Jane Austen's World

The Comforts of Bath, Rowlandson

Had Margaret Dashwood fallen from a tree and broken her forearm, Mrs. Dashwood would have sent for the surgeon to set it. A broken bone presented a painful procedure in a time before anesthesia, but simple fractures of the arm were relatively easy to fix, even in the late 18th and early 19th centuries. In reaction to the injury, muscles contract and are stretched before the bone is set. Arm muscles do not offer undue resistance. Thus the bone of a forearm can be set without too much exertion on the part of the surgeon or bone setter. Once set and placed in a sling, the arm bone required time and rest for healing.

The Crofts in their gig, 1995 Persuasion

If Admiral Croft, a notoriously bad driver, had overset his vehicle and tossed poor Mrs. Croft to the ground, breaking her leg in two places, the situation would have been different. The size and strength of her leg muscles would have been so much stronger than Margaret’s arm muscles, and the exertion to set Mrs. Croft’s bone in place would have required more effort and required the work of at least two persons.

A fracture in Mrs. Croft’s lower leg would have been easier to remedy than a fracture of the thigh, in which large and strong muscles would experience a great degree of contraction and shortening. Considerable manipulation would have been required by several assistants to overcome strong thigh muscles and stretch them in order to place the bones in their natural position.

The simple position of the injured member sometimes suffices to overcome the contraction of the muscles and to restore the broken bone to something like its natural position. Yet, in most cases, it becomes necessary to employ additional means to accomplish this object by pulling the lower fragment away from the upper. This must be done with care and yet with considerable force.”- Home Medical Treatments

If, after the pulling and resetting, both limbs were the same length again, then the procedure was succesful, but this was not always the case. Soldiers on the battlefield whose bones shattered from canon and gun fire risked getting an infection. In such instances, surgeons often chose to amputate before the tissue became necrotic.

Bone Setters

As early as the 16th century, apprentice barber-surgeons were impressed in the army to treat soldiers, where they learned their trade by neccesity Generally, surgeons and bone setters learned how to set various kinds of fractures through apprenticeship.

“Bone setters included surgeons and barbers. 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.) –  Bonesetting, Chiropractic, and Cultism Chapter 1: The Origin and Course of Bonesetting ©1963, Samuel Homola, D.C.”

Not all bone setters were apprenticed to a medical person. If no surgeon or physician lived within the vicinity, the local blacksmith would set bones in humans and animals, for a fee, of course.

Sarah Mapp, 18th Century Bone Setter

Some bonesetters became celebrated for their dexterity. One such person in the early 18th century was Mrs Mapp, whose skill was legendary. A daughter of another famous bone setter, Polly Peachum (who married the Duke of Bolton), she was known as crazy Sally. Nevertheless, her “cures earned her upward of 100 guineas per year. Sally Mapp’s marriage was not as successful as her skills with bones. Her husband thrashed her several times before absconding with a majority of her earnings.

“Her bandages were neat, and her skill in reducing dislocations and in setting fractures was said to be wonderful. If it was known that she was going to the theatre, that was sufficient to fill the house. Her own estimate of herself is shown by an interesting incident. When passing through Kent street, she was taken for one of the King’s German mistresses, who was unpopular. A mob gathered and used threatening languages. Mrs Mapp thereupon put her head out of the window and cried, “Damn your bloods, don t you know me! I am Mrs Mapp, the bone setter,”and drove away amid the applause of the multitude.” – Boston Medical and Surgeon Journal

Not everyone was a fan. “Mr Percival Pott, the celebrated surgeon, who was her contemporary, spoke of her claims as the most extravagant assertions of an ignorant illiberal drunken female savage.”  – Boston Medical and Surgeon Journal

As the medical professions evolved, barber-surgeons, midwives, and professional bone setters like Mrs. Mapp, began to be replaced by trained male physicians and surgeons. During the 19th century, colorful characters like Mrs. Mapp, and midwives, who had widely practiced across all spectrum of classes, labored primarily for the poor and could barely scrape a decent living.

By the 1860’s, British physicians and surgeons were largely registered. A case against a Mr. A.E. Shakesby, bonesetter and osteopath was dismissed, for “osteopathy was not regulated, supervised, or recognized by any statute.” Mr. Shakesby had committed the cardinal sin of elevating his stature as bonesetter and describing himself as an osteopathic physician and surgeon. While his self-description amplified his profession of bonesetter, the grander sounding title did not go against the Medical Act of 1858, which required doctors to be registered in recognized fields. – Medico-Legal, 1932

Over the centuries, scientific inventions sped up a surgeon’s or bonesetter’s ability to help patients. As early as the 15th century, the printing press churned out medical manuals, in which medical procedures were standardized and disseminated over the world. In the late 17th century, traction was used to repair a broken bone, and in 1718, French surgeon, Jean Louis Petit, invented the tourniquet to control bleeding, a medical technique that was especially helpful during amputations.

Traction to repair a broken bone is seen here in “Armamentarium Chirurgiae”, by Ioannis Sculteti (1693), and the final illustration is by Laurence Heister in “A General System of Surgery” (1743). Note the numerous assistants required to restrain the patient in this pre-anesthetic era. – Collect Medical Antiques

Pain Control

Bone setting could be extremely painful, and pain was excrutiating during amputations. Before 1853, only a few substances were available to dull pain, but these efforts were generally unsuccessful and many surgeons relied on their patients to faint from pain as a method of relief. A person in shock would feel less pain and bleed less, for their lower blood pressure would reduce the flow of blood, in the case of a jagged bone.

Methods of pain control included: icing the limb, prescribing laudanum, drinking alcohol, and providing nerve compression or hypnosis. Icing the limb was problematic in that carting ice was a hugely expensive and laborious procedure, and storage through the warms months required ice houses and was available to only a few. (Storing Ice and Making Ice cream in Georgian England)

During the latter half of the 18th century and early 19th century, there were several missed opportunities for finding an effective anesthetic. In 1773, Joseph Priestley used nitrous oxide, a gas that was difficult to synthesize and store. Humphry Davy commented in 1800 that nitroous oxide transiently “relieved a severe headache, obliterated a minor headache, and briefly quenched an aggravating toothache.” No one seems to have taken that observation further. Humprhy Davy also realized that inhaling ether relieved pain, but remarkably, ether was considered a recreational drug during this period. In Britain and Ireland, when gin was taxed to the point where the poor found the cost prohibitive, they began to drink and ounce or two of ether instead. In America, students would hold nocturnal “ether frolics” by holding ethe-soaked towels to their faces.

By 1846, the situation had changed. Ether had made its appearance as a pain reliever, and chloroform was introduced for operations a year later. In 1853, Queen Victoira requested chloroform when giving birth to her eight child, and from then on it was accepted practice to offer pain relief to women in labor.

Sources

• Clinical anesthesia
• Home Medical Treatments
• Napoleonic Surgery
• Boston Medical and Surgeon Journal
• Mrs. Mapp the bone setter