The patient met with an injury resulting in a dislocation, or fracture, or perhaps, only a severe bruise, or a sprain. He readily recovered up to a certain point; but when all inflammation had subsided, there remained a stiffness accompanied by pain on movement. In other cases there were periodical attacks of synotictus. The treatment in all such cases was active movement, with or without chloroform, which was usually accompanied by a click or crack, ascribed by the Bone-setter to the replacement of a bone, but which was due to the freeing of the connective tissue bands. In slight cases, one violent flexion might cure the trouble of months: in severe cases, the treatment might be measured by months rather than minutes. The pathology of such cases was as well marked as that of iritis, where there was the advantage of seeing the adhesions not only form but rupture and disappear. He expressed his obligation to Mr. Wharton Hood’s lecture which had induced him to study the subject. The difficulty of these cases was the selection of time for rupture, and for rest. Signs of inflammation were their guides in that matter. Rest should be regulated to its proper position in surgery, and should not be kept up when it increased instead of abating the patients’ troubles.
Dr. Keetley thought Dr. Clarke could hardly have chosen a more interesting subject, undoubtedly, the Bone-setter frequently earned great credit by the manipulations which broke down adhesions outside a joint, and at the same time, removed the cause of inflammation, for in these cases there was no contraction of membrane. When there was an osseous fibrous hand the case was of a strumous origin, it was due to the presence of organisms. In such cases the joints became altered, and there was great danger from the rough usage of the Bone-setter. In the treatment of such joints he had put on ice for several days with great advantage, and had repeatedly put them straight. When once convalescent, a joint very rarely became strumous. There was much bewilderment with regard to the value of rest, which was only a negative factor. It was the natural tendency of a column of germs to die as the joint became healthy.
Dr. Alderson related the case of a knee which became enlarged fourteen days after confinement, but without pain. He called in Dr. Hewitt who ordered rest, and the knee to be rubbed with salad oil. He also used Scott’s dressing. Subsequently, at Brighton, a sea-weed poultice was used. The treatment was successful.