Fourthly. Uneducated bone-setters fail most signally in their treatment of _fractures_. In the case of a _dislocation_, when the bone is once put into joint it is generally done with. The joints are so aptly and closely fitted, that the reduced bone is not liable to slip out of joint again from any slight cause. But in the case of a _fracture_ on the other hand, after the bones are put into place, some care and skill are required to keep them so. The pressure which is brought to bear upon different points of the limb is to be skillfully regulated, and motion of the two parts of the broken bone is to be carefully prevented, in order that they may grow together without irregularity, and with as little amount of callus as possible. The bone-setter for obvious reasons, fails in these particulars, and there may, therefore, be found among his patients a great many crooked and shortened limbs, with a large and irregular callus. One of the most deformed limbs that I ever saw was an arm which had been under the care of one of the most famous bone-setters in the country. The case was a simple fracture of the two bones of the fore-arm, about midway between the wrist and the elbow. Any ordinary surgical care would have secured to the patient a sound arm without any deformity. But when she showed me her arm, after the bone-setter had dismissed it from his care as _cured_, I found that one bone had its two parts united at quite an angle, with a large callus; and in the case of the other bone no union at all had taken place, but the ends of the fracture could be still made to rub upon each other by executing certain motions of the arm. Such mal-practice as this, in the case of a young woman, who is dependent upon her labor for a livelihood, ought to be punished with exemplary damages. The remarks which I have made refer to ordinary fractures merely. But there are some cases of fracture which require a peculiar and nice application of mechanical principles in their treatment. In these the bone-setter generally makes an utter failure. For example, there are some fractures of the elbow-joint that require a particular position of the arm, and a nice adjustment of the apparatus applied to it; and, in order to prevent stiffness of the joint it is necessary that the surgeon should, as soon as it will answer, begin to execute the motions of the limb, gradually extending their range, till the joint become entirely free. Such cases under the care of a bone-setter have always resulted, so far as my observation has extended, in permanent stiffness of the joint.