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    Claudius Galenus, or Galen, a Greek physician who I ived in the years AD 129-199, contributed much written material on early

    manual medicine, including 18


    commentaries on Hippocrates.1 His primary contribution was documentation of early neurologic investigations. He recognized seven of the cranial nerves,
    differentiated between sensory and motor nerves, and was the first to treat paresthesias and extremity pain by treating the spine. Galen describes one such incident in
    which a patient developed paresthesias and loss of sensation in the third to fifth digits of the hand after falling from a wagon. Galen found that the problem was
    "localized in the first spinal nerve below the seventh cervical vertebra,"1 and healed the patient by treating the neck. Much of the emphasis in Galen's work again
    focused on the "repositioning" of an outward dislocation of the spinal column.
    While the advent of the Middle Ages brought a decline in medical advancement, an Arabic physician named Avicenna wrote a large work around the year AD 1000
    summarizing the medical knowledge of the day. In the work, references are made to manual medicine, with descriptions and illustrations similar to the Hippocratic
    method. The Hippocratic method had survived, virtually unchanged in technique, well into the Middle Ages. It can be argued that many of the techniques (especially
    traction and extension principles) are still being utilized today.
    Renaissance
    The most well-known contributor to manual medicine in the Renaissance period was the French surgeon Ambroise Pare who lived in the 1500S.I,4 Pare was also
    instrumental in the development of some of the early orthopedic surgical techniques. The positional theory was still strong as evidenced in a chapter entitled
    "Dislocated Spinal Vertebrae."
    The exogenous causes of dislocation include falls, hard blows, and prolonged work in a greatly bent position,
    e.g. among vineyard workers.... If the vertebrae are dislocated and far apart, a good method is to lay the patient on a board, face down, fasten him to it with bands
    beneath his armpits, around his trunk and thighs, then pull from top and bottom as hard as possible, but without violence. If such tension cannot be tolerated, no
    treatment can be applied. Then you may place your hands on the outcurving part and press the projecting vel'tebrae.
    Again, early evidence exists for traction and manipulation into extension, with the fundamental theory being repositioning of the vertebra as in the Hippocratic
    method.
    Bone Setters
    From the mid-1600s well into the nineteenth century, the "bone setters" of England flourished. Bone setters, considered "quacks" by traditional medical practitioners,
    had no formal training; their art was generally passed on from parents to children, generation after generation. Bone setters were known locally, had other primary
    occupations, and usually treated "con amore," that is, without pay.
    Bone setters derived their name from their basic philosophy that small bones can move out of place, and healing takes place when the bones are restored to their
    original positions. One of the most well known bone setters was Sarah Mapp, a vagrant peasant woman, who was sought out by commoners and nobility alike (Figure
    1-3). The fact that members of the nobility sought after bone setters infuriated the traditional medical community. For many years, the medical community hotly
    debated the subject of bone setting, with some physicians being shunned for speaking in favor of bone setters.
    This controversy is exemplified by Wharton Hood, a medical doctor in the community, who learned the practice of bone setting from one of his patients whom he had
    treated for a systemic

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