfere with the effect of succussion; and his arms are to be fastened along his sides to his own body, and not to the ladder. When you have arranged these matters thus, you must hoist up the ladder, either to a high tower or to the gable end of a house; but the place where you make the succussion should be well instructed, so that they may let go their hold equally to the same extent, and suddenly, and that the ladder may neither tumble to the ground on either side, nor they themselves fall forward. But, if the ladder be let go from a tower, or the mast of a ship, fastened into the ground with its cordage, it will be better, so that the ropes run upon a pulley or axle-tree. But it is disagreeable even to enlarge upon these matters; and yet, by the contrivances now described, the proper succussion may be made.
These matters should be thus arranged, if recourse is to be had at all to succussion on a ladder; for it is disgraceful in every art, and more especially in medicine, after much trouble, much display, and much talk, to do no good after all .
When the "hump," or other disturbance, was "lower down" in the spine, the ladder was dropped vertically from a height, with the patient bound to it in a "feet-first" position, so that when the bottom of the ladder struck the pavement the effect was much like that of the jar experienced by a parachutist. When the disturbance was higher up in the spine, or in the neck, the patient was placed upon the ladder in an "up-side-down" position, so that the force of gravity, suddenly multiplied when the ladder struck the pavement, could stretch the suspended spine.
As we noted earlier, Hippocrates was not enthusiastic about the use of the ladder in treatment of spinal disorders. For the most part, he seemed to favor methods requiring controlled traction (applied from each end of the body) combined with specific corrective movements applied directly to the involved joints. For example, in the treatment of spinal curvatures, he recommended that the patient be placed face-down upon a bench "covered with robes, or any thing else which is soft, but does not yield much," with straps placed under the arm pits and across the chest, and around the knees and ankles, so that traction ("extension") could be applied from both ends of the bench while the correction was being made.
... the physician, or some person who is strong, and not uninstructed, should apply the palm of one hand to the hump, and then, having laid the other hand upon the former, he should make pressure, attending whether this force should be applied directly downward, or toward the head, or toward the hips. This method of applying force is particularly safe; and it is also sale for a person to sit upon the hump while the extension is made, and raising himself up, to let himself fall again upon the patient. And there is nothing to prevent a person from placing a foot on the hump, and supporting his weight on it, and making gentle pressure; one of the men who is practiced in the palestra would be a proper person for doing this in a suitable manner .
Here we have evidence of the use of spinal manipulation by medical practitioners hundreds of years before the birth of Christ, indicating that such practices, were probably commonly used many hundreds of years before the first written evidence indicating the use of such. The method above, as described by Hippocrates, offers a practical technique of spinal correction that has changed but little in modern orthopedic practice. (Modern orthopedic surgeons still employ combinations of traction and manipulation in the reduction of certain types of vertebral fractures not corrected by suspension or extension of the spine. "The majority of vertebral fractures may be reduced by suspension without manual manipulation at the point of fracture. Manipulative reduction under anesthesia is indicated only when ordinary suspension does not result in complete disappearance of the kyphos and should be done only by surgeons with experience." ) In principle, in fact, it has not changed at all. There are many chiropractic and osteopathic manipulations that are still quite similar in technique..
Hippocrates described another method of spinal correction that he considered to be the "most powerful of the mechanical means." Essentially, it was performed by placing heavy padding over the area of the spine to be treated (while the patient was face-down and under traction) and then ramming the padded area with a wooden beam guided in direction by an overlying, slotted, wooden plank. No doubt the spine responded to such forceful thrusts with resounding "pops" -- much like the "popping" one hears today when witnessing or experiencing certain osteopathic and chiropractic manipulations. Reminiscent of this ancient method of adjusting the spine, it is interesting to note that one chiropractic college -- only a few years ago -- devised a method of spinal adjusting employing the use of a mallet and a rubber-tipped driving rod; the rod was placed against the spinous process of the offending vertebra and then tapped by the mallet in a corrective direction. This method did not prove to be popular among chiropractors, however, and it was soon forgotten.
Another method described by Hippocrates, with which he himself had little success, but which was a less drastic method of adjusting the spine, was that of placing the patient on his back upon a deflated air bladder, and then inflating the bladder while traction was being applied from either end of the spine. Hippocrates complained that this method was rather ineffectual because the patient kept "rolling off" the expanding bladder. Although modem orthopedic measures sometimes employ this principle of spinal correction by applying turn-buckle corsets about the patient's trunk, it would appear that the ancient method of inflating an air bladder under a spine held fast on either end, with the patient placed deep within a trough to prevent movement from side to side, would actually be desirable in cases that would not permit the roughness of physical contact with solid objects.
There was one other method commonly used by the contemporaries of Hippocrates in an effort to make corrections in the spine. This was the application of suction cups to the spine so that vertebrae that have "protruded forward" could be "drawn back" into their proper positions. Considering belief in the efficacy of this method to be an error of judgment, Hippocrates looked upon use of the suction cups as a method without any value whatsoever. ". . . Displacements forward are of a fatal and injurious nature," he said, "but ... displacements backward, for the most part, do not prove fatal, nor occasion retention of urine nor torpor [paralysis] of the limbs, for they do not stretch the ducts [nerves?] leading toward the intestines, nor occasion obstruction of the same; but displacements forward produce both these bad effects, and many others in addition. And truly they are more apt to lose the power of their legs and arms, to have torpor of the body, and retention of urine, who experience no displacement either forward or backward, but merely a violent concussion along the spine, while those who have displacement backward are least subject to these symptoms." 
Thus, it appears that Hippocrates, who recognized spinal dislocation largely by clinical signs, was quite selective in the application of spinal treatment measures, since he believed that efforts to reduce the more rare spinal dislocation were often both futile and dangerous. Under such circumstances, it seems that the greater part of successful spinal "succussion" experienced in ancient medical practice probably stemmed from correction of spinal subluxations and other such disorders. The fact that mechanical treatment of the spine was both popular and prevalent in ancient medical practice is indicated by Hippocrates' hesitancy to describe "other modes of succussion" in which he had little or no confidence. "I could tell of other modes of succussion than those formerly described, which one might fancy would be more applicable in such an affection [spinal]," he wrote in On the Articulations, "but I have no great confidence in them, and therefore I do not describe them."
Since very little was known about the human body 400 years before the birth of Christ, the genius of Hippocrates was forced to start literally from "scratch." As a result, many of his theories and techniques were naturally quite crude when compared with present-day knowledge and skills. Certain of his methods of setting the joints of the spine, for example, may have been a shocking experience to some of those who underwent his treatment. Although Hippocrates seldom used the ladder method of "succussion" in treatment of the spine, he did recommend that certain patients with dislocated vertebrae be subjected to this method of treatment.
Ambroise Pare, the famous French surgeon of the 16th century, in noting such recommendations in the literature of Hippocrates, wrote:
In outward dislocation of the vertebrae Hippocrates commands to bind the man straight on a ladder, the arms and legs tied and bound, then after having raised the ladder to the top of a tower or ridge of a house, with a great cable in a pulley, let the patient fall like lead on the firm pavement, which Hippocrates said was done in his time. But I do not teach any such way of giving the strappado to men, but I show the surgeon in my works, the method of reducing them safely and without great pain .
Very likely, Pare attempted to press the dislocated vertebrae into place with his hands while the patient's spine was being placed under traction, much like methods that had already been described by Hippocrates himself. As already pointed out by Hippocrates, however, a severe injury would be required to dislocate a vertebra (often resulting in paralysis), and not all of these could be reduced by traction or manipulation. "Cutting upon the patient," or surgery, would be required to correct such injuries among patients who, in years past, simply died of their injuries. Probably a great many of the "dislocations" that were mechanically replaced by Hippocrates and Pare were actually subluxations, or vertebrae that were only partially dislocated.
Ancient Egyptian physicians used a method similar to the ladder method described by Hippocrates in attempts to reduce spinal fractures and dislocations. One wrote that those patients with spinal fractures not accompanied with paralysis could be helped by tying the patient's feet to one end of a ladder and then turning the ladder and the patient upside down, shaking the ladder in order to straighten the patient's spine . If, however, the patient was paralyzed (recognized today as indicating severe spinal damage with nerve injury), the doctor was advised not to disturb the patient with such treatment lest his reputation be ruined by the patient's failure to recover. Undoubtedly, many of the less severe spinal "dislocations" treated by Egyptian physicians were, in reality, subluxations and other less serious conditions of the spine.
Pare was one of the first surgeons to break away from many erroneous concepts of Hippocrates and Claudius Galen (two of the greatest physicians in the history of ancient medicine), whose works had bound the medical profession for centuries. Pare was responsible for a departure in ways from many detrimental and crude surgical techniques that had been handed down over the centuries without question.
The trials and tribulations of medical progress went on, resulting in an ever-changing and ever-better medical practice, but human ignorance maintained many practices and cults unchanged from the most ancient times....
As continued ignorance followed a path parallel to continued progress, the scope of medical science expanded. Claudius Galen, born about 500 years after the death of Hippocrates, gave the first correct anatomical description of the spinal column and its articulations. It was he who divided the spinal column into cervical, dorsal, and lumbar regions, designating the correct number of vertebrae. Galen's teachings on fractures and dislocations far surpassed those of Hippocrates. Although Galen died in the year 200 A.D., his authority was almost undisputed until the 16th century. It was Andreas Vesalius who first recorded the correct anatomy of the entire human body with publication of his work, De Humani Corporis Fabrica, in 1543 -- based on actual dissection of the human cadaver.
By the turn of the 18th century, when correct anatomy was common knowledge to every qualified medical practitioner, and medical science was still on the threshold of better days, many unorthodox practitioners were enjoying much popularity around the world. "Crazy" Sally Mapp, for example, was touring London from her home in Epsom, where she was paid to reside, "setting bones and curing disease." Sally Mapp was the daughter of an English bonesetter, whose technique of practice had been handed down through the centuries almost exclusively through family contacts.
In 1736, the Gentlemen's Magazine wrote of Sally Mapp:
. . . The attention of the public has been taken off from the wonder working of Mr. Ward to a strolling woman now at Epsom who calls herself "crazy Sal"; and had performed cures in bonesetting to admiration, and occasioned so great a resort that the town offered her 100 guineas to continue there a year .
Joshua "Spot" Ward (so named because of a birthmark on his face) and many other practitioners were busy dispensing nostrum pills, "laying on their hands," conveying "magnetic healing power," "setting bones," and fabricating hundreds of worthless methods of treating disease-most of which seemed to enjoy considerable popularity, even among the nobility and the literate. While medical science was making considerable progress in its methods of treatment, the public was still many years behind in knowledge of what was contained in the books of medical universities.
Although quackery ran rampant in the 18th century, in bonesetting and in every other conceivable approach appealing to human credulity, qualified practitioners were busy making contributions in the treatment of bones and joints through the field of orthopedics. Dr. John Hunter, for example, a qualified medical contemporary of "Crazy Sal," was busy teaching the value of movement of joints after injury in order to prevent stiffness and adhesions. There is no doubt that many bonesetters, such as Sally Mapp, actually did accomplish some good by breaking down adhesions in some of the joints they manipulated, even though they manipulated, without sufficient knowledge of the joints, tuberculous and infected joints alike with disastrous results. While John Hunter would have recognized the existence of adhesions in a joint that might have benefited from manipulation, as opposed to the use of such treatment in the presence of a disease process, the bonesetters always manipulated for a "bone-out-of-place," regardless of the patient's condition. Essentially, this is still the difference between the practice of the qualified and the unqualified manipulator.
Sir James Paget, a famous surgeon and authority on bone diseases in the 19th century, was one of the qualified practitioners who observed that there was actually some value in many of the manipulations performed by the bonesetter; for in a lecture entitled "Cases That Bonesetters Cure," published in the British Medical Journal, January 5, 1867, he stated:
Few of you are likely to practice without having a bone-setter for a rival; and if he can cure a case which you have failed to cure, his fortune may be made and yours marred.... Learn, then, to imitate what is good and avoid what is bad in the practice of bone-setters. (9-F)
From this statement by Dr. Paget, we get an idea of the prevalence of bonesetters who practiced during the year of that lecture. Probably, in 1867, when few specific remedies for disease were known, and public ignorance was quite pronounced, the spectacular practice of the untrained bonesetter posed a real economic threat to the more conservative and legitimate physician. Many of the early bonesetters, having little knowledge of the anatomy of the bones and joints, frequently adjusted "a little bone back-into-place" where there was, in fact, no joint at all.
Up until the 16th century, when Vesalius gave a correct anatomy of the entire human body, the numbers of bones in the human frame were given in widely varying figures, which usually included a "nucleus bone," generally known as the "bone of Luz," from which it was believed that the body would be resurrected. The Jews, Christians, and Mohammedans believed that the coccyx (tail bone) was the "resurrection bone" because it seemed to be the most indestructible of the bones. Others believed that the sacrum was the "regeneration bone," or the bone from which the body was to be reborn. Hippocrates counted only 91 bones in the body (111 including the fingernails).
Later physicians, by boiling the flesh from the bones of executed young persons, counted as many as 252 bones. This excessive number was due to the fact that many of the bones in a young frame still present growth-centers, thus dividing what was actually one bone into two or more. There are 206 bones in the mature human skeleton.
Although qualified medical practitioners had access to the correct anatomy of the body after the time of Vesalius (of the spinal column after the work of Galen), lay bonesetters continued to manipulate under false impressions of human anatomy. Like "cutting for the stone," much of the bonesetter's treatment was applied to imaginary lesions. In the area of a disturbance, the tissues were simply manipulated under the false belief that a little bone was being put back into place. Many manipulations upon joints for what were supposedly "dislocations," or "bones-out-of-place," were more often performed upon real and imaginary conditions short of actual dislocations. The pain caused by partial dislocation or subluxation of a joint was probably always attributed to alleged dislocations. No doubt, however, the bonesetter treated both imaginary and real "bones-out-of-place" with both tragic and beneficial results. Much of the value found in the bonesetter's practice was yet to be widely employed in medical practice, even though several prominent medical practitioners had published descriptions of the use and the limitations of manipulative treatment. There is much literature in old medical writings on the subject of reducing dislocated and partially dislocated joints. Although qualified medical practitioners did not dwell upon the treatment of such imaginary processes as "a-little-bone-out-of-place," there is no doubt that "subluxated" joints were treated in the same manner as those that were actually dislocated, since the symptoms are similar and the difference in displacement only one of degree.
In 1871, Wharton Hood, M.D., published a treatise (On Bonesetting) after observing the methods used by a contemporary bonesetter. Hood, who discovered that there was a great deal of value in manipulating certain joint conditions in addition to those that presented actual displacement, published a series of articles in a British journal explaining the methods of bonesetting he had learned from Robert Hutton, a well-known bonesetter in London. In describing his own findings, Hood stated:
The whole mystery of "bone-setting," precisely what it could do and where it was injurious, was laid open to the medical profession in the plainest language .
In the history of medical orthopedics, there are many other practitioners who championed more and better use of joint manipulation in medical practice. Because of the ignorant beliefs prevalent among those who practiced bonesetting exclusively, however, many members of the medical profession were slow in recognizing the real value or manipulation in correcting joints stiffened by adhesions and other correctable disorders. Even today, as a result of the efforts of spinal manipulators to cure all or most disease by manipulating the spinal joints (correcting a "bone-out-of-place"), the stigma upon manipulative treatment remains to a great degree. In spite of the fact that joint manipulation is now recognized as an important branch of orthopedic work, many physicians, in observing the doctrines and the practice of non-medical practitioners who employ manipulation, refuse to consider the value of manipulation as defined by qualified medical authority-even though treating a sacroiliac condition by manipulation, for example, is quite remote from treating a case of appendicitis by the same treatment.
There were apparently a large number of bonesetters practicing many years before the professions of osteopathy and chiropractic appeared on the horizon. Although the early history of bonesetting (as practiced among the ranks of laymen and as promoted by medical men) seems to come predominantly from England, it is a peculiar fact that the nonmedical professions stressing joint manipulation as a sovereign method of treating disease today exist almost entirely in America. There are no nonmedical chiropractic schools, for example, outside the boundaries of the United States. Canada has one chiropractic college that has been approved by the National Chiropractic Association. Although bonesetters once existed in large numbers in England (while America was being plagued by magnetic healers, faith healers, mind-cure practitioners, and so forth), the practice of bonesetting in osteopathy and chiropractic eventually became illegal in that country. According to Hill and Clegg (What Is Osteopathy), osteopathy, attempting to "erect a new theory of health and disease on an imaginary pathology and unproved hypothesis," was refused recognition in England in 1937. Today, many fine publications on joint manipulation come from the pens of orthopedic specialists in England.
It was not until 1874, under the teachings of Andrew Taylor Still, in the United States, that the art of bonesetting was organized into an independent professional practice that attempted to uniformly treat disease according to basic principles and a specific theory in competition with medical practice. As we shall note in a later chapter, however, the practice of osteopathy has branched out into the field of medicine and is, today, essentially the practice of medicine. The original tenets of osteopathy were based upon the belief that misplaced or maladjusted joints interfered with the nerve and blood supply, causing disease, and that it was only necessary to manipulate the joints to cure this disease.
Twenty-one years after osteopathy was founded, D. D. Palmer, a magnetic healer of Davenport, Iowa, announced his "discovery" of chiropractic. It seems, however, that there was little or no difference between the practice of osteopathy and chiropractic, both being merely terminological adaptions of the bonesetting that was then becoming very popular in America. While the osteopaths and chiropractors in America conveyed some value in their treatments, and originated certain uses and techniques of joint manipulation that were later recognized to be of some value, the employment and development of joint manipulation in medical quarters was to be unnecessarily delayed by the activities of these two cults that contended that all disease was the result of misplaced joints interfering with blood and nerve supply. However, some contend that the activities of the osteopath and the chiropractor speeded the recognition of manipulative therapy in the treatment of certain conditions other than dislocated or stiffened joints.
As it stands today, pure bonesetting, as a general treatment for disease, is found only in some little-changed chiropractic colleges. Along with a slow recognition of joint manipulation (in medical specialties) in America, a situation, relative to the existence of the profession of chiropractic, has developed that is quite worthy of study. Chiropractors, for the most part, have not limited themselves to values of manipulation as known by medical science, but rather continue in their efforts to treat disease. In our analysis of the situation, we shall attempt to determine, to some degree, whether the existence of the chiropractor as a physician is based upon values unrecognized by medical science or upon public ignorance . . . irrespective of what chiropractic might become in the future. As we have stated elsewhere, there are probably many good chiropractors who limit their activities according to the standards of medical science rather than according to the tenets of the chiropractic creed. Whether chiropractic becomes a practice cooperative with medical science as the specific values of manipulation become more widely known, or whether its doctrine will weigh it into the depths of oblivion, is a subject for much speculation.
Although much of the metaphysical concept was removed from the practice of bonesetting in the theory of osteopathy and chiropractic, an equally erroneous concept was established that was better suited to the changing times. While the chiropractic theory seems to have been patterned after the osteopathic premise, it is interesting to note that the founder of osteopathy claims to have originated the practice according to "divine inspiration" from the "God of Nature." "God is the Father of osteopathy," said Still, "and I am not ashamed of the child of His mind." Still's apocalyptic style of describing the origin and purpose of the practice of osteopathy provided an irresistible attraction to thousands of excessively religious Americans; thus, the practice of osteopathy was a guaranteed success. As in the days of Sally Mapp, the treatment appeared to be quite successful in a great many conditions because of the unrecognized effects of suggestive therapy. Even today, many careless and poorly-trained practitioners fail to distinguish the nervous and psychosomatic conditions (commonly called "functional" conditions) from physical diseases so that treatment may be properly evaluated.
Fifty years ago, before medical science had uncovered many specific causes and cures for human ailments, probably one treatment was as good as another if neither was of much value. As a result, many incompetent healers, bonesetters included, became real competitors of the medical physician in the treatment of disease. As medical science progressed, however, the physician's practice changed and enlarged to include the latest skills and knowledge, while the cults remained limited by their creeds. Factually, the claims and scope of each "panacea" were narrowed as science advanced -- although new facts were and still are slowly assimilated by an apathetic public.
Those who were educated 50 years ago labored under many delusions that have since been expelled in modern education. The present-day scientific student begins with an entirely different concept than did those who, years ago, did not have access to today's accumulated volumes of knowledge. True cultism hinges primarily from ignorance of this source of knowledge.
Inasmuch as the practice of early osteopathy -- and later chiropractic -- was opposed to the practice of medicine, the practice became quite popular among those who were excessively religious and who objected to the methods and practice of medicine. In addition, the simple theories of the spinal manipulators appealed to an ignorance that greatly prevailed in the 19th century and that still extends into the 20th century -- an ignorance of the progress and the scientific principles of modern medical science.
Although the theory of osteopathy -- that misaligned bones interfered with blood and nerve supply, causing disease -- might actually have been original with its founder, there is much evidence to indicate that manipulation of the joints as a treatment for disease had been used for quite some time in America before the conception of the osteopathic doctrine, especially in some religious groups that practiced faith healing by the "laying on of hands," In the middle of the 19th century, for example, the Mormon leader, Joseph Smith, Jr., practiced faith healing employing the use of bonesetting. One of his elders advertised to "set bones through faith in Christ," stating that, "while commanding the bones, they come together, making a noise like the crushing of an old basket." Only the joints of the spine can be made to give out with such sounds as the "crushing of an old basket." Obviously, the laying on of hands in this faith-healing procedure was performed with considerable force. It probably amounted to nothing more or less than the chiropractor's adjustment of the spine as it is used today. Smith and his "manipulators" failed as healers, however, when Asiatic Cholera broke out among his followers. No doubt, today's "manipulators" -- those who contend that adjustment of the joints is superior to the practice of medicine in the treatment of disease -- would also fail in the treatment of such disease if given an opportunity to administer to an epidemic and try out their theories. Fortunately, however, medical science has effectively curbed most of the epidemic-type diseases, and when they do occur, effective means are usually available to prevent their spread.
In the history of medicine, comparatively little is said about the use of bonesetting in the treatment of disease, primarily, I believe, because such practices were used by lay and religious groups more often than by medical practitioners who left records of their activities. Although there is an abundance of literature on "setting the bones" in ancient and recent medical writings, such treatment was reserved primarily for the treatment of actual joint disturbances. In religious and lay groups, on the other hand, bonesetting and the laying on of hands was a practice routinely performed, often with incantations, on many real and imaginary conditions alike in an effort to obtain some mysterious effect or result according to an all-inclusive though highly unlikely theory. As in the case of Joseph Smith, who set bones "through faith in Christ," and "Crazy Sally Mapp," who "performed cures in bonesetting to admiration," many lay bonesetters inadvertently did some good -- and a great deal of harm -- while manipulating for quite another reason. Undoubtedly, the activities of many of these unqualified practitioners uncovered certain values in the use of manipulation that were soon recognized by medical science, although manipulation of the joints in the treatment of joint conditions per se was nothing new in medical practice.
In many underdeveloped parts of the world, where qualified doctors are scarce and disease prevalent, bonesetters and other practitioners of folk medicine still command great popularity. In a 1961 Saturday Evening Post article, for example, Dr. Allan M. McKelvie, of the Orthopedic Letters Club Overseas Project, stated that: "When OLCOP alumni get together nowadays, there is always one point of agreement -- the scourge of the Middle East is 'The Bonesetter.' Apparently his profession goes back into the mists of history and sometimes is handed down from father to son. In cities he is of ten a butcher by trade. After business hours his patients come to the stable yard to have their ailments treated. Barbers and undertakers also ply this medicine-man trade." (Post, July 22, 1961)
In the Holy Bible, there are many references to the "laying on of hands" as a treatment for disease. Although such 'cures were obviously those of faith, and not necessarily the results of manipulation, a few modern-day spinal manipulators have interpreted such references to imply that "Jesus Christ was a chiropractor." Interestingly enough, in addition to the treatment of disease, there is at least one example in the Bible of the correction of an apparent back condition by the "laying on of hands." We note in St. Luke, Chapter 13, verse 11-13:
And, behold, there was a woman which had a spirit of infirmity eighteen years, and was bowed together, and could in no wise lift up herself.
And when Jesus saw her, he called her to him, and said unto her, "Woman, thou art loosed from thine infirmity."
And he laid his hands on her: and immediately she was made straight, and glorified God.
Thus, under some religious interpretations, some bonesetters were simply carrying out the performance of the only treatment Jesus Christ considered worthwhile -- that of "laying on of hands."
We do not have the space to consider all the forms of bonesetting and cultism that preceded the cultivation of scientific manipulative therapy. We have, however, cited sufficient example to construct the barest outline of the antiquity of joint manipulation. In our discussion of the status of chiropractic and its differences with medical science, we will explore the mystery of the chiropractor's treatment and the bonesetter's success -- giving credit where I feel credit is due and discredit where such is due. There are an endless array of qualified medical references describing the use of scientific manipulative procedures, many of which were written in the early part of the 19th century. We cannot, of course, mention more than a few of these. Most of our examples will be drawn from the very latest writings of qualified orthopedic authorities.
Today, cultism (in bonesetting) and medical science still run on opposite tracks, each, of course, in opposition to the other. Although bonesetters have increased in numbers through the development of osteopathy and chiropractic, much of their future existence seems to depend upon the addition of accepted medical procedures to a practice that must be hidden with explanations, borrowed accomplishments, and personality courses. While certain factions of those who practice manipulative therapy (treating disease in competition with medical practice) seem to be undergoing an evolution for the better, there are equal numbers who still believe that joint manipulation (removing nerve interference) is the superior therapy in the treatment of disease and who cling tenaciously to their tenets and to their inheritance.
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