Bone of Contention

An Andhra Pradesh family’s generations-old method of treating fractures

01 September 2017
The precise composition of the dark-green herbal paste that the Puttur doctors apply to patients’ skin is a closely-guarded secret.
amrutha manjunath

On a July morning in the town of Tirupattur, Tamil Nadu, a woman named Padmapriya fell down in her bathroom and fractured her wrist. Some of her neighbours brought her to a hospital in Puttur, a small town in southern Andhra Pradesh that is a four-hour drive from Tirupattur.

In the hospital’s waiting area, I met Sheikh Kamal, a middle-aged philosophy teacher from Tirupattur, who had been the one to suggest that Padmapriya be brought to this hospital. Kamal told me he had first heard about the place after one of his relatives, a lorry driver, severely injured his leg in a road accident. Orthopaedic doctors in their village said that they would have to amputate the limb. But instead, people brought him to the Puttur hospital, where he received the traditional bone-setting treatment. “No operation, nothing. From this treatment, his leg got better,” Kamal said.

For over six decades, the Puttur hospital has been the centre of a bone-setting practice in which fractures and dislocations are treated by “setting” the bone into place and applying a proprietary herbal paste to the skin. People from all over the country—especially from south Indian states such as Andhra Pradesh, Kerala and Tamil Nadu—travel to the hospital, which sees between 200 and 300 patients a day. But although this bone-setting practice seems to be expanding to places outside Puttur, its medical merits remain up for debate.

The hospital’s walls are plastered with diagrams of the human skeleton and photographs of famous former patients, including Krishnam Raju, a Telugu film star; NT Rama Rao, an actor and former chief minister of Andhra Pradesh; and VV Giri, India’s fourth president. The hospital’s main theatre—a large hall lined with wooden benches—buzzes with chatter and constant movement, with patients being wheeled in on carts and deposited onto examination tables.

When a patient comes to the hospital, a doctor first examines the nature of the fracture or dislocation. (The doctor occasionally, but not always, asks for an X-ray, though the hospital itself does not perform them.) The next part of the procedure is the most painful: the doctor “sets” the bone, holding it down into its desired place. As Padmapriya’s screams pierced the air, Jugalkishore Raju, a young doctor at the hospital, whom everyone knows as Kishore, explained to me that they do not use anaesthesia during the setting. They apply a dark-green herbal paste, and egg whites, onto the patient’s skin, and then bandage the injury with cloth, using bamboo sticks to ensure that the bone stays in place. The patients are asked to return to the hospital three or four times, every two weeks or so, to have fresh bandages fitted.

The Raju family, of which Kishore is a member, runs the hospital. At the entrance stands a statue of Subba Raju, who laid the foundation stone of the building, in 1954. Even before that, the family practised bone-setting in a hut that stood near where the hospital is today.

In 1881, Kadallam Gopal Raju, who was a farmer, is said to have first developed the bone-setting technique. While out hunting in a forest near Puttur, he saw an injured rabbit and applied a herb—the one that is now used in the special paste—onto its wound, bound the fracture and braced it with sticks. Within two days, the story goes, the rabbit was healed. A painting hanging in the hospital shows it hopping away from his arms, back into the forest. Jairaju Raju, the manager of the hospital, told me that Kadallam then began to experiment “on other animals, then on men. At first, he had 20 patients, then 30, and now we have hundreds of patients at the hospital every day.” Kadallam, Jairaju said, even served the British government during the First World War, and was assigned to treat wounded soldiers and civilians in various places.

Boys in the Raju family are raised to practise bone-setting. They spend time at the hospital starting at a young age, and learn by observing and assisting the doctors. Kishore, now in his late twenties, was just 14 years old when he began practising alongside Krishna Raju and Prakash Raju, who are currently the hospital’s senior doctors. Raju women, however, are not taught bone-setting. “Only gents have a right to the hospital,” Kishore told me. “Ladies do not even enter the hospital.”

One secret that the family guards closely is the composition of the dark-green paste that they apply to patients’ skin. Speaking of the herb they use to make it, Kishore said, “Scientifically, many people call it by a name, but we have no name for it in our local language,” Kishore said. “We just call it mandaku, which means ‘leaf’ in Telugu.”

A study about the Puttur hospital, conducted between 2005 and 2008, and published in 2011 in the Ayurvedic Journal of Integrative Medicine, claims that the paper’s authors “tactfully” collected samples of the herb, “since the villagers were not willing to reveal its identity.” Then, the scientists showed samples to a taxonomist at Madras University, who identified the herb as Kasamarda, or Cassia occidentalis—a plant often used in Ayurvedic treatments.

The reach of Puttur bone-setting, and the Raju family, has expanded in recent decades. For about 20 years, Raju doctors from the younger generation have been travelling frequently to Chennai, Bengaluru and other places. There, they often hold bone-setting “camps” and follow up with patients who had travelled far to reach Puttur for initial treatments.

Treatment at the Puttur hospital is relatively inexpensive; the doctors charge a consultation fee of about Rs 100, though this cost can be waived for those who cannot afford it. Patients typically spend about another Rs 50 on cloth and eggs, which they can purchase at the hospital’s pharmacy. Costs for modern orthopaedic treatments tend to be much higher, especially if surgery—which can easily cost thousands of rupees—is required.

The last few decades have seen the opening of a number of clinics that purport to perform Puttur bone-setting. I visited one such clinic in Bengaluru, which is owned by Dr Pawan Kumar Singharaju, a Puttur native and a distant relation of the Raju family. He primarily practises homeopathy in his clinic, but if a patient comes in with a minor hairline fracture, he often administers the traditional bone-setting procedure. Singharaju was sceptical of the many other Puttur bone-setting clinics that have sprung up—including others in Bengaluru, as well as in Chennai and Coimbatore. “When one main doctor is setting the bone, he is surrounded by four, five helpers who come from neighbouring villages,” and who, “in the long run, think they can start their own clinic,” Singharaju said. He warned that someone without adequate training would not know what to do if, say, a fracture’s healing process went awry.

While some claim that bone-setting is just as—or even more—effective than allopathic ways of treating fractures, others have their doubts. Dr Hemant Kalyan, an orthopaedist who has practised in Bengaluru for 25 years, warned me of the limitations of Puttur bone-setting when I spoke to him over the phone. He said that complications can easily arise during and after the setting process, sometimes resulting in stiffness, immobility, or even shortening of the bone. Kalyan said that allopathy tends to be more effective than indigenous medicine, because it is subject to far greater academic scrutiny, and utilises modern tools such as anaesthesia and X-ray imaging.

Still, Kalyan was not entirely dismissive of bone-setting. “There is no doubt that the Puttur treatment works in some cases,” he said. “But the doctors have to recognise their limitations, and warn patients about these.”

Amrutha Manjunath is an intern at The Caravan.

Keywords: Andhra Pradesh Bone setting Puttur fracture