Modern Orthopedics is shaped on the skills laid down by centuries of tradition handed over by Bone Setters from all over the world. Liverpool is not only famous for its cobbled streets, drunken brawls at the wharf, the prettiest of wimps trading their wares, the Beatles but also to one Hugh Owen Thomas who is considered, the father of British Orthopedic Surgery. His father Evan Thomas was an unqualified Bone Setter from the hills of Wales. He suffered bitter opposition from qualified doctors which gave him this firm determination of sending all his five children to Edinburgh to study for a Medical Diploma that would protect their profession of Bone Setting. Hugh was the eldest of all. 

Quoting from Watson - Jones, Fractures and Joint Injuries, 'Power, prestige and reward were as nothing to him, but he won such a place in the hearts of seamen, dockers and housewives that when he died in harness they lined the streets of Liverpool in thousands, sobbing testimony to the friend they had lost.'

I hasten to write a few words after hearing the news that my close friend, internationally renowned novelist Shreekumar Varma is afflicted with a sudden backache. Backache is one such ailment which is claimed as their own by the Physicians, Surgeons, Orthopedicians and even the Neurosurgeons, not to forget the Chiropractors and Osteopaths too. It just depends on the patient, where ever he may stray over. I have seen patients with back ache crawling to me and patients who have tearfully confessed about their severe pain and antics they had resorted and patients whose back ache disappeared after talking to them on anything and everything except the back. The pathophysiology of a back ache is such vast and diverse that this wont be the right column to talk about it.

Gwalior is a small town in Central India that I belong to. I had been practicing Orthopedics from a small surgery which was sandwiched between a tea shop owned by an overweight Sindhi and a motorcycle repair shop owned by a sharp Punjabi. My morning use to start with having cups of sweetened cardamom tea in my surgery with a host of bone setters from close and a far. I respected them for their art and they loved me as I encouraged them to see me if they ever encountered any complication. Traditional bone setting is a secret that is zealously guarded and oils and herbs that are used vary from country to country.

Khapatcchi is a word commonly used by Indian bone setters for a variety of splints made from recyclable materials. These bone setters knew their anatomy well and treated with utmost caution. There were complications which an over enthusiastic bone setter caused but such incidents were not uncommon with qualified orthopedic surgeons too. My friend the Punjabi and Sindhi use to help me with the traction as I applied the plaster bandage. There were times when my friend, the busy motor cycle repair man use to tell me, 'Do you think I should pour some engine oil on the road so that we can get a few more patients.'
 
The bone setters were available on the narrow streets of Muslim quarters of Old Gwalior.

The Low Back Ache is treated traditionally by Kale Ghore ka Naal. Well it means that a black horse will have to bump you kindly with his hooves as you stand with your back facing his ample back. This was a real answer as I saw people queuing up for a bump. I yearned for that one too. The Islamic Butchers at my place are also traditional healers. My friend Salim Javed who has the biggest butchery in the town claims that Back Ache can be cured by maalish, a massage by Lamb fat. Back Ache was also treated as documented in colonial literature by a lithesome lady dancing on her heels over the back of a patient while holding on to a tree trunk. The right amount of pressure which is needed to pop in the disc was known to these beautiful qualified well endowed women.

I saw back ache being treated by Auricular Acupuncture at Colombo General Hospital in Sri Lanka. I had gone there to study Acupuncture under the guidance of the late Professor Anton Jayasuriya. Acupuncture that deals essentially with neurological pathways has been successful in treating chronic low back pain. I also saw African Traditional healers, Sangomas treating Low Back Pain with blade pricks. I feel it has to do with the Acupuncture points used by the Chinese Physicians. The Roman Physicians used the 'Feather Treatment' by tickling the back with a feather and sponging alternatively with hot and cold water. Low back Ache was a regular post orgy phenomenon in the days of Julius Caesar.

Delhi has the largest number of Bone Setters in India. In fact there is a street leading to the Cargo Section of the airport that is lined with shops of Bone Setters jostling with cargo offices. Most of them have a picture of a well muscled man showing the many ways he can treat the pathological bone. At the end it is always written 'Shartiya Illaj', which means guaranteed treatment. The Bone Setting tradition in India has always a relationship with the sport of wrestling. The wrestlers know the fine art of manipulation of sprains and strains and therefore they are also called as Ustad.

On a chilly morning in January this year, I decided to pay a visit to this market of Bone Setters in Delhi. Ustad Masood Ali comes from a family of traditional bone setters. He is 6 feet tall and has an awesome well oiled moustache. I introduced myself to him. He kissed me on both cheeks and held me in his arms. I told him the reason of my visit to his clinic. He said that before we start talking, I must have a drink of a milk shake mixed with almonds. His assistant brought two tall steel glasses in a jiffy that had the creamiest of milk with almonds. Ustadji's moustache was covered with a layer of the cream. He told me in a Punjabi/ Urdu dialect about his roots and the profession that he practices. His father came from Lahore during the pre-partition days. He teaches wrestling and has his own aakhara (ring). He wouldn't allow me to photograph him as there are a lot of animosities between fellow bone setters. He feels that he doesn't want to hurt anybody. I left Ustad Masood with a great feeling and happiness, the taste of the Almond Milk shake still lingers in my tongue.

The Dalai Lama had Mongolian Bone setters in his team of personal physicians. 

This is an excerpt of Lama Chimpa's diary written in 1950 from Ayur Vijnana Vol.6 Spring 1999 edition -

Bone setting in Mongolia is a very interesting subject indeed. Soon after an accidental bone fracture or a dislocation of a bone, the Mongols think about nothing else than approaching the Bariachi, a bone setter, who has no medicines and no surgical instruments. The Bariachi just holds the fractured or dislocated part of the sufferer's body with his or her own hands, twisting it here and there, for some time, without any pain on the patient. This born healer, who is just a lay man, neither spells any charms nor performs any rituals, but will then advice the patient to take some rest. These bone setters cure bone disorders perfectly. After the treatment, there will be no complain at all, however serious the injury may be. The injured person will be normal soon after getting such a treatment. 

The strange thing about this treatment is that these healers have neither any medical knowledge nor do they know any charms or magic. They are just ordinary lay persons having no training of any kind. They are born as bone setters. Their hands work as magical instruments. Such healers come from a family of traditional bone setters. Their sons and daughters are all bone setters. At times, the children of such a family do the same work as their elders. But generally they do not allow their young children to practice bone setting, as they do the treatment on contract, like a business. If the case is serious and the patient is wealthy, they will demand more money for the treatment. Otherwise, they are quite generous and do not take any fee from a poor person. But if a wealthy person does not pay adequately, the treatment may be defective. In this case, it is not possible for the patients to approach another such healer, because, according to their professional rule, no one can interfere with a case which is dealt with by another traditional healer. So, a Mongolian knows very well that he has no alternative but to pay whatever the bone setter demands, if he wants to be cured perfectly.

It is not surprising to know that the actual art and science of Bone Setting may have trickled down the Silk Route. Mughal armies brought this technique with them as they came to India invading from the north. The knowledge of manipulation and healing was well known since centuries. When the British occupied India, they found a well reinforced orthopedic system in perfect practice. Medical Practitioners attached to the East India Company picked up this art from local bone setters and took it with them back home.

I came across a novel titled 'The Bone Setters Daughter' written by Amy Tan. The story and characters are very much like as in the novels of Han Suyin.

The central portion of The Bonesetter's Daughter written by Amy Tan takes place in China in the remote, mountainous region where anthropologists discovered the Peking man in the 1920s. Here superstition and tradition rule over a succession of tiny villages. And here Lu Ling grows up under the watchful eye of her hideously scarred nursemaid, Precious Auntie. As she makes clear, it's not an enviable setting: 

I noticed the ripe stench of a pig pasture, the pockmarked land dug up by dragon-bone dream-seekers, the holes in the walls, the mud by the wells, the dustiness of the unpaved roads. I saw how all the women we passed, young and old, had the same bland face, sleepy eyes that were mirrors of their sleepy minds. 

Nor is rural isolation the worst of it. Lu Ling's family, a clan of ink makers, believes itself cursed by its connection to a local doctor, who cooks up his potions and remedies from human bones. And indeed, a great deal of bad luck befalls the narrator and her sister Gao Ling before they can finally engineer their escape from China. Along the way, familial squabbles erupt around every corner, particularly among mothers, daughters, and sisters. 

The art and science of Bone Setting is very much alive as are traditions, superstitions and folklores that surround it. I might have raised the ire of my fellow bone practitioners but I believe it is necessary to have an open mind and let all forms of knowledge flow in.