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T E. T. A. T.,
R"O R.

M. A. L – PRA C T TO E.
FRANK P. FRISBY,
BY HIS NEXT FRIEND, PEARSON NOBLE,
WS.
f
DR. LEONARD PRATT,
</
IN THE CIRCUIT COURT OF CARROLL COUNTY, STATE OF ILLINOIS,
J MARCH 7th, 1864,
Reported by
JOHN S. COCHRANE,
ROCKFORD, ILL,
C HIO A G O :
PUBLISHED BY C. S. HALSEY.
John W. DEAN, BOOK AND JOB PRINTER, 148 LAKE STREET,
1864,
*
tº
(, ; 4.
cop. 2.
*,
*
* &c.
+,
PREFA CE.
*~~-
Each discovery in science, and the efforts of the progressive to adapt that
science to the uses and wants of mankind is regarded by those who have sanc-
tioned and adopted the more ancient methods, invariably, as an innovation. This
is especially true in medicine. The persecution which discoverers in the science
and reformers in the art of healing have suffered and experienced, has always
been in ratio with the value and success of their efforts. Homoeopathy—a form
of truth—is no exception to this rule. Beginning with its illustrious founder,
HAHNEMANN, they have been persecuted from “city to city,” and the system
has been the victim of public and private abuse and misrepresentation. No
opportunity for the villification of its tenets and practitioners has been permitted
to pass unimproved. Resorts beneath the notice of honorable gentlemen have
been the opening wedge of contumely and scandal. Its relative merits as com-
pared with the ancient system of medical practice, have been tried in courts of
justice and verdicts extorted by subterfuge, and every other possible means,
with a view to damage the system and ruin its prospects of success.
This volume is the record of another attempt to bring disaster to a reform in
medicine, and those who have adopted it. Although it is disclaimed in the
beginning of this trial, yet the persecutors exhibit in its progress the real cause
of all their efforts, by compelling an issue between the two schools of Medical,
practice.
INTF O DUCTION.
No one can know the condition of a patient so well as the attending physician
or surgeon. A lack of knowledge, coupled, perhaps, with an intention to deceive,
led the plaintiff’s family to remember facts which did not occur and to mistake
others which did really take place.
As this case is put into a tangible shape, justice to myself would seem to
demand from me a plain statement of the facts. There may be those who will
disbelieve what I state ; but those who best know me will know what value to
place upon my assertions; with that estimate I am satisfied. I give the following
as the principal facts: Frank Frisby and brother, on the 20th Dec., 1862, in
Rock Creek township, were on their way home, in wagons loaded with corn
in the ear. The boys, I understood, had been running their teams. The for-
ward end-board of Frank's wagon burst out by the pressure of the corn, in cross-
ing a gully. The boy was thereby thrown astride the wagon tongue, and from
thence to the frozen ground. His head, right hand and left arm were injured ;
the two latter severely. I was called to visit the boy by Mr. Morris, at his
house. I found he had fractured the lower third of the humerus in two places.
The lower fracture was a little below the entrance of the nutrient artery, and
was oblique. The other was above this point, and was transversed. The frac-
tured ends of the bone had been thrust through the flesh on the back part of the
arm, and I judged that the lower branch of the nutrient artery had been rup-
tured, as it bled profusely from this external wound. The muscles of the arm
were severely injured.
After reducing the fracture, a roller was applied from the hand to the shoulder.
Two splints were then applied, reaching from the axilla and the shoulder to the
elbow, with three shorter flexible splints between. The fore-arm was then placed
in a sling. There was a wound upon the upper and back part of the head. The
thumb and inside of the right hand were much mutilated, and the metacarpal
bone was fractured from the outside above the second joint obliquely, extend.
ng nearly the whole length of the bone.
The inside fleshy portion of the thumb was literally torn out, laying bare the
tendons and vessels near the bone. This laceration extended into the second
joint, which was dislocated downwards and inwards. The lower fragment of the
bone sliding upwards toward the wrist, prevented the joint from remaining in
V .--
position unless firmly retained. A shellae splint fitted, to the joint, effected thi
object. The injuries to the soft portions of the thumb and hand rendered it
impossible, at first, to so apply the bandage as to retain the bone precisely in
place. But when the wounds had healed sufficiently, I informed the parents and
boy that a perfect reduction of the fracture could then be made ; but they refused
to permit me to do it, and the thumb is, consequently, a trifle too short. -
As to diet, the parents were directed to give the boy light food—toast, crack-
ers, &c.—until the inflammation and fever had subsided; after that, such food as
the family used. -
The wounds of the head, arm and hand healed within a reasonable time, and
the process of repair went on well. The upper and transverse fracture of the
arm became quite firm in six weeks, but the lower, oblique fracture united more
slowly. My visits, after the first ten days, were at intervals of from one to two
weeks. A careful examination of these injuries was made at nearly every visit.
On the 20th Feb'y, I think, I visited the boy with Dr. Wales. The dressings
were removed and the fractures were found to be well united. -
I thought of leaving off the splints entirely, but Dr. Wales' suggested he was a
boy, somewhat restless, and I re-adjusted the dressing and splints. The mother's
attention was directed to the fact that there was no motion at the site of the
fracture. She expressed herself much pleased at the result. The boy raised
and elevated his arm himself without aid. After bathing the arm, I replaced the
bandages and splints, for the reason above stated.
A few days afterwards I called again. I found the arm “loosened,” or refrac-
tured, and the angular splint badly split at the joint in two places. The family
told me the boy injured his arm in playing ball, by hitting the fore-arm against
a post. .
The fragments were merely separated, no other displacement. They were
again placed in apposition and retained by firm bandaging and splints. A few
weeks; afterwards the fragments appeared to be uniting, but shortly after this
they were again “loose.” I informed the parents there was no union.
In April, I think, I used friction. Afterwards, at Mr. Frisby's request, a con-
sultation was had at Milledgeville, with Drs. Belding and Freas. This was in
May. Drs. Belding and Freas were informed of the refracture. Dr. Freas
examined the elbow splint, and observed it must have taken a severe blow to have
split it thus. The mother suggested it was basswood and would split easily. Dr.
Freas remarked he could discover a remnant of the provisional callus where the
upper fracture had been. The subject matter of remedies was talked over. I
was in favor of more stringent measures. Dr. Belding was opposed. Dr. Freas was
for resorting to friction once more, and which was finally agreed upon. He
rubbed the fractured ends of the bone together, applied the roller and the same
splints, and I assisted. Another consultation was to be had at my office tw
weeks afterwards, but neither Dr. Belding nor Freas came. At this time I exam-
ined the arm; found no union had taken place. I urged the necessity of an
operation to restore the arm. The father partially assented to what I said at the
time—said he had not friends there, but would determine in a few days what he
Yi
would do. Subsequently I saw him; said he had concluded to employ Dr. Miller,
and did not longer desire my services. Such is a plain, unvarnished statement
of the facts. There may be testimony that conflicts with what I have here
stated. If there is such testimony, I can only state it is incorrect. The boy
was careless, and the parents, I presume, acting under the advice of some one or
more medical advisors, are stubbornly bent upon not having that done which is
necessary for the boy's complete recovery. The consequence is, he has a bad
arm. It is a case where re-section could be used with little danger, and with
every probability of success.
Conscious that I have performed my duty faithfully and carefully, in strict
accordance with the principles and practice of surgery, as held and practiced
by the best authors, I rely upon this for a complete and final vindication of my
acts, and without further comment I submit this case to the candid judgment of
he public,
L. PRATT.
SUIT FOR MAL-PRACTICE.
sº
©
º
FRANK P. FRISBY,
ØS.
DR. LEONARD PRATT.
Statemeut of the case to the jury, by Col. Turner.
Gentlemen of the jury:-Sometime in Dec. 1862, the plaintiff in
this suit, a young, healthy lad, had the misfortune to get his left arm
broken. There may be some little question in regard to the wound,
whether a simple or compound fracture. Dr. Pratt, the defend-
ant in this suit, was residing in the neighborhood, holding himself
out to be a physician and surgeon, and practicing as such, and
professed to be competent to do that work. The father of the
boy employed Dr. Pratt to treat the case, and as it was a difficult
matter, the father had much interest in it, and asked Dr. Pratt if
he felt himself competent to take the case. Dr. Pratt assured
him that he was competent, and under that assurance he was
employed to treat the arm of this boy. Dr. Pratt came to the
house, did up the arm and took exclusive charge of it. There
was no other physician called; the parents of the boy felt satisfied
from the representation of Dr. Pratt, that he was a proper man
to attend to it. It was put in splints and kept there some little
time, and I suppose that the plaintiff will show that there were
several examinations made of the arm; and after a long period of
time had elapsed after the arm ought to have been well, the boy’s
parents became uneasy and expressed their uneasiness to Dr.
Pratt, and he assured them that it was all right and doing well;
and he still assured them that it was not necessary to set the arm
again, that it was doing well enough. It continued this way for
sometime after the splints were taken off, and it was found the
viii
arm had not adhered at all. There is what is called the false
joint, caused by improper treatment. The truth in regard to the
manner of that treatment will be brought out better in the testi-
mony than I can bring it out before you. The boy’s arm was
never cured. The bone has become shortened to a considerable ex-
tent, and at all events, the boy has no use of his arm—cannot lift it.
The theory of our case is this, that Dr. Pratt did not treat that
arm as it should have been treated, and that the question we sub-
mit to you, and the primary point in this case is this, was it
treated in a proper manner? If it was, you must find him not guilty.
If, on the contrary, you find that he ought to have been cured, the
probabilities are, that he might have been cured if he had had
proper treatment in this case, you must find him guilty, and assess
the amount of damages the plaintiff sustained.
His thumb was injured, and that was never properly set. I
speak more particularly of the arm because that was more seri.
ous than the other. I wish to direct your mind to this point. The
issue in the case is this, did Dr. Pratt treat this case properly,
and is he a skillful physician, as he ought to be to understand such
a case? If he did not treat this right you must find him
guilty and assess such damages as will be justifiable from the
treatment the boy received and the condition he was in, and we
think it is one of those cases that the jury cannot refrain from
awarding large damages. This is a case exciting a great deal of
interest one way and the other. So far as the plaintiff
is concerned, he has no prejudice, one way or the other, as to
medical practice. They have no ill feeling againstaman because he
practices one system of medicine or another. The fact is, the
boy has lost an arm, and we must represent the case to you. We
have no fault to find with the theory at all, but with Dr. Pratt, as
a professional man; he should have done his work right. The
only safety that humanity has in the world is in making surgeons
do their work right. If he holds himself out to the world as a
doctor, he is bound by the law to be skillful, and the very same
thing applies to the lawyers around this bar. When you place a
note of $5,000 in a lawyer's hands for collection, he must col-
lect it. If he carelessly manages the case, and gets defeated,
and you lose the case, he is bound by law, to pay for that note,
because he assumed to do that work for you which you cannot do
yourself. You cannot, when you are sick, doctor yourself. When
you have a limb broken you cannot set that bone yourself, and
ix
consequently it is of very great importance to the people in a
community, that when a man holds his name out to the world to
do this work, he should do it properly, and if he fail he must pay
the damages.
If Dr. Pratt has suffered this boy to lose his arm, when a
skillful physician.could have saved it, and the thumb is out of
order and he has not prevented a bad case, then he should pay
for it. We present both cases to you. The boy being a minor,
the suit is brought by his next friend.
—- sº- --dºse-–
MR. KNOWLTON'S OPENING FOR THE DEFEND ANT.
Gentlemen of the Jury —I appear before you as one of the
counsel for the defendant. At this time it is proper that I should
give you our understanding of this case. Most cases have at
least two sides—and some have more.
Mr. Turner has given you their theory of this case in behalf of
the plaintiff. It will not be necessary for me to take issue with
him as to what he has said about the liability of attorneys, and
I will only remark, that should he ever be sued on such a state
of facts as he has supposed, I have no doubt that he would, upon
an examination of authority, change his opinion. +.
It is proper that I should say to you, that when skill is required
of an attorney, surgeon, or other professional character, it is not
the utmost or highest skill that is required, but ordinary skill.
Ordinary skill and care is all that the law requires of a physician
or surgeon. If this kind of skill is employed, there is no legal
liability. What this skill is, must, to a great degree, be obtained
from professional witnesses. As this case involves professional
considerations, professional testimony will have a controlling
effect as to the proper mode of treatment. Ordinary skill and
attention to the plaintiff is what the defendant owed in this case,
and upon their exercise this case and your verdict will depend.
There is a great gradation of skill. The gentleman will not
deny that some men have more skill than others. Ilawyers are
presumed and bound to know enough of law to conduct the busi-
ness entrusted to them with ordinary skill, care and attention.
A man like Daniel Webster, or Marshall, might have more skill
than many other men.
In this case the plaintiff must establish, by competent evidence,
X
that the defendant did not exercise ordinary skill and care in
treating the injuries of the plaintiff in the particulars complained
of in the declaration, and we are not bound to prove that he did
use this skill and care. The undertaking of the defendant was,
that he would treat the plaintiff with ordinary skill and care.
This was the obligation on his part, and that in doing this he
would resort, if necessary, to all the means that promised success,
and recognized as proper by the surgical profession.
The obligation of the plaintiff was, to permit the defendant to
resort to all such means, if necessary, to effect a cure, and to pay
the defendant such sum as his services were reasonably worth,
whether he succeeded in accomplishing the object or failed. The
undertaking of the defendant was not that of a guarantor or
insurer that a eure should be effected.
In case of fracture, the surgeon is bound (if it can be done) to
put the broken fragments of bone in proper place, or in apposi-
tion, and bring into requisition such appliances as will keep them
in that position. Re-union is the operation of nature, and not of
the surgeon. When nature refuses to perform this work, where
the pieces of bone are put and kept in apposition, no liability
attaches to the surgeon. In some cases, means may be used that
will aid the operations of nature. This should be resorted to
when need demands. The sum total and short of the matter is
this: the surgeon must do his part, and nature hers. When from
past experience it has been ascertained that different modes of
treatment are proper and succeed, the pursuit of either is not, in
legal contemplation, want of skill or care. When the means most
generally resorted to fail, and there are others that promise
success, (because they have been successful,) the surgeon should—
and has a right to—resort to those other means; and if he is not
allowed to do so by the patient, or by others who control the
matter—as the parent of a child—then we claim that no action
can be maintained because a cure was not effected. This is the
very state of case that we expect will be developed on this trial.
In this case it will not be denied that the boy’s arm was frac-
tured—precisely how it was done may not be proved. It is proper
that I should say to you that surgeons have designated particular
kinds of fractures. -
First, there are what are termed simple fractures. These are
the least dangerous. In simple fracture only one bone is broken
at one place, and no other injury.
xi
Second, there is what is termed a compound fracture. This is
where the bone is broken at more than one place. This is more
dangerous than simple fracture.
Third, there is what is termed compound comminuted fracture.
This is where the bone is broken at more than one place, and an
external wound leading to or connected with the point of fracture.
This species is much more dangerous than simple or compound
fractures. -
Fourth, there is compound comminuted complicated fracture. Here
the bone is broken at more than one place—an external wound
of the flesh communicating with the fracture, and a wound or
some injury upon some other part of the body. This is the most
dangerous of the whole class. - -
This last is the kind (as we anticipate the proof will show) with
which the plaintiff was afflicted. We expect that the proof will
show that the humerus of the left arm of the plaintiff was broken
in two places, and in its lower third, and that there was an exter-
nal wound of the flesh communicating with the lowest fracture;
and in addition to this, that the right hand was badly lacerated,
and one joint of the thumb dislocated. -
That Dr. Pratt set these bones and dressed them all in proper
manner, and gave them the requisite attention so long as he had
charge of the case. That some short time after the injury was
inflicted, the defendant, in dressing the hand, discovered that the
thumb was not in correct position, and desired to adjust it; but
the parents of the boy would not allow him to do it. That in
some few weeks after the arm was first dressed, the defendant, in
the presence of another physician, examined the arm and found
it all right—even to its length by measurement. That in about
eight weeks from the time of the injury, the doctor, in the pres-
ence of Dr. Wales, again examined the arm and found the bone
well united. That it was again, however, re-dressed, and that
some short time thereafter, by some improper act of the plaintiff,
his arm was refractured. That it was again set, dressed, and
properly attended to, but that re-union would not take place.
The roller and splints were applied to the arm in the usual
manner, and this angular splint was put on over the dressing.
We also expect to prove that some months after the injury, pro-
visional callus was perceptible to the touch at the points of frac-
ture. This kind of callus sometimes soon entirely disappears, and
sometimes it remains a good while. Provisional callus is, as I
X11
ought to inform you, a sort of band or hoop thrown around the
fractured bone to hold the fragments in place, like the hoop upon
a barrel. -
If I have made any mistakes in my defining surgical terms, the
professional witnesses will correct me when they come to testify.
After Dr. Pratt had treated the case for some months, and
wished to resort to other and stronger measures, in order to induce
pe-union, the case was taken from him and placed in charge of
Dr. Miller—a brother of one of the attorneys for the plaintiff.
I agree with Mr. Turner, that persons who hold themselves out to
the world as physicians, surgeons, lawyers, or of other professional
character, should possess a certain amount of knowledge and skill,
so that they may pursue their legitimate pursuits in a proper man-
nor. -
I concede, and Dr. Pratt concedes this, and he does not wish
to evade the responsibility of his position in any manner what-
ever. He is ready and willing, on this and every occasion, to
stand up to all that the law requires of a surgeon ; and holds
himself answerable for any lack of skill on his part. I apprehend
that this case will turn mainly upon points of law, but the end
can only be known by your verdict upon the testimony. All this
talk among the people, which accumulates as it spreads, like a wet
snow-ball rolling down hill, you should wholly disregard.
I have now stated to you our theory of this case, and the main
points of law which govern it. The facts will be developed by
the evidence, as well from non-professional as professional men.
I do not believe that you will have any trouble in disposing of the
case when you have heard the testimony, although it may be
lengthy. It is correctly said, that when a man’s life is in danger,
no time spent in saving it is too long. This is also true when the
reputation of a professional man is at stake, especially when a
party claims to have been injured by his neglect. -
Listen, gentlemen, to the case as it is developed and get a
proper understanding of its merits. I must, in the outset, crave
your patient attention. The case cannot be tried in a few
moments, like many cases submitted to juries. -
I shall take no more time at presentation, but will see what the
prosecution has to offer. - - - -
IN CARROLL CIRCUIT COURT,
March Term, A. D., 1864.
STATE OF ILLINOIs, CARROLL county, ss.
FRANK P. FRISBY, a minor, under the age of twenty-one years, by PIERSON
NOBLE, his next friend, vs. LEONARD PRATT.
BILL OF ExCEPTIONS.
BE it remembered, that on the trial of this case, at the March
term, A. D. 1864, of the said Circuit Court, the said Plaintiff, to
maintain the issue on his part, gave in evidence to the jury the
following testimony, to wit: - -
Charles Frisby, sworn, says that, I was not along when this
boy, the plaintiff, broke his arm. It was in Dec., 1862. I did
not see him for one or two hours after he was hurt. I know Dr.
Pratt. When I got there the neighbors had got him into Mr.
Morris' house and Dr. Pratt had sewed up the wound on his hand.
I asked Dr. Pratt if he was a surgeon. He said he was. I asked
him if he could set his arm right. He said he could do it as well
as anybody else. He came to my house and dressed the arm two
or three times. He was treating it, in all, some five months. There
was nothing said about paying him anything at that time. I
never offered to pay him anything. I told him to attend to the
boy at once, without delay, and not to stand about expenses. He
said he would do it. He then went on and did the arm up. This
was on the 20th of Dec., 1862, that the arm was broken. Dr.
Pratt was a stranger to me, was the reason of my asking him if
he was a surgeon. I knew he practiced medicine, that is, he held
himself out as a doctor. It was in Carroll County. I think he
treated the arm about five months and ten days. He did non
come as often as I wanted him to, and I went after him some-
10
times. Iſeard him say the arm bone was all mashed fine, and that
the matter to heal the arm was like the white of an egg.
There was a wound on the outside of the arm. I do not know
how long before the external wound healed. The thumb was cut
some, and I think he said it was out of joint. I don’t know that
he ever had a fit of sickness in his life. He has always been as
healthy as any boy in the country. All the time Dr. Pratt said
the boy was doing well, except once. I think it was about the
first of May when he dressed the arm and said it was doing well.
It was at this time I told Dr. Pratt I wanted some one for
counsel. He wanted to know who I wanted. I told him I was
not particular. He appointed a day to go to Milledgeville, about
one week from that time, and we agreed to meet at Dr. Belding's,
and Dr. Belding and Dr. Freas to meet with Dr. Pratt. In two
weeks from that time we were to meet at Dr. Pratt's. On this day
I took the boy down, and Dr. Pratt undid the arm and said it was
not any better. He said he must have very little food. He said
he might have toast and gruel and crackers. I don’t know for
how long a time it was. We begged him to let him have some
meat. He said the boy better have a good arm than to eat too
much. I think it was three or four weeks before he changed the
diet—it might have been more, or less, I cannot tell. I was pres-
ent sometimes when he dressed the arm; I cannot tell how long
it was before he took off the dressing. He left it longer than I
thought he ought. Usually he took the elbow and rested it on
the leg; did not move the arm much ; the doctor kept hold of it
all the time. -
Cross-Examined.—I saw my son first in one or two hours
after his arm was broken. It was about four miles from my house
where he got hurt. The boy, who was with my boys, came up with
one team, and I took one horse out of the harness. I first saw
the boy at Morris' house. I found Dr. Pratt there when I got
there. The Morris boys were there. I cannot tell whether David
Morris assisted Dr. Pratt or not. I cannot tell who assisted. I
was so nervous that I cannot tell much about it. Dr. Wales was
ºthere and held the chloroform to the boy’s nose. I cannot tell
who else assisted the doctor. He had sewed up the hand when I
got there; I think had completed it. I did not notice in what
manner it was done up. The thumb was considerably torn. I
cannot tell how the arm was injured. It bled some. I do not
know how much. Well, there was considerable blood at the point
11
where the arm was broken. I did not notice a bone protruding.
I did not examine the arm so as to know for myself how it was
hurt. There was a splint put on. I think he brought that splint
afterwards; I cannot tell when it was. He came after breakfast.
I do not know whether he brought the brace or not. I am under
the impression he brought it the next morning. I did not notice
the hand much. I did not examine the hand at any time to see
how it looked. I do not know when he came again after the next
morning. I cannot tell how long it was before he visited the boy.
It might have been three or four weeks; it may have been three
or four days. I think it was more than that. I remember when
Drs. Pratt and Burbank came there. I cannot tell whether I was
away much about that time or not. I was not always there when
the doctor came. I was sowing grain frequently; it was seed
time, and I was busy in the Spring. I cannot have been away
more than one or two nights. I was hauling posts, and was away
frequently during the day. I cannot tell what I was doing when
Dr. Burbank came. I recollect he stopped, but cannot tell pre-
cisely when. I think it was some two or three or four weeks. I
think there was no person present when Dr. Pratt dressed the arm.
I cannot tell how long after Drs. Pratt and Burbank were there.
They took off the bandages and brace when Dr. Burbank was
there, except the bandage next to the arm. The brace was on
the outside. He usually did up the arm when he came. There
was a string to hold the brace at the lower end and near the wrist,
and another near the shoulder, and I don’t know but there was
another near the elbow. Dr. Pratt took off the bandage. I don’t
know whether Dr. Burbank felt of the arm or examined it. I do
not think he did in my presence. I think they took the bandage
off from the thumb. I don’t think Dr. Pratt ever told me the
thumb was out of place until after the wound was healed. He
then said he was ashamed of it and wanted to fix it. I did not
hear anything about re-setting it at the time Dr. Burbank was
there. It was after that, he put the compresses on it, I think he
called them. At the time Dr. Burbank was there the wound on
the thumb was not healed. I do not know what dressing he put
on to keep the thumb in place. I cannot tell how long after Dr.
Burbank was there that the thumb was healed. I cannot tell
when that was, that he wanted to fix the thumb. It must have
been sometime after Dr. Burbank was there. I cannot tell
whether the boy objected to it or not. His mother and I thought
12
he had been hurt about enough, and I told him he needn't fix it. I
don’t remember whether the boy objected or not. I never blamed
him for not putting the thumb in place. I told him he need not
fix it. I guess the boy didn't say anything. I don’t think he said
much about it. I don’t recollect that he did. He will be fifteen
years old the twenty-fourth day of next May. From that time to
the present there has been no surgical treatment of the thumb. I do
not recollect of ever seeing the boy whittle or try to use the arm.
He did not use the arm because he could not. We fed the boy.
until the hand got well enough to hold a knife, I think; I am not
positive how long we fed him. It was on the night he broke the
arm that he gave us directions about the diet. I think it was over
a month that we gave him this kind of food. I don’t know
exactly what he said. He might have said we might give him a
little toast, crackers and gruel. I cannot tell how long the low
diet continued; as long as the Dr. required; when he consented
to a higher diet we gave the boy such food as we used ourselves.
The brace was broken while the boy had it on. He was at
home, out of the house. I did not see it done. (A brace was
shown the witness, and he was asked if that was the one.) This may
or may not be the brace. It was not broken like this at the time.
It was only a small check, but afterwards the boy slept in it, and
it was thrown about the house and split worse. The boy told me
that in attempting to kick a ball he hit the brace against the fence,
and checked it a little, not a quarter as much as it is broken now.
The boy never said it hurt his arm. My wife saw the check, and
then I told the boy to tell me if he had hurt his arm, because if
it was hurt, we must go for the Dr. He said it did not hurt him
one particle. A day or two afterwards the Dr. was passing by
and I called him in. The Dr. looked at it and said the boy had
loosened the arm a little. I do not know of his attempting to
reset the arm. I think the short end of the brace was up. From
the time the arm was first broken until the brace was split, was
about two months. The boy never complained of any pain after
the brace was split, and never has to this day.
Don't know how long after the injury before the external
wound in the arm was healed. I took the boy down to Dr. Pratt
several times at the Dr.'s request. Dr. examined the arm at such
times. I took the boy down two or three times. The last time,
about the first of May. The Dr. never proposed to try any other
operation to make the bones unite before I took the case out of
13
his hands. He never had told me the bones were not united.
Dr. Freas was the first to tell me that the bones had not united.
At Belding's, the 10th or 15th of May, was when Dr. Freas said it
was not united. When Freas said that, Pratt said he thought it
was united some. They agreed to rub the bones together and see
if they could not get up an irritation and make them unite, and
did so, and agreed to meet again at Dr. Pratt's in two weeks. I
went there with the boy, and only Dr. Pratt was there. He ex-
amined the arm and said it was no better. I then took it out of
his hands. He did not then propose another mode of treatment.
A few days after that I met the Dr. near his house, and told him
I had concluded to get somebody else to treat the arm. After
that he came to my house and proposed another mode of treat-
ment. He proposed to have me take the boy to Chicago, and
let Dr. Beebe operate on the arm, and proposed to go himself, at
his own expense. It was, I think, about a week after I took the
case out of Pratt's hands that he made the proposal to go to Chi-
cago. I told him I should employ Dr. Miller. Dr. looked at it
and said it would have to be operated on. Dr. Miller never did
anything except to examine and propose an operation. No opera-
tion has ever been performed on the boy. I think Miller said it was
not in a healthy condition to operate upon. Dr. Miller set a day
to meet McPherson there and examine the arm, but never set a
day for an operation. I do not know Isaac Hodgeson. I know
Dr. Wales. Have no recollection of Dr. Pratt's proposing an op-
eration in their presence, at his house. He proposed, at my house,
to have an operation performed. He might have proposed to
have Dr. Beebe perform an operation before that time, at Dr.
Belding's. Dr. Belding said he guessed if they would put a
couple of shingle nails through the arm it might get well. Heard
nothing at Belding's about ivory pegs, or wiring the arm. Dr.
Pratt his since spoken of such things.
Direct Resumed.—The boy never said his arm hurt him when
the brace was split; did not complain of any pain, and that was
about two months after the hurt. - ... • .
Cross-Ea'amined.—The boy complained of pain in the fore-
arm on account of the tightness of the binding; it was almost
black in consequence of the tightness.
Mrs. Charles Frisby, sworn, says: I am the mother of this
boy. I went up and saw the boy when he was hurt. The Drs.
had gone and the boy was getting over the influence of chloro-
14
form. We moved the boy Sunday about noon. The bandage was
put around the arm and then splints were put on, and then a
bandage was put around them. The injury occurred on Satur-
day, about 4 o’clock in the afternoon. This outside one was not
put on until the second Tuesday after the injury. The first I
saw Dr. Pratt was on Sunday; he did nothing to the arm then.
On Tuesday he looked at the hand and the arm; he dressed the
hand and arm on Tuesday; on Thursday he undone the hand and
looked at it. Dr. Burbank came with him the second week after
he was hurt. It was six or seven weeks before he removed the
bandage. The thumb joint was then out, as it is now. He con-
tinued to treat the boy five months and ten days. Said I must
give no coffee or tea. The Dr. told us to give the boy very little
and very light food, toast and crackers, or a little gruel, and we
did just as he directed. It was dressed on Tuesday, the second
week; about ten days after the injury he took off the bandages
and dressed it; another person held the arm. It was three or
four weeks before the wound healed up; it run some matter out
of the arm; the arm was not swelled much; the arm looked white
and natural, except a small hole. On Wednesday, the third
week, he done up his arm, and his hand and arm swelled up and
looked black, and the boy complained, and I told the Dr. about
it before he left, and he said, “Rub it and it will come right; if it
don’t, send your elder boy for me;” and we sent the elder boy, and
he sent word to loosen the bandages, and I did a little about the
hand. The next day Dr. Pratt came and took off the bandage,
and put it on again. I did not see where the brace was cracked.
I knew when it was checked. It was checked a little on one
side. The boy did not complain at all. The Dr. told me the
arm was doing well; told me every time he looked at the arm he
thought it was doing well, except after the brace was checked he
said he thought the boy had loosened it a little. The brace was
checked a little over two months after the injury. He did not
take off the bandages at the time he said the boy had loosened
the arm a little. About two weeks afterwards, he told me the
arm was back just about as it was before. All this time Dr.
Pratt never intimated there was a false joint. We watched him
day and night for two or three weeks; my sister was with me. , “ .
The directions were carried out in every point. His health was
good at the time; was never sick twenty-four hours. His general
health has been good since he was hurt. I was there when Dr.
15
•
Burbank came there the second week. Dr. Wales was there twice
afterwards; was there four times in all, I think. r
Cross-Eacamined.—They did not do anything the first time Dr.
Wales was there, but to take the bandage off and put it on. It
was some five or six weeks after the hurt, it was dressed in the
presence of Dr. Wales. Dr. Pratt did not call my attention to
see that the arm was right; never did call my attention to it;
never did any such thing. When it was first dressed there were
two small flat splints outside of the under bandage, about as wide
as between the width of two and three of my fingers; one above
and the other on the under side. There were also three narrow
splints, not quite as wide as my fingers. I did not observe whether
the splint was on the outside the wound, one under and the other
upper; there were three small splints about half the length of this
elbow splint. He came a week from the next Tuesday and un-
done it, that was the first time I saw the splints. At first the
arm was not swollen; on the third week the arm first swelled;
it continued to swell more or less all winter; the swelling would
always be worse immediately after dressing. The arm was not
bandaged below the elbow much ; I never saw there was much
swelling, except on the hand; I spoke to the Dr. about it and he
said, “Rub the hand, and the swelling would get better when the
blood circulated.” It would swell up every time. I told him I
hated to have him bandage it so tight. He became so used to
the splint that we kept it on until after we had discharged the
Dr. The boy came in and went up stairs. When he came down
stairs he says, “Mother, I believe I have split the splint.” He said it
did not hurt him much ; he never complained. I cannot tell when
that piece was split out. I did not notice that little piece out at
the time he checked it; I do not think it was out, or I should
have seen it. I cannot tell when that was done. I took the out-
side splint off every day and washed the arm in a wash the Dr.
gave me. I cannot tell exactly when this splint was put on. It
was about three weeks. There were little blisters along that
arm. Some festered matter came out of the wound at the time
the splint was split. On Sunday and Tuesday the Dr. dressed
the arm and examined it. He said the boy had loosened the arm
a little. Nobody ever examined the boy’s arm until after he was
taken out of Dr. Pratt's hands, in my presence. Dr. Pratt spoke
about fixing the arm. Frank did not say much. Dr. Pratt said
“I think Frank won't object to my doing it.” Mr. Frisby was
16
away more than usual. He was off and on some ten or twelve nights.
He was away a good deal of time during the day time. The Dr.
was there several times when he was not there. We were mov-
ing from Elkhorn at the time of the injury. My husband was
hauling from there a good deal that winter. I do not know Mrs.
Dr. Belding; I never had any conversation with Mrs. Belding;
I don’t know the lady; a lady, I supposed was Mrs. Belding, was
in and out of the room while we were at Dr. Belding’s, but I had
no conversation with her about Frank’s arm ; nor did I speak to
her that day. I did not then and there say in her presence and
that of Mrs. Pratt's, that Frank had broken his arm over again;
nor that I had got Frank to own that he had broken his arm over
again. Mrs. Pratt said Frank fell off from the fence and broke the
splint and broke his arm over, again; and I said Frank did not
fall off the fence at all. Dr. Pratt never called my attention to.
the arm when it was undressed, in the presence of Dr. Wales, to
see that it was united. I never told Mrs. Downs that the arm was
well. I told that the wound in the flesh was healed up. I may
have told Mrs. Downs that the Dr. said the arm was doing well.
Direct Resumed.—The splint was cracked two or three inches.
The splint is broke a great deal worse now than it was when the
Dr. took it from our house. -
Mrs. Jane Moscript, sworn, says: I am a sister of Mrs. Fris-
by, and the one who helped nurse the boy. The boy was hurt
on Saturday, and I went there Monday. That brace was put on
the second week after the hurt. The boy was well taken care of,
according to the Dr.’s directions. The Dr. came there on Tues-
day; Dr. Wales came with him. On Thursday of the same week,
Dr. Burbank. I stayed there until after the arm stopped running.
If I should say what I thought about the diet, I should say he
had no diet at all. He was watched day and night; our eyes
were never taken off from him at all, day nor night, for three weeks.
He put on the splint so hot he burned the thumb ironing it.
Cross-Examined.—I heard him say he must be kept on toast
and some light food. I once toasted him a half slice of bread,
and his mother came in and said it was too much, and we divided
it. The Dr. told the boy, if he wanted a good arm, he must not
eat too much. I cannot tell how often I heard the Dr. say the
arm was doing well. I said to the Dr. that it seems to me that
the arm is getting along very slow. He said it was doing well
and uniting. On the 12th March he said the arm had been hit,
17
and I asked my sister; she told me the splint had been split about
two weeks before. The day this splint was brought home the
Dr. bandaged the arm too tight, and the next day after he loosened
it. I never saw much discharge until he put on the outside
splint on the elbow, when it discharged considerable bloody and
corrupt matter. It commenced soon after I went there. It was
not dressed more than two or three times. I saw the arm every
time he undressed it while I was there. I think Dr. Wales was
there one day, and then washed his head in arnica. That wound
on the head bled some; it had not healed when I left there; it
was hurt worse than the arm. There was a separation of the
skin on the back side of the head, near the top of the head on
the side. I did not dress it; my sister dressed the wounds. When
I left it was not healed. Dr. Pratt gave my sister some weeds.
I know catnip, but I did not know what it was ; the Dr. called it
armica. There was a bandage around his head, and it was taken
off and the wash made out of these leaves, steeped in a basin, and
put on every day; I frequently saw Mrs. Frisby wash it. He left
a phial with some medicine, but it had no color in it. I never
saw any medicine of theirs that had any color. Every
time Dr. Pratt came there and moved the arm, it would bow out
just as much as it does now. When he took hold of the arm to
dress it, it bowed out every time just as it does now. I noticed
the arm was not in line with the dressing. -
He could not move it without lifting it with the other hand.
Dr. Pratt brought Dr. Burbank with him on Thursday of the first
week I was there. Dr. Pratt took off the three outside shingle
splints, and showed the arm to Dr. Burbank, and told him there
was two more splints on with the bandages. Dr. Burbank did
not examine the arm. Dr. Wales did not examine the arm while
I was there. Mrs. Frisby did not want this elbow splint put on
again. She said the arm looked crooked, and she did not want it
on. The splint on the thumb Dr. Pratt made; it looked like
woolen cloth. He dressed the hand every time he came. He
took and heated a flat-iron and pressed it on a board, and put it
on so hot that it burned him. It had some stuff on it that
made it stiff when it got cold. He did not put any splint on
the hand, but the woolen cloth-looking article. I do not know
that this was gum shellae. When I came back, in March, the
head was pretty nearly healed.
Edward S. Shafer: I am thirteen years of age. I have seen
18
that splint; Frank hit it on the fence post and split it. I was
about a rod from him. He was standing on the corner, and hit
the post. He went to kick the ball. I did not see that it was
split. When he went up stairs and came down, his father and
mother talked with him about it. He did not fall down when he
kicked the ball; he only hit the fence post.
Cross-Ezamined: I did not see that the splint was split until
he went up stairs. He did not complain of its hurting him. I
did not see it was split until I heard him talking with his mother
about it. ---
Prancis T. Yeomans says, he is acquainted with this boy, is his
grandfather. Was present when Dr. Pratt called to dress the
fractures at Mr. Frisby's; it was on the 3rd day of February, A. D.
1863. I remember it well, because it was Mrs. Frisby's birth-
day, and I went there on a visit. Dr. Pratt took off the bandage
of the arm, and I held him at the shoulder, standing behind him,
and the Dr. tried to press down the bone in the arm into its place ;
it stuck up some. He took hold of the arm and pressed down the
bone. He wanted me and my wife to pull on the arm, and we did
so. I should judge that we pulled a hundred pounds. I stood at
the back of the chair and held him in the chair, and my wife took
hold of the arm at the elbow, bent up in this way. I think we
pulled all of a hundred pounds. The boy had not at that time
been out of doors. I have never noticed this splint since until to-
day. - . - -
Cross-Examined.—I resided at Eagle Point. I knew the arm
was broken. He left my house on the morning of the 20th Dec.,
A. D. 1862. If there is any particular event which occurs in my
family or my neighbors’ families, I can always remember. I
went there on the 2nd day of February, and I remember it for the
reason that Mrs. Frisby's birthday was on that day. She was
born on the 2d day of February, A. D. 1823. The Dr. came
there the next day. There was no external wound at that time,
but there was a red spot where there appeared to have been a
wound. The arm appeared to be natural when it was straight,
but when moved it would bow out as if the bones had not united.
There was a little spot which stuck up a little. It was, I should
judge, nearer the elbow than the shoulder where it was broke.
The Dr. said there was a loose piece of bone. He said he wanted
to press it into place. It appeared to be raised some higher than
it was below. My wife had hold of the elbow. I think my wife
19
did not let go until we got through. I know I did not let go.
I don't know but Mrs. Frisby helped some at last. I know that
this was before the splint was split. It was about the first of
April I heard of that. Mrs. Moscript told me about the splint
being split. These are the splints. I examined them when he took
them off. I should think they are about the same width; there
was a widish splint. He put on the splints again and bandaged
the arm. .
Dr. John Porter, sworn : I am a physician and surgeon ;
practice medicine in Carroll County. I graduated on the first of
March, A. D. 1843, at the Medical University in the city of Balti-
more. I have been regularly and extensively engaged in the
practice of my profession, except some two years I devoted to
farming. (The witness here examined the plaintiff’s arm and
took up a bone.) In the first place I would state to the jury, here
is a bone called the humerus. This corresponds with the bone
broken—that is broken here. Anatomically speaking, this bone
is divided into three portions—the head, the shaft and the lower
extremity. I doubt whether there is another bone in the human
body which is used as much as this bone, and there is no bone,
from its anatomical structure, that is so well adapted to perform
as great a variety of uses. Here is a bone which is attached to
the shoulder, and is calculated to perform all the varied uses
which the wants of man may require. You will also observe
that here are ridges on this bone, which by the muscles, motion
is produced. The structure here is large. We have then, here
two varieties of motion. In this arrangement is manifest the
wise provisions of nature. These muscles lay along the groove of
this bone horizontally, to make them work. If you were to draw
a log you would hitch your chain over one side so as to gain a
lever power or force. This bone is also spongy, and it increases
as you see, at the upper end of the bone. The articulating sur-
face is by this means much increased. You see by these two
bones, we have points of attachment for these muscles, by
means of which they can move the arm. You can readily per-
ceive that a joint and bone possessing such a wide range of mus-
cular action, must necessarily, in case of accident, require a great
deal of force to steady it, and keep it in a quiet position. He has
broken what I call the lower third of the humerus. We have
what I call an oblique fracture across the bone. We have also
what is called a longtitudinal fracture; it is when one end is fast
20
and is broken on one side. A longtitudinal fracture is generally
produced by gunshot wounds. We have what is called a simple
fracture, which is when the bone is merely broken and the flesh
not bruised or lacerated. If broken more than once, it is a com-
pound fracture. If in addition to this, the flesh be lacerated by
the bone being thrust through the tissue, it is a compound com-
minuted fracture. In this case the fracture is of the lower third.
You will discover by the end of these bones, that it was something
of an oblique fracture, not exactly oblique either. The bone is
rounded by cartilage. I see here a scar which might have been
caused by the protrusion of the bone, this may have been a com-
pound fracture caused by violence. You discover here I can
make a pressure without causing much pain to the boy. Nature
at once throws around that broken bone a fleshy substance to
repair the injury. It is said General Scott has two bullets in him
now, received in the Mexican war. Nature has thrown around
this ball a kind of sack to preventinjury to other parts of the body.
So with this, there is thrown around the bone a muscular or car-
tilagenous substance to shield it. This will continue as long as
he lives, to prevent the spicula, or cragged ends of bone, from
producing too much irritation or nervous sensation.
The first time I saw this boy’s arm was in the month of June
last; I had been visiting a patient near the red school house. I
observed a man rapidly approaching, and motioned me to stop.
When he came up I discovered it was Dr. Miller. He asked me
if I wished to see a case. I answered I would like to do so. I
went with him and he called this boy up to us, and I gave it a
partial examination. I have since seen him in Lanark. I examined
it carefully. My opinion was, that it was a simple fracture. But
the evidence of this small scar shows that if made at the time of
the fracture, it may have been a compound fracture.
I did not at the time I made the examination recognize this
scar. But I pronounce it a simple fracture. According to my
medical reading, a simple fracture is when the bone is broken
without injury to the soft parts. Secondly, a compound fracture :
in addition to the fracture of the bone, there is a laceration of the
soft parts of the flesh. Third, the comminuted fracture: the
bone is broken into two or more pieces or spicula. If I were
called upon to examine a fracture, there would be a difference,
very perceptible, between a simple and a compound fracture. I
will state to the jury that if the fracture has, by its violence, pro-
21
duced a laceration of the flesh, the blood vessels around the bone
immediately throw a large quantity of blood around the seat of
the fracture, which, if I may so speak, is a scaffolding which nature
kindly throws around the bone to aid it or protect it in its present
injured condition. After a while nature goes into her work of
organizing these materials into callus, and in a short time this
callus is thrown entirely round the bone a sort of band, and the
work is complete. -
There is no callus here, and if there ever was one it must have
been entirely absorbed, which cannot be; and I see no evidence
here that there ever was a comminuted fracture. I think the best
writers all agree upon this point as to callus being the proper
evidence of a fracture, which always remains. Taking this, then,
as true, I cannot find any evidence whatever that there was ever
a comminuted fracture. I can discover nothing to indicate it. I
think the evidence of such a fracture could not have disappeared
so soon as at the time I made that examination.
Question: From what you know of the case, what is your
opinion, as a surgeon, as to the necessity of the arm being in its
present condition, if it had been properly treated ? .
Ans. In order to answer that question, I must explain some of the
general principles of surgery. If there had been coaptation—by
this I mean when bones are broken and united again—when the
bones override each other, there is no proper coaptation. From
the condition of the boy, as I saw him last June and frequently
since, and at the present time, I would state that if there ever had
been a proper coaptation of the bone, and it had been properly
taken care of, I see no reason why there should not have been
proper and perfect union. I have seen similar cases in the course
of my practice. There are a variety of causes which will produce
the formation of a false joint. .
In the first place, after a bone is fractured, if there are any soft
parts around the broken structure, if they are allowed to remain
between the portions of the bone, these will prevent a perfect
union. After a bone has been fractured and the surgeon leaves
any portion of the flesh to intervene between the fragments, this
foreign substance must be first thrown out before the bone will
unite. This flesh, if not thrown out, will cause a false joint.
There may be a proper coaptation, or bringing of the bones together,
and there may be an officious intermeddling of the surgeon, so as
to break up, or prevent the formation of provisional callus; or
22
there may be too much motion, however produced. There are
very many other causes which would prevent a union and cause a
false joint. * , - .
I heard the testimony of Mr. Yeomans yesterday. It would not
be correct practice to have two persons, after six weeks from the
injury, to take hold, one at the shoulder, and the other at the elbow,
and to pull with sufficient force to pull a weight equal to one hund-
red pounds; and it might, and would probably, altogether break
up the provisional callus. I say, that under these circumstances
it is my opinion that such an unusual force applied to the
limb with these manipulations of the surgeon, would break up,
if not destroy, the ossific structure there formed. In a boy of this
age the circulation is much more active than in one of older years,
or an adult, and the ossific repair would be much quicker accom-
plished than in an older person. I see no reason why this bone
would not unite. - - -
There are false joints stated in surgical works, of this kind, but
they seldom occur if properly treated. The food should be nutri-
tious; thisis one of the means to which the physician resorts to work
out some desired end. If a person is accustomed to eat hearty
food, and we put him on a low diet, he will become emaciated, the
circulation of blood will be feeble, no inflammation will take place,
and no ossific matter will be furnished to repair the injury. A
generous diet, therefore, is necessary to furnish ossific matter for
the repair of the bone; this is in harmony with all the beneficent
operations of nature. - -
Question: Was it proper dietetic treatment to keep the patient
upon a small supply of toast, crackers and gruel, in absence of
inflammation ? - - " . . .
Answer: By no means, sir. The dietetic treatment would be
aggravating instead of furnishing the organizing stimuli which
nature requires in such a case. . -
Question: What is that which forms the new bone
Answer: Permitme, sir, to state to the jury, that the bone is wisely
provided with ossific matter to keep it up. Now, this bone in its
natural condition, is surrounded with a thin substance, by what
we call in surgical terms, the periosteum. It is the medium
through which the ossific matter passes around the seat of the
injury. It is there massed, and is of a plastic substance, or char-
acter. It grows harder and harder, and the blood vessels deposit
this ossific matter which is supplied by the blood. This periosteum -
23
is thin, and delicate in its formation, and these little blood vessels
pass through it. It is thus the bone is supplied with nutriment.
Under ordinary circumstances the first step of nature is to throw
around it a kind of shield to protect the bone. It may be in the
course of a week; it may be less, or longer, owing to circumstances,
the constitution of the patient. Without local inflammation this
bone cannot be repaired.
Question: Under these circumstances and in the absence of
that inflammation, was a small portion of crackers, toast and gruel
sufficient nourishment to furnish Ossific matter, necessary for the
repair of this fracture. -
Answer. By no means, sir. -
Question: Doctor, upon the hypothesis that there was a wound
produced at the time of fracture, that resulted in a running sore, that
was cured in four to six weeks, what was the condition of the
health of the boy P
Answer: The condition of the boy's health was good. A
wound of that kind healing up in that time is evidence that there
was no material derangement in his system. -
Question: If there had been any constitutional derangement
or disease of the boy, would that wound have healed up directly?
Answer: Perhaps it would if there had been no hidden disease.
Question: If that fracture had been properly reduced, had not
the bone time to unite in from four to six weeks?
Answer: Under ordinary circumstances, I should expect the
union in bone from four to six weeks. The more a man works
the harder the muscles become. The arm of the blacksmith is
much harder than the farmer’s. These muscles have remained
inactive, and by reason of that they have become shriveled up
and lost their healthful condition. - .
Question: What do you find in the right hand and thumb of
this boy P. -
Answer: There appears to have been a dislocation of the
thumb, and at present there does not appear to be a union of this
thumb; there is a partial dislocation. When the surgeon fails to
do his work the beneficent hand of nature does the work for him.
There is not a perfect reduction here. The bone is down. There
may have been a fracture. There is evidence of a want of proper
adjustment. . r
Question: State the condition of the joints here in the thumb.
Answer: I have already stated there appears to be a partial dis-
24
location of the second joint of the thumb. In this bone, I am of
the opinion that there may possibly have been a fracture here
sometime. It is made up of three bones. There is a displacement
here at the lower joint, also. - -
Question: Has that fracture been properly reduced?
Answer: It is not in proper position now. My attention was
called to the thumb here, and I never examined the point or end
above. - - -
Question: Does the boy have any use of that thumb now 2
Answer: He has not. -
Question: Has this bone been properly set 2
Answer: The boney structure of the hand is very complicated
and I know not what might have been the condition of the hand.
There is now a bad union. Thus you see there is a partial dislo.
cation, as I said before. . -
Question: Dr., is it good surgical practice in the treatment of
that wound, three weeks after the fracture, to bandage it so tightly
as to produce blackness and swelling of the lower arm and hand 2
Answer: By no means, sir; just the opposite, sir.
Question: What produces this blackness and swelling after
bandaging 2 -
Answer: I will explain this to the jury. It will not be gener-
ally understood by those who are not medically educated. We
have the arterial circulation which is going on always from the
heart, and we have the venous circulation always returning to the
heart. Too much bandaging was applied here, and this when too
tightly applied, prevents circulation of the blood in the veins, and
if continued would produce mortification, and would tend to retard
the union of the bone, and would also produce a high amount of
local inflammation.
Question: Would that have a tendency to make a bad structure?
Answer: Undoubtedly it would. The blood is the great foun-
tain by which all this is made perfect, consequently it would pre-
vent all local inflammation. The arterial blood is that which comes
out from the heart, and the venous, that which returns back again.
This high bandaging would cause them to meet at this point, and
would produce too light an amount of local inflammation. -
Question: How long would a skillful surgeon treat a fracture
of that kind and not discover the bone had not united ?
Answer: He would discover it in a week or ten days, that the .
25
proper co-adjustment of the parts had not been effected, and a
proper deposit of ossific matter. -
Question. In this case should not the surgeon know that adhe-
sion had not taken place in five months -
Answer: I see no reason why he should not have found that
out four months before that time, unless there should have been
some great constitutional defect. I mean by this that the child is
the offspring of a parent afflicted with some constitutional disease,
as scrofula, or tuberculous affection by which the blood is tainted
If a person is predisposed to consumption, that is a constitu.
tional defect. That is what I mean by constitutional defect. There
is no constitutional defect in this boy. -
Cross Evamined.—I judge, sir, very much of the constitutional
defect of the patient, from his general appearance. There may
be some hidden disease. I judge from the appearance of the per-
son himself. If there is what we call a scrofulous diathesis, any-
thing in the lungs like tubercles, which is found by a post mortem
examination. I mean by diathesis that he has a transparent skin,
their eyes are watery, we find a flattened chest, which shows a
tendency to tuberculous formation. We find in that person a
development of weakness—a flush upon the cheek. In case of
another disease, these constitutional diseases manifest themselves
by retarding—by a slow and tedious union. -
You will find, sir, that people who have lungs filled with tuber-
culous matter, may live to extreme old age, and that scrofula
will not be developed until the age of puberty—may be ascertained
very early in life. In many instances it may be that a man or
woman may have these tubercles in their lungs—their lungs lined
with tuberculous matter. -
There may be scrofula and yet not have tubercles. If they
have tubercles they must be scrofulous. The hip joint
disease is nothing but a scrofulous disease. The patient may
pass to the grave with this hip joint complaint. It is attendant
upon a scrofulous diathesis. I can refer you to Sir Astley Cooper
and others. It is the opinion of all physicians, there becomes a
wasting of the parts. This wasting and debilitating of the body
is the development of the disease from its incipient state. It does
not always develop itself in such discharge. When there has
been inflammatory disease, this violent action may have been
transferred to other organs, what we call metastasis, and the per-
son may pass off with a phthisis pulmonalis. It is spontaneous
2
26
dislocation of the joint. This spontaneous dislocation takes place
when it changes the structure of the body. In some instances it
is dislocated by the debilitating process of the disease itself. I do
not pretend to say that these are the invariable results. I take
the position, sir, that the person must be scrofulous in order to be
tuberculous. We discover this by autopsy. I speak of the exami-
nation after death. We find in the lungs the scrofulous disease.
If a person has gone on with a scrofulous disease, there might be
tubercles and they not manifest in the lungs. Tubercles are all over
the body. The infant six weeks old may be saturated with tubercles.
It is stated that tubercles are found in the brain, and present
almost the same appearance as in other parts of the body. This
is not a rare thing to find tubercles in the brain and in all parts of
the body, and the history of medicine abounds with such instances.
I cannot say, sir, as to how you are, but I think I might have that
opinion. First, then, is flatness of the chest—small muscular
development, and one good reason, we find an uneven articulation.
There is no small amount of muscle in you for your size. While
a man is developing the brain instead of the muscular system;
the development of your muscular system for a man in your occu-
pation is good. I do not see anything in your general formation
which would lead to that conclusion. It is not an unerring test.
When you find a flattened chest, a small amount of pulmonary
capacity, you find shortness of breath, hurried respiration. This
is so sometimes, not invariably so. Show me a man with a large
chest, and I will show you a man with a good pair of lungs. I
claim in consequence of flatness of the chest, that the lungs cannot
have the amount of action required. It is utterly impossible for
you to inhale the same amount of atmosphere as those whose
lungs are more abundantly developed. Medicine is not a mathe-
matical science, sir. You cannot demonstrate it upon the black
board. Through the strength of the general system it does. I
stated to them that from the blood this peculiar ossific matter,
which we term the bony tissue, is derived. Blood contains every
element of the human economy. Blood is the pabulum from
which all the tissues are made. The flesh of the hand is the result
of secretions from the blood, held there by the bony tissue derived
from the blood. Every tissue in the animal and in man, even the
very hairs of your head, are fed and supported by the blood.
When we speak of the tissues we mean the various organs, as the
brain, the nerves, lungs, &c., which are made from the blood.
27
They are all tissues. The nervous tissues and all other tissues—
man is made of tissues which is the result or product of blood, by
the secerning process of the organs adapted to that office. The
blood is the result of the assimilating process—the chylific prin-
ciple. The very moment you receive your breakfast into your
stomach, the beefsteak you ate is being assimilated to your nature.
It results in the formation of blood, as this circulation of the mat-
ter is sent out. When the blood comes in contact with these
organs, constituted for that purpose, there is a deposit of this
Ossific matter. Hence, I repeat it, that bone is not only formed
by it, but it is sustained by it, so as to prevent any loss.
No sir; if a man come from Ireland and eat American food, he
would not become thereby an American. But the beef does
change itself into my system from the assimilating powers of the
digestive organs which send it out into all parts of the system.
In animal food we have more fibrin than in vegetable. If we
should eat altogether vegetables the fibrin of the blood would
grow small. I speak of that theory, sir, that has been handed
down from the remotest ages, and taught by the most illustrious
men known in history. There are encroachments upon almost
every orthodox system. Man living in a cold climate, for comfort
and convenience and health, I should claim, must eat a larger
amount of animal food than in a warm climate. This I am willing
to admit, so far as the theory of the production of animal heat is
concerned, animal food is more carbonaceous, and is calorific in
its nature. That is the reason why a man living in a cold climate
requires more animal food than one living in a warm climate. In
living under a vertical sun, man might live almost entirely upon
vegetables. Man, by the formation of his teeth, is shown to be
an omniverous animal. He is not intended by his Creator to live
exclusively on either vegetable or animal food, but upon both. T
claim that from the formation of the teeth man is intended to eat
meat. A horse is not intended to live on meat, but the dog is.
We base our opinion upon the formation of the teeth. I answer
this question, that a hen or turkey does not masticate their food.
Mastication is performed in the stomach, hence the hen does not
need meat. There are points of insertion of the muscles of the
fore-arm upon these condyles. These muscles are intended to pro-
nate the hand; the office of that muscle (the deltoid) is to raise
the arm. This bone is used as a lever for the action of the deltoid
muscle by which the arm is raised. We have the triceps muscle,
28
which forms the capsular ligament of the joints. We have the
various muscles so arranged as to work the arm in accordance
with the will. We have the triceps muscle, which is simply for
the purpose of extending the arm. We have the supinators and
pronators; we have in connection with these, the pectoralis
major and minor. We have the lissimus dorsi, which is used
for moving the arm backwards. I cannot, or have not time to,
run over the whole list of these. I state that the brachialis anti-
cus is one of the muscles which perform action, which might dis-
place this bone and would prevent the ends of the bones from
being kept in a proper coaptation. The very same muscle would
cause the fragments to separate. This is one reason why an intel-
ligent surgeon will place his bandages over the fore-arm, so as to
confine these muscles to prevent action, and thus prevent the bone
from being displaced. We have the triceps, a three headed mus-
cle, which might possibly have a tendency to displace it. Now
take, for instance, this bone (the humerus). We have on the
front part of the arm the four leading muscles which I have named,
which have a tendency to displace the bone. The triceps exten-
sor cubiti which would have this tendency. We have here two mus-
cles in front and one behind. This behind is attached to the
forearm (radius and ulna). For instance, when we come to the del-
toid, the office of which is to elevate the arm, it is connected
with the fore-arm in its motion. These muscles which I speak of
would, if they were irritated, have a tendency to displace the
bone. If not irritated, they would not have such a tendency.
We have to put the whole leg in splints and fasten the foot down,
or, in consequence of this spasmodic action, the bone would be
loosed. If the muscles had not been irritated it would not.
The brain is the great sensorium of all nervous action. If there
be any disturbance of the brain, it being the grand sensorium,
it may be from congestion, caused by pain, sorrrow, etc. Let a
child go to sleep when this disturbance is in the system, and it will
start and jerk; a spicula may cause this irritation. I am of the
opinion, if there was nothing to excite this muscular system, there
would be no such spasmodic action. I was called upon to see a
little child who fell from its chair and broke its thigh. I took hold
of the limb and discovered crepitus; and no intelligent physician
will take hold of a limb to operate on it until they examine it to
see if there is crepitus. It formed an angle of ninety degrees. I
am happy to say that the treatment was successful. She recovered.
29
The limb was not shortened. There is nothing peculiar in my
treatment, sir, from any other. I have stated before, there are two
muscles there, which will make the bone come down. When I
speak of raising the arm, you may understand that I mean the
deltoid muscle. One of these muscles runs down, and is inserted in
the fore-arm ; but this has nothing to do with the muscles of the
fingers. There is no muscle inserted here in the humerus which
has anything to do with the motion of the hand. It would be
impossible to move the arm without producing muscular contrac-
tion. My method of treatment of the forea-rm is, that I would
splint the arm properly. I may state I am not fond of these
splints. I take a piece of pasteboard cut it into two small
pieces, and let it extend from the shoulder to the elbow; I saturate
it with starch, and put it on so as to enclose the arm. I satisfy
myself of the proper coaptation of the bone. I put this binder’s
board around. After it becomes hard I remove the splints. I
think this splint keeps the surface pleasant and cool. I am not
disposed to grumble with my medical friends for using these man-
ufactured splints; I do not use them. But when one of the lower
extremities is fractured, I have one prepared by a mechanic under
my direction. If the fracture has been reduced, and the parts
properly coaptated, the provisional callus will be formed in about
a week or ten days, owing to the condition of the patient. When
there is callus formed around the bone, as there is a profusion of
blood accumulated around the seat of the fracture, if the vio-
lence which produced the fracture lacerate the parts, inflammation
ensues. It depends entirely upon this muscular action. This
muscular action would be more likely to exist to a greater extent
in comminuted fracture. -
There is an idea which has originated within the last few years,
that a union of bone can take place within the soft parts without
provisional callus. If that holds true, this bone can unite without
it. I did intend to convey the idea that there must always be
more or less of provisional callus. After the fracture is produced,
nature goes to work and throws around the seat of fracture a pro-
visional callus. If the constitution is susceptible of reproduction of
bone, this work cannot be performed without provisional callus.
It is the sine qua non for a reunion. The surgeon who follows
up measurably the dictates of nature is the most successful. If the
fracture had been of recent date, I would ascertain from my patient
the length of time this superabundance of vascular excitement
30
had existed, and I would pursue an opposite course. It is possible
that in this case a violent inflammation might ensue, which if not
arrested, the surgeon would have a more difficult case for treat-
ment—if not arrested in season, endangering even life itself. But
when nature is a little languid she needs medical aid to stimulate
and strengthen her action. You may have destruction of the
parts and lose your patient. Without provisional callus there
can be no union of bone. The necessity of inflammation is
imperative. If there be such a case of over inflammation, it is the
duty of the surgeon to correct it by antiphlogistic means. But with-
out inflammation there is no such thing as union of bone. If it
is a local cause and remains a long time it will become a general
'cause, and there may be a large amount of provisional callus
thrown out. For a while the process of repair may go on. If you
have severe inflammation, local or general, it may delay a union
for a long time; there must necessarily be some inflammation to
produce union; your patient may go on and live through this, but
this over-inflammation will retard the union. If it be below that,
it will perform the work; if it be above, it will not. I do not say
that the surgeon can do it; I am perfectly satisfied, from my read-
ing, he cannot do it without this. There will be that long delayed
union, provided the patient lives. This excessive inflammation
would have its evidences by the Superabundance of pus. Inflam-
mation, if permitted to go on in this excessive degree, would
destroy the parts. It may be, to a certain extent, interfered with.
After having gone on in this way for a length of time, the patient
may survive. If the inflammation has ceased, or gone by, the
surgeon should recall it. I say, that the inflammation may stop
short of producing re-union. If there be extensive inflammation it
must be a fact that ossific matter is there. If there be excess of
inflammation, an abscess must inevitably take place, and this
deposit of ossific matter will be thrown off as the result of this
inflammatory action. After all this has taken place, the union
may be completed and the patient live. I am not prepared to
speak of any observation of my own. I gather this from authors
—that without inflammation there can be no provisional callus;
without provisional callus no union of bone. I. Bertrand, of
Paris, has been investigating this matter, and I take it from him
and from a professional gentleman of Baltimore. They take the
ground that there cannot be union by first intention, and I give
it as my own opinion here. It is at variance with the order of
31
life. This subject has not been long before the medical world.
I say, then, there can be no union of bone without provisional
callus. I refer you to Sir Astley Cooper and all who have written
on the subject from that time down to the present. I have con-
sulted Norris. I regard Sir Astley Cooper as the father of sur-
gery; upon all subjects pertaining to surgery. There has been
undoubtedly, some improvements, but there is no proof that pro-
visional callus is not necessary to the union of bone. A com-
pound dislocation of the joint, sometime ago it was thought, must
necessarily resultin amputation. My impression is, that Sir Astley
Cooper advocates such principles. Since then there has been
introduced what is called the cutting down of the parts. These
are the principal things in Cooper. Surgery is progressive. I
say the leading opinions and doctrines laid down by Cooper are
not altered materially. - -
Yes, sir. Flat bones, as a general thing, are less liable to non-
union. Liston claims, I believe, that the humerus posesses less
liability to unite than others. Liston, I believe, in speaking of the
liability to unite of the long bones, the humerus, he says, has the
largest per centum of non-union. That bone is more liable to non-
union than the femur. I cannot say that this is not the opinion
of other medical men. I have been more than twenty-two years
in the profession; with the exception of two years, I have been
engaged in it entirely. I cannot call to mind any cases of Sir
Astley Cooper, similar, but I have had some. I have not prac-
ticed surgery here much. In the city we have more. I do not
know that I have had a case of the femur. I had access to the
hospital. I was connected with the Marine hospital. I had the
privilege to go into the hospital wards at any time. I never
reduced a fracture and carried it through in the hospital. I have
in my private practice. I located myself in the city of Balti-
more, and practiced about 11 years. I enjoyed an extensive and
lucrative practice. I have treated, in private practice, fracture of
the humerus, I think. I could not individualize any of these cases.
I cannot tell whether they were fractured in the upper, lower end,
or middle. (Witness was here shown the canal in the bone of the
humerus.) That is what is called the nutritive foramen, where the
blood enters. There is a little artery which goes through it. There
are little blood vessels which go through the bone, by what may be
called little foramina. The surgeon who is deficient of the knowl-
edge of that littleforamen, is deficient in his profession. Nature has
32
wisely provided for any miscarriage or interruption of these walls
of the arteries by what we call an anastomosing process. Suppose I
cut down and tie up the artery of my arm ; the parts will die,
because I have cut off the blood which nature furnishes to sustain
the part. What is called anastomosing. I assisted Dr. Matthew-
bury, of Baltimore, to operate on an abscess. We cut down into
it, and thought we had lost our patient; after a while he became
cold. We thought we had lost our patient, but nature went to
work and cured the patient. Let there be a destruction of the
nutritive foramen and nature goes to work to supply the loss by
other vessels, and it will supply the blood.by means of the perios-
teum. There are littleb lood-vessels passing through the perios-
teum. In case of loss of the artery, these little vessels increase their
calibre and they become, or perform what I may call a vicarious
office—that is, they supply the deficiency occasioned by the
destruction of the nutritive artery. The periosteum is the medi-
um through which the blood is carried. The periosteum sur-
rounds the bone, and through it the blood-vessels make their
entrance into the bone, in the middle, and vicarious action com-
mences above and below ; each side is furnished by its own peri-
usteum. There are said to be absorbents in every structure, and
tissue of the animal economy. As to the brain, I am not certain
but what absorbents have been discovered even there. There
could be no inflammation at the point of fracture until re-action.
After a concussion of the brain the vital powers of the brain must
re-act. In this boy you might have inflammation in a few hours
after the accident. In a case in the navy, where a sailor was
blown up some hundred feet in the air, a surgeon was asked what
he would do. He said, very coolly, he “should wait until he came
down.” After the bones were broken I should wait until re-ac-
tion commenced, and then reduce the fracture, as he would be
already down. After inflammation had commenced, an improper
coaptation might hinder the union of bone; nothing else could.
It would be impossible to have a compound comminuted fracture
without swelling and, threefore, suppuration. There must be inflam-
mation, sir. Inflammation and suppuration may occur in the soft
parts in a very short time. The time in which you might expect
suppuration would be in a few hours. If it were a low type, it
would be longer. In an ordinary case it would occur in a few
hours. The formation of pus is made very soon after the wound
is inflicted. Without inflammation there could be no pus. Pus
33
may be deposited in the tissue and remain there, and the surgeon
may fail to attend to his duty, and absorption take place. The
pus you find in the lower extremity to-day may be found in the
lungs to-morrow. A nutritious diet would include fried oysters,
meats, highly seasoned roast beef, and capsicum. An abstemious
diet, which I would prescribe, would be this; I would go down to
the hotel and order a part of the wing of a chicken, and wrap a
cloth around it, put it into a few quarts of water, boil a few min-
utes, and take that broth and dilute it in a gallon of pure water,
and give the patient a gill of that at proper intervals. This is
what I would prescribe as an abstemious diet.
Question: Do you consider capsicum nutritious, doctor ?
Answer: I consider it a local stimulant, rather. This joint
was partially dislocated. There appears to have been some mal-
formation. (Explains to the jury.) (The witness was here shown
the second joint of the thumb of a skeleton hand, and asked to
explain how there could be a partial dislocation of that joint
without a complete one.) Every joint has ligaments thrown around
it to retain it in its location. There may be partial dislocation, that
may depend upon the force brought to bear. There may have
been some displacement and the joint not humanely brought
back, or reduced, and, on account of the condition of the liga-
ments, might remain for life. There does appear to be some
slight dislocation there of the lower metacarpal joint. It depends
upon the violence brought to bear on the ligaments. The joint
is held and protected by the ligamental structure. The hip is
sometimes thrown out of place. If not reduced, the articulating
surface may be changed. Every joint is retained in position by
the ligaments thrown around it. If not reduced at the proper
time it will form a new articulating surface. The former is fast-
ened into the cup of the thigh for the purpose of retaining it.
When dislocation occurs this joint is thrown forward, and
remains there. The individual may go through life with this
degree of deformity. The larger articulating surface will act the
same as a smaller one. It may be that this is only partially thrown
out. I maintain that a partial dislocation might remain until the
joint became accustomed to it. If that joint was elevated it
would come back; if depressed it could not; that might account
for a partial dislocation. I saw a lady, who, in walking, broke
the neck of the femur. There was no Ossific union, and never was,
on account of there being no ossific deposit. Sir Astley Cooper
§
34
#
does say these cases will occur, and he gives the statement I have
given you. There may be false joints without any assignable
cause. It is the arterial blood which carries the pabulum of the
tissues of the human body. It is when the arterial blood has
been submitted to the secerning organs of the respective secretions.
When we have had the arterial coursings going on, it is thrown
back into the veins. We have often ossific deposit in the artery
and in the heart, and we have ossific deposit in the whole animal
structure. I do not pretend to answer the question, whether
it deposits itself in the artery, and not in all other places. Ossific
deposits have been found in the heart. The gall duct has been
found completely ossified, showing that the ossific matter is
flowing through the blood, and is deposited in the soft parts.
There is phosphate of lime in the blood. The proportion of phos-
phate of lime in an infant is forty-eight and some hundredths per
cent. It is not the same in all. In some there is more phosphate
of lime than in others. I speak of a healthy person. As we
grow from infancy to old age, the ossific elements predominate
much. The bone of an elderly person will break much sooner than
that of a young person. While the bone with fifty per cent. animal
matter will not break, with twenty in one and ëighty in another,
it will easily break. I do not recollect of ever reading an account
of a fracture in a person of ninety years of age uniting as soon
as in a young person. There is no difference of opinion among
surgeons in reference to repair of bones. There may be more
phosphate of lime in one person than in another, as different cir-
cumstances may exist. There may be some torpidity of the liver,
or the secerning of the urine. That bone is the product of blood
is certain. I do not know, sir, how much phosphate of lime there
may be in the blood in the human system. I do not know exactly,
it differs in different persons. There is a difference in the same
person at different periods. There may be other secerning organs
which take on a vicarious action, and secern to that part. I do
not say that a person may have fifty per cent. of phosphate of
lime in the blood and in the bone; they must be in similar quan-
tities in each, but they differ in quantity in the same person, at
different periods of life, as I have just stated. They are not uni-
form. Physiology, surgery and anatomy are not susceptible of
mathematical demonstration. There is iron in the blood. It is
iron that gives to the blood its color, to the cheek and to the hair.
It is the coloring matter of all the body. There is a certain amount
35
of local inflammation produced by fracture. There may be general
inflammation of the whole system. The local inflammation does
not always produce general inflammation. There may be local
inflammation and no fracture at all. If you obstruct the venous
circulation by bandaging too tight, this obstruction will engorge
the capillaries and produce inflammation in the tissue, and gan-
grene in the external parts. A slight obstruction of the venous
circulation will gorge the soft parts and the general health
must participate in this derangement. It will depend entirely
upon the arrest of the returning circulation. Under certain cir-
cumstances, this inflammation may commence in a week or
more after the accident. It may be delayed six months; in this
case you will be very likely to have false joint. There are vari-
ous causes: 1st, Want of proper coaptation. 2nd, Want of proper
appliances to preserve proper coaptation. 3d, Too much friction or
movement of parts, 4th, Age or constitutional defects. 5th,
Some other disease or local inflammation which diverts the inflam-
mation, and prevents a sufficient amount in the fractured part to
carry on the process of ossification. 6th, Paralysis occasioned by
the injury, sufficient to prevent the action necessary to ossification,
also the intervention of some of the soft parts between the broken
bones. The treatment is various. If I had examined it and
found there was non-union, I would next ascertain the general
health of my patient, and this every intelligent physcian will do,
and I profess to understand my profession; I would enquire if
every organ in the body had performed its proper function. If I
should find that to be the case, I would then use friction by tak-
ing hold of the ends of the bone and rubbing them firmly together,
simply for the purpose of removing the cartillaginous substance,
and to bring on an inflammation. Should I fail in that case I
next would prepare me an apparatus and adjust it to the ends of
the bone. For, after using friction, I should try to produce inflam-
matory action. I would make a pressure upon these bones and
keep up pressure until inflammation ensued. There are other
means; one is a seton, that is, to carry a needle with silk down
and in between the broken ends of the bones, and let it remain,
for the purpose of producing inflammatory action.
I should probably resort to electricity—galvanic power. I
would then try the dernier resort, that is re-section; I cannot say
much about it, some have tried gold and silver wire. I believe
that would not succeed—some have succeeded, some have not.
36
This re-section would be my last resort. I know something about
acupuncturing; I do not use it, and do not believe in it, and
know of no surgeon who has succeeded with it; I understand
there are some who have. Acupuncturing is carrying down a
sharp pointed instrument to the point of fracture, and boring into
the bone at different points, to produce inflammation.
Yes, sir; we might have a good limb by these means in from
four to six months. I think a case should never be abandoned
until all these means are resorted to. Yes, sir; I take it there
will always be provisional callus remaining. It does not disap-
pear as true bone forms. The provisional callus is not taken into
the new bone. No man would think of an aneurism being
absorbed. It is an artery the walls of which have become
enlarged and expanded, and forms some peculiar characteristic
of fibre. It becomes more and more expansive, until in some
physical exertion, these walls give way, and life becomes thereby
extinct. Aneurism is simply an enlargement of the walls of the
artery, nothing else. There is no branch in aneurism.
It is a proper application of the roller which keeps the muscles
quiet. -
The Dr. was here shown the splints used in dressing the case,
and asked what he thought of them for that purpose?
Answer : I should think them entirely inutile. That material
of splint, if long enough, might answer; but of this length, I
regard them as entirely inadequate; they are too short. I think
the whole arm should be kept in a quiescent state. f
The union of bone under such circumstances is the rule; the
failure, the exception. I cannot call up a case where a boy of
this age did not have the bone united, when properly treated.
I cannot speak positively on the subject of false joint; when it is
properly treated it will not occur. Our medical authors do
describe certain failures of union of the bone. (Mr. Turner
here showed the witness his own thumb.) There is a partial
dislocation of the thumb joint here; I think a partial dislocation
could be made of that joint, and remain so through life.
DR. BUCKLEY’s TESTIMONY.
Dr. Buckley, sworn, says: I am a physician and surgeon; have
been in the practice 12 years. - .-, *
Question: Did you make an examination of this boy’s arm—
(Frank P. Frisby ?)
37
Answer : Yes, sir, I have ; I made the first examination of
that arm, I think, the middle of December, 1863.
Question : What condition did you find it in then 2
Answer : Precisely the same as it is now.
Question : Have you made a careful examination of that arm 2
Answer . Yes, sir; within a day or two. -
Question : From the examination you have made of that arm
professionally what was the character of that fracture when it
was made 3
Answer : I was of the opinion, sir, that it was a simple
fracture.
Question : Did you find any evidence of its being a commi-
nuted frncture ? -
Answer: I did not, sir; I could discover none, sir.
Question : If it had been a comminuted fracture, would any
evidences have remained at the time you made the examination ?
Answer : There would, sir; there would have been a “pro-
visional callus.” Were I treating this arm, I should apply a
roller in the first place, from the end of the fingers the whole
extent of the limb. Then I should have applied splints, of some
preparation of binders' board, or perhaps this form of splint, that
would have extended from the elbow to the shoulder, the whole
length of the humerus. These splints would not have been long
enough. I should say they were not proper splints to use in that
case. I think it very essential, sir, to keep the fore-arm in a quiet
state, because, if it were not kept in a quiet state, it would destroy
coaptation, and secondly, the union. I should think it would
not be necessary, if the arm had been properly coaptated, to
apply force at each end, equal to one hundred pounds, in order
that a surgeon might manipulate the fracture. I should think, if
this had been the case, that the extremities had not been properly
approximated. I have examined the arm since I came here, and
I find it to be a false joint; the muscles are somewhat wasted
away. I see nothing in the constitution and age of the boy, indicat-
ing any other than a successful result, and union of the bone. I
think, if a union had not taken place within four months, the surgeon
attending should have known it. I should think it would be four
or five weeks, perhaps more, perhaps less, before union in a boy
of his age and character would take place. If I found, after six
weeks, there was no union of the bone whatever, I think I should
extend the time a little longer, say up to ten days or two weeks, and
38
then, if I found no union I should resort to friction, do it up again,
and after waiting a suitable length of time, if I found no union, I
would resort to some other means. As regards diet, I never made
a great deal of difference. If there was not much arterial excite-
ment I should make no change; if there was, use less. Where
there is no swelling of the parts I should not reduce the food, if
it was my own case. If there had been union and re-breaking at
eight weeks, there would have been some pain. I have examined
the plaintiff’s right hand and thumb; I find a partial dislocation.
I suppose it might have been reduced. If this has ever been in
its proper place, it may have been forced out again. I do not
think if this bone had been properly reduced, it would be out of
place now. From the condition of the thumb now, I think he
has not much use of it, although some. I never met a case of
false joint of the humerus. The fore-arm should be kept in close
confinement from the time the arm was first done up. If this had
not been done for three weeks, I should expect to find a false joint,
on account of the mobility of the patient. -
Cross-Eacamined.—I did not notice any evidence of a wound
in the soft parts. If there had been a severe wound in the soft
portions of the hand, it might have had a tendency to draw down
the joint. If the bone was broken, also, that would increase the
difficulty. If the parents would not submit to having a second
reduction, the surgeon, of course, would not be to blame. I do
not see why there could not be a partial dislocation of that joint,
as well as any other. The ligaments which surround that joint
may be so lacerated as to permit of a partial dislocation. It migut
be the integuments on the outside of the thumb would occasion
it by laceration. After using friction, I might make another trial
in a couple of weeks. If I found the parts tender, I might wait a
day or two, or perhaps a week, longer. I should not try friction
more than twice. Never having had a case, I cannot tell what
I should do next. A seton, I believe, has been used by some
surgeons; they take an instrument something like a tape needle
and draw a skein of silk through near the ends of the bone. There
are ivory pegs used sometimes; that is done by cutting down
to the bone, and boring holes in the bone, and riveting them
together with the ivory pegs.
Question: Dr., in case the bone was broken directly across
its shaft, so as to make the line of fracture at a right angle
39
with the line of the shaft of the bone, how would you use the
pins then 2
Answer: I would bore into the end of the bone and insert the
ivory pins at the ends of the fragments. -
Question: Suppose, then, that by some severe blow or force
upon the arm or shaft of the bone, the ends of the bone should be
pushed by and made to overlap, and you could not bring them
back to their proper place; how would you use the ivory pegs in
that case ?
Answer: I would pin them together on the sides.
Question: Should a surgeon in the treatment of a fracture ever
abandon a case until he has tried all the remedies known and
used to produce union of bone in the surgical art?
Answer: He should not.
Question: If a surgeon is discharged while using means known
to surgery as good surgery, and before he has had a proper time
to try all the means recognized as proper in uniting bone in the
surgical art, could the surgeon prevent a false joint?
Answer: I do not see any way to avoid a false-joint in such
C3, S63.
Jee-Eacamined.—Question by Turner: If a surgeon should treat
a patient for five months and ten days for a fracture of the
humerus and not know whether there was a union of bone, would
that be good surgery P
Answer: It would not be skillful surgery. I should expect to
be discharged as a surgeon, if at the end of five months no union
had taken place, and I had constantly told the family the arm was
doing well. It would not be skillful surgery to treat a case like this
five months without producing union, and only resort to the first
mode of treatment without resorting to the other means I have
mentioned. - .
Dr. B. P. Miller, sworn, says: I have been practicing medi-
cine and surgery in this county and Jo Daviess, twenty years. I
have been engaged in practice all the time. I have done the
principal part of the surgery in this county; am acquainted with
the plaintiff. Saw the arm 6th June last; found the arm to have
a false joint. The fracture was on the lower portion of the
humerus. There was no union. It was about the same as now.
I was sent for, with Dr. McPherson, to see whether there could
be an operation performed. I thought it was a simple fracture.
From enquiries made of the friends I thought it was a simple
40
fracture, though it may have been a compound fracture- There
was a cicatrix, which might indicate a compound fracture. If this
was a comminuted fracture, I saw no evidence of it then. The
boy appeared to be in good health, except he had been in the
house some time and had had a very light diet. The proper sur-
gical treatment would have been, to put the bones in place and
confine them. Where there is a simple fracture, I use a
roller, commencing at the wrist and roll up to the shoulder. I
then put on sufficient splints, coming from the shoulder to the
elbow, and from the arm-pit to the elbow, on the inside. I would
then put on a supporting splint, and put the arm into a sling. I
would then wait a day or two and examine it again; if no inflam-
mation, I would then bind it more tightly. I would then leave it
two or three weeks and then see if there was any provisional
callus. I consider these splints not sufficient, they are too short.
They might do, perhaps, with this outside splint, but I consider
them too short. I consider it necessary to put on longer splints
to support the fore-arm. The breaking up of the provisional callus
would be likely to make a false joint. º
Question: Six weeks after the fracture, what would be the
necessity of having a person take hold of the arm and pull to the
amount of a hundred pounds weight? What would be the object
and what the effect of such pulling?
Answer: After six weeks I should expect to have provisional
callus, and it would be very likely to break that up. As to diet-
etic treatment, I make very little difference in food; tell them to
keep quiet and not eat quite as much as usual. Toast, crackers
and gruel is very good food; I like crackers myself. It is not a
proper diet to give such a boy, a little toast and gruel and crack-
ers. It would not be sufficient, in my opinion. I cannot state
what the course was in this particular case. I do not know of
any cause, except the bone was kept movable, or some improper
motion of the limb. I do not know what the cause was. Had I
had the case myself I can see no reason why it should not go on
and unite if properly attended to. In four months the surgeon
ought to have known whether it had not united. He ought to
have known it in four or five weeks. If, after six weeks, I found no
union or sign of union, I would have used some friction on the
bones. If I found the ends of the bones were getting smooth, Imight
then have put them together somewhat firmer and waited a few weeks
longer. It is not proper surgical treatment to permit a fracture
41 .
to remain from Dec. 20 till the 3d of February following, I think
I should have used some means to excite the formation of provis-
ional callus or Ossific action. If, at eight weeks, there had been
a breaking up of the ossific formation, there would have been
some pain. I have had experience in bones partially. I have never
failed to have the limb unite. I have had a case of the breaking of
the femur; it united at the proper time. Also of the humerus, the
second time, and there has always been permanent union. There
was a case. I do not recollect of being called to but one case of
false joint. I took the case after it had been delayed some time.
In six or seven weeks there was union by forcing the bones
through the muscles and applying considerable pressure.
Cross-Examined—This was a case of the humerus. I used
considerable pressure to force the bone into place; the fracture
was not compound. I do not remember that it had been any
thing more than an obligue and a simple fracture. The fact of
non-union, and the length of time was the reason why I thought
there was danger of false joint. There was muscular substance
intervening was another reason. It required extension. If it
had been a transverse fracture, I don’t know it would be any
more difficult. I have always found provisional callus. I think
I have read of some cases without it. There may have been cases
of union without provisional callus. There would be after a time,
a rounding off of the bone. I should feel in my own practice
when I found the bone rounding off, that it was a case requiring
more stringentmeasures. *
Question: May not provisional callus be carried off by absorp-
tion ? - .
Answer: I have always found provisional callus formed in all
my cases. It might be absorbed after a while so that it would
not be sensible. I have examined some cases after a year, where
I found it. It might be possible that the parts might not have
been put in proper apposition. Provisional callus disappears as
true bone forms. I have not examined cases to see how long it
would take callus to disappear through the circulation. I sup-
pose through the blood there is a set of vessels that deposits
the bony substance. I think it is not deposited directly from the
arteries, although they contain the bony matter. The vessels
through the periosteum furnish the supply of osseous matter.
The system is continually throwing off old matter and depositing
new matter quicker in the soft than in the harder tissue. I think
3 x.
42
the lymph furnishes the matter from the blood. The extravasation
of the blood first takes place and is carried off in ten or twelve
days. In three or four weeks considerable deposit of bony mat-
ter is made. I do not think I have seen it take place in ten or
twelve days. These splints are too short. That splint might be
long enough to clasp the inside portion. I would ordinarily use
longer splints than these. I might use them if I had no other.
They might answer with this splint on the outside; this is a good
splint. I use it myself. The extensor muscles are attached here.
These muscles would draw the bone up if not properly confined.
I don’t know that it makes any difference in the union by break-
ing this bone at the point of the nutritive foramen. I never
heard it would. I don’t remember the names of these muscles
here. I am the worst hand in the world to remember names; the
brachialis and biseps lie along the whole length. The pronator
and supinator, flexor and extensor, are all attached to the humerus.
In case of refracture the union would be about the same time
as the original fracture; it might be longer if the injury was such
as to break up the provisional callus entirely. The compound
and comminuted fracture are more dangerous than simple frac-
tures. A slight comminuted fracture would be some more dan-
gerous. - -
Question: May there not be fractures when it is not possible
to assign the cause of non-union ? - . -
Answer: Most certainly. (Turner resumes.)
Answer: (He was here shown Miller's Surgery.) I consider
this a standard author. There are such cases, I rely upon these
authors for my opinion that false joint may occur without any
assignable cause. The general principles I obtain from these
authors, I would make a difference in the diet. In a compound
fracture I would order a vegetable diet, if there was evidence
of inflammation; if I saw no evidence of inflammation, I would
not make much change. Toast, crackers and gruel are very good diet.
Dr. Mason C. McPherson, sworn, says: I am a physician and
surgeon; practice at Eagle Point, in Ogle County. I am
acquainted with Dr. Pratt and with the plaintiff. I was called
to see the plaintiff, 6th June last. I examined his left arm, in the
same condition as now. I examined it carefully at that time with
Dr. Miller. We concluded it was a simple fracture; no evidence
of a comminuted fracture. There would be a provisionary callus
detected there. That was the reason we thought it was a simple
43
fracture. I would have applied a roller and two long splints from
the shoulder to the elbow. If compound, it is necessary to keep
the arm quiet, and if considerable action to keep the bones in
place. I would put the bones in a proper coaptation. I use a
roller or bandage. I have never treated but one case of this kind.
I rolled from the wrist to the shoulder, used long splints, and put
the arm in a sling, and kept the fore-arm quiet. If not properly
bandaged the use of the forearm might displace the fracture.
There are muscles attached all the way down ; the biseps and the
“biseps flea-or” on the forearm might displace the bone. Should
have made no change in the diet. There might have been some
inflammation, and might make some difference, otherwise I would
not. I do not generally make any change. I should have looked
for partial union in a boy of this age, under proper treatment, in
about three weeks. I should have wanted to know whether the
bone had commenced uniting. There would be considerable
union in two weeks in such a lad. In case of simple fracture,
from six to eight weeks, the splints might be taken off. If com-
pound comminuted fracture, it would be owing to the amount of
inflammation, and how bad the fracture was. If properly adjusted,
at the end of six weeks, would not have been necessary to make
extension by pulling the arm to the amount of a hundred pounds”
weight. I have never tried that; I think not. If union of the
bone had taken place, it might have broken it up. A skilful sur-
geon would have known before five months whether it was united.
If not united, before two months, I would have used friction. If
no union had taken place, the surgeon ought to have known it;
if not, some other means ought to have been adopted. I think it
would not have been good treatment to wait so long. I have
never examined the thumb; have known the family and boy some
four years. I have attended some of the family as physician, not
the boy. So far as I know, his health has been good. Don’t know
his age. In doing up the arm fractured, as that was, these splints
were too short. Should have been from the shoulder to the elbow.
I do not think they would keep the bone in a proper coaptation.
If a compound comminuted fracture, I should think them not pro-
per splints. . - -
Cross-Eeamined.—I never had but one case of the fracture of
the humerus; it was a simple fracture. I cannot say at what
point. It was a young man, twenty or twenty-one years of age.
I used two long splints from the shoulder to the elbow, bandaged
44
from the hand to the shoulder; that was the principal thing. I
hung it in a sling, and ordered them to keep it there. I cannot
say how long it took it to heal. Practiced in this county, at Elk
Horn Grove, eight years; practiced some before I attended lec-
tures in Philadelphia Medical College, Pa.
Ques. Where did you graduate, Dr.? (A long pause.)
I have slightly forgotten the place where I graduated. I had no
money to pay for graduating. I never graduated. I attended a
full course of lectures on medical science, anatomy, etc. Attended
six months, or nearly so. Practiced about a year or so with my
preceptor. At the time I examined it I came to the conclusion
as to the nature of the injury as certainly as I could. I answered
that I could not detect provisional callus. I never saw a case of
the kind I could not detect. I would have resorted to friction
before the 13th day of May. It is recommended, I believe, by
Gibson. In case of non-union, I would have tried friction after
two or three months. I would have waited a few days, and then,
if there was tenderness and inflammation, I would have done
it up and waited two or three weeks. If there had been no ten-
derness I would have repeated the friction, and if that did not
succeed, I would have tried other means. I might have tried the
seton. It is merely done by passing down some silk between the
ends of the bone to produce inflammation. Other operations are
recommended—taking up the ends of the bone and sawing them
off. Different surgeons have different theories. Some practice
other modes. That is about as far as I would recommend. A
case might be treated five months, and treated skilfully, and not
unite. I believe there are such cases. -
This (pointing to the foramen in a humerus) point is where
a blood vessel enters. It is diffused to different parts, I sup-
pose. If there was a destruction of that artery there would
be more effusion, I suppose. I don’t know that that would make
any difference in the union of the bone; might make some difference.
Question: You spoke of the muscles of the fore-arm that were
attached at this point. - -
Answer: That muscle has nothing to do with the finger, hand
or wrist. The motion of the flexor muscles has the power of
raising the arm up. There are more muscles here. There is the
biseps and the biseps flexor that are attached to the bone down
there, pretty well in that neighborhood. I cannot tell exactly
where; and one is in the top of the arm. They are attached
45
within two inches of the place I pointed out. One and a half
inches, probability is that it is within two inches; I do not know
exactly where. I understand that they are attached to the lower
third of the humerus. The biseps or the biseps flexor is connected
back here somewhere, and passes through the occipital groove,
which gives it motion. I assisted in dissecting two or three sub-
jects. I do not remember that I ever assisted in dissecting this
portion of the arm. I call this formation around the bone “pro-
visionary” callus. I cannot say when that begins to form;
it commences in two weeks or so. I can discover it after union
commences. There is no material difference between that and
definitive callus. There is no difference. I do not know that it
could be discovered during life. I have seen it after two years,
in the hip, the upper portion. A young man I saw yesterday
states it was twenty years since it took place. There is provisional
callus there now ; I know it was. It was elevated above; the sur-
rounding bone not so elevated. I could feel all around it far
enough to discover; the edge of it might be as large as your little
finger. I cannot say how large it was. I never saw a case of
twenty years standing before my attention was called to it by the
man himself. I do not know whether this callus gradually disap-
pears as true bone forms or not. I cannot tell whether a union can
be formed withoutit or not. I have Gross and Miller; I don’t know
anything about Hamilton. I never read Sir Astley. I never
examined any work but Gibson’s and Parri; that is all I have.
It is a good work (Gibson’s.) It is about the size of Miller’s ;
may be a little larger. Well, it is ossiseous matter which it takes
to make bone, that is something like similia similibus ſºon curanter.
Dr. H. M. Freas, sworn, says: I am a physician and surgeon.
Graduated in Philadelphia—practiced since 1854; practice now
at Milledgeville. Am acquainted with Dr. Pratt and plaintiff. He
came to my house two or three years ago to have a finger set.
I saw the boy at Dr. Belding's. Dr. Belding, Dr. Pratt and
myself were present, 16th May last. Had a consultation; found
the arm in about the same condition as now. I merely examined
it. A few days before Dr. Pratt spoke to me about the case. I
cannot swear whether these were the splints or not ; similar to
these. Dr. Pratt and myself made some friction of the parts and
done it up. At the time I saw it was a simple fracture. In the
examination I made, I did not see any evidence of its having
been a compound comminuted fracture. There would probably
46
have been some ridges left on the bone. My treatment would
have been to bandage from the hand, with a splint from the elbow
up to the shoulder, and some small splints between. These would
do for a child, put on to keep the bone in place, and keep the
muscles quiet. I can hardly tell you the result; I never tried
them; I don’t pretend to know much about surgery. It was
necessary to confine the muscles of the forearm. (Here he applied
the splints to his own arm.) These splints are shorter than I
would use. With such short splints there might be contraction of
the muscles, which draw the bone out of place. I always con-
sider it about as important to keep the muscles at the forearm as
quiet as at the point of fracture. It would not have been neces-
sary to have a man pull a hundred weight at six weeks from the
time of the fracture. If there was union, it might tend to break
up the bone and cause delay in union. I never give any direc-
tions as to diet unless unusual inflammation. They usually will
eat enough. Toast and crackers would be enough in a state of
high inflammation. I should give nutritive diet; such a light
diet might retard a cure if kept up too long. A surgeon ought
to know within three weeks. At six weeks at fartherest. I
should give the arm eight or ten weeks to unite. I would then
have tried to get up an inflammation in some way. Not skillful
practice to wait five months. If he examined his patients he
would know at the end of four months, whether union had taken
place, I should think. I never examined that thumb; I don’t
know that I should know much about it if I did. I cannot decide
whether that was a fracture or partial dislocation; it should have
been put in place when it was first injured, and kept so. I gen-
erally use a bandage and splint to keep the bone in place and the
muscles quiet. There was no union when I examined it at Dr.
Belding's. I cannot say what Dr. Pratt did say. His opinion
about getting up an inflammation was about the same as mine.
I believe he claimed at that time, that there had been a fracture
above. I did not discover evidences of another fracture. I
helped to apply friction, and did up the arm, or assisted. -
Ceoss-Ea'amined—Dr. Pratt called my attention to there being
provisional callus above the fracture, but I could discover none.
Nor do I remember of telling Drs. Pratt or Belding since, that I
then discovered evidence of provisional callus. The bone was
not united. I believe there was an outside splint fastened to the
arm above and below the elbow, and a strap of leather or mus-
47
lin, and several small bandages around the arm. These, or splints
similar to these. I cannot tell whether longer or shorter, or
whether these are the ones or not. I recollect the Dr. stated
there had been a fracture. I do not recollect he stated he
had tried friction before. I do not know who suggested fric-
tion. I think Dr. Belding asked me what I thought about it. I
would have waited two or three weeks after using friction to see
if union had commenced. Dr. Pratt and myself did it up. I
remember there being other splints. I cannot tell whether they
were like these or not. I do not pretend to be a professional sur-
geon. I spent some time in the East; graduated in 1854, at
Pennsylvania College at Philadelphia, as physician and surgeon.
Came here six years ago last fall. I don’t recollect that Dr. Pratt
said, he might have said he had no confidence in friction, and
that an operation would have be performed. He might have
stated so. I do not recollect; after friction the seton would be
used, perhaps, or cutting down and cutting off the ends of the
bones. I don’t know of any other method. I have heard of the
system of Dieffenbach of pegs; heard of one or two successful
cases. I believe a case might have been well treated five or six
months and not have united. I do not think anybody could have
told by examining the arm at that time, whether it had been well
treated or not. As a general principle, it is necessary for pro-
visional callus to form, to unitebone. I do not thinkbone could unite
without inflammation. I see no other way but that there should
always be provisional callus. It cannot be formed without inflam-
mation. I do not know that there is any other callus but provis-
ional callus. That will disappear ordinarily ; that depends how
much was there. I cannot state how long it would take. I do
not think that provisional callus begins to disappear as true bone
begins to form; but not until the bone is fully united. Bone
contains phosphate and carbonate of lime; cannot tell how
much. I believe there is some difference. Cannot explain the
difference between phosphate and carbonate. I guess marble is
not carbonate of lime; cannot tell. I understand there is phos-
phate of lime in bone. Don’t think there is much difference in
the provisional callus and bone itself. I cannot tell in healthy
bone, what proportion of phosphate there is in healthy bone. Blood
contains phosphate of lime. Not much difference in quantity
between that and bone. Water is a constituent of blood; cannot
tell the per cent. New bone is formed; my idea of this forma-
48
tion of bone, is that the phosphate of lime is carried through the
arteries. Probably I got that information from Physiology and
Anatomy. Read Carpenter's. Don’t recollect any other. Read
Dunglison's. My impression is that it is so ; cannot tell, certainly.
I think I got it from Carpenter's. I believe there are two or three
muscles attached to the lower third of the humerus; cannot give
their names. In diet, I would, if no unusual inflammation, make
no change. For three weeks toast, crackers and gruel are very
good diet. Generally have inflammation in compound fracture.
That would be good diet if enough of it. Would depend upon
the quantity. I do not think it would hinder the union of bone.
It would depend upon the inflammation. If high, more sparing.
Ordinarily, in compound fracture, where there is inflammation, it
might produce suppuration for two or three weeks. I should
think a spare diet, in that case, proper. I have not paid much
attention to the theories of men who have treated upon this
subject. -
Rarvey Frisby, sworn: I am a brother of the plaintiff. Plaintiff’s
name is Frank P. Frisby. Has lived at home all his life. He was
always healthy. I was with him at the time of the accident. It hap-
pened about eight miles from here, near Morris's. He was driving
a team with a load of corn. The front end board fell out, and
the corn fell on to the horses, and he fell out astride of the
tongue. The horses ran and kicked for about twelve rods, and
the wagon went into a sort of gully, and he ſell down and came
out behind. I saw him all the time, and was the first one to him.
He appeared to be dead. I took him into Mr. Morris’s. Dr.
Pratt first saw him about half an hour afterwards. When the
arm was undressed, Dr. Pratt and I did it. It was the left arm.
Dr. Pratt dressed it in Carroll county. The arm was broke in
too. And the arm had been hurt and bled a little. It was not a
large wound. It bled some, but not a very great deal. I saw no
protrusion of the bone. I did not feel the bone. Dr. Pratt pro-
fesses to be a physician and surgeon in that neighborhood. Dr.
Pratt was sewing up the hand as my father came. He dressed the
hand first ; it seemed to be torn. He took a needle and thread and
and sewed it up. I don’t know what bandages he put on ; I was
not present when the arm was done up. Dr. Pratt treated the arm.
(Witness here shown the two shorter splints.) I have seen these
splints before. Dr. Pratt brought them to our house the first time I
49
saw them. Don’t know how long it was after the injury. He put and
kept them on the arm as long as he treated it. I cannot tell
when that patent brace was first put on. I went after it. I think
is was as much as two weeks after the injury. He used a few
other splints which he made out of shingles. My brother was
hurt Saturday and was taken home Sunday. Dr. Pratt vis-
ited him about once in two weeks. Dr. Pratt treated my brother
some five or six months, I should think; I don’t know exactly
how long. The injury took place in 1862.
Dr. Joseph Haller, sworn, says: I am a physician and surgeon;
graduated two years and one month ago, at Chicago Medical
College, Lind University. I saw the boy in my office in the
month of October last, at Lanark. I examined his left arm, and
also right hand and thumb. I found a dislocation of the joint of
the thumb. I found the thumb very much atrophied. It is very
difficult to tell what was the fracture. I made an examination
merely casually; found they terminated without any thickening
at the end. If a comminuted fracture, as I have seen these fre-
quently, there would have been considerable thickening. I could not
find any. If the case had come before me, as I thinkit was, I should
have treated it as a simple fracture. I should commenced ban-
daging from the wrist, and bandaged to the shoulder. I would
have used not manufactured splints, but manufactured them
myself, and applied to the whole length of the humerus. These
splints are too short. In ordinary cases, it would swell con-
siderably, and too light bandaging might have produced morti-
fication or gangrene. Not proper to apply extension six weeks
after the fracture, to the amount of one hundred pounds. If it
had been done up properly in the start, would ordinarily been
united ; if united, have broke the fragments of bone apart. Bone
will unite in from four to six weeks. I should resort to friction
before ten weeks. Not good practice to allow it to go from Dec.
to May following without resorting to friction. If no inflamma-
tion, allow regular diet, except stimulating meats; allow plenty
of lean meat. Low diet would reduce too much and retard union.
It is a reducing process, and of course a low diet would not fur-
nish a sufficient supply of nutriment. If the bone had not
united, and eight weeks after the injury was re-fractured by ex-
ternal force, it would hurt the patient. *
Cross-Eeamined.—Would reduce the diet if inflammation
was severe, and add to it as it subsided. It would not hurt as
50
much as at first if inflammation had subsided. If out of place
at six weeks, I should endeavor to remedy it the best I could. It
would be fracturing it over again to attempt to adjust the parts.
If it had got out of place, I would reduce the fracture. I would
put it in place; it would be necessary to adopt extension and
manipulate the parts. If it continued not united for six to eight
weeks, I would try friction, and do it up as at first. I should not
wait more than seven days after using friction before I would
ascertain, in some degree, whether it was uniting. If not by that
time, I would call in assistance and try and move it a little more,
and I would do it up. If I found no union in two weeks, then I
should call another surgeon and perforate the surface, or put in a
seton; either is correct practice. I would resort to these expe-
dients, when I found friction did not answer in from four to six
weeks; if by attempting slight motion, and it had not united. I
think you will find this laid down in Miller's surgery. In Cooper's
surgery. Don’t state it possitively. I have read several medi-
cal pamphlets. Cannot state any thing more. Professor
Andrews, Professor of Surgery in the Lind Medical University.
I cannot state the authors; think it was Robert Durit. I think
this treatment may be found in Miller's. Sir Astley Cooper's
Surgical Directory. Don’t know whether his name is Astley
Cooper, or William. If after trying seton. I would try acu-
puncturing-seton first. I think, not positive upon the subject.
Don’t remember which. If I had a case to treat, and got as far
as that, I would call for a consultation with some other surgeon.
Never got as far as that. I would perforate as often as once in
ten days, and keep it in apposition; then let it remain five or six
weeks. I have seen that done. I do not know which bone; the
tibia, I think, about the middle third of the larger bone of the
big lower joint. I had one case of fracture, the middle third, in
October, A. D. 1863. I think the humerus is not any more liable
to non-union than other bones. I state these opinions from
authors and from my teachers. I could find no particular enlarge-
ment of the ends of the bone when I examined it. I recollect
distinctly of examining both ends of the bone. Discovered a
slight scar a little over or above the fracture. -
JDr. Beebe being sworn, says: I am a surgeon by occupation,
and reside in the city of Chicago—have been engaged in the prac-
tice of medicine and surgery for about eight years. I graduated
at Philadelphia, in the spring of 1857. I have had a moderately
51
extensive practice in private life, and a somewhat more extensive
practice in the government service. I was engaged in field and
hospital practice about eighteen months. I estimate the number
of cases which I treated while in the army, or which came under
my personal observation, at 4,000. I had the care of about seventy
regiments. I can safely say that the cases of wounds numbered
4,000. After all battles all severe cases came under my
observation for final decision as to treatment. They might num-
ber fifteen hundred more, perhaps. I think that thirty per cent.
of these injuries were of bone. In some of these cases, or rather
taken as a whole, every bone in the body was injured, either by
cannon or musket shot, sabre or bayonet. I have had consider-
able surgical practice in private life, for one of my years. The
first year of my practice was in Albany, New York, and a little
less than seven years in Chicago, excepting the time I was in the
service. I am now practicing in Chicago; I have had cases of
fracture of the humerus in civil life. I now call to mind two cases.
The whole shaft of the bone is liable to fracture. It is, by all
good surgeons, regarded that a fracture of the humerus or any
other long bone, at or near the nutritive foramen, will unite more
slowly than at other portions of the bone. The humerus is more
liable to non-union than any other bone in the body.
Examination of the boy.—Right hand.--I discover, from an
extensive cicatrix, an evidence that there has been an extensive
lacerated wound through the web of the thumb. It was not a cut
that caused this cicatrix. It draws from various angles, and
seems to be somewhat extensive. In this, the scar is irregular,
and I judge from the integuments forming this scar, that the
wound was lacerated and considerably torn. This first joint of
the thumb is healthy and natural. The second joint I find per-
fectly in place. I grasp now the point of articulation between
the bone of the thumb–the phalanx—and the metacarpal bone.
Between my finger and thumb I grasp the joint which is not at
all displaced. Behind this joint, a half an inch, I find a project-
ing point of bone, and tracing along backward I find a projecting
margin of bone, and passing my finger down along the inner side
of the bone I find too great a thickness of the shaft of the bone.
The corresponding bone in the other hand is not as thick as this
one. The shaft of this bone is very much thicker than it should
be in health. The shaft of the bone is also too short, indicating
to me that there has been a fracture of this bone, and I am posi-
52
tively of the opinion that thus the fracture extends from a point
near its articulation with the thumb, nearly the entire length of
the shaft of this bone; and the anterior fragment has dropped
down somewhat, and is over-lapped by the other fragment.
Taking into consideration, then, the fact which I must suppose in
this case, that this lacerated wound was produced at the same
time that the fracture occurred, and I am led to infer that the
injury was quite severe. And if there was a lacerated wound of
the soft tissues, and it communicated with the fracture, making it
a compound fracture, I consider it exceedingly fortunate, owing
to the great laceration of the soft tissues, that the extremity is as
good as it is. The thumb appears now to be in a condition of
usefulness. So far as the mal-position of this bone is concerned,
this thumb would be as useful as it ever was. The surgeon is not
responsible for the lacerated wound and the resulting cicatrix or
scar. I should say that that case was very successful in its result,
sir. I see some slight cicatrices, but no other material injuries
in either hand.
Examination of left arm.—I find here an un-united fracture of
the humerus, at the junction of the middle and lower thirds of
the bone, extending diagonally from below, upward and forward.
I notice beveling on the upper fragment, extending downward
and backward, and corresponding beveling on the lower frag-
ment, extending upward and forward, which confirms me in this
opinion. I examine upon the shaft, somewhat above where the
beveling begins, and I find one point which presents tenderness to
the touch, as indicated by the boy shrinking away from pressure
upon it. There is but a slight tumefaction of the periosteum at
this point, and I should be unable to say, from this tumefaction
alone, that this was a remnant of provisional callus. But taking
the tenderness in connection with this slight tumefaction, I should
suspect that there had been fracture of the bone at this point. I
find when the arm hangs loosely that the fragments still over-lap,
though the bony surfaces are not brought together. I find on the
back side of the arm, a patch of skin an inch in extent differing
in structure from the surrounding skin, and this is evidence of
there having been a wound there sometime. A question as to
the depth of this wound presents itself to my mind. If I lift up
the surrounding skin, I find that this scar pits in the centre, indi-
cating attachment to the deep tissues. From these deep attach-
ments, it appears that the wound must have extended through the
53
integuments and deep tissues well down to the point of the upper
fragment of bone. It does not present the appearance of a clean
cut wound. It appears to have been a lacerated wound, torn
through by some substance, and the wound immediately overly-
ing the point of this upper fragment. I suspect that this wound
was produced by this fragment of bone being thrust through the
soft parts. If this supposition be correct, I should then feel safe
in saying we have a compound fracture.
A compound fracture is one wherein the bone is fractured, and
there is a wound through the soft parts, down to the point of
fracture. If the point of tenderness above be an indication of
previous fracture, then we have a compound comminuted frac-
ture, or a compound fracture where the bone is broken at more
than one point. If, in forming my opinion of the nature of this
injury, I should learn that the arm was broken by a loaded wagon
passing over it, and especially if the arm rested on frozen earth
, when the wheel passed over it, I should be strongly of the opin-
ion that the bone was comminuted, or crushed, and we should
then have a compound comminuted fracture. If the injury to the
hand were produced at the same time, giving a fracture of another
bone with extensive laceration of tissue, then we should have a
compound comminuted complicated fracture—that is, the frac-
ture of the arm is complicated by the injury of the opposite
hand, in that, nature, while called upon to repair the fractured
arm, is also required to furnish material for the repair of the
other injury, and this; by retarding the process of repair, would
complicate the fractures and dimish the chances of ultimate union.
Especially would this be the case if there were other severe
injuries, such as a severe wound on the head, as named by another
witness. So that now, sir, if I were called upon to pronounce a
professional opinion, as to the nature of the injury received, I
should judge, from the evidence before me, that it was a compound
comminuted complicated fracture. - -
I do not find in this arm, a false joint, but simply non-union.
In false joint there is not only non-union of fragments, but the
fractured ends being brought in contact are tipped with cartilage,
so as to glide upon each other, and held in that position by bands
of fibrous tissue, extending from one fragment to the other.
There is nothing of that kind here; there is simply non-union.
The causes of non-union are various, and are divided by surgeons
into two classes. First, local causes, such as the interposition of
54
other tissue between the fractured surfaces, a deficient supply of
nervous influence, or the circulation may be cut off or impaired,
and its nutrition thus being arrested there might result non-union.
A fracture partially united, and then re-fractured, would be less
likely to unite a second time. Second, the general causes are
such as affect the general health of the patient, and might depend
upon the condition of the patient. If the parent had been
addicted to a free use of intoxicating liquors, it might so influ-
ence the constitution of the son as to retard union. So, also of
an hereditary scrofulous tubercular or cancerous tendency. But
the local causes are of the first importance, and of these perhaps
none more important than the destruction of the nutrition of the
bone. If the nutrition of the bone be perfect, then union of the
fragments of broken bone follows rapidly; but if this nutrition be
arrested, or impaired, or delayed, non-union is the result. When
the system is called upon to repair several fractures, requiring large
amount of material, some of the fractures may unite and others
may not, or may be so delayed that non-union would result by
reason of the fractured ends being covered by fibrous or cartilag-
inous tissue before the system was ready to begin the repair. I may
illustrate : It was but a few months since, that a bank of frozen
coal, falling upon a man, produced a compound comminuted frac-
ture of the tibia and fibula, at the middle, crushing the tibia for
two and a half to three inches. The fragments were united to
the upper portion of the shaft some weeks before the lower por-
tion of the shaft was united to them ; so that some portions of
fractured bones may unite and the union of other fragments be
delayed until the repair of the first is secured; and by reason of
this delay, it might never unite, although the best surgical treat-
ment has been employed. -
The bone receives its nutritious supply from two sources; first,
from the periosteum, the membrane which lies upon the surface
of the bone, and sends minute vessels into the bony structure
from without. Second, The nutritive artery passing in through
the nutritive foramen, is distributed to the bone from within, along
the canal or cavity which contains the marrow. This canal is
lined by an internal periosteum, and from the distribution of blood
vessels, as shown in this fresh bone, which I here present, we per-
ceive that the supply of blood to the bone is greater from within
than from without. The bone within is seen to be spongy, or
less dense than without, and this spongy or cancellated structure
55
is permeated by minute canals, called “Haversian canals,” and in
these the minute blood-vessels distribute themselves to the bone.
The bone, as a whole, is made up of minute cells of an oval form,
each of which has the power to re-produce other cells like itself,
and it is from the growth and multiplication of these cells that bone
is formed, and when fractured repaired. For the development of
other tissues different and distinct forms of cells exist; thus, the
cell which forms muscular tissue differs from that which forms the
mucous membranes, and so there exist in the body distinct sets
or types of cells which differ widely one from another. Now,
when blood comes in contact with these cells, they have the power
to take up that which will promote their own growth and devel-
opment, and when they have reached a certain stage of develop-
ment these divide up to form a multiplication of similar cells.
The bone cell appropriates to itself only those portions which
will develop bone; and so of the other types of cells. As the
grain of corn has the power to draw from the soil those elements
which favor its growth, and to produce other grains of corn like
itself, and as all animals possess the power to re-produce other
animals like themselves, so these different types of cells reproduce
cells like unto themselves. -
Now, if the bone be broken, and a portion of its substance
destroyed, nature at once proceeds to repair the loss. The frac-
tured surfaces being brought in apposition, the bone cells are
multiplied and thrust out into the gap; but it becomes necessary
to steady the fragments, and hence nature throws out around the
fragments, what is termed “provisional callus,” and within the
medullary canal a pin or plug of granular matter extending to
either side of the line of fracture. While these provisions of
nature aid in maintaining the fragments in position, there is
thrown out an exudation of plastic matter which serves as a plat-
form in or upon which the bony cells may be deposited as formed.
This exudation of plastic matter between the fractured surfaces
is termed the “definitive callus,” or in other words, it defines the
limit within which bone cells are deposited. As these bone cells
are deposited and bony union progresses, the provisional callus is
removed by absorption, and so the callus within the canal is grad-
ually excavated into cavities, and these are filled with marrow
again, until at length the shell of bone is restored to nearly its
former condition and appearance. - -
We see, from this bone before us, that the nutrition derived
56
from the nutrient artery is greater, by half, than that derived from
the periosteum, and if, therefore, a fracture take place at or near
the nutrient foramen, so as to cut off the supply of nutrition from
this source, then the bone, instead of receiving more than its
usual supply of nutrition, as needed, actually receives only about
one third the usual amount.
In one of the cases of fracture of the humerus seen by me, the
bone had been fractured near the nutrient foramen, and when
partially united, was by some accident re-fractured. Instead of
uniting a second time, it seemed to have been so far deprived of
its nutrition as really to refuse to unite not only, but, by the pro-
cess of absorption, the bone was gradually carried away, and
removed from the system, till nothing remained but the articular
ends of this bone.
Bones may be repaired by different methods. In general terms,
they may be repaired by two processes, the one without pro-
visional callus, the other with ; but, to be definite, there are, as
near as I recollect, six distinct modes of union. First, by imme-
diate union, the parts being brought in accurate apposition, they
unite at once, as will a clean cut in the soft tissues, and without
the formation of any provisional material. Second, the parts being
coaptated, the material for repair is thrown out between the frac-
tured surfaces, and the bone unites by means of this without any
provisional callus. Third, the bony fragments are surrounded
by the provisional callus, the plug or pin is developed within the
canal, and then the definitive callus is thrown out between the
fractured surfaces, in which the final deposit of bone takes place.
Fourth, the provisional and internal callus form, as in the last case;
but no definitive callus forms; indeed, the fractured surfaces do
not unite, and bony deposit takes place in the structure of the
provisional callus, making it a permanent instead of provisional
structure. Fifth, when bones overlap, the provisional callus forms
between contiguous sides of the bone, and union takes place in
that manner. Sixth, the fractured surfaces being more or less
widely separated, the provisional callus pushes out to meet the
fragments and unites them, and in this provisional structure to
deposit bony matter. If there is a covering over the ends of the
bone by a fibrous or cartilaginous tissue, and friction is used to
remove this from the bone, then, when this is absorbed, the
repairative process will go on. It would excite a degree of inflam-
mation, and a more full supply of blood; it would cause a tender-
57
ness, and thereby keep the parts partially at rest. The tenderness
would prevent the patient from moving the muscles of the part,
and thereby favor rapid union. My own opinion would be, that
©
if there was nothing discoverable but non-union, friction should
not be resorted to under six months, and I am borne out in this
opinion by good authority. Upon fractures and dislocations,
Hamilton of New York, is one of the best. Gross is also good
authority. Gross, Smith and Hamilton are the most reliable
authors. Miller's is a good work. The perforation of the bone
in un-united fractures is recommended by Hamilton as good prac-
tice. The instrument used is a drill, something like a brad awl,
but so pointed as to make no chips. A slit is made through the
skin and the drill is passed down to and through the bone.
Having drilled once through the bone, the drill is withdrawn from
the bone, but not from the soft parts, and by giving the drill a
different slant or inclination, other holes are drilled in various
directions through the bone at the seat of fracture. Splints are
then applied, and the parts kept at rest. The surgeon should wait
four or five weeks for a result. If not successful he resorts to
other modes of treatment. The seton is one. It does not stand
however, very high with the profession. This is done by passing
a skein of silk between the ends of the bone by means of a needle.
The next one I should resort to, if perforation did not succeed,
would be resection. This mode dates as far back as John Hunter.
It has been revived lately, especially in army practice. It may
be applied to the shafts of long bones or to the removal of joints
injured or diseased, and is received by the profession with much
favor. In the case before us I think it can yet be used with suc-
cess. Were I going to operate upon it I should prefer to do so
soon, as the boy is growing and in good condition for recovery.
The incision should be made from behind to avoid the artery.
In oblique fractures, where the fragments overlap and fail to unite,
the bones may be brought into apposition and secured by ivory
pegs, and some recommend silver wire. Some use blisters over
the point of fracture. Electricity is applied by means of wires
passed down to the bone at the point of fracture. Cauterization
is also used, but this is a somewhat barbarous mode of treatment;.
and some have applied caustic to the bone itself. It is proper for
me to state, that all these varieties of treatment are sanctioned by
good authority. j
There are several methods of splinting a fractured humerus.
4. %
58
One method would be, to put on splints from the shoulder to the
elbow, and from the arm-pit to the elbow, with shorter supporting
splints between. These splints would answer well enough for
that purpose. A roller bandage should be applied from the wrist
or hand to the shoulder, and by successive turns be made to
envelop the splints and steady the parts. The arm should be
brought to the side, and the wrist and fore-arm placed in a sling.
The elbow and arm should be allowed to hang unsupported, that
by its weight, it may keep the bone extended. This is the treat-
ment given by Gross of Philadelphia. Perhaps no better author-
ity can be found in this country. It is to be regarded as skillful
dressing. Hamilton recommends an angular side splint. Smith
also approves of these side splints. Another method mentioned
is, the application of a hollow splint to the outside of the arm, and
a roller outside. (Witness here took up the longer of the short
splints.) This splint would be long enough for the inside one at
the seat of fracture with the arm resting in the outside splint.
This is a good splint. These three methods are the ones generally
recommended by surgeons. Some would make splints of sole-
leather, some of felt, stiffened with gum shellac, and others of tin
or sheet iron. These embrace the range of splints for such frac-
tures, and are sustained by good authority. Either would be
called skillful;dressing. I should think these splints long enough
and proper to be placed on this bone. I think a splint two inches
longer than these, with these small ones on the inside, would be
amply sufficient, and as well, perhaps as surgeon Gross himself could
dress it. If I found the patient restless, I would use the angular
splint as an additional protection, otherwise these splints would
be sufficient. I should examine it two or three days after the
fracture to see if it was in place; it would not be necessary to
remove the bandages. Surgeons sometimes apply a roller next
to the skin, before applying splints. This practice has been
adopted by almost all surgeons, until recently; some have now .
abandoned this mode. By enveloping the splints with the
first roller the arm is saved from being encumbered by too
ſhuch dressing, and avoids too much heat; still it is good surgery
to apply the roller to the skin before any splints are applied. It
is only necessary for the surgeon to set the fragments and see
that they are in place, to trace the outline of the bone while
the dressings are on, and see that the fragments are in line and
the dressings secure. It is not necessary to examine them other-
59
wise for eight or ten days. If there is no active inflammation
and the swelling had subsided, I would examine and re-adjust
the dressings as before, perhaps a little firmer. If the hand should
swell some for six or twelve hours, it will do no damage. It will
not retard the repair of bone. It is the small vessels that do the
work and furnish nutrition. The extremities may be blue from
six to twelve, or even twenty-four hours, and still not retard the
repair of bone. It is only when the bandage is applied so tightly
as to produce inflammation, resulting in gangrene and the death
of the part. It is my practice, and the practice of all good sur-
geons, to apply extension at any time when the case requires it.
There is no danger of gangrene from slight swelling of the extrem.
ities and blueness of the skin. I should call to see the case once
in two or three days at first ; after a few days, once in a week or
ten days; oftener if there were any untoward symptoms to give
me greater anxiety. In the case of fracture of the femur of
which I spoke, I go once a week. Pus never forms without
inflammation having preceded it. It is the result or product of
inflammation. The question would be, has there not been too
much inflammation ? That, at the seat of fracture, is a frequent
cause of non-union, by exciting absorption of the provisional callus
or preventing its formation by provoking suppuration. This
absorption may go so far as to remove a large portion of the bone
itself. I would order a light diet—mostly, if not entirely, a vege.
table diet—for the reason that I should expect these grave injuries
—severe laceration of the arm, hand and head—would produce a
high degree of inflammation, such as would materially interfere
(if not timely prevented) with the healing of the wounds. The
vegetable diet should be prescribed at first, not wait until inflam-
mation had set in. I have no such objections to vegetable diet
as some of the witnesses who preceded me. They did not seem
to take into consideration the fact, that the vegetable, the wheat,
the corn and the oats take from the ground earthy matter, out of
which to make tissue. We derive more earthy matter from vege-
table than from animal food. From whence do such animals
as the ox and horse derive the earthy matter to make their bone 2
Is it not from eating these vegetables 2 And when we, in turn, eat
the animal food, as beef, we get the vegetable food, so to speak,
second hand, from which the earthy matter has been sifted out
to make the bones of the animal. This food furnishes not only
material for bone, but fibrin; there is no lack of fibrin in the vege:
*
60 |
table. This vegetable food, then, furnishes to the body the
earthy matter which the boy wanted in the production of bone.
The earthy matter has to be taken out to make bone. We do
not eat bone. We do not deprive the system of this earthy mat-
ter by eating vegetable food. He had in the vegetable all the
necessary elements to produce bone. He was nourished as well,
and even better by vegetables, than he would have been by animal
food. Had he taken animal food, he must have eaten some fat
with every fibre. In this fat is carbon, which, passing into the
lungs, is there consumed or burnt, and generates heat. In such
an injury you want as little heat as possible, therefore vegetable
diet is the best. In continuing vegetable I would be guided by
the case. If there was evidence of inflammation, and I still
desired an absence of heat in the body, I should continue the
vegetable diet. If I found that the vital forces were flagging, or
if the patient were becoming emaciated, I would order a mixed
diet. I have had experience in cases treated in this manner. I
have treated thousands of cases in hospitals, suffering simi-
lar wounds. I can speak of the beneficial effects of vegetable
diet from much experience. In these remarks, I speak from a
knowledge acquired by treatment of thousands of cases for whom
I prescribed this kind of diet. I have stated to the jury my views
of the diet from the complications of the case and from the evi-
dences now before me. In giving my opinion as to the proper
treatment, I assume that the injuries occurred on the 20th Dec.,
1862; that the period of treatment was five months and ten days,
and I say that friction is the severest measure which should have
been adopted. My professional opinion is based upon the facts
before me, and upon facts assumed, as before stated; and, based
upon these facts, I give it as my professional opinion that this
bone might have refused to unite up to the thirtieth day of May
next ensuing, under the best of surgical treatment. That it would
not have been good surgery to have resorted to any more strin-
gent means than that of friction. To resort to acupuncturing
during the period named, would be in direct opposition to the
opinion I have just given. It might have been delayed for six or
even eight months, and be well endorsed as nothing unusual in
good surgery. If the surgeon resort to more stringent measures to
obtain union, there must be evidence of something more than
non-union. The points of the bone must be rounded off and
covered with a cartilaginous tissue. If, when the fragments were
61
g
brought in contact, there was grating or crepitus, then there is
the fact only of non-union. The condition of these fragments at
the period of five months, may have been, and probably was, very
different from their appearance now. They are now rounded off
and covered with cartilaginous tissue; this may have been
developing daily since that time. I do not know how the blood
would deposit this ossific matter as it passes through the nutritive
artery, from the fact that the blood does not contain this ossific
matter. There is no bone in blood. In bone there is fifty-one
per cent. of phosphate of lime, and twelve of carbonate of lime.
We are unable to say that any phosphate of lime, as such, is con-
tained in the blood. There is an insoluble salt wnich chemists
find in the blood, about one part in the hundred; but they are
unable to say how much, if any, is phosphate or carbonate of
lime, or whether it is sulphate or carbonate of soda. There is phos-
phate and carbonate of lime, as I have stated, in bone ; there is
some in the animal tissues, and they enter into the formation of
cartilage. There is a much less quantity of phosphate of lime in
provisional callus than in bone; the plug that extends along the
medullary cavity contains about thirty per cent., and that without
about thirty-three per cent. These are formed by the periosteum
and internal periosteum. The bone cells of which I have spoken
establish bony union within the structure of the definitive callus.
I say union may take place without provisional callus. In frac-
ture of the skull there is no provisional callus. The knee-pan
will not develope provisional callus upon the inner surface, and
but a small amount on the outer surface. Definitive callus forms
in the spongy portions of bone, and fractures through the spongy
portions of the bone are more likely to unite than in the shaft.
The head of the humerus driven into the shaft, constituting
impacted fracture, is united immediately and without provisional
callus. (Witness explains anastomosing.) I do not, myself,
know how anastomosis can take place in or through bone suffi-
cient to establish collateral circulation. The gentleman to-day
spoke of the ligation of the femoral artery—that when the main
trunk is obliterated the small branches given off above rapidly.
enlarge and establish what he termed a “vicarious circulation,”
so as to keep up a supply of blood to the extremity; but if the
trunk of this nutritive artery be destroyed, I do not see what is
to anastomose. Whether the witness meant to say some artery
from within would anastomose, I know of no such artery, and
62
how an artery which is a soft tissue is to drill a hole through the
solid shaft of bone, is beyond my comprehension; or that it will
materially enlarge its calibre through the bone, is equally absurd.
This is the difficulty that meets me, sir, at the threshold of
this anastomosing theory.
On the first of June, 1863, I could not have told, from the ap-
pearance of the boy’s arm, what his previous treatment had been,
whether skillful or otherwise. The appearance only shows non-
union. The failure of the treatment would be no evidence of
want of skill. If one of the fragments of bone appeared out of
place at any time, it was the duty of the surgeon to put it in
place or reduce the fracture and re-apply the pressing more firmly
over the point of bone thus elevated. It would be proper to
manipulate the arm to see how this should be adjusted, to the end
that proper treatment might be applied. If properly coaptated, the
wound being healed, I should presume the process of repair
would be even more rapid than if there had been an open wound
at the point of fracture. The system would have been in a much
better condition for carrying on the repair at six weeks after the
fracture than previous to that period. If the fragments of bone
were then brought in apposition accurately, and there maintained,
I see no reason why there might not have been a union of bone
in three weeks from that time. I should have expected it (assum-
ing that the nutrient artery was entire) in from three to four
weeks, and even at two weeks provisional callus, under the cir-
cumstances related by the witness, might have formed. If the
bones passed by each other, any course would have been proper
which was necessary to reduce the fracture. Extension would,
in that case, have been necessary. I do not think it possible
for a person standing at the shoulder and another at the elbow,
and with it flexed, to pull more than enough to antagonize the
contraction of the muscles. It would have been necessary to
make this extension to prevent the muscles from drawing the
fragments past each other. -
Cross-Examination.—I graduated the first of March, 1857.
I first practiced in Albany, N. Y. I graduated at the College of
Pennsylvania. It had another name. It was known as the Homoe-
opathic Medical College of Pennsylvania. But I had previously
taken a full course of study at the Albany Medical College, which
per contra was known as an Allopathic Medical College, and I had
practiced about a year before going to Philadelphia. I came West
º
63
in the month of April, 1857, and settled in Chicago. I have prac-
ticed surgery and medicine in connection with it, since that time.
I have been connected with the Hahnemann Medical College of
Chicago for two years. I lectured during the last year upon sur-
gery; in the former year upon anatomy. This college advocates
the Homoeopathic system. -
The term Homoeopathy is derived from two Greek words,
“Omoios,” like or similar, and “Pathos,” disease. By this we
mean that diseases may be cured by agents capable of producing
similar diseased conditions. That which in a healthy man will
produce a given diseased state, will cure a similar disease existing
from other causes. Not that poisoning by arsenic may be cured
by arsenic, but that an inflammation of the stomach, say, which
is very similar to that which arsenic produces, may be cured by
that drug properly administered. This describes the system of
medicine, so far as medication goes. I practiced in Chicago up
to Dec., 1861, when I entered the service. I was in the field
about eighteen months. I was surgeon-in-chief of Maj. General
Thomas’ corps, known as the 14th army corps, which was em-
braced in what was called the “Department of the Cumber-
land.” Two cases of this kind have come under my observation
in private practice. In one the fracture was at or near the nutri-
ent foramen. Union took place, but by some accident the bone
was again fractured, when it not only refused to unite, but was
gradually absorbed and carried away, until nothing remained but
the articular extremities. The fact of non-union was established .
before it came under my observation. While in the service I was
constantly with the troops in the field. Did not stay in the hos-
pitals all the time. Ihad charge of about seventy regiments. I could
not estimate now, accurately, the cases I treated personally. In
the course of treatment always after battles, I was constantly
operating. My operations were mostly confined to the more
grave cases. I was not entirely engaged in amputating. I had
a supervision of the whole. After battles I had the care of these
cases for two or three weeks. They did not remain, at longest,
over six or eight weeks under my charge. After the battle of
Stone river, which was fought on the first of January, I remained
with the wounded until the middle of March. That, perhaps,
was the longest period I had personal observation of a given
number of cases. ~
We sometimes fed them toast, not always, because we could
64
not get the bread; when we could not, we gave them “hard.
tack.” In the hospitals I kept a supply of farinaceous articles for
low diet—corn starch, sago, barley, farina. These articles
were always kept on hand along with the army. This food was
sufficiently stimulating for severe wounds in the inflammatory
stage. I say this system of diet contains all the earthy elements
in abundance, which are required in the repair of bone. I did
not say that animal matter was only to produce heat. Animal
food is not only useful in producing heat by combustion in the
lungs, but it contains earthy matter, though in less quantity than
vegetables.
I have no notion, of diet peculiar to my system of practice.
What I state is recognized by the medical world as safe treat-
ment. It is very necessary to change the diet if there is much
inflammation. I would not wait for it to come on before I changed
the diet. I would do it at once, for the purpose of preventing
inflammation. I do not think that any surgeon could be held
responsible for that injury to the thumb. It would be difficult to
have done better. From anatomical knowledge, I may state to
the jury, that there are muscles passing through this web, on the
inside of the thumb, which enable it to grasp any object. They
make their insertion deep in the palm of the hand. From the
lacerated appearance of the wound, I infer that these were torn
across, and in that case the action of the thumb would be much
impaired. The agent that produced this wound may have been a
hook. I cannot tell what. If the front-board of the wagon slid
out and the boy was precipitated upon the tongue, it may have
been the hook of the trace. It certainly was badly torn. I think
it was a good job, considering the nature of the injury. I should
be proud of it—that is, I should be exceedingly gratified it was
no worse. I would not try to repair it in its present condition.
He might have got a better union, possibly, at the time the wound
was healed, but I should be gratified with the result as it is now.
The blood does not always give sustenance alike to all parts of
the system, when there are different injuries to be repaired. If
the bones were placed in proper position at first, I would not
meddle with them. If they were not, or had got out of place, I
would then have placed them in proper position. Whether they
would have remained in place, and resulted in a better union, I
do not know. My object would have been, to get an exact coap-
tation of the fragments, but when I go back and imagine the
65
injury, with the integuments torn and lacerated, the bone broken,
and the joint dislocated; examining it now, it is better than I
could have expected from such an injury. I am supposing the
bones of the arm not united in six or eight weeks. It is proper
for the surgeon, at all times, in treating a fracture, when he finds
the bones out of place, to reduce the fracture. It does not
require much knowledge to know that such fragments should be
at once replaced. In such a fracture, the surgeon attending would
be likely to discover whether the bones were out of place, and it
is always his duty to replace and get the fragments in apposition,
as perfectly as possible. I could not say that these bones would
have been united in six weeks; I should hope they might be. A
surgeon should never cease his efforts while there is reasonable
hope of cure. If he does not give up and nature seconds his
efforts, he should be gratified he has succeeded so well, even
though it stop short of absolute perfection. In a compound
fracture and dislocation of these bones, most surgeons would
have taken off the thumb. I say it was commendable in the sur-
geon to retain the thumb and try and save it. I do not say I
would have taken it off. I would not have taken it off. I feel
and know that there are agencies to subdue inflammation in the
Homoeopathic system, which give us confidence safely to risk and
do what, in these cases, the Allopathists can not and dare not do.
There is one agent as a substitute for the lancet, which
Homoeopathy has given to the world, which is invaluable, that
is aconite; and there are others. When inflammation is progress-
ing to a destruction of the parts, that agent steps in and arrests
it. Allopathy draws from the system the blood which is needed
to make repair. Homoeopathy comes, with milder means and
more sure remedies, to save the blood for the work of repair.
Fortunately my researches upon this subject go far enough to
ascertain that aconite was not used in place of the lancet until
Homoeopathy brought it into use. Aconite is now used exten-
sively in place of the lancet. It would control inflammatory
action better than the lancet. The lancet, in no case, is necessary.
Imean to say to the jury, that I was educated an Allopathist before
I studied Homoeopathy. I availed myself of all the information
I could obtain, and which any student has who passes through
the schools of that system. I then availed myself of the superior
advantages which may be derived from the Homoeopathic schools
and practice; and I say to-day, that aconite is an invaluable
66 |
remedy, and is far better to control inflammation than the lancet.
Dr. Pratt mentioned this case to me in May, last year. He told
me it was a case of non-union. I had a more full description of
it in June following. I do not know that he has since spoken to
me concerning it; it seems to me he has once. I have not talked
with Judge Knowlton since I came here, other than to make a
casual remark. We have spoken together but twice, that was
yesterday and day before. It was about the medical testimony
which has been given here, not particularly relating to the case.
I have felt considerable interest in regard to the medical testi-
mony—that is all. I have no idea that the success, or want of
success in this case will affect Homoeopathy; that is a system of
truth which stands upon its own merits. I have no recollection
of saying that when I came on to the stand I would make it all
right, or any words to that effect. I certainly entertained no
such idea, and I say now, I have not said so. I have felt much
interest since I heard the medical testimony.
In the case I mentioned there was about two and a half inches of
the bone crushed. I said the union occurred in the upper fragments
first, and the case is still under treatment. The last examination
I made was March 4th. It had been under treatment since some-
time in last December, as near as I recollect. There is a nutri-
ent foramen'in the tibia; it enters at the middle of the bone, and
takes a direction upwards. The nutrient artery sends branches
toward the lower extremity of the bone. Fracture of any other
bone of the extremities will unite more rapidly than the humerus.
There are no other vessels named nutrient arteries, save that
which enters at the nutrient foramen. The location is about the
same, relatively, in every bone. The hole in this bone points
toward the elbow. There is a branch inside pointing upwards.
A fracture at or near the entry of this artery will retard union
very much. The foramen is this hole in the bone. Some of these
smaller holes are for the entrance of small arteries, and some for
the exit of small veins which carry the impure blood back to the
heart. Sometimes the vein and the artery pass through the same
place in the bone. The blood flows so much more rapidly in the
artery; a small artery takes in more blood than a vein of larger
calibre can carry back. These holes are the places through
which the vessels pass in from the periosteum to nourish the
bone. This one is known as the nutrient foramen—these small
holes are, so far as the outside of the shaft is concerned, nutrient
67
foramen, but a much larger supply of nutriment is from the inner
surface of the bone supplied by the nutrient artery.
If above the foramen it would not cut off the supply, but a
fracture at or near this point might cause the destruction of this
artery. It is the experience of Gross, Smith and Hamilton, who
are among the first surgeons in the country, that a fracture above
will unite much more readily than one below this foramen. All
agree in this—the destruction of this artery causes delay. Sup-
pose it destroyed at the point of entrance, the upper portion
receives a much larger supply of nutriment than the portion below.
I say many of these small holes are for veins and arteries; in the
spongy portions of bone these are more numerous and larger,
and the larger portion of spongy bone is at the upper end. There
are more above than below the foramen.
Adult bone contains fifty-one to fifty-four per cent. of phos-
phate of lime, and about eleven per cent. of carbonate. I think
there is more than sixty per cent. Of lime in adult bone. I think
there is some thirty-two per cent. of animal matter. I say the
blood contains about one per cent. of insoluble salts. This insol-
uble salt is not bony matter. These bone cells have the power of
drawing from the blood the elements of nutrition, and from these
elements developing bony matter. Newly formed bone is not so
hard because the bone cells are not so compactly arranged as in
the older bone. I cannot go back of the callus and tell what per
cent. There is one per cent. in the blood, out of which elements
bone is made. I said there is "no bony matter in the blood; by
bony matter I mean these little cells of which bone is made. I
said these are not deposited by the blood; as it courses through
the arteries that they are developed and grow within the cylinder
of the bone; they derive their nourishment from the blood.
The arterial blood brings the nutriment which is needed to
develop bone. I do not agree to the proposition that bony mat-
ter is deposited from the blood. The blood does not bring along
ossific matter and deposit it in its course; but the blood conveys
certain elements, through the arteries and distributing vessels; by
means of capillaries, these elements come in contact with these
bone cells. The artery comes from the outside, pours its blood .
into the branch inside of the bone and through the capillaries,
and by these means these cells are made to grow. This blood,
after imparting its nutrient qualities, is returned through the
veins to the heart again. These capillaries do not terminate in
68
the bone, but in veins; but they pass through the bone, and these
little cells are fed and nourished by this arterial blood. There is
quite a difference, sir, whether the Mississippi, coming down from
the northern regions, deposits wheat or wheaty matter upon its
banks, or whether the kernel of wheat already sown draws from
the Mississippi the moisture which it needs to develop it and
make it grow. The nutrition is in the arterial blood, which fur-
nishes the elements by which bone cells develop into solid bone.
It is, therefore, only in the manner I have described that bone is
made from the blood. Bone grows as wheat grows; the rain
furnishes moisture, but not wheat nor wheaty matter. Neither
does the earth furnish wheat or wheaty matter. There is not in
the rain nor in the earth, a particle of starch or pectin, yet the
wheat is composed of these substances with others.
We, perhaps, could not say that here was a creation, because
Omnipotence created all the matter which exists. The wheat
plant, like every other plant, was endowed at its creation with the
power to reproduce itself. Comparatively, the more correct term
to be used would be pro-creation, by which, as used by physiolo-
gists, we mean that faculty in nature by which living objects
appropriate from the elements that which causes development
and growth, and from these elements construct other objects like
themselves. In this confined sense of the term, it is a creation.
It draws material from the elements in one shape, and by its own
vitality transforms this material into forms and qualities identical
with its own. It transmutes one "kind of material into another
and different kind; but it stamps upon the material thus trans-
muted its own identity.
Withhold from the plant carbonic acid, and it will shrink and
die. You can see no resemblance between the starchy matter in
corn and wheat, and the surrounding atmosphere which supplies
its nourishment. So you cannot say that the plant draws ammo-
nia and carbonic acid from the atmosphere, and holds them there;
it does more. It acts from a power, as it were, within itself,
which changes the character of these substances. The soil may
be never so rich in the quality which the wheat plant requires, yet
from dryness the wheat may not be developed; and so of all other
vegetables. I said it is the plant which takes up the earthy ele-
ments and makes its own particles from these elements. These
earthy matters are taken up in solution by the plant. There is
an endless variety in these processes. The soil only furnishes
69
elements for the growth, and not the actual material of which the
plant is composed in that form. If you plant wheat on a limy
soil, the plant readily finds in the solution of that soil, by mois-
ture, the elements to make wheat, because the plant takes its
healthy support from the soil. The animal gets his earthy matter
second-hand, from the ground. If you sow wheat on alluvial
soil it will produce straw, not wheat. Lime is necessary to pro-
duce wheat. There must be some lime elements in the vessels
which feed bone to make bone. There must be lime from some
source, but it does not follow that it gets lime from the arterial
blood. It does follow that there is some material or quality in
blood from which this lime in the bone is fed and nourished.
Either the blood must circulate more rapidly or freely to the part,
or there will be a slow recovery. Sometimes nature supplies a
greater amount of blood to the seat of fracture than to any other
portion of the system. :
I state to the jury, that I assume that there will be always more
or less inflammation at the seat of injury, but it does not from
thence follow that inflammation is nature's remedy for the repair
of the injury; simply that the violence caused the inflammation.
Because it was injured it inflamed. Inflammation is the natural
result of injury, not nature's design. I might go farther, and say
to the jury, that the repair of bone is not produced by inflamma-
tion. Inflammation is a disease ; no matter whether slight or
extensive, it is a diseased process, and must necessarily be so;
but the repair of bone is always a healthy process. It is a purely
physiological process, just as much so as to build up the skin on
my hand. It is a healthy process—the method and material are
not essentially different in repair from that in the original forma-
tion of the bone in the infant. The same general law governs in
the formation which becomes operative in repair, but I would not
be understood by the jury, that the whole process of repair after
injury is the same precisely as in the original growth; because
inflammation is present, although the result of violence solely. The
process of circulation is different under the injury and at the point
of injury than would be required in the formation or repair of
bone. I want to separate, in the minds of the jury, the results of
the injury from the process of repair. The process of repair,
merely, does not occasion an increased supply of blood. By
lymph I mean the same as by fibrous or plastic exudation. I used
this term to the jury. It is my own medical parlance. In the
70
first instance, it is a gummy substance, and in wounds of the skin
presents itself as soon as the bleeding ceases, where it soon
becomes a glossy substance, covering the surface of the wound.
The provisional callus depends entirely upon circumstances; the
character of the injury, the condition of the patient. Often times
this callus is exceedingly small when thrown out; that is, a small
amount is required to hold the fragments of bone in position,
especially if supported by bandages. I wish to be understood,
that by this I do not mean the cells which are thrown out from
the fractured surfaces of bone—bone cells. This could be infer-
red from the very fact that I called it provisional callus. I stated
definitive callus is that which intervenes between the bony sur-
faces and within which are developed these minute cells which
grow up to be bone cells, that by multiplication they produce
bone. This matter thrown up on the outside cannot form bone.
I say nature throws out a sort of platform around the gap and
between the extremities. While making these explanations I do
not wish the jury to be engaged in looking out of the windows.
When there is a gap between the fractured ends of bone, nature
throws out a platform which enables her to deposit these bone
cells. . This plastic exudation forms the bridge within which this
bone structure can be built. As in bridging a stream, a platform
must be erected upon which to swing the arches across and to
sustain the stringers. When the bridge is built the platform is
removed. So this plastic matter has little else to do, and is
removed by absorption as soon as the work of repair is done. As
I have before repeatedly said, these bony cells are pushed out from
the points of bone longitudinally, until they fill up this plastic
medium—until they fill the entire space, meeting at the centre.
Then, we say, there is bony union; but the development of bone
cells does not stop now, for at this time you will find but a com-
paratively small per centage of bony matter. These go on multi-
plying in numbers and increasing in density until it becomes com-
pact bony tissue; only then does this process cease. In a healthy
subject; in simple fracture, under favorable circumstances, nature
would be employed during the first eight days in clearing away
the wreck of the old structure; at the ninth day the plastic exuda-
tion begins around the bone, and the provisional callus has com-
menced forming—this process lasts from twelve to seventeen days,
under favorable circumstances—it takes that additional period to
build up provisional callus; this extends the time to twenty
71
or twenty-five days in which to clear away the rubbish and
put on nature's splint. From the twentieth or twenty-fifth
day the real work of repair begins. How long this period con-
tinues depends upon the extent of the fracture and the amount of
space to be filled. There are contingencies which may extend
the first operation described from thirty to sixty days. Ordinarily
there should be bony union in sixty days, but do not understand
me that this new bone will be compact in that period: in a simple
fracture it would be strong enough to be used. To complete the
work it takes months, sometimes years. When there is a large
amount of provisional callus it takes sometimes years. All physi-
ologists agree that it will eventually be removed. There is a differ-
ence between the elements and the materials of which bone is
made. I understand the material; the bone cells do not and can-
not pass through the blood. It is only the fluid which circulates
through the artery which goes to make up the bone cells by
growth or development. I do not want you should get the idea
which is implied in the question, that the blood deposits so much
animal and other matter. The blood constantly bears these ele-
ments throughout the system. It goes from the heart to the
extremities and back again to the heart. In twenty-four hours
an immense quantity of blood passes this fractured part, so that
it is not necessary the blood should contain fifty per cent. of lime.
Its rapid progress would be checked, and even entirely stopped, did
it contain any such quantity. I heard the gentleman [Dr. Porter]
say that the blood and the bone contain phosphate of lime in about
equal proportions. That is clearly impossible. -
In a healthy person the amount of provisional callus thrown out
depends upon the care with which the points of bone are brought
together, the nature of the accident. An oblique fracture would
require more than one square across the bone. If comminuted, it
would require provisional callus at different points. Surgeons
never attempt to estimate this. The plastic exudation takes
place from any of the vessels in the human body. The blood is
very rich in this fibrin, and what is needed is rapidly supplied. I
do not say increased action is necessary to form this. I entirely
ignore the idea that inflammatory action is necessary. Inflamma-
tion retards all the physiological processes of repair. I say that
aconite is a powerful agent in allaying inflammation. It controls
the circulation. The heart, the arteries and other blood vessels
are all affected by it. It acts upon them to diminish the circula-
72
tion to the inflamed part. It does not operate like the surgeon's
knife, by removing the vital fluid which is so necessary to repair
the injury, but it enables us to husband the only source of repair.
Nothing is wasted, nothing is lost. With this and similar agents
applied, it is unnecessary in any case to take blood. It is always
injurious to do so. If that sluggish circulation was attended by a
slow, feeble pulse, indicating a want of blood or a feeble circula-
tion, aconite would not be the remedy, unless I found this
enfeebled circulation depending upon some distant congestion, as
when the brain is overloaded with blood, and when it appears
from the injuries, a feeble pulse is the result. There are other
remedies which would act upon the impeded circulation and
restore it. I think the healthy condition of the blood depends
much upon what food we eat. In a sluggish state of the blood
and under a low diet, and no inflammation, I would not use
aconite, unless the injury was such that inflammation would be
likely to ensue; then I would use aconite.I would put the patient
under this remedy to prevent inflammation. A light, healthy diet
is necessary. A generous diet is not necessary under all circum-
stances. It depends upon the time to which you apply the ques-
tion. If you ask me in reference to an injury just received—a
severe compound fracture of the humerus, I must shorten the
period of inflammation by a low diet during the early stages.
If, after the inflammatory action had subsided, the soft-parts
healed, and a healthy action in the injured parts, tending to a
repair, I would then give a more generous diet, because there
would then be no danger of exciting inflammatory action. The
union of bone might be prevented by starvation, sir. It might
not unite under a diet the next door to starvation. It would not
necessarily retard it because the boy complained of being hungry.
The bone cells would begin to form about the thirtieth
day from the injury. Provisional callus would usually begin
to form in ten days, but I did not say that in this case it would.
I did not say the inflammatory stage would have passed in
that time. Here were complicated injuries of the head, arm
and hand; and in that case I could not say the inflam-
matory period had passed in ten days. I would not have
given a generous diet in that period of time. It would have been
hazardous to have done so. It would take some eight days for
the absorbents to clear away the rubbish in case of simple frac-
ture, and unless there was suppuration the absorbents would do
J.
73
it alone. They are kept at work by the vitality of the system at
large, receiving nutrition by the circulation and nerve fibres from
the brain. In other words, they depend upon the nutritious and
nervous supply. The supply of nutrition is essential; that must
be had or the vital powers will give way. It would not necessarily
retard the union of bone. There would be a nervous supply
though nutrition should be largely diminished. The absorb-
ents might be kept up for eight or ten days upon nervous
stimulus alone. The elements of repair come from the stomach
and blood. I do not come to the conclusion that it is essential to
have a continual supply of nutrition. It is necessary to reduce
the accustomed nutrition to maintain an equilibrium. Suppose
the usual supply of nutrition to be kept up and the nervous excite-
ment present which the injury would induce—it would terminate
in a violent inflammation. The surgeon must adapt his food, in
kind and quantity, to the condition of his patient. *.
Take the laboring man from his active vocation and confine him
for some time upon his back, without an injury, giving him his
accustomed food, and what is the result 2. It could be nothing
less than disease. The food must be digested. The surgeon
presupposes that the injuries of the head, arm and hand, as in this
case, will require the patient to be kept quiet. He must not move
about and must not be fed like a man in active life. These jurors
do not require the same food here that they do on their farms.
So the patient must eat less or suffer still more serious conse-
quences. I say that under the allopathic system, if they be intel-
ligent practitioners of that system, they will reduce the diet to the
condition of the patient's system. If I should cry for food I
should stand in great need of it, I presume. Friction is one of the
earliest methods adopted. I said to denude the surface, not to
produce inflammation. Fractured ends of the bone may
become coated over with cartilage. Friction is partly to remove
this and partly to excite the absorbents to take it up and carry it
off. The object of puncturing is to give to the fragments points
of attachment. When I drill through the bone, instead of insert-
ing ivory pegs, I let nature go on and insert bony pieces. The
object is to produce action in the bone, and an increased activity
of the parts increases absorption of the portions which are by that
means to be removed. There may be a sluggish circulation that
needs to be brought up to the natural standard. It is not to excite
inflammation, but the production of bone cells. You are begging
5
74
the question, sir. I speak of fractured bones; you are speaking
of the process necessary to remove from the fractured surfaces
the unhealthy secretions which prevent union.
You misunderstand me, sir. Your mistake is this: you said
the object of drilling was to produce inflammation; I said the
object of drilling was to produce activity. I do not seek inflam-
matory action ; that is an incidental accompaniment of what I
seek, an active nutrition, an active absorption and repair—the
building up of new, healthy material. I do not seek inflammation,
but to irritate the bone so as to place it in a condition similar to
the first fracture. There is a plug formed in this medullary cavity.
It is easily removed. I could not say whether that had been the
method adopted. There is no evidence of inside callus, and very
little of outside. I could not say there is any positive evidence
of provisional callus now. It would, probably, be absorbed
now. I do not think the term principally can be attributed
to me. (Witness exhibits a beef bone.) If you examine
the blood vessels of the spongy portions and compare them with
those without, you will perceive there is a much less arterial sup-
ply from without than from within. I have stated already, that is
called the nutrient foramen. It is not possible, in examining bones
of this kind,to say which of these minute canals transmit veins, and
which arteries. The bone derives nourishment from other sources
than from the nutrient artery, but in much less amount. This
artery was cut off in this fracture. Here we approach, in this
beef bone, a tuberosity of bone in which the spongy structure of
bone comes much nearer to the surface. The minute vessels are
seen from within, and these are the minute vessels from the
periosteum without. The jury can see the relative calibre of
those outside and inside.
Millions are a great many. They are the same as in the shaft
of the bone, only a much larger number on the inside. The artery
might have been destroyed by the laceration. I said the supply
would be diminished. If you cut this off, the supply of nutriment
would be much less. I would state that this artery passes along
near the bone and near the periosteum, and it branches after it
enters the bone; the one supplies the upper, the other the lower
part of the shaft. If the bone is fractured as this is, at the point
of nutrition, it would cut off all use of the artery to the lower por-
tion of the bone. It would be doubtful whether it would have
been introduced afterwards to nourish the bone. It having no
"75
branches without, it could not make new ones through the bone,
I have seen a large number of cases of fracture of the humerus.
I could not call them cases of non-union, though somewhat
delayed. I named a case in which the bone partially united, but
before union was complete, was re-fractured, and although treated
with the same care as at first, the nutrition was so impaired that
the bone itself was absorbed. I saw it at Albany, N. Y. The
non-union had commenced before I saw it. The young man
was about twenty-One years. Saw nothing in his constitution to
have caused it but the destruction of this artery. I think I am
not alone in this, I think Gross and others. (Refers to cases in
Gross and Miller.) There is no constitutional defect, these authors
say. New made provisional callus would be liable to rapid
absorption. Prof. Hamilton's work on the specialty of disloca-
tions and fractures, stands at the head of the list. It has been
published about four years. Hamilton belongs to the Bellevue
Hospital School, New York, Allopathic. This work, which I now
hold in my hand, is the first volume of Smith's Surgery, also Allo-
pathic. Gross is of the Jefferson School, Allopathic. Miller is
of the Allopathic School, University of Edinburgh, Scotland.
These are standard works on Mechanical Surgery. Mechanical
Surgery is the same in all schools—there is no demarcation here,
and cannot be. Their system of surgery is my system; it belongs
to my system as much as to theirs—there is no other to teach.
But so far as treating the patient by medicinal agencies is con-
cerned, the system has been much improved by discoveries made
in Homoeopathy. I can stand before this jury and say, in truth,
that the danger from this class of injuries is very much reduced
by the discoveries made by Homoeopathists. The treatment has
been much improved through their agency. Surgery, like medi-
cine, will never reach its highest point of success until brought
under the benign influence of Homoeopathic medication. And I
predict to-day that the time is not far distant when surgery, like
medicine, must yield the palm of success to Homoeopathy. I esti-
mate the number of cases treated by me in this way: At the
battle of Perryville, the casualties in my corps were 2,331. At
Murfreesboro, 2,021. After the battle Gen. Rosecrans ordered
me to take charge of all the hospitals in Murfreesboro, both rebel
and Federal, containing 1,800 rebel wounded, besides some 700 or
800. I think I issued rations to 2,800; making in all, with the
rebel wounded at Perryville, about 8,000. These latter did not
76
all come under my immediate observation. T said I thought I
had examined, and had under my own supervision, about 4,000.
It must have been a thousand or fifteen hundred more. I say in
that number were fractuers of every bone in the body. I have
already stated to the jury, some half a dozen times, that there were
no cases which remained in my hands long enough to result in
non-union. It would be improper for me to say I had any cases
of non-union. Some of these cases were treated Homoeopathically
—all that I treated myself, and I had one medical man under me,
who also used Homoeopathic remedies. After all the great battles
I was actively engaged, although much of the time was taken up
with the more grave injuries or fractures. I decided upon all
cases of hazardous operation. I think for fourteen days and
nights after the battle of Murfreesboro, I did not take my clothes
off day or night. I had entire control of the medical and surgical
department of my corps, embracing about 200 Allopathic sur-
geons, who were subject to my orders. There was one man who
out-ranked me, but I had direct authority from Major-General
Thomas, to use his name in any order Idesired; and to all Briga-
diers to carry out the orders so made, I was, therefore, master
surgeon, and appointed Surgeon-in-Chief. I am now practicing
in Chicago, and am connected with the Homoepathic College in
Chicago, where these principles are taught.
Defendant Resumes.—I wish to ask you, Dr., (handing the wit-
ness an humerus) to what part of this bone the biceps muscle is
attached ? . *-- - - -
Answer: It is not attached to that bone at all. One head
arises from the margin of the glenoid cavity, on the scapula, and
the other from the coranoid process of the scapula. It is inserted
into the tubercle on the upper extremity of the radius, one of the
bones of the fore-arm, and has no attachment to the humerus.
Question: Dr., will you explain to the jury where the biceps
flexor is attached 2 ~ * . . .
Ł, Answer: I was ignorant of the existence of any such muscle
until yesterday. I am still ignorant. There is no such muscle.
I have heard much, however, which is new in regard to the human
system since I came here. The brachialis auticus is attached to
the shaft of humerus above and to the base of the coranoid pro-
cess of the ulua, at its lower insertion.
Turner Resumes.—Is it not important to keep all these muscles
of the lower portion of the arm quiet?
77
Answer: . It is. The roller should be applied so as to confine
the bellies of the muscles. In the fore-arm you cannot confine
them so they cannot move. You may fasten my fingers So I can
not shut them, yet the effort, if made, will produce a greater effect
at the point of attachment of the muscles above than it would if
I were permitted to move the fingers. There should be no splints
below the elbow; the patient should be instructed not to use it.
If he disobeys, it cannot be prevented by the surgeon. The
injury caused would be the patient’s.
R. P. Wales, sworn, says: I reside in Lanark, Carroll Co.,
Illinois. I know the plaintiff and defendant, Dr. Pratt. I first
saw the boy on the 20th December, 1862, at John and David
Morris's. When I first came there he was on the cot or lounge,
his clothes pretty well saturated with blood and a puddle on the
floor. There was a wound on the head. The hand was bleeding;
on the upper and back part of the head was a wound. I exam-
ined it. It was a lacerated wound. It appeared to have been
struck on the frozen ground. The skin on the head was torn off
some, also, about an inch in diameter, perhaps, and badly bruised.
I noticed the thumb had been torn, extending into the palm of
the hand and laying some portion of the metacarpal bone, and it
was torn in two or three different directions and dislocated down-
wards, and the bone was fractured obliquely across the metacar-
pal bone, commencing a little back of the joint and extending
nearly back to the next joint. It was dressed that day. The
dressing was delayed for some time after the injury, for the rea-
son that the boy was so sensitive he would not let the Dr. touch
it until he administered to him some chloroform. John Morris
went after it. The wound was drawn together and edges fast-
ened; two or three stitches were taken and tied, and then fastened
by adhesive straps. One piece of the bone dropped down, and
the Dr. replaced it and secured it by means of adhesive straps.
There was one strap put on to hold it up. The dislocated joint
and the fracture of the thumb were then properly reduced. It
was a question with Dr. Pratt, for some time, how to keep this
bone in place; the muscles on the other side were so badly torn
that it was almost impossible to keep it in place. It was, indeed,
a question whether it could be done. He finally succeeded by
the strap, and by flexible splints extending from the back side of
the thumb down to the edge of the wound. The fragments were
then put into position and properly secured by a bandage. The
78
arm was still bleeding somewhat profusely. There was a wound
on the back of the arm. Dr. Pratt examined it first, and con-
cluded it was made by the bone being pushed through the flesh.
I came to the same conclusion. It had that appearance; by draw-
ing the arm sidewise I saw the end of the bone protruded. Dr.
Pratt did this to ascertain the precise condition of the fracture
and the injury. It was an oblique fracture. Behind the lower
portion of the fragment, and on the upper fragment, the bone was
broken directly across it, and making three pieces or fragments.
The muscles had the appearance of having been bruised or
crushed under the wheel of the wagon, or some body or instru-
ment of great weight. The fracture of the arm was reduced and
secured by a dressing or roller, passed from the wrist up to the
shoulder, and then there were flexible splints put on like these.
There was three of this kind and two other longer ones put
between, one on the upper and towards the back side of the arm,
and the other on the under side and opposite the upper splint.
These splints, made by Morris, extended from the shoulder and
arm-pit to the elbow joint. There was a place cut in the roller to
dress the wound, and the roller was passed down from the shoul-
der over these splints to the wrist again, and the bandage secured
and the arm placed in a sling. The bones were placed in apposi-
tion by Dr. Pratt, by manipulating, and by measurement he ascer-
tained the bones were in place. The arm was of the same length
of the other. There were longer splints put on the arm than
these, and none as short as these. He was then put upon a sofa. I
did not remain until he was moved. I saw him again on Mon-
day or Tuesday, at the residence of his father. Dr. Pratt, Mr.
and Mrs. Frisby and myself were present. The arm was
undressed far enough to see its condition; it appeared to be doing
well. Dr. Pratt thought it not necessary to do anything more
to the arm ; the thumb was dressed and the wound on the arm
and head. There was, at that time, an angular splint on the arm.
Dr. Pratt told me he had placed it on to remove the boy and to
prevent his getting the arm out of place in moving home. This
conversation was had in presence of Mr. Frisby and family, and
the boy did not deny it, or say anything to the contrary. There
was considerable inflammation in the thumb and back part of the
arm. The boy had some fever; the parents stated he had fever
the previous night. Dr. Pratt said he would give him aconite.
I saw him prepare it, put some eight or ten drops in a half tum-
79
bler of water, and gave him two tea-spoonfuls. The head was
bathed with arnica, steeped in water, and the arm and thumb
were bathed with tincture of calendula or marigold. I have
used this remedy and found it useful in preventing suppuration in
cases of lacerated wounds. I visited him nearly a week after-
wards. Dr. Pratt took off the dressing of the thumb and dressed
it with calendula. The thumb had been kept in proper place by
the flexible splints. The arm was in its proper position, also.
When the shellae splint was taken off, Dr. Pratt remarked that it
was a very difficult thing to keep that thumb in place, on account
of the ligaments being so badly lacerated, and it would probably
be some time before the shellae splint could be removed. Some
of the adhesive straps had been loosened by the suppuration, but
not sufficient to permit the bone to get out of place. It had to be
watched closely. The wound on the head appeared to be doing well.
The arm was partly undressed and one of the splints removed;
and Dr. Pratt, by feeling carefully, found the bones in place and
the inflammation partially subsided. After he had examined it I
made an examination of it, and manipulated the arm sufficiently
to satisfy myself the bones were in place. The long splint was
then replaced and secured by the roller, and the angular splint
was then replaced and secured by bands passed through the
straps on the splint, and another near the elbow. Dr. Pratt
observed, he was surprised to find the arm and the boy in so good
a condition. On a former occasion he had doubts whether the
arm and thumb might not have to be amputated. He examined
it to see if it was uniting; moved it slightly, and found it was
uniting. Dr. Pratt thought it not safe to move it much. Some
pus had been discharged. He said the boy was better than he
expected. He said he thought the boy would not want to eat
much; might give some toast or other light food. This was the
first directions. At Morris's. At this last time he said the boy
could eat any common food in moderate quantities. Something
was said by the parents about his having eaten too much, and had
brought on some fever, but it had subsided. Dr. Pratt told him
not to eat too freely of meat. At the time the bone was set, on
making pressure or extension, the wound bled more freely. The
roller was placed on the wrist first, and then to the shoulder; the
splints were then put on and the roller passed over them twice.
The roller was not far from two inches wide, and the edges over-
lapped as it was rolled along. I saw the boy in from one to two
80
weeks. Dr. Pratt was with me, except once when I visited the
mother. Dr. Pratt and myself carefully examined the arm every
time we went to see whether it was uniting, and it was doing
well. We also felt provisional callus distinctly at the point of the
oblique fracture. On the 20th February he examined the arm and
took everything off. Dr. Pratt took hold of the arm and exam-
ined it thoroughly, and there was no motion except at the shoul-
der and elbow. Dr. Pratt told him to raise his hand up to his
head, and he did; so Dr. Pratt thought it would do to remove
the splints. The mother was present and saw the boy move his
arm and raise his hand to his head, and expressed herself satisfied
that the bone had united. I suggested to Dr. Pratt, that the boy
was very uneasy, and perhaps it would be better to put on
the splint to prevent accident; he thought it might be so, and
replaced the splints, or some of them, with an angular splint. I
saw the boy about three weeks afterwards, and the arm had been
refractured. I examined it and saw that the oblique fracture had
separated. I could distinctly discover crepitus. This was in
March. I was surprised, and enquired of the mother about it. I
cannot state whether she said he fell down or hit his arm against
the fence. She said he had hit his arm and refractured it; I can-
not give the language. The boy did not deny it, or offer any
other explanation. I assisted in making extension sufficient to
counteract the effects of muscular contraction. There was five
splints besides the angular splint. There was some change in the
position of the splints. The external wound had healed up. I
cannot state when I next saw it. The arm was dressed and
placed in proper position. I never saw any blisters on the hand.
These splints were made of woolen cloth saturated with shellae;
when used, they are placed on a table on a press-board and ironed,
heated so as to make them pliable; they are not ironed on the
hand. I never discovered the bandages were so tight as to make
the arm black and blue; some puffing out of the hand shortly
after bandaging, nothing else. I saw the boy last 30th day of
May, 1863, at Dr. Pratt's office. There was to have been a con-
sultation there that day. The arm was undone, but the frag-
ments had not united. Some three or four weeks before this Dr.
Pratt used friction; I assisted him. It was done by holding the
bones and rubbing one against the other. This was about the
last of April or first of May. . .
On the 30th day of May Dr. Pratt mentioned what had been
81
done, and said he had lost all hopes of effecting anything by
friction; that an operation would have to be performed on the
arm, and proposed to Mr. Frisby to operate on the arm; said he
thought that was the only means which could be adopted to restore
it. He explained to Mr. Frisby the different methods which
had been used; one was cutting down to the fracture and
scraping or sawing off the ends of the bone. Another was by
silver wires; ivory pegs were also mentioned. The father asked
Dr. Pratt about consulting with Dr. Miller. Dr. Pratt said he
would have no objection to any other man, and his only objec-
tion to Miller was, that his prejudice against Homoeopathy was
So great he did not believe he would give an honest opinion. He
told him that he thought that an operation would secure a good
arm. This was the last of May or first part of June. I cannot
state the precise time. I did not examine the splints. Dr. Pratt
said he could perform the operation himself, as well as any other
surgeon. But if Mr. Frisby wished or prefered it, he would get
an experienced surgeon from Chicago, and it should not cost him
any more than if performed by a surgeon residing here; or he
would go to Chicago, and each should pay his own expenses.
Cross-Ea:amined.—Dr. Pratt is an uncle of my wife. Have
been acquainted with him some five or six years; lived in his
family some three or four years. Spent part of the time in study
and part in practice. I graduated three years ago the first of
this month. Commenced reading with Dr. Pratt four years ago,
and graduated. I had read some before I attended lectures at the
St. Louis Homoeopathic Medical College. The course of instruc-
tion included Anatomy, Surgery, Surgical Anatomy, Pathology,
Physiology and Midwifery. Used Yeoman and Town’s Chemistry,
&c., principally in that institution. Had studied medicine at my
father's. I had practiced some. I had been engaged in practice
some six months or more before I graduated. I am at present in
partnership with Dr. Pratt, in the practice of medicine. There
was medicine given to the boy to prevent inflammation; it was
aconite. Aconite grows from the earth as all other plants do.
Aconite is a deadly poison. It is made from a plant called
Aconitum Napellus, but it is generally known by the name of
Aconite. The medicine is prepared by expressing the juice from
the plant and root. This juice is mixed with alchohol. Its med-
ical qualities, as used by us, are those controlling the cir-
culation. It has a controlling effect upon the circulation, by its
82
action upon the nervous centres. Its primary effect, when given to
persons in health, in large doses, would be depressing. Its second-
ary effect would be increased sensitiveness of the nervous sys-
tem and increased circulation. If there is inflammation, with
sensitiveness of the nervous system augmented, small doses act
specifically upon the inflammation, and allay the nervous irritabil-
ity. I might use it on saccharum lactus (or sugar of milk), or I
might use it in water. It is diluted. The dilution is made by
what is called the centesimal scale; ten drops are mixed with nine-
ty-eight drops of alcohol. Medicating by infection was an ancient
theory. It is not used now. Years ago, while Homoeopathy was
in its infancy, this was practiced. It was an ancient theory of
some of its advocates. I do not know that it proves Homoe-
opathy to be founded in error. It only shows that some of its
advocates made a mistake. Dr. Pratt gave the third attenuation
of aconite. The second attenuation is prepared in the same man-
ner as the first, and the third in like manner. He prepared it by
putting some eight or ten drops in a half tumbler of water; about a
gill, I should think, of water. I forget whether he gave one or
two teaspoonfuls, and directed it to be given from half an hour to
an hour, according as the fever might be. It would control the cir-
culation ; and I think it did do it. Dr. Pratt was surprised to see
the boy in as good condition as he was, considering his injury.
We did know what effect it would produce on the system. By
it, the pulse was reduced to its normal condition, or nearly so.
You may shut off the food in disease, and it will not always
reduce the circulation. If a man has typhoid fever his circula-
tion is not reduced by fasting. I have not treated any case of frac-
tured humerus. I have had one of the clavicle and fractured
ribs, which I treated. I administered the chloroform to the boy,
and I examined the fracture myself, and saw Dr. Pratt make an
examination. The boy was extremely sensitive when touched or
attempted to be touched. The father, John and David Morris
were present, and one or two other persons came in afterwards.
I think it was on the second or third day, Monday or Tuesday,
that I was at his father's, that Dr. Pratt told me he had put on
this angular splint to move the boy with ; I think this angular
splint was on Monday or Tuesday following the injury. It
was in the presence of the boy, I am pretty positive ; I am posi-
tive, I do not think I am mistaken. I did not get there until
after Dr. Pratt. The boy was partially undressed; his coat was
83
off. I cannot state positively. The arm may have been
undressed; nothing was done to the arm or thumb until after the
chloroform had been brought. I cannot state which was dressed
first ; I think it was the arm. The arm bled profusely. I am
positive the arm bled most. Head bled some. I have no recol-
lection as to the time we made examination. I cannot state the
time I examined it. Enough to see that the bone was broken into
three pieces, that there was an external wound and the bone was
broken in an oblique form, and then again across the bone on the
upper fragment, and making, as I have said, three pieces of bone. I
believe there are cases where bone unites with very little provis-
ional callus. I understand that the surgeon applies his splints to
keep the parts in apposition, and that the fractured bone or parts
surrounding it, may be kept quiet, and that provisional callus is
nature's splint. I believe it has been said that nature is very wise
in these matters. I visited this lad during the whole period Dr.
Pratt was treating him, at intervals, varying from one to two, and
perhaps three weeks. I visited the boy on Monday or Tuesday
following the injury. I was there again in about ten days. The
first visit I found the boy doing well. Medicine was keeping
down inflammation, and the medicine was continued and wounds
both dressed, and the arm was in proper position; at the end of a
week or ten days from that time the wounds were again dressed
as before, and the bones were examined and found in proper posi-
tion ; measured the arm from the coronoid process at the shoul-
der to the elbow, and found it of proper length and bones in posi-
tion. I visited the third time between two and three weeks from
the first time, and the fractures were again dressed as before. I
think the bandages were removed sufficiently every time, or nearly
so, to see that the arm was in position, I think I was there some
five times in eight or ten weeks. I visited him on the 20th Feb-
ruary. I think this was the fifth time. I went there once alone
to see Mrs. Frisby. I cannot state when that was. I prescribed
for her throat. I had been there five or six times up to the eighth
or tenth week. I did nothing for the thumb except to examine
it. About the tenth week, I should think, the arm had so far
united that he could move it. It was about the 20th February,
1863, I recollect this date from the fact that I remember Dr.
Pratt made a passing visit to Seymour Down's on that day. I
have a distinct recollection of that fact, and that it was in Febru-
ary. In looking over his accounts one day, I saw that charge
84
was made on the 20th February. In looking over that account,
about two months ago, and Iremember his making that call. Dr.
Pratt did not call my attention to this matter. I know this from
recollection, and from other circumstances. I had a patient at
Georgetown, and I went to Polo about that time. Mrs. Frisby was
present at the time. The boy raised his arm up and the mother
saw it. Dr. Pratt placed his hand under his (the boy's) hand to
steady it, and the boy raised up his hand above his head, and turned
his hand backwards and forwards. Dr. Pratt merely put his hand
under the boy's. Dr. Pratt said he did not lift any; merely
steadied it. I did not say that after the refracture we moved the
bone. I said I assisted in making extension sufficient to keep the
muscles from drawing them out of place. I never saw Mr. Yeo-
man until I saw him here in court. There is always a tendency
in the muscles, in case of injury, to contract. All that was
needed, was to keep the muscles from getting the fragments out
of place. It was after the twentieth of February that this was
done, and it was at this time that there was crepitus; it is a dis-
tinct grating sound. I distinctly heard that grating sound. It
was some eight or ten weeks when we found the bone united;
about three weeks after that time it was refractured. Bone
will unite in eight or ten weeks; it may unite sooner; it may be
longer delayed. A fibrous cartilagnious substance which forms
in case of non-union, around the ends of the bone, would destroy
crepitus. But it will not form in eight or ten weeks; I give it as
my opinion, that it will not. The crepitus would not have been
heard if it had. The fragments were put in apposition, and the
bandages and splints put on again. I do say, that these are not
the same splints, I am positive of that; they were longer and wider.
It may be they are the same splints. These splints are not as long
as at first, but they are not the same length now. I never made
any splints. I saw other splints on, and longer ones. I did not
say I visited him at any stated periods. The head may have
healed in a week or two; I cannot state. I cannot state when
the thumb healed—probably three or four weeks before they all
healed. My recollection is, that Dr. Pratt, within ten days or
two weeks, directed that the boy might have ordinary food. Dr.
Pratt applied friction to the arm three or four weeks before going
to Milledgeville. I do not know whether the attention of the
family was called to it specially or not. Mr. Frisby was there
in the room. I do not know of any thing being said to Mr.
85
Frisby. It did not appear to hurt him much. At that time I -
held one bone and Dr. Pratt rubbed the other against it.
Mrs. Hannah Belding, sworn, says: I have no acquaintance
with Mrs. Frisby, except I was introduced to her by Dr. Pratt's
wife, when the consultation was held at our house. It was the
first of May, 1863. I think Dr. Pratt and wife, Dr. Freas,
this boy, Frank, Dr. Belding and myself were present. The
boy's father came in just after the boy and his mother. I think
I was not in the room when the arm was undone. When I came
in they were washing the arm. I don’t think I noticed any splint
except that outside one. I was looking at the arm, and I asked
Dr. Pratt how it came that the boy was in that condition, when
but a few weeks ago I was at your house, and you were talking
of taking off the splints. Heraised up this splint and said, “This
shows how it was done. The boy was playing ball, and in kick-
ing the ball, he fell against, or hit the fence, and refractured his
arm;” and he says to Frank, “That was the way it was done, was
it not ? If that is not the way, state how it was done.” Frank
said that was the way it was done. I then spoke to his mother,
and said it must have hurt him very much. His mother answered
that he didn’t complain, but she thought it hurt him more than
he was willing to acknowledge, as he went up stairs and seemed
to be quite uneasy about it. -
Cross-Ea:amined.—They were all present when I asked that
question, Dr. Pratt, Dr. Freas and Dr. Belding, Mr. and Mrs.
Frisby and Mrs. Pratt. I asked how it happened that this arm
was in this condition. He said the boy was playing ball, and
went to kick at the ball and hit his arm against the fence. He
then appealed to the boy, if that was not so, and the boy said it
was. I said to Dr. Pratt, “Did you not state to me that you inten-
ded to take off the splints soon º’ I cannot state how long it was
before this time, that I had the conversation with Dr. Pratt; it
may have been three, four or five weeks; I cannot tell how long
it was. Dr. Pratt is a son-in-law by marriage. I am a second
wife, married in 1858. ~ . - -
Mahlon Brown, sworn, says: I reside in Rock Creek town-
ship, Carroll County, Illinois. I never saw Frank Frisby before
his arm was broken. I saw him when he passed with his team;
his brother was driving the other team, and trying to run by
Frank. I did not see Frank until some two months after it hap-
86
pened. They had got out of sight when it happened, and I did
not go down where he was. - -
Dr. James C. Burbank, sworn. I reside at Polo, Ogle County.
I have resided there about eight years; am a physician and sur-
geon. Graduated at Philadelphia, in 1856, at the Homoeopathic
Medical College of Pennsylvania, located at Philadelphia. I saw
this boy on one occasion. I cannot state the time precisely; last
of Dec., 1862, after the arm was fractured, at his father’s house.
His father, and mother and another lady, his mother's sister, and
i)r. Pratt and myself were present. I saw the left arm of this boy
and examined it; the arm was partly undressed. Dr. Pratt requested
me to examine it. Took off some of the splints; all, I believe,
except the narrow ones. I measured the arm carefully, and found
it was all right, that it corresponded in length with the other arm.
I thought we had not better remove the inner ones. There was
something outside, but I cannot state that it was this angular
splint. There were two longer splints, and long enough to reach
from the shoulder and from the arm-pit to the elbow joint. I
examined the thumb; it was in a very bad condition, much lacer-
ated, and the bone was badly fractured, commencing just behind
the joint. The bone was fractured in an oblique direction, nearly
back to the next joint. The thumb was out of place as soon as
we removed the dressing; the injury was so great that it was
almost impossible to keep it in place. Dr. Pratt dressed it and
put it in place. He fitted a splint of gum shellac, and put the
thumb in proper place. He cut it so as to have it come down as
far as he could, on account of the wound. That splint is a proper
one. I think it was as good a splint as could be used for that
kind of injury. - -
Cross-Ea:amined—I graduated at the Homoeopathic College, at
Philadelphia. There are several other authors on surgery now.
When I graduated, we used Druit's Surgery as a text book. I
do not know whether that is a foreign author or not. We have
better works at present, and I have not consulted it lately. I do
not remember of having but one case of the humerus. It was at
Polo, a boy of twelve years of age; it was just above the con-
dyles. It terminated favorably. I think it was the first or second
day after Christmas. (Was shown the splints.) I cannot say
whether these splints were on the arm or not. I presume they
were. I do not know whether there was some of these splints
broke. I examined the hand after taking the dressing off. He
87
put the bones in place. I am not certain that the shellac splint
was cloth. It may be felt; it is a good splint. I helped him put
it in place. He cut the splint out of the piece he had. They have
to be heated pretty hot. It might be hot enough to blister. I
should avoid blistering it if I could. The hand was badly lacer-
ated at that time, and much inflamed on the inside. It would not
be good practice to put it on hot enough to blister much, but it
must be hot enough to put in place.
William Brown, sworn, says: I reside at Rock Creek, in this
county. I do not recollect the name of the boy. I saw him
there on the day the arm was broken. When opposite my
house the horses started to run. I did not see them afterwards.
JDavid Morris, sworn, says: I reside in Rock Creek township,
Carroll county. I have seen this boy, Frank Frisby. I saw him
a few minutes after the accident occurred. My brother went out
to him first, and was fetching him to the house. He looked as
though he was hurt pretty badly. I told him I thought his arm
was broke; he thought not. He was taken to my brother's, John
Morris. It was torn through the inside of the hand, as near as I
can recollect. Dr. Pratt got there in half an hour. He did not
say anything which I remember. I was present when this arm
was dressed. It was Dec., 1862. I cannot tell the day of the
month. I made two splints of pine out of a shingle. I saw them
put on the arm near the wound, and the other on the inside oppo-
site to the first ; there were other splints like these. As near as
I can recollect the splints I made, reached from the elbow to the
shoulder. The arm bled considerably; it ran on the floor when
we put on the bandage. I do not remember which way he put
on the bandage. I should think he was moved the next day
about ten o’clock. Dr. Pratt was there ; I do not know whether
he examined the arm or not. Mr. Downs and wife were there
and went away with him. His arm was in a sling, and a pillow
placed under it. I saw the boy some time afterwards. It was
after the consultation at Milledgeville. I think I asked him how
he was getting along. I told him I heard he had broken his arm.
over again. He said that he fell against a post. That was all
the conversation we had. He said Dr. Miller was going to set it
over again when it was cool weather.
Cross-Eacamined—Dr. Pratt came there about half an hour
88
after the accident, but did not set the arm until evening, some
hour and a half after the injury. Did up the thumb first. The
boy had some pain at times. I do not know whether the thumb
was done up before the chloroform came or not. Do not remem-
ber what Dr. Pratt did while my brother was after chloroform,
except to take the clothing off. Couldn’t say what Wales was
doing before the chloroform came. Dr. Wales applied the chlo-
roform to the nose. I did not shave all the splints that were put
on. I shaved out two shingle splints, the others came from Dr.
Pratt's. The shingle splints; I should think, were about one and
a half inches in width; might have been narrower, might have
been wider.
John Morris, sworn, says: I reside in Rock Creek township.
I know Frank Frisby. At the time he had his arm broken I was
eating supper. I heard the horses run by and started immediately
to go down where the boys were. It was about thirty rods from
the house; before I got there his brother, older, was holding him
up, and told me his brother was killed, and wanted I should go
and get the Dr., which I did. But before I returned, I went, at
Dr. Pratt's request, and got Dr. Wales to assist. I was present
when the fractures were dressed. I think the thumb was dressed
first. The arm bled considerably. It bled enough to wet the ban-
dages, and then it bled considerably on the blankets were he lay.
I saw them while making splints and getting ready to commence
operations. These other splints were made out of a shingle, one on
the inside and the other on the outside, extending from the elbow
nearly to the shoulder. I remember there being other splints. I
should judge these were not the same. I did not examine them
particularly.
Cross- Eacamined—I went after chloroform and for Dr. Wales.
The bones were not set until I got back.
Dr. Lemuel C. Belding, affirmed, says: I reside in the dense
settlement of Milledgeville, in Carroll county, Illinois. I am a.
physician by profession. I have some acquaintance with Dr.
Pratt. I don’t know that he is any relation of mine; he married
my daughter, I believe. I have seen this boy, Frank Frisby, once
before this term of court. I saw him at my residence in May,
1863. Dr. Pratt, Dr. Freas, myself and family, a woman, said to
be his mother, and his father, were there. There was nobody else
89.
that I know of. I was invited by Dr. Pratt. I should not have
officiated if I had not been invited. I looked to see if there was
any provisional callus. We found the arm bandaged and in pro-
per position. But supposing Dr. Pratt to be a graduate, and Dr.
Freas also, I do not know but I made my conclusions as
much from their examination as my own. I thought I found pro-
visional callus. Dr. Freas said there was, and Dr. Pratt said
there was. I got it fixed in my mind, from manipulating the arm,
that there was provisional callus. It was a little above the pres-
ent fracture where the transverse fracture was. The arm was
very much in the same condition in appearance then as it is now,
except I do not think it was so much elongated. I think the
points of fracture were much nearer together than now. (I
wish to make an explanation.) It is a long time since I
studied surgery, and the first study makes its impress on
the mind not easily obliterated; recent things or events
do not produce the impression on the mind which past
ones do. The old man does not retain these as he does the events
of early life. And when Dr. Pratt spoke about using rivets, it
seemed to me so absurd. To me it was a funny thing, to pin
bones together and think they would unite, and I did not think
how it would sound, and I said, “Drive in a couple of shingle nails;
they will answer just as well.” And derogatory as it was to my
professional character, when Mr. Frisby swore to what I said, I
remembered it, and did not wish to have it said that the man
lied. For I did say it, but it was a joke brought out by Dr. Pratt's
mentioning the ivory pegs. I have practiced Allopathy twenty-
five years, and since that I have found something; better and
being a progressive man, I have taken hold of Homoeopathy, and
with my whole soul and strength, am trying to do what I can by
way of medicine to save suffering humanity, and let the boys fix
up the bones, which is now done so differently from what it used
to be. I never studied modern surgery. It was proposed by Dr.
Pratt, and assented to by Dr. Freas, that friction should be
resorted to. It looked like a very strange proceeding to me. I
did not know anything about it, and I thought it would be of no
use, and was opposed to it. I was for placing the fragments in
juxtaposition, and let nature perform her perfect work, and cure
up the arm. I did not advise friction. I had my reasons for it.
I have seen bones in that condition before now, and I have known.
them unite. There was something said about the re-breaking,
6
90
and it was not denied by the boy. Dr. Pratt said that the bones
had been united so strongly that the arm could be moved and
lifted by the boy; that it had been tried, and found united. The
father and mother and boy were all present, and no one contra-
dicted that statement, or said that it was not so. But I did hear
some words confirming it. The mother said it did not hurt so
much as she should have thought it would, and the boy said it
did not hurt him a great deal. I think the mother said she
thought it hurt him more than he was willing to own, that he
went up stairs and appeared uneasy. I heard nothing at that time
opposing these statements. The splint that was on the outside
looked like this, and was split in two places. It seems to me it
was not split quite so far as it is now. I do not believe it was. I
recollect Dr. Freas making the remark, that it must unavoidably
have broken the bone. I do not remember all that was said. My
wife was passing in and out, and she had some conversation with
the mother about it. This was the substance of what was said
about this matter. I saw the arm undone on that occasion ; this
yellow splint was on the outside, or one like it. There were other
splints. I do not know whether these small ones were there or
not. There were longer ones, too. I think there were enough to
cover the arm, and long enough to extend from the elbow to the
shoulder. I do not know about these short ones. I remember
there were longer ones than these. I have a very clear recollec-
tion of that.
Cross-Eatamined—I recollect it was one year ago next May
that Dr. Pratt and Dr. Freas and myself held a consultation at
my house, over this boy’s arm. This old brain gets confused
somewhat, and I don’t want to say much about my speaking or
thinking powers; my friends are better judges than I am. I am
somewhat absent-minded; I might recollect your name to-day
and forget it to-morrow, and remember it again in half an hour.
Question: How old are you, Dr 2
Answer: I don’t know when I was born ; I was there, I
expect, but I do not recollect it. I have the records written by
my mother, I guess, which says I was seventy-three years old the
14th day of last August, and my mother said I was born a few
minutes past one o’clock in the morning. Whether I shall live to
see seventy-four, I know not. I remember she told me I was born
in a thunder storm, and got thunder-shocked. Some things I do not
remember as well as I did in my youth. I did not expect to have
9i *~ *-*.*.*.*.
;
to bring these facts before this jury to-day (not at that time). At
that time I was thinking of what could be done to relieve this
poor boy from the terrible calamity or misfortune. I think, sir,
what I do give is right, and what I cannot give I will not utter,
I think he did say his arm did not hurt him much, or a great deal,
when he fell against the fence post. -
I now say that the mother did say, that it did not appear to
hurt him as much as she should suppose it would, but she thought
it hurt worse than he let her know of, as he went up stairs and
seemed uneasy. He remained about an hour, I guess. I had
over some nonsense of mine about the shingle nails, and I did not
want that witness to be accused of lying, because what I said
jocosely would injure my professional reputation. I do believe,
as I said, that man has an internal memory, in which is stored up
all he does, whether good or bad, and under certain favorable cir
cumstances, these acts stored in the internal memory, may become
reproduced in the external memory, clear and distinct as at first.
But I think these facts which I have stated, or a great portion, if
not all, have remained in the external memory, and have not passed
away. I remember the terrific appearance of that boy’s arm. It
is in the external memory, and it will always remain there, per-
haps. I can say that we were there met together, as a board, for
consultation over the arm of this boy. I suppose, sir, there were
no other persons present but Dr. Pratt and wife, and the other
persons I have mentioned. -* -
Question: What was said about the right hand 2
Answer: I don’t know as I heard anything said about it. I
don’t think I said at that time, I would rather have the arm in its
then condition, than the thumb on that right hand; I have not
said so, I think. But I have not thought so. If I did say so, I
would not be as likely to rememberit as I would the remark about
the shingle nails. If I had thought the thumb was as bad as the
arm, I would have pitied him much more. It is a sad pity for a
young lad to get such an injury, I don’t think, now, the thumb
is very bad. s *
Isaac H. Hodgeson, sworn says: Isaac H. Hodgeson is my
name. I reside in Rock Creek township; have lived there,
off and on, for five years. I know Dr. Pratt, and have
seen Frank Frisby since this case came up. Saw him at.
Dr. Pratt's last of March or first of April, A. D. 1863
92
Dr. Pratt was not there. Mrs. Pratt, Mr. Frisby, Frank and
myself were there. Mrs. Pratt, in the presence of the father and
boy, said something about the boy's having re-broken his arm, Mr.
Frisby came there with the expectation of meeting the Drs.; they
were going to have a consultation, I believe. Dr. Pratt was not
present, and the other Drs. were not there, either. Mr. Frisby
said it was seed time and he must go home, that Dr. Pratt
agreed to meet him there, and he thought the Dr. ought to have
been there. Mrs. Pratt thought the arm would have been well by
that time if the boy had not broken it over again. Frisby said
he knew that the arm had been broken again, but it seemed to
him, it ought to have been well by that time. Mrs. Pratt told
him he ought not to have let the boy use his arm, nor play ball
out doors. He replied, he would play, he could not prevent it.
Mrs. Pratt told him he should not have let the boy attempt to
put on his boot, he should have known it would hurt his arm.
Frisby said the pulling on his boot did not hurt him as bad as he
did playing ball—it was there he broke it over. This was the
last of March or first of April, 1863. I was Dr. Pratt's when
Dr. Wales was there. I did not hear anything a sout the rebreak-
ing the arm, that I remember, but it was about an operation.
Mr. Frisby said he did not feel satisfied about the way the arm
was getting along, and they talked about having an operation on
the arm. The Dr. said he would do it himself, or he would go to
Chicago and have it done. But Mr. Frisby must pay his and the
boy's expenses, and Dr. Pratt would pay his own. Dr. Pratt
said he would get as good a surgeon as there was in Chicago,
and it should cost him no more than it would if done by a sur-
geon here; that it should be done as reasonably as any man
would do it. Frisby said he had not got the means just then,
and they concluded to postpone it one week. No day was set,
but he was to let the Dr. know the next week. There was some-
thing said about having Drs. about here to assist him, or to give
counsel. Frisby asked him if he would not have Dr. Miller to
assist him. Dr. Pratt replied, he thought Miller would not do
justice to the case, he was so prejudiced against Homoeopathy;
but he would have no objection against any other Allopathic
surgeon. • - º
Cross-Earamined. I was present on two occasions at Dr.
Pratt’s, once when he was absent and once when he was present.
I heard what Mr. Frisby said, I was living at D. W. Dame's at
93
the time, and was sick. Went to Dr. Pratt's to get some medi-
cine several times; was well enough to get around, and happened
there both times the boy was there. The first time was the last
of March or first of April. I was present when Dr. Wales was
there. I used to go there frequently. I used to go to meetings
at the school house near Dr. Pratt's. I heard Dr. Belding preach
there. I don’t remember the text or anything in particular that
he said. But I do remember we used to meet at Dr. Pratt's to
sing. We sung some popular songs, sir—as Old Hundred, Lan-
singburg and others. Do you wish any more ? (Counsel—Yes,
sir.) Well, we sung Dundee and “Why this Look of Sadness.”
George Copp, Henry Worcester and myself sung, sir. Sometimes
one requested to sing a particular piece, and sometimes another.
Good many things said which I do not remember. Dr. Belding
advocated Swedenborgianism, and wanted sinners to repent. I
cannot state what he said. When there is anything of importance
said I can generally remember it sometime afterwards. I was
not very much interested, consequently I do not remember what
he preached about. He spoke on different subjects.
Question: Did you go up on the cars Saturday evening,
towards Lanark, and can you tell me what you or any one else,
said to you on the cars ?
Answer: I did. Mr. Brown and myself talked about differ-
ent subjects. We talked about wrestling, sir.
Turner.—Well, you can go now. ...’
JHodgeson.—You might have said so before, sir, I think.
TESTIMONY OF PROF. LUDLAM.
Direct Eacamination.—My name is Reuben Ludlam. I have
resided in Chicago for nearly thirteen years. Am a physician
and surgeon, a graduate of the University of Pennsylvania, located
in Philadelphia. This is the oldest Medical College in this coun-
try, and has no such appellation as Homoeopathic. I graduated
at the close of the session of 1851 and ’52, and began to prac-
tice my profession immediately.
[Dr. L. examines the arm and thumb of the boy, Frank Frisby.]
There has been an oblique fracture of the metacarpal bone of
the right thumb, and perhaps, also, a dislocation of the thumb
itself. Such a dislocation is not to be discovered at the present
time, the joint being undoubtedly in its proper place. I find a
cicatrix in the web of the thumb, which prevents a free motion
94
thereof. This cicatrix is of such a nature as to denote a lacerated
or torn wound. A laceration involving this web and the lateral
ligaments, as well as the muscles of the ball of the thumb, would
interfere with the cure of the fracture and the dislocation.
The left arm presents a case of non-union between two extrem-
ities of a fractured humerus, and not a false joint. In a false
joint, as I understand it, one bone or extremity is necessarily fixed,
while the other plays upon, or in it. If this upper fragment were
stationary, and a species of ligament had been improvised, so that
the lower one played in or upon it, that would make it a false
joint. In false joint, both fragments are held near together.
These are widely removed. I find evidence of non-union, but
fail to detect any provisional callus. There is a cicatrix on the
outer side of the arm, which indicates the original fracture of the
humerus may have been a compound one. It seems to have com-
municated with the seat of the fracture. Such a wound may be
caused by the fragments protruding through the flesh, or by some
external means. In either case a fracture, with an external wound
reaching in depth to the bone, is of the compound variety.
In case of comminuted fracture, there would necessarily have
been three or more fragments. Compound fractures are invari-
ably regarded as more difficult to treat, and more dangerous in
their results than simple fractures. -
The original wounds upon the head and in the palm of th
right hand constituted this a complicated fracture also. Such
wounds would retard or delay the cure of the fracture proper,
and the more complicated, the more time would be required to
repair the injury. -
If, in the outset, this were a compound comminuted complicated
fracture, it might require from six to twelve, or sixteen weeks, in
order that union should take place. I cannot be more specific,
for a considerable margin should be allowed in such a case. There
are many contingencies in the way of a complete cure. In case
of a young lad like this one, it might be very difficult, if not impos-
sible, to harness him into the necessary rest and quiet. Unrest
would retard the cure. In a fracture of the compound variety, and
unless measures are taken to prevent it, inflammation is a certain
consequence. In order to its prevention, we must equalize the
circulation. For the accomplishment of this object, the great
agent in our hands is aconite. With our school of medical prac-
titioners it supersedes the lancet and other antiphlogistics. I
*S -
95.
speak, from experience, of their relative value, upon which point
there can indeed be no adverse opinion. -
It would be as absurd always to measure the effects of doses by
their size, as to measure the capacity of a physician by his size.
In regulating the dose of aconite, as of all other remedies, it is
necessary to take into account the condition, susceptibility, and
all the peculiarities of the patient. Under the hypothesis that
this boy had just suffered a compound comminuted complicated
fracture of the humerus, I would have taken the third dilution of
aconite, put ten or twelve drops in half a glass of water, and
ordered him to take two teaspoonfuls every hour, in anticipation
of the inflammatory process. -
The blood is furnished to all of the bodily tissues through small
capillaries, which vessels are supplied by delicate filaments from
the spinal and ganglionic systems of nerves. By means of what
is called “reflex action,” these nerves supply a motor, or moving
force to the muscular coats of the vessels, which, by stimulating
their contraction, serves to carry on the circulation of the blood
through them. Now, aconite, more than any other known agent,
holds a specific relation to these nerve filaments, and thus is
capable of regulating the circulation of the blood in these little
capillary vessels. Its first effect is to stimulate contraction,
and consequently an increased rapidity of flow in the current ;
its second result is to promote relaxation, and thus to retard the
flow ; while in the third it may arrest the current and produce
what physicians call a stasis, or complete stoppage thereof. Aco-
nite benumbs these nerve-filaments, and thus influences the local
sensation, circulation and nutrition of a part. My views are based
upon personal observation of its effects in the treatment of diseased
conditions, and also upon what has taken place under my own eye
in field of the microscope. ‘..
In case of compound comminuted complicated fracture of the
humerus, the surgeon might reasonably wait, for union of the
fragments, for the space of two to six months before operating
for non-union. In some cases such means should never be resorted
to. The proper course would be to keep the limb quiet and wait
for re-union. Excepting constitutional means, the first treatment
of such a fracture would not differ materially from that which is
proper for a simple fracture. Inflammation is not a necessary
condition of the reparative process in bone any more than in the
96
healing of wounds of the soft parts. This view of the question
I am willing to defend.
I would use two long splints, especially in compound fracture
of the humerus. An opening should be left in the dressings, to
permit the discharge of pus and other matters, otherwise their
retention might serve to poison the wound and, possibly, the gen-
eral system. The arm should be bound with a roller before the
application of the splints, and the whole injury being properly
dressed and cared for in the outset, the patient should be visited
as often as once in one, two or three weeks, according to circum-
stances. Too much meddling with the seat of fracture might do
harm, as doctors sometimes do mischief by seeing their patients
too frequently. . - -
In case of a re-fracture of the humerus, after having once
united under the adverse circumstances already specified, the
chances for complete re-union would be very much lessened.
Indeed, I should not expect a prompt repair of the injury as a
result of the very best treatment. The cure would be slow, if it
took place at all. Craigie, I think, says that the chances of com-
plete re-union in a compound comminuted fracture are very
slight. Perfect union in such a case would be regarded as the
exception to the rule; and the greater the complication, the fewer
the chances of union in such cases. -
Pus is always to be taken as an evidence of inflammation, and
is never found excepting as a result of the inflammatory process.
In such a case as this appears to have been, I would have pre-
scribed a mild vegetable diet for the first eight or ten days, at
least. I certainly should have denied the boy both fat and lean
meats. Circumstances should govern as to the length of time in
which this diet should be employed. If necessary, I might con-
tinue it for a month or two. The diet I am speaking of might be
composed of farinaceous articles, such as farina, rice, toast and
crackers, or might include mealy potatoes, corn starch, etc. If
the wound discharged profusely and for a long time, the excess of
flow might constitute a drain upon the system against which I
should fortify by means of a more liberal diet. ~ -
It is difficult to determine the exact proportion of phosphate of
lime in the blood. The earthy salts are found in about eight per
centum, or eighty parts in one hundred of blood. In bone there
are said to be fifty-one parts of phosphate of lime, and eleven parts
of carbonate of lime in one hundred. The blood does not make
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97
bone, but bone is made of blood. With your permission I will
explain to the jury.
Here is a diagram which I have drawn, in order that I may be
understood. :
(See Fig. 3.)
All the tissues in the body are made of cells. These cells have
each their own proper form and size and function, or duty assigned
them. The history of the nerve-cell is the history of the nerve;
of a muscle-cell, the history of a muscle; of a bone-cell, the his-
tory of the bone. Tissues are composed of cells, as communities
3. I’é composed of individuals. What concerns one concerns all;
the history of one is the history of all. I have labeled each of
these type-cells in the diagram, in order that you may know where
they belong. -
Now these cells are the agents or architects, which, out of the
blood that is brought to them by the small capillaries, build up
and repair all the tissues, just as the carpenter and mason are
the agents or builders of timber and brick and mortar into a
dwelling or edifice. The muscle-cell, out of the blood, constructs
a muscle-cell having the same form and properties with itself.
The bone-cell develops bone; the cartilage-cell, cartilage, and so
on. In health, each reproduces its own kind. The law of types
is as marked in tissues as it is in species among animals. -
What is true of the healthy development and growth of the
tissues is equally true of their repair after injuries. Life itself is
chiefly manifested in this double process of waste and repair.
Again and again the textures are broken down and built up.
Repair is a healthy physiological function, although it may be
accompanied by the diseased or morbid consequences of injury
to the solids, or bad quality of the blood from which they are all
to be nourished. - 2 ^s
There is nothing in our bodies which is fixed and unchangeable.
The blood itself is made chiefly from substances taken in at the
mouth. The chyle is not the blood, neither is blood tissue. The
elements of the blood may and do exist, in chief part, in the
chyle, but, in all animals that have red blood, the chyle is one
thing and the blood another. So with the tissues and their rela-
tion to the blood. These are composed of, or made from elements
which pre-exist in the blood, but the blood is not muscle or bone,
or nerve, or ligament, any more than the chyle is blood. The
98 .
chyle is made of food which has been digested and is ready to be
absorbed. It is poured into the circulation by means of the lac-
teal system. Another portion of the blood-making product finds
its way into that fluid through what is called the portal system, or,
in plain English, by way of the liver. -
The bone-cells and the blood are, therefore, chiefly concerned
in the repair of injuries to the osseous textures. The first of
these are the agents, the latter supplies a condition of reparation.
This diagram will give you an idea of the manner in which the
blood is furnished to bones. - -
(See Fig. 1.)
The fibrous membrane around the bone, constituting its outer
envelop, is the periosteum. The inner membrane is of similar
texture and function, and lines the medullary canal in the long
bones, that canal which contains the marrow. Flat bones do not
have any well defined medullary canals. The external membrane,
the periosteum, is supplied with innumerable small vessels carrying
arterial blood, which are twigs set down from the capillaries of
the soft textures overlying the bone. The inner periosteum derives
its nourishment chiefly from a nutrient artery which penetrates
the shaft of the bone at its nutrient foramen, and, running down
to the medullary canal, passes along its course. When this artery
has passed through the compact tissue of the bone, and reached the
medullary cavity, it divides, as you see represented in the diagram,
into two branches, each of which travels towards its respective
extremity of the bone. This artery supplies the internal perios-
teum with blood, and from it the long bones derive a very consid-
erable share of their nourishment. There may be one or more
of these arteries running along together through the marrow.
In case of oblique fracture of the lower third of the humerus,
with rupture of this nutrient artery, as shown in the drawing, you
will readily perceive that re-union would be retarded, if indeed it
took place at all. When the artery is fractured in this manner,
nature plugs up its open extremity with fibrin; but you will readily
see that the nutrition of this inferior extremity of the bone could
not go on through its internal periosteum, until its circulation was
restored. In such case, the means or elements of repair must be
furnished to the osseous cells by the little twigs from the perios-
teum. As these latter could not enlarge or multiply very con-
siderably, since they pass into little holes in the bone, and cannot,
99
therefore, dilate, neither be pierced by new vessels from the out-
side, a compensatory circulation through the outer envelop would be
impossible. The flat bones may be nourished exclusively through
their external periosteum, but as a rule, the long bones cannot.
It is a property of cells, wherever we find them, to multiply
themselves by segmentation, or division. This process takes
place in the reparation of bone. For some days after the fracture
the time is occupied in removing the debris. At about the eighth
or ninth day the provisional callus is thrown out. This callus or
sheath, thrown around the seat of the fracture, the extremities
being placed in apposition and kept there, is formed chiefly by
the exudation of plasma from the periosteum and other neighbor-
ing tissues that have been wounded. Its hardness, as well as the
readiness of its absorption, will depend upon the amount of bony
or earthy matter deposited within it. This drawing illus-
trates the site of the provisional callus, and the organization of
the plasma into a fibrous structure in which are interspersed a
few osseous or bony cells.
(See Fig. 2.) -
In October 1841, more than twenty years ago, M. Flourens pres-
ented to the French Academy of Sciences a paper upon the Repair
of Bones after Fractures, in which he said: “The so-called pro-
visional callus is a fact altogether apart from the proper forma-
tion of bone; it results from the rupture of the vessels of the
periosteum and the surrounding parts.” *
Inflammation is a diseased and not a healthy or physiological
process, and is therefore not essential to the production of bony
or other tissue. Union of bone may take place, as in case of the
flat bones, the neck of the thigh bone, and the olecranori and
coracoid processes of the ulna, when fractured, without the for-
mation of provisional callus. In case of transverse fractures of
the long bones directly across their shaft, providing the extrem-
ities are kept in direct apposition, there may be no provisional
callus thrown out. Fractures, like wounds, may sometimes heal
by what is called the “first intention,” that is, without inflamma-
tion or suppuration.
The bone-cells do not receive the earthy matters as though they
were dumped into them by the blood. The blood is not to be
regarded as a peddle distributing his wares. The cells select from
this common reservoir what they need. They are real agents,
bona fide organs, as may be seen in the field of the microscope.
:
:
.
*
:
:
.
;
:
100
I have made this study a kind of specialty, having had the honor
of holding the chair of Physiology and Pathology in the Hahne-
mann Medical College, Chicago, during the past four years.
There is no fixed and positive period for the complete re-union
of broken bones. Within the space of four months, in an extreme
case, I might be able to determine whether the fragments would
or would not unite.
I would not resort to friction or other means to induce re-union,
other than the dressings and rest aforesaid, within four to six
months after the fracture. The best evidence of non-union would
consist in the mobility of the fragments without crepitus, which
condition would indicate that the ends of the bone were rounded
off, become smooth or ivory-like, or their surfaces covered with a
fibro-cartilaginous envelop. *
In case of a re-fracture, after ten weeks had elapsed, from six
weeks to three months might be required before it would unite
again. In case of non-union after a second fracture, we should
at least wait as long as that before resorting to surgical or opera-
tive means for its cure. Friction should first be tried, after which
it would be best to wait from four to six weeks. If this means is
successful, it may unite in three to four weeks, or thereabouts.
Among the means for the cure of non-united fractures there is
one which has not been mentioned by former medical witnesses.
This is an old expedient which consisted in enclosing the limb in
a cast of Plaster of Paris, and permitting it to remain quiet, in
order that Nature may have the best possible chance to re-unite
the fractured bone. When I had resorted to friction, I would
treat as in case of an original fracture. Resection, in my opinion,
promises the best results. This operation is more frequently per-
formed than either Brainard's or that of Dieffenbach. Either of
these operations would occasion an increased afflux or determina-
tion of blood to the parts, and thus, by stimulating their cell activ-
ities, minister to the production of definitive callus.
There is no question but this lad's arm might be cured by re-sec-
tion, although the chances of complete recovery are somewhat
lessened by the delay already experienced. -
It would be impossible for any physician or surgeon, by an
examination of this arm, at this remote period, one and a half
years after the accident, to decide as to the nature of the original
fracture, or what was the method of treatment, or the degree of
skill practiced in the outset.
;
:
;
:
:
:
:
:
101
The humerus, when fractured, is more liable to non-union than
is any other of the long bones; and in case of fracture into or
across this nutritient artery, the danger of such a sequel would
be very greatly increased.
For the reproduction of bone, merely, I would regard vegetable
food as relatively more nutritious and appropriate than animal
food. Taking all the tissues into account, this would not hold
true. The vegetable cell is the laboratory in which the earthy
matters are elaborated for the use of animals. It prepares the
earthy salts in the grass and grain which the animal eats, and
which ultimately find their way into our own blood. Vegetables
live upon the earth, and animals upon vegetables. We do not eat
these substances directly, but indirectly. This is the plain Saxon
of it.
This boy might have been treated with the best possible skill,
and yet be found in the condition in which he now is. As I
understand it, when a surgeon consents to take professional charge
of a fractured or dislocated limb, he by no means guarantees a.
good recovery independent of contingencies. The amount of
force required to re-fracture a broken humerus might be very
slight. I have known a preacher to fracture his arm by moderate
gesticulation, and a boy to fracture his leg by a mis-step upon the
carpet. A fall against the fence, or a blow against a post when
kicking a ball, might be sufficient to produce a re-fracture of the
3. "IYl.
These splints would answer to dress that arm with. A year
and a half ago, in so young a subject, they might have been quite
long enough. Before the invention of Day's elbow splint, cures
of a fractured humerus, and with just such splints as these, were
by no means uncommon.
In dressing a fractured arm, the bandage should begin at the
wrist and extend upwards, and so compress the belly of the mus-
cles of the fore-arm as to render the hand and fingers immovable,
or nearly so. If the arm were bandaged too tightly, the first
effect thereof would be manifest in the soft parts. Sloughing and
ulceration of the skin and adjacent tissues would ensue before
the circulation and nutrition of the bone could be impaired. Any
discoloration of the surface which could be readily removed by
friction, could not possibly do harm. A slight ecchymosis, or dis-
coloration of the skin, is a frequent and almost an invariable result
in case the proper and appropriate bandaging and dressing are
10% ;
applied. The more compound and oblique the fracture, the
greater the necessity for a snug and secure application of the
dressings.
Cross-Facamination.—I graduated in the Medical Department
of the University of Pennsylvania, in which school Homoeopathy
has never, to my knowledge, been taught. A change in my
medical sentiments is the result of a promise to investigate the
subject experimentally. I entered upon the practice of medicine
as I had been taught it, immediately after graduation. Have
formerly occupied the chair of Clinical Medicine, in addition to
that of Physiology and Pathology, in the Hahnemann Medical
College. 3.
My interest in this trial is not founded upon a fear lest a ver-
dict against the defendant should injure Homoeopathy. Truth is
not especially influenced by such local causes. My physiological
and pathological investigations were made before the commence-
ment of this trial; indeed, I may say, long before the fracture
itself occurred. My diagrams are roughly drawn, but they repre-
sent the idea which I wish to convey to the jury. My desire is
to be plain and specific, in order that the jury may comprehend
my meaning. Surgery, as taught and practiced in the Homoeo-
pathic school of medicine, is the same as in other schools, with
the single exception of the medical means which are sometimes
used as adjuvants to the mechanical treatment.
My prejudices in this case are not strong. I am, and have
always been an advocate of the largest liberality and toleration
in medical, as in political or religious preferences. My interest
and confidence in the success and triumph of Homoeopathy is
based upon the belief that it is a form of truth. I have been
much interested in this trial since its commencement, in hearing
the medical and other testimony. I have felt as one would in
rummaging through an old garret or museum which he had not
visited in a long time. Besides, I have learned some new things
in anatomy and physiology, as for example, we have been told
of a new muscle on the arm (McPherson’s muscle), of the termina-
tion of the osseous capillaries within the bone cells, etc., etc.
The text books upon surgery, in use in the Hahnemann Medi-
cal College are the works of Gross, Smith, Hamilton and Hel-
muth, or Hill and Hunt. Miller is and has long been a standard
author upon surgery. Norris is certainly regarded as a very
303
good authority, and I am happy to have heard him lecture, during
at least two winters, in the Pennsylvania Hospital. His edition
of Liston was published some twenty-two years ago. It would
now be regarded as belonging to the old style.
The manner of dressing a fracture of the humerus would be to
apply a bandage from the hand or wrist to the elbow, and per-
haps also to the shoulder, before adjusting the splints; then bring
the roller down over the splints in order to secure them firmly.
This is the method which I learned from the teaching of Prof.
Gibson in the University of Pennsylvania. It was also practiced
by Dr. Norris when I was a student in the Pennsylvania Hos-
pital. I am not positive if Hamilton, Miller and others insist that,
in all cases of fractured humerus, the bandage must first begin at
the fingers and not at the wrist. The object of this bandage is, so
to secure the muscles of the fore-arm as to prevent motion. As
'far as possible, this object is attained by binding securely the
belly of these muscles at the middle of the fore-arm. Authors
have their own peculiar views about this matter of bandaging the
hand and fingers.
The muscles of the fore-arm are chiefly attached, at their upper
extremity, to the external and internal condyles of the humerus.
Any considerable motion of the fingers and hand would neces-
sarily involve motion of the inferior fragment, in case of fracture
of the lower third of the humerus,
Aconite controls and regulates the capillary circulation by
means of its action upon the nerve filaments of these little vessels.
It appears to be the only known agent that, in any very marked
degree, acts thus. I have already described what are called its
primary and secondary effects. Belladonna operates by first
unpressing the nerve centre and afterward the part to which those
nerves are distributed. Aconite is the analogue of the first or
congestive stage of the inflammatory process. In order that it
shall be Homoeopathic it is only necessary that it be capable of
producing a like set of symptoms with those which it is expected
to remove. The question is one, not of identity, but of similarity
of action. In collapse of cholera I have given larger doses than
those already specified. Here it would be better to employ the
strong tincture, diluted with water and given every half hour.
Digitalis acts upon the heart, controlling its movements and
modifying the pulse through its specific effect upon what is called
the “cardiac plexus”—a knot of nervous matter belonging to the
104
ganglionic system. It never can be properly used as a substitute
for aconite. Both these remedies control the pulse, but in a very
different manner. :
Prior to the time in which Hahnemann lived, and excepting
only by a few eccentric physicians, aconite was not used as a
febrifuge. It is only a few years since the distribution of nervous
filaments upon the smaller blood-vessels has been demonstrated.
The dose and strength of preparation of aconite should be
regulated to suit different cases and conditions of the system. It
might be indicated in congestion of the brain, of the liver, or of
any other organ or tissue. Starvation itself might be accom-
panied by a frequent pulse. -
Vegetable food contains relatively more of the earthy salts
than animal food. Milk is the only exception to this rule. The
milk of young mothers is especially rich in matters which are
designed for the growth of the child’s skeleton. The bone is .
made of blood constituents, but the blood alone cannot create
bone. The cell is the agent in the manufacture of bone, as it is
of every other tissue, animal and vegetable. The elements of the
tissues, as of the various secretions, pre-exist in the blood, and yet
neither the tissues nor the secretions are to be found in that fluid.
The saliva does not exist in the blood, yet no one will doubt that
all of its elements are derived by a particular set of glands from
the blood. A condition of the secretion or manufacture of sugar
by the liver is an active flow of blood to that organ. The ele-
ments of this liver-sugar are found in the blood of the portal vein
before it reaches the liver, but the sugar itself is manufactured
by the cells of which that largest of all the glands is really an
aggregation. The elements of a bone may be found in the
blood, but those elements can only be constructed into true osseous
tissue by the direct agency of the bone-cell itself. -
An active circulation is a most important condition of the growth
and repair of tissue. It is also a condition of a healthy perform-
ance of the glandular functions. The gastric juice, which is the
solvent for the food, is secreted most actively when the mucous
membrane has become reddened by an increased flow of blood,
to the organ ; an injected condition of its capillaries. The same
is true of every gland in the body. Increased flow of blood
toward, and in them implies increased glandular activity. There
is this difference, however, between an injection and a congestion
&f a tissue. One is a healthy, the other a diseased process. The
105
former passes away as soon as the secretion has been thrown out
by the glandular cells of the organ; the latter is not so speedily
renewed. The former passes away without troublesome sequela,
while the latter does not. In the repair of injuries to any tissue,
a mere temporary injection of its capillaries may supply the
necessary condition for the reparative process to be carried on by
the cells of the part. A congestion thereof could do no more,
and might possibly do harm by establishing a diseased condition
where a healthy one would have been equally satisfactory and
salutary. This distinction is therefore a practical one.
When organized into tissue, the elements are changed in char-
acter. Thus, the farmer is aware that bone-earth, which has once
been an element in the animal skeleton, is richer in nutritious
material for the soil than the phosphate of lime which is obtained
from the laboratory. The fibrin of the blood and the fibrin of
muscle are quite different in character. Organization works
specific changes in these elements, so that they are not the
same within the animal organism as we find them in the inorganic
universe. - -
Cross-Examined.—Carniverous animals, like the dog and lion,
have no need of a vegetable diet to supply them with earthy
matters. They get their supply of these saline principles by
eating bones and cartilages with their food, both kinds of nutri-
ment at once, and in the most available form. I never feed my
patients upon bones, for the simple reason that I can safely trust
to the proper cells the work of elaborating the elements which
the osseous structures need. A tub-full of blood could not, of
itself, create a man. We must have a type-cell in bony tissue,
just as in the grain of wheat or corn, the acorn and the full-
grown tree. The blood contains the elements from which all the
tissues are formed. The plant finds its blood in the soil. The
rootlets of the man are the lacteals in his intestinal tract. In
both cases the nutritious elements are held in solution in water,
while the solids are developed from them by, and in conformity
with a specific type-force.
Inflammation is not necessary to produce union in a fractured
bone. Pus is not formed, save as a result of inflammation. In
case of non-union of a broken bone, I would stimulate or covet
an increased activity of the logal circulation of the part as a con-
dition of re-union. Provisional callus is usually, and sometimes
speedily absorbed. The absorbents, technically the organico-
7
106
molecular absorbents, take it up again, and it is finally thrown
out by the skin or kidneys as excrementitious matter. The hard-
ness and permanency of the provisional callus depends upon its
ossification. Provisional callus is not formed to the same extent
in flat as in the long bones.
I am not at present in active surgical practice, it not being the
custom in cities for all of our physicians to practice surgery. We
usually refer our surgical business to a competent person who
makes a specialty of surgery. I have not assumed that there has
been any especial or general reform in this branch of medicine
since my graduation, neither to be an authority for myself in sur-
gical matters. My remarks have been chiefly confined to the sub-
ject of physiology, or healthy action, and of pathology, or dis-
eased action, as bearing upon the question of the growth and
reproduction of bone and of other animal tissue. In my own prac-
tice, I have never had a case of non-union of the humerus after.
fracture. x- .
Resection of the extremities of a fractured bone, which has
failed of union, in my opinion, promises a better result than either
of the various operations proposed. Different authorities differ
upon this subject. Authors have their peculiar preferences. In
case of non-union in a transverse fracture, Dieffenbach’s method
might succeed better than any other. º .
In case the nutrient artery is broken across at the point of
fracture, I do not see any means by which a collateral circulation
into the medullary canal of the separated extremity could be
carried on, unless its branches should anastomose through the
definitive callus while it is being formed. The office of the inter-
nal periosteum is certainly very analagous to that of the external
one. The veins in the long bones are very numerous, and find
their exit through small foramina, or holes, about the heads of the
bones. * . - -
A complete cure in case of fracture depends very much upon
constitutional conditions and other contingencies. I would not
be too anxious if union were delayed, nor resort to friction until
after waiting a long time, say from four to six months. In
young, or in very aged persons more especially, bones are refrac-
tured by the most trivial causes. After such an accident the cure
would progress more slowly. The careful examination or mani-
pulation of a bone by a surgeon, while it is knitting together, and
the repair progressing, would not necessarily be injurious, while
107
if the limb were handled as roughly as just indicated by gestures
of the counsel, harm would be very likely to result.
From a careful examination of this boy’s arm, I am not able to
say whether there hsa ever been any provisional callus formed
since the original fracture occurred. -
And the defendant here closed his testimony, and the Plaintiff
further to maintain the said issue on his part, then and there gave
in evidence, the following testimony, to wit: -
Charles Frisby, sworn, says: I have heard the testimony of
this man, Mr. Hodgeson. I could not say that I had ever seen
the man before. I never said anything about the boy’s putting
on his boots. I am positive, sir, that I never said anything about it.
I never knew, or suspected that the arm was broken, only at
the time they stated it had been loosened a little. I said to Mrs.
Pratt, about the boy's playing on that occasion. There was noth-
ing said by me about the boy’s not hurting the arm so much in
pulling on his boot. I don't see how he could do it with both
hands tied. I know he never did to my knowledge. I deny ever
telling Mrs. Pratt anything of the kind.
- - |
Mrs. Frisby recalled—(Here shown the splints). These splints
have not been shortened since. Dr. Pratt brought a splint of the
length of this longer one. My husband took his knife and cut it
off by Dr. Pratt's orders, and these are the splints that were on
the first time the arm was dressed, and one short one which got
broke. The pine splints were about as long as the longest splint
here before me. The two short ones and the long one were on
together. I was present at every visit Dr. Pratt made. Dr.
Pratt didn’t reset that arm any time I was not present. Dr.
Pratt did not tell Dr. Wales he had set the arm over. Dr. Wales
was not at my house only three times with Dr. Pratt, besides he
came once without Dr. Pratt. Dr. Wales did not examine or
manipulate that arm in my presence. I was present when Mr.
Yeoman and my mother extended the arm. Dr. Pratt did not
say, the first time he came after the boy was brought home, in
presence of Dr. Wales, that he had put on this brace to keep the
boy’s arm in place while riding home. -
Mrs. Moscript recalled.—I was present at the time those
splints were taken off, about two weeks after I went there, and
108
they have not been shortened since. They are the same splints
Dr. Miller and Dr. McPherson took off his arm on the 6th day of
June, 1863. They have not been shortened since, sir.
Dr. Freas recalled.—Question: I ask you if at the time of the
consultation at Dr. Belding's, whether you stated to Dr. Beld-
ing, as your opinion, that the arm had been once united and
refractured 2 -
Answer: I did not state that, sir.
Question: Sir, if on that occasion you heard the remark from
Rºr. Pratt, that the arm had been united once and refractured ?
Answer: Dr. Pratt remarked that the arm had been broken,
but did not state that it had been united and rebroken; my atten-
tion was not called to a former union. I believe Mrs. Frisby was
present during that time. I did not, to my recollection, hear the
conversation between her and Mrs. Belding. I might, and I
might not have heard the conversation between her and Mrs.
Belding. I was busily engaged in tending to the fracture, and
not to what the ladies had to say. Mrs. Belding might have been
there, and I not have noticed her. Dr. Belding paid particular
attention to the arm, as we were manipulating it considerably.
If anything had been said about the arm being broken over at
that time, I could not tell what Mrs. Frisby said, if she said any-
thing. - -
(The argument of Counsels are inserted at the end of the volume.)
Which was all the evidence offered and introduced by either of
said parties, upon the trial of said cause. Whereupon the said
plaintiff then and there moved the said court, upon the evidence
aforesaid, to instruct the jury as follows, to wit:
PLAINTIFF's INSTRUCTIONs.
1st. If the jury believe, from the evidence, that Dr. Pratt,
the defendant, held himself out in the neighborhood, as a phy-
sician and surgeon, competent to dress and attend upon the plain-
tiff’s wound in question, and that as such physician and surgeon,
he undertook, for fee or reward, to properly set and arrange the
plaintiff’s said bones, and that he failed to use ordinary skill and
diligence in setting, arranging, and putting in proper position,
said bone, whereby the plaintiff’s arm and hand were never cured,
the jury must find the defendant guilty. a. -
109
2nd. A physician or surgeon, as well as a mechanic, is liable to
respond in damages for the ill consequences resulting from want
of due skill in the management of a case, or the treatment of a
patient, which he has undertaken to manage or treat, for fee or
reward, or the hope of fee or reward. - x
3rd. False in one thing, false in everything, is a maxim of
the law, and means that if the jury are satisfied, from the evidence,
that any witness in the case has testified wilfully false in any
material point, the jury are at liberty to disregard the entire tes-
timony of that witness. - •. -
4th. If the jury believe, from the evidence, that the defendant
did not use due skill and diligence, as a physician and surgeon,
in the treatment of the plaintiff’s wounds in question, as alleged
in the declaration of this case, and having undertaken so to do,
while professing to possess the requisite skill for that purpose, and
that as a consequence the plaintiff’s wounds were not cured, they
must find the defendant guilty, and in that case, the jury may
assess the damages in any amount not exceeding ten thousand
dollars ($10,000). } . . .
5th. In case the jury find the defendant guilty, they are at
liberty to assess the damages of the plaintiff at any amount not
exceeding ten thousand dollars. . . .
6th. The court instructs the jury, that when a person under-
takes to perform the duties of a physician and surgeon, the law
will hold him responsible for the consequences of a want of due
ordinary skill, even if there is no express pretense of sufficient
skill as physician and surgeon. . .
7th. The court instructs the jury, that the mere discharge of
the defendant from the treatment of plaintiff’s arm, before all the
means known to surgery had been by him employed, to bring
about a union of the broken bones, is no bar to the recovery on
the part of plaintiff; if the jury believe, from the evidence, that
previous to such discharge, the defendant had failed to use due
medical and surgical skill and care in the said treatment, that is
ordinary skill and care as a surgeon.
8th. If the jury find that during the time the defendant treated
the plaintiff, he did not treat him properly, and with ordinary skill
and care, then the plaintiff had a right to discharge the defend-
ant, and recover in this action his damages for the injuries he
sustained for the want of ordinary skill and care on the part of
the defendant in treating the plaintiff, as laid in the declaration.
110
DEFENDANT’s INSTRUCTIONs.
And the said defendant then and there moved the court, upon
the evidence aforesaid, to instruct the jury that,
I. If you believe, from the evidence, that without any agreement
as to compensation, the defendant was employed, and that, as a
Surgeon, undertook the treatment of fractures, dislocations and
wounds under which the plaintiff was suffering, then the follow-
ing relations arose between the plaintiff and defendant:
1st. That the defendant should be paid a reasonable compensa-
tion for the services rendered, if bestowed with ordinary care and
skill.
2nd. That the defendant should, with ordinary skill and care,
treat the plaintiff’s injuries, and if necessary, resort to all the
modes of treatment, and in the order recognized as proper and
generally or usually employed by gentlemen of the surgical pro-
fession; and to such treatment the plaintiff was bound to submit,
and himself do no act that would materially interfere with such
treatment.
3rd. If, then, from the evidence you further believe that the
defendant did treat the plaintiff in the manner just above stated—
that is, with ordinary skill as a surgeon, and that the plaintiff, or
his father, would not allow the defendant to go any farther in
attempting to cure the plaintiff, and that all the well recognized
modes had not been resorted to, and that at the time it was still
possible, by further and different treatment, (but well recognized
as proper) to have cured the plaintiff, then this action cannot be
maintained, and your verdict must be for the defendant.
II. If you believe, from the evidence, that the non-cure or
mon-union of the plaintiff’s left arm was, in some considerable
degree, caused by the fault of the plaintiff in not keeping out of
danger, or in other words, by refracturing his arm, or loosening
the parts by a fall,—in consequence of kicking at a ball, or in
some other way, after union had once fully, or to a considerable
degree taken place, then this action cannot be maintained so far
as the arm is concerned, and as to so much, your verdict must be
for the defendant; even if he was also guilty of some previous
failure to use ordinary skill, care and judgment in treating the
plaintiff. The law will not permit a person to maintain an action for
an injury of which he was himself the cause, or to which he, in
some considerable degree contributed. If you are satisfied, from
111
the evidence, that there are different modes of treating such
injuries as the plaintiff was laboring under when the defendant
commenced to treat him, all of which are approved by good sur-
gery, then the defendant had a right to select and pursue any
one of these remedies, including the diet of the plaintiff; and if
you also believe that the defendant did so, and therein and there-
about exercised ordinary skill, care and judgment, this action
cannot be maintained, although you should also believe, from the
evidence, that the plaintiff was wholly incurable when the treat-
ment of the defendant closed; and accordingly your verdict should
be for the defendant. *
III. The gravamen of the charge in this case is, that the plain-
tiff has not been cured of a fracture of his left arm, above the
elbow, and of a displacement of the joint of his right thumb, but
that he has been greatly delayed therein by the defendant’s never
properly setting and arranging the broken bone of that arm, and
by not properly setting, arranging and restoring to proper posi-
tion the displaced joint of the right thumb. No other lack or
want of skill, care or diligence, either as to splints, bandaging or
anything else, is complained of, or alleged in the declaration, and
none other can be considered by you. Unless, then, the evidence
establishes the fact, that the plaintiff’s left arm was never properly .
set or arranged, or that the displaced joint of the right thumb
was never properly set, arranged or restored to its proper position
by the defendant, no right of recovery has been made out; and
your verdict must be for the defendant.
IV. If you believe, from the evidence, that on the third day
of February, 1863, the defendant discovered some displacement
of the bone of the plaintiff’s arm, and that it was proper to reduce
the bone to its natural position, and that defendant did so replace
the bone, then instead of this act of the defendant being wrong
or actionable, it was commendable and right, and for that act
this action cannot be maintained.
V. In this case, as to the thumb of the plaintiff, if you believe
from the evidence, that sometime after it was first injured, the
defendant wished to adjust it and put it in its natural position,
and that he could have done so, but was prevented, or not allowed
to do so by the plaintiff or his father, then, as to the thumb, this
action cannot be maintained, unless the defendant, up to that time,
had failed to properly set, arrange and put in its place the dislo-
A
112
cated thumb joint of the said plaintiff, with an ordinary degree of
surgical skill and care.
The fact that the plaintiff was not cured of his injuries, is not
sufficient to maintain this action, but it must be established by the
evidence, that he was incurable at the time the defendant ceased
to treat him, and that he was rendered thus incurable by the fail-
ure of the defendant to use, with ordinary skill and care, the
means which, by the surgical art, were proper and necessary to
effect a cure. If the plaintiff was curable at the time the treat-
ment of the defendant ceased, and he was willing (and you so
believe from the evidence) to go on, and try to effect a cure; and
that he was not permitted to do so, but was prevented by the
plaintiff or by his father, then this action cannot be maintained,
and your verdict must be for the defendant, unless the evidence
shows that the defendant had, up to such a time, failed to arrange,
set and put in their proper place the said broken and dislocated
bones of the said plaintiff, with the ordinary skill and care of a
Surgeon.
VI. When a surgeon undertakes to cure a person of a wound,
fracture or dislocation, he does not become a guarantor or insurer
that a cure shall be effected ; nor does he undertake that in case
of cure, or in a curable case, that such cures shall be effected
within any particular time. He simply undertakes to treat the
case with ordinary skill, care and diligence, and, if necessary, to
resort to all the modes of treatment recognized as necessary or
proper, and employed generally or usually by good surgeons. If
he does this, although he does not exercise or use the highest skill
possessed by some in the surgical art, he is not liable in law to
answer in damages for not curing the patient. In such a case
the patient must submit to the consequences of non-cure, how-
ever serious, without right of action against the surgeon.
VII. If you believe, from the evidence, that the cause of the
plaintiff’s not being cured of the fracture of his left arm, was a
re-fracture of, or loosening of the parts after union had once fully
or to some considerable degree taken place, or that such injury
or re-fracture was occasioned by a fall of the plaintiff, or by the
hitting of the arm against a fence post, or anything else, without
the consent or fault of the defendant, then this action cannot be
maintained, as to the arm; and as to so much, your verdict must
be for the defendant. * f
113
And upon the evidence and instructions aforesaid, said cause
was submitted to the jury, who returned a verdict for the plain-
tiff, of which mention is within made. &
Whereupon the counsel for the defendant filed the following
motion for a new trial, to wit.
The defendant, by Lyman E. D. Wolf, his counsel, appears,
and moves a new trial in this case, for the following reasons, to
Wit :
First—The verdict of the jury in this case is plainly against the
instructions given to them by the court.
Secondly—It is clearly against the evidence given in this case.
Thirdly—It is directly against the law governing the case.
But the court overruled the said motion and gave judgment
upon the said verdict of the said jury, against the said defendant,
to which said verdict of the said jury against said defendant, and
to the said ruling of said court, upon said motion, the said defend-
ant then and there excepted, and inasmuch as the matters afore-
said do not appear of record, the counsel for the defendant pre-
sents this bill of exceptions, and prays that the same may be
signed and sealed by the court, and made part of the record in
said cause, and it is done accordingly.
(SEAL) W. H. HEATON, Judge.
114
A R G UMENTS OF CO UN SEL.
W. J. MILLER's ARGUMENT FOR PLAINTIFF.
GENTLEMEN OF THE JURY:-We have got along to this point,
that it devolves upon me to open this case to the jury, and in
doing so I do not intend, and do not suppose it to be necessary
to go over this long detail of testimony, and occupy your time
with it. It will not be proper for me to do so. You have sat
here with a great deal of patience, every one of you, and I have
noticed you have paid particular attention to this case, showing
that you appreciate its importance. So, going outside of this
matter, as we thought it to be right, you have been selected here
as jurors. I know most all of you, and it is not flattering you
when I tell you that I believe that you are honest and candid men.
And you have no prejudices in this case one way or the other,
and you have stated that you did not know anything of Dr. Pratt.
You had no feeling one way or the other about these pathys and
àsms. We come here presenting this case before you. A poor
boy has had his arm badly treated. You have seen it, and I think
the proper word was used when Dr. Belding said it had a very
“terrific” look. We claim it was for want of skill in Dr. Pratt,
for he had it, and has failed to exercise it. If he had skill he did
not exercise it. He professes surgical skill, and expects to
make his living from the community by rendering assistance when
called upon. If he had it in his power to exercise skill he did
not do so, and the present condition of the boy’s arm is the con-
sequence. We have charged here a large amount of damages.
It is hard to tell what disadvantages this boy may have to over-
come if he goes out into the world maimed—if he lives to the age
of forty or fifty years. It is not proper that we should come up
here, lawyers and doctors, firing and cross-firing about Allopathy
and Homoeopathy, Hydropathy, or any other pathy, and get up a
fuss, and this boy goes out of here without a fair trial. If this
should enter into the minds of this jury it is not doing the boy
justice. The boy does not care anything about these pathy's. We
have the facts that when Dr. Pratt was called there he was called
as a physician and surgeon, and they supposed, one that under-
stood his business. The father did not care anything about his
115
being Allopathy, or Homoeopathy or any other pathy, but asked
Dr. Pratt if he was capable to take charge of the case. Dr.
Pratt says “I can do it,” and went on from the father’s orders to
treat the case. We have nothing to do with this doctrine of
Homoeopathy or Allopathy, but are trying the case of this boy.
I do not find fault with other men for practicing any system
because I do not have faith in that particular system. I must
have faith to accompany pills, but I have not got it, so the pills
would do me no good. If they have faith that it acts all right, it
makes no difference about that. I asked them not to let any of
this pathy kind enter into the case. It is not right that it should.
We do not have any feeling on that subject. I do not know why
it was that Judge Knowlton, when he opened this case, said to
the jury, that this man wanted to send for [Dr. Miller] and that he
was a brother of the counsel, and that I, as an attorney, had taken
up this case because my brother, was an Allopathist. The idea
was, that he connected it with bringing this suit on account of
Dr. Pratt's being a Homoeopathist. I do not know why it was
important to mention here that I was a brother of Dr. Miller, and
that I had a feeling between these two systems of medicine.
Gentlemen, I want you and all the people to understand that so
far as there is any personal feeling, I have just as good feelings
towards Dr. Pratt, as a man, as any other man, and he knows it.
If he had come to us with his case to be tried, we would have
done it with much pleasure. We hold ourselves out here as
attorneys. When a man comes to us to have a suit attended to,
if we think it can be sustained, we bring that suit. If my friend,
Dr. Pratt, had applied to us we would have done the same. I
would not neglect that boy’s rights because I have good feelings
towards Dr. Pratt, nor because Dr. Miller is my brother. I have
no such feeling. When I have any doctoring done it is upon the
other principle. I say this much for myself. My friend Smith
is a Homoeopathist and employs a physician of that school. I do
not know how it is with friend Turner. It makes no difference.
I would not have said anything about this if Judge Knowlton
had not mentioned it. I will leave this to you. I do not care
how these lawyers, or Judge Knowlton, or witnesses feel about
this matter. This has nothing to do with it. I claim here that
they brought this boy and showed him to you. They have shown
that the boy was entirely healthy, of about fourteen years of age,
his mother and father appear to be healthy. If there has been
j j6
any hereditary disease in the family they have failed to show it.
He shows to you a healthy boy, full of vigor, who, by an accident,
has had his arm broken, and Dr. Pratt has failed to make it a
good arm. If you have heard all these celebrated doctors from
Chicago have said, every one of you are entitled to a diploma
from the Hahnemann Medical College. That gentleman [Dr.
Ludlam] has been a farmer, and has now the credit of holding a
high position, and has shown to you that he is a very extraor-
dinary man. I claim to have only common sense, just like you.
You claim to know something. Some of you are mechanics.
Some of you may have children who have had limbs broken, and
you know when broken bones are put together they unite, except
in extraordinary cases. If a person is healthy there is no reason
why they should not unite. I never heard of any such thing as
we have upon that point here, as to whether there was anything in
the constitution of the person to prevent the union of this bone.
The witnesses detailed how it was broke, that there was a small
wound. It does not make any difference whether something made
it by going down to the bone, or whether it was made by the
bone running out. It was reduced, and went to work and healed
up, going to show that everything was right. If so, they all agree
that it would have knit and worked right. And when they go to
work to show how it was done, they show that they have got wise
above what is written. They have not got anything of the kind.
They have theories and speculations. They agree and disagree.
My Chicago friend said that which I understand to be true, that
any old woman knows, that too tight bandaging would destroy
the soft parts of a limb, before it would effect the repair of bone.
It only proves this fact, that doctors disagree, when you get them
spun up in this mighty science. Dr. Ludlam says, “I wish
you to understand that the bony matter is not carried to the part
by the blood and dumped down where it is needed. It comes
down.” How does it come down 2. It is a speculation, and you
and I have as much right to speculate as he has. I take the priv-
ilege to do it, anyhow. We have a right to believe that things
are so or not so. It is a free country. And when they tell us
they know these little vessels do not dump this matter, they don’t
know. It is a system of nature. Man is an enigma. You cannot
understand anything about man. You cannot tell how it is done,
and they can just as well tell how this repairing of bone and
muscle is effected as well as they can tell how grass grows. The
117
good book tells us this, and man has never found out how it was
done. Now here, Dr. Porter says ossific matter is deposited by
the blood. Now, if Dr. Porter was from Chicago, it would add a
great deal to the force of what he says. Here I must be allowed
to assume a little. I am proud that we have got a man settled
among us here who can tell us something new. Dr. Beebe, the
seven years' wonder, says he came from a college a graduate of
seven years. He goes on to tell all. I will tell you as it comes
along; you will get my ideas, anyway. Now, they went out on the
presumption that these gentlemen in the country don’t know any-
thing. We have the two Dr. McAfees, Dr. Belding and another
doctor, and Dr. Kennedy, all are in court. They did not want
their opinions. We went upon the principle that these men out
here knew as much as any of them. We have called Dr. McPher-
son and Dr. Miller, Dr. Porter and all these other doctors, and
we have called some from another adjoining town, Drs. Buckley
and Hantz. Can you tell where this honor comes from ? They
came from where these men did, and how did they get ahead 2
They learned it from the same books. They are not old enough
to-day. My friend (Dr. Ludlam), he had naught to do with this
matter. It is not a specialty with him. He has not had any
cases. Dr. Beebe has treated only one case. He was called to
see another where there was a stump left, the balance had become
absorbed; and one case he treated came out all right. Dr. Haller
has treated one case of this kind, and that turned out favorably.
Dr. Miller said he had a number of cases, and they turned out
favorably. Dr. Miller has been in a situation to have more cases
and perform more operations than the others, and he has witnessed
but two cases which resulted unfavorably. He was near the
mines, where the breaking of bones was very frequent. He has
treated several cases of this kind, and none of them turned out
unfavorably. We judge from this, that if bones are only put
together properly, that nature will go on and make that thing
right. Nature has a system of its own, and it struck me as being
in accordance with the operations of nature when Dr. Porter
says, if you take an artery that becomes enlarged. [My friend
the judge knows more about that than many others.] He spoke
of its being very large where it swells out. What is to be done
there? Tie the artery above the swelling, and nature goes to
work and makes a way around. The doctor said it had been
done recently, and the limb below that point dwindled away.
118
Nature goes to work and throws out all this and carries on the
circulation. First, Dr. Beebe goes on and tells you; and he made
it as clear as mud to me, and no doubt to you. I know some-
thing, too. We thought so before Chicago enlightened us, and
we know it yet. Dr. Beebe went to work and tells about throw-
ing out pegs. The pegs reached out from that side and this side,
and met together. The other gentieman—I don’t recollect his
name—[Dr. Ludlam], he has fixed up here that it is thrown out in
this way by cells; that these cells run out in this kind of shape, as
you see on his diagram. We don’t know how, and I don’t know
that it makes any difference to us. When we come to inquire
how it is done, we are lost in the fog. We don’t know anything
about it. They have made it as clear as mud to me, and I don’t
think you got any light from it at all. I was troubled somewhat
about this provisional callus and did not know what they were
driving at. They all agree that this provisional callus was thrown
off around the bone. Why? We take it that as soon as there
has been fracture of the bone, nature goes to work to do the
work right. We find it is all right when we have examined it.
They all agree that this provisional callus is a sort of a band
around it, as a hoop around a barrel, as they conclude to hold it
there, but we don’t know whether that was it or not. We may
judge that in science, which they say is improving all the time,
that this provisional callus may be something else, or it might
make some other use of it. -
No doctor ever knew what was going on under that bone. We
have no information that that went to work at that time. We
have to speculate and judge about that. At any rate there is a
band thrown around there—that is, a provisional callus, as they
call it. There was a good deal of difficulty about whether the
callus went away or not. Why does he want us to state that?
I thought, after a while, that their theory was, that it was a com-
pound comminuted fracture. They wanted to establish that there
was three bones broken, and therefore it was harder to form a
union. Afterwards they only established the fact that there was one
bone broken. They must get rid of this matter by absorption. It
might be there was a little bone broken off above this, and there
united. Wales may tell the truth about it, but you cannot see
any remains of the provisional callus. The doctors on our side
say that there is now no provisional callus. There has been but
two others examined with reference to provisional callus, and
119
they are the two learned professors. They introduced here Dr.
Belding and Dr. Wales, who graduated at St. Louis, and they
did not ask his opinion. They did not care anything about it.
I)r. Burbank was introduced, and his opinion was not asked for.
But Dr. Porter (and as to his science and intelligence in books
and practice, I leave with you,) and Dr. Miller, they all agree
here, has had considerable practice. Dr. Freas, Dr. Buckley,
Dr. McPherson and others have been examined in reference to
this same question. They have been asked their opinions, and
they all agree on this point. We have the opinion of those other
two gentlemen, and they do not materially disagree. None of
these men tell you, who have examined it, why this bone did not
unite. There is only one proposition that they tell about, and
that is, these bones were not properly put together. These men
have had practice, and have the same books, and have grown up
upon the same milk, if I may be allowed the expression, that the
professors have fed upon. These gentlemen do not know the
reason that these bones do not unite. Can you tell me, from any
thing that these gentlemen told you, that there is any constitu-
tional derangement. What says these gentlemen? They started
off here, on the high horse, on a perfect trot. We have heard a
great deal about cohabitation. That is pretty good. [Laughter.]
I called it cohabitation. They had to explain it to you. It was
putting together two things and making them fit. But when I
heard Wales I thought he was trying to make everything fit.
[Here told to go slow.] I don’t care how my speech may read
in print, I cannot go slow. I claim here, as I started out, to be
a common sense man, nothing more. When they tell you these
things in technical terms, there is nothing so dangerous after all.
It means putting the bones together. When we come down to
the common sense of the thing we know it. They call a plant
by names which would break any common man’s jaw. When it
means nothing but cabbage, then we understand it. We always
transverse arrangements, in making these figures. I don’t know
that there is any testimony that this bone was broken that way.
They call it breaking straight across. They can put them
together just as well. But I was astonished, of course. I am aston-
ished at everything, and every other man would be. When the
judge discovered a little hole in the bone, there was something
there wrong. Dr. Beebe found out something about that little
thing there. Before this he says, the doctor, and I understand
120
it perfectly. The doctor says this is the nutritient foramen. I
always get it wrong. It is a little hole here, any way. It is no
matter about the name, because it is said that the “rose will
smell as sweet by any other name.” There is a number of little
holes here, and these little blood-vessels go in there. The proof
of these doctors is, that the vessel goes in there and is broke
short off, and that is going to delay this. The doctor says: “Well,
now, that is not giving nature sufficient credit, because in every
wound there is power in nature to go to work and repair it.”
Would it not be the same on that bone, if brought together ?
Bring these bones together and here comes this little vein to
nourish the bone, and all these veins that lie down below there
are arteries. I would like to know, myself, the judge’s idea of
things. There is a canal or artery. It is an opening through
which blood flows any way. There is two kinds of blood; one is
that which goes from the heart; it is passed through the lungs,
and is laden with chyle, what we eat; and it comes from that,
that all these things are made up, and afterwards being unbur-
dened of these things, it goes back to the heart. It is all called
blood; one arterial, the other venous blood. Dr. Porter gave us
an illustration that has not been controverted at all. Nature clears
off the rubbish, as he says, and goes to work and repairs it.
Then, why not put this together, and let nature do its work? If
she could not operate to carry this blood with the arteries, as this
was intended to do, how does it get its sustenance. They showed
you here a beef bone, with these veins, and this is a little branch
that runs off. It is the little artery that runs down the arm here,
as a vein. Here are more. There is a little thin membrane, and
it is ramified by millions of veins that fill up with blood. The
blood goes in and the most of it went up them. He has got it,
not so extensively. Nature always goes to work and does things
right. But they do not say so. Well, now, we would ask, for
we asked them the question: Is not this sufficient to furnish this
bone with nutriment? and they say it will not do it. This sur-
gery is measured by success. A man is a horse doctor, and goes
to work to fix up a horse’s leg, and does it up right; he is success-
ful, and he gets practice. If a boy gets his arm broke, call a
physician; he wants to put these bones together. It does not
make any difference how the work is done. If there was a frac-
ture above that acute small piece of bone broken off, and it went
to work a knitting, why should not the other ? If the cut on the
• 121
head, this compound comminuted complicated fracture had made
any difference, I understand that this cut on the hand and on
the head complicate it. Did not they feel it, that is the common
sense of the thing? They went to work and done the thing up
all right. It healed. Is it not reasonable? It proved that the health
and constitution of that boy is all right. If it is not, why do we
not find some difficulty with the head and hand. It went to work
and in ordinary time, all healed up. Oh but, say, the nature
was attending to that. She had to let something else go. So
they are putting nature to fault again. I claim that, if this thing
was going on here, and nature, as they undersand it, had to
expend a great deal of her help to this wound and hand, they
ought to make more blood. They ought to have given him some-
thing more to eat which makes blood. With the aconite in their
hands, that wonderful remedy, could not they have done any-
thing? Has inflammation anything to do with it? With such
a thing as aconite, having two times the success with it as other
doctors had with their lancet and other means. They wouldn’t
let him eat a bit of food. It was to reduce the circulation, there-
fore they kept him from food. Why do that, with that wonder-
ful agent, aconite * That would do it up so nice, and supersedes the
the lancet and everything else. The most wonderful thing ever
heard of. They had to adopt this old way of practice for inflam-
mation. Was there a necessity of starving him down 2 I should
think, according to the testimony of those two physicians, that
Dr. Pratt should be held to a more strict accountabilitiy, because
he had this wonderful agent, aconite, and by putting a half tea-
spoonful into the Mississippi, and taking out two, they put it
down to the thousandth part of nothing, and by giving two tea-
spoonfuls, they go to work and make it all right. If this aconite
would perform such wonderful cures, they would have had no
difficulty with this inflammation. That could not have been the
cause of it. Why do they say this complication had anything to
do with it? This one piece of bone seemed to have cut off, and
shut off this nutritient foramen. When they admit the fact that
blood makes the bone, why was it necessary to put him upon this
diet 2 They would not give him food, although he cried for it.
With their wonderful aconite in their hands to prevent this inflam-
mation, yet they would not give him any food. Because they
said this application would not do the work, under these circum-
stances it would not heal at all. And nature commenced her
8
122 s
work and went on with it. I do not think there is a Dr. here who
spoke of a case of this kind. All of them agree that if they ever
had a case of that kind, they have proved successful. They say,
if there was anything to hinder it, or to retard it, it would stop
its growth. There is nothing of the kind here. Now, what was
the testimony here, as to the manner in which this arm was done
up 2 This boy’s arm was broken; Dr. Wales says the arm was
fixed up first. I think you will come to the conclusion that the
hand should have been fixed up first, I know enough for that
myself—for the reason that they all agree that it is necessary to
wrap the whole hand here, and to keep it quiet. You know that
we must keep the hand and the muscles here all quiet, in order to
keep the bone in place. The common sense of this thing is, if
this arm had not been kept quiet, that it was not properly treated,
The wrapping of this around did not keep the belly of the mus-
cles quiet. Their own physicians claim that this ought to have
been done, and it accounts for this being out of place. For the proof
is, that it was not fixed right in the first place, it was just as hard
to keep that bone in place as it was to keep this one on the thumb
in place. If these wounds healed up, then nature was not in fault,
and it went to work and did everything right. Now, when that boy’s
arm was done up, there was, at that time, these splints, or similar
ones put upon it. Mrs. Frisby says these splints were taken off
there at the same time they fixed them on Monday. After that
time these were the articles upon that hand. Now these Drs.
here, Miller, Porter, Freas and the gentlemen from Freeport say
they do not think that they were sufficient. They say the bones
is broken off here; they want something here to hold them.
As we understood them, the muscles working here extend to the
fore-arm, and would cause motion. When you draw up your arm
the muscles here contract. When I raise the weight of fifty
pounds there is just so much strain on the arm, and these two
ends must be properly confined; they must be kept quiet. The
testimony is that he went there and examined it in about two
weeks, and went to feeling it, and fussing around it; that he never
discovered anything out of place, but he told them the arm was
doing well all the time, till the 3d of February, when Dr. Pratt
took off the bandage and it was not united. It was after this
that this boy knocked it against the fence, about the 20th Febru-
ary. It was after the time that the old man was there, and Dr.
Pratt said the arm was not united, and went to work and put it
* 123
together. Now, then, if that was the fact, and this thing took
place afterwards, it did not put it out of place. He did not say
there was any signs of refracture. If there was, he ought to have
set it over. Dr. Miller had such a case, and he set it over again,
and it came out all right. It was knitted on the 20th February.
This pulling on the 3d of February would have put it out of
place, if it had been knit. If on the 3d of February it was in
place, why did he go to work and pull it, can you tell that ? It
was not at that time in its place. He said it was loosened a little.
There had been no union at that time. Now, that was after the
time it should have united; was it not ? What does this thing of
his having knocked it against the fence have to do with it?
Now, the Drs. all agree upon this, that if it had been united at
this time it would put it out of place. Why was it that he went
to work and pulled ? Here common sense would teach us that if
a fracture of this kind had been rebroken about that time, it would
have hurt him ; the boy did not complain. That little boy that
was with him, and tells the truth about it, says he was out some
time after that playing ball. After he hit his arm against the
fence, he went into the house and went up stairs; there was no
complaint of its hurting him. Now do you suppose that, if that
bone had been broken up and torn loose, that that boy would
not have made some complaint about it?
The Drs. say it would have produced pain, more or less.
The boy said it did not hurt him. Now, these people had every
confidence in Dr. Pratt, and did what he told them to. Do you
suppose they would not have had it done up, if it was broken
again? They are no such fools, not to do so. These circum-
stances show it was not broken, and Dr. Pratt examined it. They
did not keep anything from Dr. Pratt. This splint was broken a
little. He went to kick a ball, and caught it slightly against the
corner of the fence and broke it a little; it could have been dis-
placed a little, and nothing wrong about it. They take him to
Dr. Belding's to see Dr. Freas. Dr. Belding said he had noth-
ing to do with surgery, had quit practice, said he did not examine.
it, or in other words, he had nothing to do in the matter. He Said,
Drive a couple of shingle nails in it. Dr. Freas says there was
nothing said then by Dr. Pratt about there having been a refrac-
ture. There was non-union. I suppose, the judge will insist, as
long as there was anything left to try, that surgical science
had discovered, they might go to work and pursue it. Nature
124
does the work In this way, it forms gristle around it, and they
could not get this off, and he has got to have his arm cut up
which is a dangerous operation. The bones have got to be
pulled out and sawed off and fixed together. They have got to
rivet it; and if that won’t do, they have got to go to work and
stick down an awl, and do all this before he can say he has
done his duty. If I take my watch to a man, I do not know
anything about watches, he has got to go to work and fix it; if
he does not fix it rightly, he has got to pay me for it. He assumes
to do what I cannot. Therefore, he is held responsible to do it
well. Now, this boy has got to have his arm cut open ; he has got
to have these gentlemen from Chicago cutting and slashing. I
would not have these gentlemen of Chicago cutting and slashing
my bones in this way, before I could get a chance to recover dam-
ages. And whether a man should have to give up his boy into
the Dr.’s hands until this could all be done before he can get
damages, is what I don’t believe. The law does not claim that
he should do it. The law would be against the common sense
of the thing. The boy goes down there and submits to the
arm operation, which they do not call hazardous. The rub-
bing of the bones is not called a hazardous operation. We
admit, we must have the jury decide these damages. The
Drs. were at him rubbing these bones some two weeks
before he went to have these bones rubbed together at Dr. Beld-
ing's, about the last of April or first of May, and the examination
of that arm took place. Dr. Freas came to the conclusion that
there had been no union. TXr. Pratt did not claim that there had
been any refracture; he said the bones was rubbed together. He
said there was some of this gristle matter around the ends of the
bone. It is told here by all, that if you break a bone, it must be
put together or nature can’t do anything. After a while, nature
says, it is no use for me to go any further, and I will coat them
over so that they cannot hurt the rest of the body. She goes to
work and throws this gristle around it, so that these bones can
play and not hurt the integuments. If nature did otherwise than
that, thi grating would be heard all the time. It does not when
it is coated over. But it goes to work and knits it together in
some way. We claim to say, that it does it because the blood
sets the lime in it to work,+I forget what they call it, to make
a bone. We can speculate just how she does it as well as they
can. We do know that this was at that time the situation; so
125
says Dr. Freas. He examined at that time, for nothing else. Dr.
Pratt said, at that time there was another fracture there. What
were the evidences that it had been refractured? Provisional callus
—it is certain that provisional callus should have been seen there
then. They ask the Dr. if there had been a callus where the
bone had been broken—that is, the band thrown round there, they
call provisional callus. We can detect it a long time afterwards.
After a while it is taken away. My friend, the Chicago Dr., says
he could see no evidences of provisional callus. He says it was
too long, a year and half ago, to be now discovered. It was not
too long on the tenth of May. There was no evidences at that
time that this provisional callus had ever been thrown out.
It was not there so it could be detected. Then we say that it
was not a comminuted fracture—there was no other bone broken.
Now, then, we are answered by the Dr. from' Lanark—[the Dr.
will pardon me for not using any other term]—but saying he would
not have known there was a comminuted fracture, if there was
any—that is my honest conviction. From the evidence here of
Mrs. Frisby, the boy’s mother, that all Dr. Wales did was to hold
the chloroform. When he came there he did not make any exami-
nation. That is reasonable. Now, Dr. Wales was a partner and
student of Dr. Pratt. Dr. Wales had lived with him in his family.
He had no experience at this time in matters of bones at all; had
only two cases of fracture of bones, but none of these long bones.
That was all he knew about the business. Said Dr. Pratt did all
this business. What did Dr. Pratt want of Dr. Wales 2 In this
testimony we find he only went with him. And he comes, and
then and there listens to all this testimony, and makes a coapta-
tion of this whole thing. If he wanted him for anything, why did
he not ask him down to Dr. Belding's. He had no confidence in
Wales for he was a student. He swears there was another
piece of bone which was broken. Now, the fact is, there was no
evidence of that on the 10th of May; none say there were any
traces of it afterwards. Well, it is true Dr. Beebe said right here,
that I pinched his arm a little and he flinched, and that that was
evidence of this callus, and this is the only evidence there is of
this fact. He saw all the time what was going on here, and has
has fixed it to suit Dr. Wales’ statements. I don’t know but Mr.
Turner will present this case in a different way. We asked Mr.
Beebe if he did not tell Mr. Orcut that when he came on to the
stand he would make it all right. Mr. Orcut said afterwards that
126
it was not Dr. Beebe, but Dr. Ludlam, who said he would make it
all right. I forgot to call Mr. Orcut. You saw the interest that
those men felt, and how they gave their testimony as to their
knowledge, and you may take it from the manner in which they
went at it. I have not had the idea all along that the jury would
take into consideration these free lectures. They got it all from
books. They have nothing of their own at all about it. They
disagree; and what can you make of it when Drs. disagree?
And I say Dr. Porter gave his illustration about it and it was
right, and these gentlemen’s object seems to be to knock over Dr.
Porter’s testimony. But when they come down to a cross-exam-
ination, the bony matter which comes from the circulation was
not sufficient to carry on this repair, that it did in reference to the
hand and everything went on well and right. Now, you must
come to the conclusion that it all comes from the blood after all.
It was in a healthy condition; it healed over. If it was ºroken
at all, it must have been broken on the 3rd Feb’y. If it was set
then, there was not time for it to have been united. Now, this
angular splint was not put upon that arm at all; it was bandaged
from the elbow up. These short splints were put upon it and these
were not sufficient by the testimony of all the Drs. Dr. Wales
says, this splint was sent for at Dr. Pratt's, and was put on for
the purpose of taking the boy home. The mother knows and
understands the ways of the boy, and it is likely that she should
know and recollect all these things. She set up and watched
with him for weeks, and everything was done the Dr. said should
be done, and that splint was not put on there for three weeks
after the fracture. By that time it would have commenced uniting.
In four weeks it would have been in a very good condition ; in
six weeks the splints could have been taken off. Before this time
the old man helped pull it into position. This makes it about the
20th of Feb’y that they said he was there, and it would do to
take off the splints. Now then, there was nothing of any com-
plaint heard from it at all until Dr. Pratt went there and under-
took to fix it—few days before that, Dr. goes to work and puts on
that splint, it is true, and they cannot get around it. Then it can
be settled that nature was attending to those other wounds—the
hand and head—herself. The head had healed up and there was
no difficulty about the circulation. -
There was at this time of the rubbing of the bones no inclina-
tion in the bones on the 10th May, 1863, to unite did not produce
127
any inflammation; but my learned friend, Dr. L., says they did
not want inflammation. Dr. Porter says there must be inflamma-
tion; the object of this is to carry the blood to the point of frac-
ture. If there is too much inflammation it would result in morti-
fication. What was the object of putting down this awl? To pro-
duce inflammation ? What was the object 2 We want a sort o
disease to set together the bones. If you cure another disease
you must get up another just like it. If that is the object, Dr.
Porter is right. If there is too much inflammation, give aconite
or use the lancet; go to work and complete the thing. Give
moderate food, and in ordinary cases this makes no difference.
There must be a certain amount of inflammation. It must be the
injection of blood into that part. They give aconite to create a
gradual flow of blood. What is the difference? The inflamma-
tion is the same. If you get up a certain amount of circulation
there is blood goes there—that is the object of pegging, to get up
inflammation. It is a distinction without a difference. The object
in cutting down is, to excite the parts to produce inflammation.
There is some blood goes there, and the part is disturbed, and
nature puts her forces to work in this way. Well now, gentle-
men, these are the main points in this case, as I told you in the
opening. I am to be followed by Mr. De Wolf. He will shield
me a little, and make the blow come easy. Chicago has come
out here to crush us, and I want it to come easy. I sup-
pose the judge will give me the big maul as I have been furnish-
ing him a text. It is throwing all this thing of science away, and
they do not know anything more about it than you or I. It is
evident that there has been an arm broken and the boy has been
wronged. We know if this arm was set right, all would be right.
Now, in reference to the thumb, as far as I can see, I believe the
thumb is a bad job, and I must say it is curious, and it is carrying
out the coaptation system that Dr. Beebe thought it was an admir-
able job. All done up right. It did not look as though the hand had
been torn out. Beebe thought a hook might have caught in there
and cut it. That thumb was out of joint, and there was a frac-
ture, and it might have been fixed then as well as any time. It
was fixed all right at the second dressing. When they took off
the bandages it would fly out. It is all speculation. He said
it was a horrible state of affairs. Dr. Pratt said after it was fixed
he was ashamed of it. He knew he ought to have done that
thing better. The difficulty was, he knew he ought to have put
128
it up right. He wanted to crucify this boy by cutting it up and
cutting it down, because he did not fix it right the first time.
They do not say he could not do it. He said it was not right,
and might be fixed right yet. In the start he told you that it was
admirable. He says now he should be proud of such a job. When
the man himself said he was ashamed of it, look at the absurdity
of it. Well, gentlemen, I believe I have said all that strikes me is
necessary. All in the opening that is proper for me to say. If I was
closing the case I would examine it more thoroughly. It is prob-
able that the other two gentlemen will do it. But the conclu-
sion I have come to is to say whatever struck me. I have been
much interested in this case; these things have made deep impres-
sions on my mind. In the short speech I have made to you I
have given my views of the testimony, which will bear me out
without going into it in this particular way. And now I must sit
down and wait quietly until the sledge hammer comes, which will
use up everything I have said, because they have all the wisdom
concentrated in Chicago—they have not asked anybody but the
profession, as they knew all about it. They have brought my
learned friend the judge here, and I must sit still until he hits me.
Remember the poor boy and decide his case instead of mine.
\
ARGUMENT OF L. E. DEWOLF, For DEFEND ANT,
MAY IT PLEASE THE COURT-Gentlemen of the Jury: I do not
know but I shall interrupt, too suddenly, the pleasing vein of
humor with which my friend, Miller, was exercising his unusually
good powers for your entertainment this morning. *
I had supposed you were sworn to try the issue between the
parties according to the law and the evidence. Mr. Miller thinks
otherwise. If he is right, I am clearly wrong. -
The defendant, in view of the scientific aspects of the case, has
obtained the testimony of two medical gentlemen of the city of
Chicago, of well established reputation, and of minute ability in
their respective department of science.
In Mr. Miller's eye, this was a most grievous offence, and he now
asks you to turn away from these important questions of right, to
vindicate the very equivocal position of certain medical gentle-
men, merely because they reside in the country; but I appre-
hend, gentlemen, you occupy your places for no such purpose, and
that you will do no such vile act. - . -
129
The counsel says he has known you for many years and paid
you the compliment, to say he knew you to be plain, common sense,
honest men.
But the attempt to make this a mere question of country phy-
sicians against city physicians, and the call upon you to vindicate
the former, because they reside among you is a very equivocal
compliment, both to your judgment and to your sense of justice.
I should be very unwilling to believe that you will permit your-
selves to be actuated by any such motive. The defendant, in his
defence, relies upon facts clearly proven, and the law fairly
applied. He has not and will not raise any other issue. There
ought not to be any other on the part of the plaintiff. There is
no other issue which you can properly try. - . -
The facts which we have proven, not only exonorate the defend-
ant from all blame, but they also show that he exercised more
than ordinary skill, and the most unremitting care in the treatment
of this difficult case. These facts ought, and will, we trust, exer-
cise a controlling influence in your decision.
But Mr. Miller claims that this important testimony should be
discarded, because the witnesses were from Chicago, and because
scientific knowledge is the mere will 'o wisp of a fanciful brain, of
all things real, the most unreal. - -
Thus, in his estimation, ignorance is the height of bliss.
But gentlemen, let me say to you, that Messrs. Beebe and Lud-
lam are scientific men; the testimony they have given is founded
on no visionary theories, but well established, scientific truth, and
belongs to that department of knowledge which may be denom-
inated actual knowledge. - -
If, then, you have any impression that this testimony is of the
character represented by Mr. Miller, it is certainly a great error,
and I trust we shall be able to show you, before we get through,
that these opinions are based upon grounds which are admitted
to be correct by scientific men of all the different schools of med-
icine. If there are any visionary or false theories, or any empir-
icism here, you will find it all on the other side. .
I do not blame the gentleman for his antipathy against scien-
tific knowledge. He has, undoubtedly, good reasons for it; but
that is a matter relating personally to himself. He need not have
published it here. It could all be gathered from the tenor of his
argument. .
180
Yet, when he undertakes to make you believe that, at this day,
scientific knowledge is all a delusion, he is imposing on you a
most extraordinary delusion, indeed. I do not intend to enter
into a full discussion of the many questions of a purely scientific
character which have been presented. I shall leave this field
entirely for Judge Knowlton, who is better prepared and better
qualified to do the subject justice than I claim to be. -
Yet, I will say, Mr. Miller is the last one who should talk of
“visionary theories,” or “being wise above what is written.” I
think his friend, Dr. Porter, and those who followed in his wake,
would make a sorry figure when tried by the practical test which
he proposes. The counsel, in opening, told you that his client,
or those who represented him, had no predilections for, nor pre-
judices against any particular system of medical practice. That
this action was purely to recover damages for injuries actually
sustained. This declaration was significant. What was said did
not convey an idea of what was meant. But broad as was the
allegation, it could not cover up and hide the real cause of this
legal controversy. It was not that a boy had been injured either
by the neglect or want of skill on the part of Dr. Pratt. He had
exerted all his energies and more than ordinary skill to save him
from the effects of his own indiscretion and folly; but his impru-
dence and restlessness added to the severe character of the injur-
ies, delayed the recovery. Broken limbs, at any time, are not
desirable. The boy was uneasy under his long restraint, and the
parents, from the same causes, became dissatisfied. They fell into
Dr. Porter’s hands. Now the doctor hates Homoeopathy, and
here was a rare chance.
. By his manipulation the mole hill became a mountain; every
variance, real or supposed, between the two systems was unduly
magnified. All of the boy’s misfortunes, in short originated out
of a failure to observe the wise axioms of Allopathy. The ani-
mus of this whole case is the deadly hate of Allopathy against
Homoeopathy. Dr. Porter told you that he was educated in the
Medical University of the city of Baltimore—that he enjoyed an
eactensive and lucrative practice. Having exhibited to you his
rare opportunities for acquiring medical knowledge. He com-
menced his testimony by a dissertation on the uses of the arm,
and he dangled the arm of the plaintiff before you, not in a man-
ner calculated to manifest his surgical skill, but as a means of
exciting sympathy. Every important question which he has asked
131
is made the occasion of a stump speech ; and no opportunity is
lost in making a malignant fling at Homoeopathy. He told you
this is a false joint. He then, descanted upon the causes which
would be likely to produce such a result. In these opinions he
was followed by every medical witness on that side. This was
the programme, and the family of the plaintiff are gifted with a
wonderful recollection of such facts, as will be likely to tally
with these medical opinions. The boy wants a generous diet,
said the doctors. He was half starved, the family replied. The
arm wants rest; tight bandaging and long splints are necessary,
said the doctors. Short splints and insufficient bandaging are on
hand. The bandaging only reached to the elbow, and the splints
are not half the length required. The two long splints escaped
alike their hands and their memories. They have not brought
the long splints here; no one recollects them, and the angular
splint, which they attempted to withhold, and which we have
brought here, has a very uncertain history in their minds. The
time it was put on is a question of argument. Had we not
secured it and brought it here, there would probably have been
no question on their side that it was not put on, and the splint
ftself would have been a myth. The doctors for the plaintiff all
said that to treat the arm five months and ten days without know-
ing whether it was united or not, manifested gross inattention, or
ignorance on the part of the surgeon. The family at once remem-
ber, unanimously, that Dr. Pratt never told them it was not united,
nor did he tell them it had been refractured. They merely saw
the bone bend every time the injury was dressed, and Dr. Pratt,
after the boy hit the arm against the fence, only told them that
the arm was loosened. They did not know bones would not
bend, nor that loosening them was not union. All these impor-
tant revelations was left for Dr. Freas to make, at Milledgeville.
But, gentlemen, I tell you that these bones never bent for five
months and ten days. If they did this family knew the fracture
had not become united. Nor did that boy plunge against the
fence post with force sufficient to break loose the brace fastened
together with two screws and glued, and split the splint, as you
have seen, without both parents and child being aware that the
arm was refractured thereby. How came this family to bring
these short splints here, and not the long ones? How came them
to remember that the arm bent every time it was dressed, and not
know the bone was not united 2 How came them to remember
132
what Dr. Pratt said about diet, or about the loosening of the
bone? If they remembered all these things so accurately, why
did not they remember how this arm was situated on the night it
was dressed ? Why not remember the conversation at Dr. Pratt's
in the presence of Mr. Hodgeson 2 Dr. Pratt and wife, Dr.
Belding and wife was present, and heard the parents admit the
refracture and describe the manner it was done. Mr. Morris, too,
had a conversation with the boy, and he told him about the
refracture. There was no concealment or denial about this ques-
tion previous to this trial. There is no probability that the boy
was injured by the spare diet; it only lasted ten days, while
inflammation lasted; and the father tells you that after that he
was fed on farmer's diet, pork and potatoes. -
How, then, came all this strange testimony to be given on the
part of the family P All of it is to be accounted for, not upon the
original facts, there is no base here for it to rest upon; but it is the
medical opinions which required it. In short it is the medi-
cal opinions which was made the facts, and not the facts the Medi-
cal opinions and these will explain it. Dr. Porter told you that
the repair of bone is effected by “the deposit of ossific matter,”
which is contained in the blood, and which, by means of the arteries,
is deposited as the various tissues require; that a generous diet is
needed to supply ossific matter; that animal food contains this in
much larger quantities than vegetable food; that tight bandaging
would check the free flow of the blood, and thus the deposit of
ossific matter. Here, then, is a solution of the family testimony
respecting diet, and so of all the important statements made by
them, wherein they differed materially from the many creditable
witnesses examined on the part of the defendant. Dr. Porter has
gorged this family with his medical opinions as he would have
gorged his patient with roast beef, and with a like deleterious
effect. - -
But how stands this ossific depository theory as a matter of
science 2 Has it any better foundation in science than the flimsy
facts relied on for its support 2 - -
Drs. Beebe and Ludlam tell you that there is no ossific deposit;
that the blood contains no such material; that the bone itself and
all the tissues of the human body are but an aggregation of differ-
ent kinds of cells; that, in case of fracture, these little cells, called
bone cells, are thrown out from the end of the bone, and deposited
in a plastic substance, which is gathered around the seat of frac-
133
ture, and which answers as a platform or scaffolding in or upon
which to repair the injury. They further tell you, this is no mere
theory, but well established scientific truth, acknowledged and
taught by every physiologist of note, and not disputed by any.
Here, then, is a world-wide difference between them and Dr.
Porter. Mr. Miller tells you this is all guess work—that any one
can guess as well as Messrs. Beebe and Ludlam, and that, for one,
he is determined to exercise that right, and he calls upon you to
do the same. Now, the practical question is, who is right, and
who is wrong? And I propose to examine these opinions and to
compare them with the doctrines laid down by standard authors,
and see how they agree therewith. I hold in my hand Miller's
Physiology and Anatomy. It is a standard work, and so recog-
nized by the different medical schools. You see these plates;
they are to illustrate cells. Dr. Ludlam made a rude sketch or
chart, to illustrate his views upon that subject; and these cells,
you see, are similar. I will read you a description from this author
—page 47: title, Development of bone: “To explain the develop-
ment of bone it is necessary to inform the student, that all organ-
ized bodies, whether belonging to the vegetable or the animal
kingdom, are developed primordially from minute vesicles. These
vesicles, or, as they are commonly termed, cells, are composed of
a thin membrane containing a fluid or granular matter, and a
small rounded mass, the nucleus, around which the cell was origin-
ally formed. Moreover, the nucleus generally contains one or
more small granules, the nucleolus or nucleoli. From cells having
this structure all the tissues of the body are elaborated; the ovum
itself originally presented this simple form, and the embryo at an
early period is wholly composed of such nucleated cells. In their
relation to each other, cells may be isolated and independent, as
is exemplified in the corpuscles of the blood—chyle and lymph;
secondly—they may cohere by their surfaces and borders, as in
the epiderma and epithileum; thirdly, they may be connected by
an intermediate substance, which is thin, termed intercellular, as
in cartilage and bone; and fourthly, they may unite with each
other in rows, and on the removal, by liquefaction, of the adherent
surfaces be converted into hollow tubuli. In the latter mode
capillary vessels are formed, as also are the tubuli of nerve and
muscular fibre. One of the properties of cells may also be
adverted to in this place; it is that of reproducing similar cells in
their interior. In this case the nucleoli become the nuclei of the
134
secondary cells, and as the latter increase in size, the membrane
of the primary parent cell is lost.
“Bone, in its earliest step, is composed of an assemblage of these
minute cells, which are soft and transparent, and are disposed
within the embryo in the site of the future skeleton. From the
resemblance which the soft tissues bear to jelly, this has been
termed the gelatinous stage of osteo-genesis. As development
advances, the cells, heretofore loosely collected together, become
separated by the interposition of a transparent intercellular sub-
stance, which is at first fluid, but gradually becomes hard and
condensed. The cartilaginous stage of osteo-genesis is now
established, and cartilage is shown to exist, of a transparent matrix,
having minute cells disseminated at pretty equal distance, and
without order, through its structure. Coincident with the forma-
tion of cartilage is the development of vascular canals in its sub-
stance, the canals being formed by the formation of the cells in
rows, and the subsequent liquefaction of the adhering surfaces.
The change which next ensues is the concentration of the vascu-
lar canals toward some one point, for example, the centre of the
shaft of a long, or the mid-point of a flat bone, and here the punc-
tum ossificationis, or centre of ossification, is established. What
determines the vascular concentration now alluded to, is a ques-
tion not easily solved, but that it takes place is certain, and the
vascular punctum is the most easily demonstrable of all the
phenomena of ossification.
“During the formation of the punctum ossificationis, changes
begin to be apparent in the cartilage cells. Originally, they are
simply nucleated cells (zºo to gº of an inch in diameter), having
a rounded form. As growth proceeds, they become elongated in
their figure, and it is then perceived that each cell contains two,
and often three nucleoli, around which smaller cells are in pro-
gress of formation. If we examine them nearer to the punctum
ossificationis, we find that the young or secondary cells have each
attained the size of the parent cell (soºn of an inch), the membrane
of the parent cell has disappeared, and the young cells are separated
io a short distance by freshly effused intercellular substance.
Nearer still to the punctum ossificationis a more remarkable
change has ensued, the energy of cellule reproduction has aug-
mented with proximity to the ossifying point, and each cell, in
place of producing two, gives birth to four, five or six young
cells which rapidly destroy the parent membrane and attain a
135
greater size (rºyo of an inch) than the parent cell. Each cell
being, as in the previous case, separated to a slight extent from
its neighbor by intercellular substance. By one other repetition
of the same process, each cell producing four, five or six young
cells, a cluster is formed, containing from thirty to fifty cells.
These clusters lie in immediate relation with the punctum ossifi-
cationis; they are oval in figure (about goºd in length, by goºd in
breadth), and placed in the direction of the longitudinal axis of
the bone. The cells composing the cluster lie transversely with
regard to its axis. In the first instance they are closely com-
pressed, but by degrees are parted by a thin layer of intercellular
substance, and each cluster is separated from neighboring clus-
ters by a border layer [gºro of an inch] of intercellular substance.
Such are the changes which occur in cartilage preparatory to the
formation of bone.”
From what I have read it will readily be perceived, that the form-
ation of bone, as here described, agrees with the testimony
given by Messrs. Beebe and Ludlam. This author says that
these contain, within their inner surfaces, smaller cells, which are
pushed out from the parent cell. They spoke of it as a creation,
or more properly, a pro-creation, and said this prolific principle is
contained in the cell itself—that its production and growth was
similar to that of the wheat, corn, and other vegetables. There
is no conflict there between the testimony of the defendant’s wit-
nesses and the works of standard authors, they agree precisely.
If bone is formed in this manner, it would be reasonable to con-
clude, without other evidence, that it would be likely to be repaired
in a manner somewhat analogous—otherwise there would be a
gross defect in dame nature’s perfect, handiwork. You will
perceive, too, that the standard authors, those authors who fur-
nish the milk which, Mr. Miller says, supports the plaintiff’s wit-
nesses, as well as ours, pretend to know at least, what is going on
under the surface and within the precincts of that gorgeous tem-
ple, the human body. If Mr. Miller was better acquainted with
science and with scientific men, he would be guilty of making no
such argument as he made here to-day. It is not our witnesses
who are “wise above what is written.” But how stand theirs
when tried by this test ? What becomes of Dr. Porter’s ossific
depositing theory What of his anastomosing theory P. Where
is the author that the gentleman have or will read, who will sus-
tain Dr. Porter in these theories? You will bear in mind that
136
he said the bone is wisely provided by nature with a thin sub-
stance, called the periosteum—that this ossific deposit is effected
by the blood through the periosteum, by means of inflammation—
that without inflammation there is no such thing as repair of
bone. He further said that bone contained some fifty per cent.
of phosphate of line, and the blood a similar quantity. But Drs.
Beebe and Ludlam told you that there is no such ossific deposit,
and that the blood only contains about one per cent. of an insolu-
ble salt—that it does not contain phosphate of lime. Dr. Lud-
lam said that the bone cells do not receive their earthy matter as
though they were dumped into them. That the blood was not to
be regarded as a peddler distributing his wares—and that the
order of nature was an orderly development. That bone is made
of blood constituents, but the blood alone cannot create bone.
The cell is the agent in the manufacture of bone, as it is of any
other tissue, animal and vegetable. The elements of the tissues,
as of the various secretions, pre-exist in the blood and yet neither
the tissues nor the secretons are to be found in that fluid, that the
Soliver does not exist in the blood. Yet no one will doubt that all of
its elements are derived by a particular set of glands from the
blood. A condition of the secretion or manufacture of sugar by
the liver, is an active flow of the blood to that organ. The ele-
ments of this liver-sugar are found in the blood of the portal
vein before it reaches the liver, but the sugar itself is manufac-
tured by these cells, of which that largest of all the glands is
really an aggregation. The elements of a bone may be found in
the blood, but these elements can only be constructed into true
osseous tissue by the direct agency of the bone-cell itself. That a
tub-full of blood could not, of itself, create a man. We must
have the type-cell in bony tissue, just as in the grain of wheat or
corn, the acorn and the full-grown tree. That the blood contains
the elements from which all the tissues are formed. The plant
finds its blood in the soil. The rootlets of the man are the lac-
teals in his intestinal tract. In both cases the nutritious elements
are held in solution in water, while the solids are developed from
them by, and in conformity with a specific type force. Now,
after what I have read from Wilson's Physiology and Anatomy,
I need not attempt to convince you, gentlemen, that this testi-
mony explains fully the true process of forming, and the repair of
bone; and that it is much more reliable, as a matter of science,
than Dr. Porter’s ossific depositing and amostomosing theories.
137
Only think, for a moment, of the blood carrying fifty per cent. of
the phosphate of lime. It would soon cease to flow, and the
man would become, not a statue of salt, but of solid bone. As
to inflammation being necessary to the repair of bone, both Drs.
Beebe and Ludlam agreed it was not necessary. Dr. Ludlam said
inflammation is not necessary to produce union in a fractured
bone. The repair of bone is a healthy physiological process.
Inflammation is a diseased condition—the effect of injury. Pus
is not found save as a result of inflammation.
Here, too, I need not refer to authors to show which of these
witnesses are correct. The testimony I have referred to carries
with itself, an evidence of its correctness, too plain to need any
other support. We all know that inflammation is the result of
injury. Pound your finger, and inflammation is the result; yet
who supposes that inflammation is the necessary condition to
repair the injury P Dr. Porter is the first one sworn who has made
that discovery. The other side will bring no scientific writer o
modern date for his support.
From these premises then, I infer: First. That the testimony
of the plaintiff’s family cannot be relied upon, on account of its
inconsistency with itself; and besides, it is contradicted by too
many credible witnesses for it to be true. g
Second. There is that kind of harmony between this testi-
mony and the medical opinions which have been promulgated
here, which shows that the memory of this family has been too
much stimulated or excited by these medical opinions to be relied
upon ; and, \
Thirdly. That the plaintiff has a very questionable state of
facts, and a still more questionable state of medical opinions. If
the facts are questionable, the medical opinions are worse. I ask
you, gentlemen, what reliance can be placed upon the opinions of
men who will make a false joint where there is none, and who
testify that there is a dislocation of one joint and a partial one of
another, when the former has no existence and the latter does
not and cannot exist, on account of the peculiar formation of the
joint. Messrs. Beebe and Ludlam showed you what constituted a
false joint, and you saw there was no such joint here. The frag-
ments of bone were loose; there was no ligamentous substance
fastening them together, as with a hinge.
I ask you, too, to scan well that testimony which would supply
the loss of the nutrient artery by amastomosing through the solid
9 X
138
bone. If that artery was destroyed, how could the blood-vessels,
through the bone, be enlarged to supply its place. You have
competent testimony that it could not be done. The loss of this
artery, as the cases in the books show, reduces the chances of a
union of bone nearly one third. Yet Dr. Porter and all the wit-
nesses on that side did not know that THAT would make any
difference.
I say, then, such testimony is a very unsafe guide by which to
judge of human rights in a court of justice. These matters of
opinion, to have any force as testimony, should be grounded in
an accurate knowledge of science. The witnesses to be entitled
to pronounce an opinion, should have such a knowledge of the
subject, and of science, to enable them not to pronounce an injury
of one character when it is of another and entirely different,
especially when such opinions are made upon an actual examina-
tion of the case itself. If, then, these witnesses have made such
gross blunders upon matters which they have seen, and examined
for themselves, what blunders may not be expected in their opin-
ions, based upon the uncertain testimony of non-professional
witnesses, and upon a state of facts occurring months before. If
these witnesses do not know a false joint or the dislocation of a
joint, how can it be expected that they can give testimony which
is to be relied upon, as to the effect of treatment of injuries in a
given case, which they have not seen; and especially when the
opinion thus given does not agree with standard authors upon
that subject. -
I tell you, gentlemen, plainly, such opinions are not to be relied
upon in determining rights of the importance of these involved
in this case, and I caution you how you receive such testimony,
and not to place too much reliance upon it. It is not entitled to
credit. For it is not sustained by facts, nor by good surgical
authority, and is at variance with the just dictates of reason and
COIn InCI). Sen Se.
But having exposed some of the deep malignity and gross
ignorance of this medical testimony, I want you to divest your
minds, as much as possible, of the extraneous matter thrown around
the case by the ingenuity of the counsel, and go back and see
how it stood on that memorable night, the 20th of Dec., 1862.
The boy was riding upon a load of corn. Mr. Brown says he
and the brother were running horses. The brother testifies that
the horses ran until they struck a gully, when the end board was
139
burst out and this boy thrown astride of the wagon tongue.
His right hand was lacerated, head bruised, and his arm was
broken. Mr. Miller says it makes no difference how this was
done. But I think it does. The mode and manner and charac-
ter of the injury has everything to do with a proper decision of
the case. Dr. Wales, who was present at the time, says that, in
moving the arm to ascertain the character of the injury, the bone
protruded through the flesh, that the bone was fractured, or
crushed into three pieces—the thumb of the right hand was frac-
tured in the lower or metacarpal bone, the first and second joint
of the thumb dislocated, and the head badly bruised and lacer-
ated. Now, place yourselves in the position which Dr. Pratt occu-
pied on that eventful night, and, under the testimony, tell me how
you or any one else could have done better. The plaintiff’s
family did not observe much, either as to the character of the
injury or its treatment. But Dr. Wales, who was present, has
given a full and accurate account of it. He testifies that Dr.
Pratt reduced the fracture of the thumb and arm, and dressed
the wounds, while he assisted. A word in passing, as to the
intelligent manner in which Dr. Wales testifies. He may not have
answered the scientific questions proposed as fully as older men,
but his answers were correct.
He says, Dr. Pratt reduced the fracture and applied a roller to
the arm, between two and three inches in width, commencing at the
wrist and overlapping it about one half at each roll. This was
extended to the shoulder; the splints were then applied to the
arm—two long ones and three shorter ones,—that these long
splints extended from the shoulder to the elbow, one upon the
upper and back portion ; the other on the under and for eside of
the arm, opposite. That the small splints were placed between
and the roller was then wound from the shoulder to the wrist and
back again, enveloping the splints with the bandages twice. The
arm was then placed in a sling. Dr. Burbank testifies that when
he examined the arm, some six or eight days after, he found the
bandaging applied from the wrist to the shoulder; that he saw
these long splints extending from the shoulder to the elbow; and
David and John Morris both testify to these long splints. David
Morris states he made these splints, at Dr. Pratt's request. Dr.
Belding, who saw this arm four or five months afterwards, found
bandaging of a similar character upon it, and these long splints.
Dr. Freas is very indefinite in his recollection about the splints,
140
but mentions there was two or three bandages on the arm. Mr.
Frisby did not pay much attention to this matter, and does not
recollect anything about it. I claim, then, that there was put on
to this arm, on the night of the 20th Dec., '62, five splints, two
long ones and three short ones; that two of these extended
from the shoulder to the elbow; that the bandage or roller was
applied from the wrist to the shoulder once, and then twice over
the splints in the manner I have before described. Now, gentle-
men, where is the testimony by which this position can be suc-
cessfully controverted? and where is the medical witness who
has given his opinion upon this state of facts, that these band-
ages and splints were not amply sufficient. If there has been
any such testimony, I have not heard it. I ask you, looking at the
object to be attained by this process. Wherein could Dr. Pratt have
done better? Taking the authors which have been referred to
here, and the medical testimony upon this subject, as your guide.
I ask you if he did not do all that could be reasonably asked of
him 3
But here comes up the question of the angular splint, or brace,
as it has been called. Dr. Wales testifies that on Monday or
Tuesday he was at Mr. Frisby's, and saw this splint on the arm,
that Dr. Pratt, in presence of the boy and family, remarked he
had put it on to move the boy. Mr. Frisby does not remember
when it was put on ; thinks it was the next morning. Cannot
state certainly. But Mrs. Frisby and Mrs. Moscript fix it on the
second week, some ten days after the injury. I am of the opinion
that Dr. Wales is right. He was a young man just commencing
practice, and from that fact he would be likely to observe and
remember the mode in which the work was done. But admitting
he is mistaken, the splinting was sufficient without it. The
putting it on was only a matter of extra caution. Even Dr.
Miller admitted that with this splint the short splints would
have answered, though he said he should have used some longer
One S,
That is precisely what Dr. Pratt did, he put on longer splints.
Taking Dr. Miller, then, as authority, and Dr. Pratt so far was
right. As to this angular splint, admitting it was not put on until
the time Mrs. Frisby and Mrs. Moscript claim it was, still Dr.
Pratt is fully up to the requirements of the medical testimony
upon both sides as to bandages and splints, excepting, perhaps,
Dr. Buckley, the man who pins or dowels bones together—he
141
would bandage from the tip of the fingers. With that single
exception Dr. Pratt is all right upon that question.
Now, I will take up the treatment of the hand. Dr. Wales
tells you that the hand was very badly lacerated—that the meta-
carpal bone was fractured obliquely, extending from near the
second joint of the thumb back almost to the next joint; that one
giece of the bone would drop down, and that the only way it
could be held in place was by means of adhesive straps and by a
splint made of woolen cloth saturated with shellac gum. By
heating or pressing this with a hot flat iron, the splint was pliables
and Dr. Pratt, with Dr. Wales’ assistance, reduced this fracture,
but with much difficulty. From time to time these adhesive
straps would get loose by the discharge of pus. Dr. Pratt watched
it closely, and put on new strips and new splints as often as
required. Dr. Burbank also testifies that he examined the hand
and arm ; found the hand much lacerated, and it was difficult
to keep it in place, but by means of the adhesive straps and the
flexible splint it was kept in place; that he helped Dr. Pratt dress
it on that occasion ; that the fracture was properly reduced and
bandaged. He mentions the fact, too, referred to by Dr. Wales,
that the bone would drop down and it had to be held up by adhe-
sive straps. He said these flexible splints were good splints—the
very best that could have been used for that purpose. Mr. Frisby
told you that Dr. Pratt wanted to reset the thumb and he would
not permit him to do it, and that ne never blamed Dr. Pratt for
the thumb. Yet, after all this, the plaintiff comes in here and
claims damages on the thumb. Mrs. Moscript testifies that the
Dr. blistered the thumb, and all these learned doctors come in
and testify that there is a partial dislocation of the thumb. Dr.
Porter testified that there was a dislocation of one joint, and a
partial dislocation of the other. Yet, when Drs. Beebe and Lud-
lam come to testify, they show that there is no partial or any other
dislocation whatever, that both joints are in proper position, that
there has been a fracture of the bone as testified by Drs. Wales
and Burbank; that the joints are both in place; that the use of
the thumb is somewhat impaired by the severe injury to the integ-
uments which surround it and the resulting cicatrix, but there is
no other deformity. Dr. Beebe tells you he should be proud of
that surgery, and considering the character of the injury, exceed-
ingly gratified that the thumb is no worse. Now, this disposes
of the question respecting the injury to the thumb, and I could
142
not, if I desired, place the subject in a more favorable position
than it is placed by the testimony.
The subject of diet next claims our attention. Mrs. Frisby
stated that Dr. Pratt said the boy might have toast, crackers and
gruel. Mrs. Moscript said she should call it no diet at all. The
father, the mother and Mrs. Moseript claim that the boy was clam-
orous for food. Now, taking their testimony together, this order
of Dr. Pratt’s about food only lasted some ten days. He merely
prescribed his articles of diet, and cautioned them about over-
feeding while the inflammatory stage lasted. If the boy was
starved under this regime, who is to blame but the parents?
Besides this, Dr. Wales told you that the boy had considerable
inflammation; that the parents told Dr. Pratt of the boy having
eaten too much, and brought on some fever, but it had subsided
then, and Dr. Pratt told them they might let him eat any ordinary
food. Why, then, this clamor about food? There is no founda-
tion laid in the facts to show to the mind of any sensible man that
there is even a probability that the boy was injured in the matter
of diet. -
What nonsense it is to suppose that the limiting this boy to
toast, crackers and gruel for ten days might produce a false joint,
as testified to by Dr. Porter. But listen for a moment to the
oracular responses of this learned gentleman. Was it a proper
dietetic treatment to keep this young lad upon a small supply of
toast, crackers and gruel in the absence of inflammation?
Answer: By no means, sir. The dietetic treatment would be
aggravating instead of furnishing the organizing stimuli which
nature requires.
Question: What is that, Dr., which forms bone 2
Answer: Permit me, sir, to state to the jury that the bone is
wisely provided with ossific matter to keep it up. The false joint,
the simple fracture and dietetic answers are about the only direct
answers which Dr. Porter gave, and in neither is he correct.
There is no false joint. It was not a simple fracture, and his
system of dietetics shows he does not digest science well if he does
roast beef. We have seen by the testimony that the injuries
received by this boy were severe. The fractures and dislocations
were properly reduced; the bandaging and splinting was done in
the manner pointed out by the best surgical authority, and the
diet is such as is recommended by good medical authority, and
such as a prudent physician would be very likely to adopt. The
º:
143
next question is, the degree of attention which the defendant paid
to this case. Mr. Frisby seemed to think that the Dr. did not
call as often as he ought, but Mrs. Frisby tells you that Dr. Pratt
was there several times in the absence of Mr. Frisby ; that
accounts for Mr. Frisby's lack of information upon that point.
But Drs. Wales, Burbank, Belding, Freas and Hodgeson's state-
ments of what took place shows that there is no ground for any
complaint on this score, and Mrs. Moscript and Mrs. Frisby also
testify as to the care used in dressing the arm ; that the doctor
held the arm himself and had some one to assist him. He was
present on Sunday, on Tuesday and Thursday following the
injury, and examined the arm. It appears he did not remove the
inside bandages, and that this was proper is shown by the medical
testimony, too much intermeddling being injurious.
A few words here as to the medical treatment. Dr. Walestestifies
that he saw Dr. Pratt prepare some aconite of the third attenuation,
by putting some eight or ten drops in half a tumbler of water,
and ordering two teaspoonfuls every half hour; that he saw him
administer one dose of this. He farther states that some arnica
blows were furnished, and some calendula to prevent suppuration,
and the proper directions given as to their use. Drs. Beebe and
Ludlam, Burbank and Wales, all testify that this was proper
treatment. -
Drs. Ludlam and Beebe, and all others who testified upon this
point, all agree that the giving of aconite was not only the proper
remedy, but the best one to control the circulation and prevent or
subdue inflammation, and that this treatment is to be preferred to
that of the lancet or any other mode yet known. Dr. Beebe, who
has had much experience in the army surgery, tells you that
aconite is the best remedy for this purpose, and that surgery will
never attain its highest perfection until this Homoeopathic treat-
ment is generally resorted to. There is no medical witness on the
other side who has contradicted this testimony. They attempt to
meet this by merely ridiculing the small doses. I shall only say
that if any of you have tried the small doses of aconite in cases
of fever or inflammation, and I believe some of you have, you
very well know its effect, and I am willing to risk that question
with you under the medical testimony, adding thereto your own
experience, if you have used this remedy in such cases. The
next question which I shall discuss is that relating to the length
of time it will take fractured bone to unite, and at what period
144
of time friction should be used. The time generally fixed upon
by the plaintiff’s witnesses for bones to unite seems to be from
four to eight weeks. In case of non-union, that friction should be
resorted to in from six to ten weeks. But Drs. Beebe and Ludlam
show that there is no fixed and definite period in which nature
will perform her work. But each case must depend upon the
character of the injury, the age and condition of the patient, and
especially the condition of the fracture, how far it had progressed,
either in uniting or in refusing to unite. If there was simply non-
union, it should remain under the ordinary modes of treatment from
six to eight months before resorting to friction. If, however, there
appeared to be a ligamentous substance forming, evidenced by the
fragments of bone becoming rounded off, then friction should be
resorted to sooner, but in no case which they could imagine
should it be used in less than from four to six months from the
date of the injury. From the testimony, and from the current of
the medical authorities, I think, in this case, that from four to six
months may be assumed as the correct period in which friction
should have been employed. But it will also be borne in mind
that this was not only a severe injury, but it had been aggravated
by repeated injuries. Let the plaintiff cover up the ease as much
as he will, yet he cannot hide from your view the fact that after
the boy had fractured his arm, and after the bone had been knit-
ted together, it was re-fractured. I know a strenuous effort has
been made to hide this from your sight; that the family of the
plaintiff are now entirely oblivious to any re-fracture of the arm.
But take the facts which they relate, and which stand out in bold
relief against their verbal statements, and it shows that when they
would make you believe that the boy’s arm was not re-fractured,
in plain, blunt Saxon, it is a lie. The arm was re-fractured, and
their own stories show it. Their testimony is, that this boy and
a neighbor’s boy were playing ball; that the boy went to kick the
ball and fell or hit his arm against the fence; that he stopped
playing, came into the house and went up stairs. When he came
down he said to his mother he did not know but he had injured
his arm; that he had hit it and split the splint a little. The father
and mother interrogated the boy about it. He said it didn't hurt
him any, and therefore, they would have you conclude the hitting
the fence was a very small matter, merely splitting the angular
splint, could not have done any damage. But, gentlemen, some
of you are mechanics, and all of you must have some knowledge
145
of the laws of physical force. Now, I ask you as reasonable men,
taking that angular splint, or brace, as the plaintiff chooses to call
it. If that brace was split at the elbow by a blow at the wrist,
how could it split it at that point on one side 2 Judging from its
appearance, and from the manner it is split, how could it help
being split on both sides at once 2 I judge it could not, for the
obvious reason that the splint being hollow, with a screw on each
side, and a brace screwed on the outsides of each piece of which
the splints was composed. The splint, you perceive, is much nar-
rower on the inside than upon the outside. If the elbow was
struck with such force as to split the splint on the inside, and
thrust the bones of the arm outwards, it would have certainly
split both sides, and it would as certainly have refractured the
arm. If, on the other hand, the splint being fastened at the
wrist, at the elbow, and just below the arm-pit. If it was hit at the
wrist so as to split it, the same result would follow—it would have
split the splint on both sides and re-fractured the arm. The elbow,
in that case, would have acted as fulcrum for the lever, and the
split on the outside exactly agrees with this view, showing that
the whole was done at one blow, and upon the lower end. It is
idle, therefore—not to say ridiculous—to suppose for a moment
that anything else could result from such a blow, but a refracture
of the arm. -
Now, this conclusion is based solely upon the facts detailed by
the family of the plaintiff, and from the condition of the splints,
but when to this is added the direct testimony of Dr. Wales, that
such was the case; that the arm was refractured, Dr. Belding,
Mrs. Belding, Mr. Hodgeson and David Morris, show that pre-
vious to this trial, neither the family nor the boy himself ever
denied that the arm had been refractured, and they themselves
testify here, that Dr. Pratt, when they spoke to him about the
arm, said it had been loosened a little. These facts establish the
refracture beyond a doubt. Now, then, gentlemen, with these
accumulated injuries, it seems to me that, under the testimony,
and under the medical authorities which have been referred to,
from four to six months was a proper period in which to resort to
friction; and friction was resorted to in between four and five
months. Dr. Wales testifies to the fact, that he assisted Dr. Pratt in
applying friction about two weeks before the meeting at Milledge-
ville. At a consultation with Dr. Freas and Dr. Belding at Milledge-
ville, friction was again resorted to. When this failed, Dr. Pratt
146
desired to operate upon the arm, and described the different
modes which had been used. After the meeting at Milledgeville,
which was on or about the 6th of May, 1863, Mr. Frisby and Dr.
Pratt had agreed to have an operation performed on the arm, at
Chicago, and Mr. Frisby was to let the Dr. know the next week
when he would go down for that purpose. He said he had not
the money then. This was the only excuse. So that during this
whole period we find Dr. Pratt ever in his line of duty, treating
the fracture in the manner pointed out by the works on sur-
gery, and ever willing and anxious to ameliorate the condition
of the boy, and to save him from the effects of his terrible injury.
AFTERNOON SESSION.
When the court adjourned, I had reviewed this case at some
length, and was endeavoring to show that everything recognized
as good surgery had been done by Dr. Pratt during the time he
treated the plaintiff’s injury. If the injury was not repaired, it
was not his fault. All that he contracted to do was, to use such
skill and care as is recognized as correct practice by men
skilled in the surgical art. By undertaking to treat this case he
did not guarantee a cure; all he did contract to do was, that he
would use due skill and care in the case. This he has done. I
ask you, gentlemen, to look these facts squarely in the face and
judge it, under the whole testimony, by what the Dr. has done, or
omitted to do, and not by the mere present condition of the boy.
On the other side, they have spent two or three days in sup-
posing a certain state of facts entirely at variance with the real
facts, and then getting the opinion of diverse professional men,
not overlearned in their profession, as to this supposed case.
What part this will be made to play in this case I know not; its
design is apparent; it is to lay a foundation for a decision adverse
to the rights of the defendant, by the medical opinions, based on
this false foundation. Indeed, the effort on their part seems to
be to carry this case by influences entirely outside of its merits.
Their whole stock in trade being on the hypothesis that you
will be more likely to be prejudiced against Homoeopathy than
against Allopathy. Hence they say it is visionary and absurd,
and this speech-making gentlemen, Dr. Porter tells you that Allo-
pathy is venerable for its age, and is entitled to your respect on
that account. I am willing to admit its claims to antiquity; that
it is ancient, I acknowledge. That it is deeply imbedded in the
147
memories of the present generation, I also admit; but that it is
entitled to our grateful remembrance I can only admit upon the
principle that its strongest claims are founded upon the maxim
that “Dead men tell no tales;” that the grave hides alike from
our view, the injury and the injured. :
But our learned friend, Dr. Porter, has further claim. When
upon the stand he went back to the old fathers and patriarchs of
the system. -
Oh! his system was no new-fangled theory. It was as old as
science—handed down from the fathers, age after age. This
new system was all heterodox. Not so, his. It stands upon its
old base. The fathers had discovered all in the system which was
essential, and made a record of it. As the fathers left it, so it
stands now. In short, it is a system or school which rests upon
antiquity, and its watchword is orthodoxy. -
But, gentlemen, I have ever found that, in science, as in theol-
ogy, when a man can present no better claim for his system than
Orthodoxy or antiquity, his claims simply means a false system,
fossilized, incapable of progress or improvement. His statements
and his judgment should alike be distrusted. His blind vene-
ration of the past makes him overlook the important truths of the
ever moving, ever living present. Advancement is stamped upon
every thing by which we are surrounded. The stand-still policy
means death. So with his system, life has departed from it, but
its dead carcass is among us, and among us to hinder the advance
of true philosophy and true science in the case of disease. But
we are told that these questions of system have nothing to do
with this case; yet, at every turn we are met with a thrust at our
system. The counsel will not pretend to discuss its merits; his
weapon is ridicule, and Dr. Porter, when upon the stand, under
the solemnity of an oath, attempted to get off a very stale Allo-
pathic anecdote upon Homoepathy, and under this oath he told
you, gentlemen, that a spare diet consisted in taking a part of the
wing of a chicken, wrapping it in a cloth, and boiling it a few
minutes in a gallon of water, and then giving the patient half a
gill at proper intervals. I wonder he had not given it in the old
style he so mnch admires, and that was, that Homoeopathic broth
was made by hanging a chicken on a limb and let the shadow
strike the water, then take that water and boil it ten minutes,
then take three drops and mix it well in Lake Superior, then give
half a gill every two hours. That was said to be Homoepathic
148
broth for sick people. Yet the counsel has no intention of rais-
ing any question about systems.
But, aside from this question of systems, gentlemen, the coun-
sel of the plaintiff would not dare present his case before you.
He relies upon these vulgar prejudices, and not upon the merits
of his case.
Dr. Pratt comes before you asking justice at your hands.
He took this boy all mutilated, torn and bleeding, and he acted
the part of a good samaritan towards him—he bound up his
wounds in an intelligent and skillful manner; and he has placed
before you, the way and manner in which this work was done,
and he asks at your hands a judgment upon the facts here pre-
sented. He asks that you take the facts and the whole facts in
making that decision. And he justly claims he is fully entitled
to an acquittal at your hands. Col. Turner will close this case
on the part of the plaintiff. I cannot anticipate the course he
will pursue. Judging from what he has already done, I antici-
pate he will rely upon your sympathies, and upon the prejudices
created, or attempted to be created, by the Allopathic school
against the Homoeopathic. I know he is a man of decided abil-
ity in this line of practice. He is well skilled in the art of making
the worse appear the better reason. I have no disposition or
wish not to have you listen to what he says; on the contrary, I
say, listen to it all, but when you have done so, under the instruc-
tions which the court will give you, take up the case and examine
it carefully and critically, and where the current of testimony
leads, follow, and you cannot well go astray. But as you exam-
ine this case, bear in mind that in such a mass of testimony, there
may be conflicting statements of witnesses. You are to reconcile
these statements, if you can, if not, you are to look at the testi-
mony as it is, see who are entitled to credit and who are not so
entitled; compare one portion of a witnesses testimony with
another portion, and see how they agree. Then look at the means
of information possessed by the witnesses, the mode. and manner
of testifying, and when you have done this, draw such conclu-
sions as to the facts detailed, as you think just. But, especially
let it be remembered, that much of this testimony is of a profes-
sional character, where opinions are to be received. While due
weight should be given to this testimony where it come
recommended with a proper knowledge of authors and of the
principles of science, upon which such evidence is based. Yet,
149
without such knowledge, opinions thus given are of no account,
for this reason, you should carefully examine every opinion, and
see what foundations have been established, in fact, for the giving
of such an opinion, and as far as you can, compare these opinions
with the standard authors, whose works, so far as they are appli-
able to this case, will be read before you. In this connection,
however, permit me to say, that Dr. Pratt is the only medical
man who has ever attempted to save this boy from the fruits of
his own folly, or from the misfortune which has befallen him, and
while a most labored effort has been make on the part of the pro-
fessional gentlemen, who have taken the lead against him in this
prosecution. Yet that boy has been permitted to remain without
treatment for nine months, without any attempt on their part to
cure him. Physicians and surgeons whose opinions are entitled
to respect, testify that this boy can be cured, and that delay ren-
ders the chances of recovery less certain. There is a neglect
here, both on the part of the parents and on the part of their
medical advisers, which should be duly weighed in determining
this case. The man who has faithfully discharged his duty should
not be held accountable for this negligence of the boy or parents,
and especially when, without any reasonable excuse, he is denied
the privilege of effecting the cure.
From all these considerations, then, I conclude that the defend-
ant ought to be acquitted from any costs or damages on account
of the plaintiff’s misfortunes, and my conclusion is based upon
the following facts:
First.—The plaintiff has not shown that the defendant has
been guilty either of negligence or want of skill.
Second.—The defendant shows that, for the cure of the boy, he
exercised all the skill and diligence that was required for his
recovery; that in reducing the fracture, bandaging, splinting,
and in prescriptions of medicine, he was scientifically correct.
Third.—It has been shown that the plaintiff was guilty of gross
negligence and inattention to the directions which were given for
his recovery; besides this, that he was injured by his own volun-
tary act, without the agency of the defendant, in a manner which
would be likely to retard, if not entirely prevent his recovery.
For these reasons, then, I conclude your verdict should be for
the defendant.
But I have already taken up more of your time than I intended,
and perhaps more than I ought to have done, yet the importance
150
of the case, if I have done so, is my apology, and so far as I am
concerned, I will conclude by saying, take up this case and judge
of it in the manner you would be willing to be judged by, under
the facts detailed before you. Dr. Pratt has performed his duties
faithfully and with more than ordinary skill. He has done this
without fee or reward. After having for months attended to the
plaintiff’s injuries thus faithfully, to be now subjected to the
expense and trouble of a long trial, is a poor return for the ser-
vices thus rendered. Yet, to all this he cheerfully submits, con-
scious that he has performed his duty; and having by the testi-
mony, placed a full knowledge of these facts before you, he
trusts that in accordance with these facts, you will render your
verdict. and with this, and this alone, he will be fully satisfied.
ARGUMENT OF J. H. KNOWLTON FOR, DEFEND ANT.
MAY IT PLEASE THE COURT-Gentlemen of the Jury.—I pro-
pose to discuss the facts in this case iu as brief space as I well
can, and to draw such conclusions as I think warranted by the
testimony, and in so doing I shall, probably, occasionally allude
to what I understand to be the law applicable to the facts.
In the outset, in opening this case to your consideration, I
stated to you the primary principles of the law which should
govern your action.
Now, I crave your most careful attention, not that I shall be
interesting, or that I shall amuse, or occasion merriment, as did
the gentleman who opened the argument on behalf of the plaintiff.
I possess very little, if any, of this kind of capacity.
I ought, perhaps, before I go further, confess that I was, prob-
ably, guilty of an indiscretion, for which I ought to ask your par-
don, by indulging in more than a smile, and coming to an audible
laugh when the gentleman (Brother Miller) was talking about the
blood vessel that enters the “nutritious foramen.” He said,
“ these arteries are all veins.” I laughed; I could not well avoid
it. You as farmers, would be very likely to laugh should I say,
“ these horses are cows.”
I understand the difference between arteries and veins, and this
is all the apology I have for this little indiscretion. This is not a
case for merriment in any point of view.
When we consider the condition of the boy’s arm, the fact is
lamentable. What is the cause of this condition ? This ques-
tion involves enquiry of a highly scientific character. We ought
151
to seek and explore this scientific field. You, twelve men of this
county, have been called from your ordinary avocations and
placed upon this pannel. It is fortunate that you have heard
something, and so much of the structure of your own bodies. We
are all too ignorant upon that subject; all men, even the most
learned, are too ignorant in this behalf. We can no more than
say, all knowledge is a grade of ignorance.
I say, you have been more than ordinarily fortunate upon this
subject. This fortune is one of the results of the breaking of the
boy's arm. I trust that, upon this trial you have learned some-
thing, and that you will treasure it up and make it useful to your-
selves and fellow men in after life. Something, perhaps, is due
to myself, gentlemen, after the many assaults made by brother Mil-
ler, not only upon the professional gentlemen from Chicago, but
upon myself. In plain English he assures you that I am to annihilate
him by my argument. I shall submit to your learned judgment
whether I have evinced any such disposition. Yes, when my
duty shall end and yours shall begin, in the quiet of the jury room,
you will, I trust, bear witness that I have not during this trial,
attempted by word, or deed, to injure that gentleman or any one
else. I have had, and now have no such intention. I shall also
submit to your judgment whether I have made any attempts at
display upon any point under consideration. If I have, it was
unintentional; of its existence I am wholly unconscious. I des-
pise all attempts at display.
The position I occupy in this case gives me the right to animad-
vert upon such conduct, whether the actor be witness, or other
person. In practice, I have often had occasion to do so. The
counsel seems to think it very strange that I should have been
called so great a distance for no other purpose than to attend to
this case for Dr. Pratt. I suppose the Dr. employed me because
he wished my assistance, and I can only say that I hope my con-
nection with the case, will not prejudice your minds, so that you
cannot properly decide the case upon the evidence.
I shall be gratified if I can in a plain manner perform the duties
which devolve upon me in this truly important case. And now,
gentlemen, it is proper that I should say to you that we stand
here simply denying what the plaintiff has alleged, and what he is
bound to prove, or establish by evidence. It was not necessary
that we should go into the proof of facts which would amount to
a justification. All that was essential for us to do, was to see
152
that the plaintiff made, or failed to make a case, which, in law, is
prima facioe, or at first blush, or first view ; and we claim, and I
trust that I shall demonstrate, that they have entirely failed to
establish such a case. In their attempts to do this we had a
right to a full and complete investigation of the whole case and
its surroundings. We had the right to introduce witnesses, in
order to unfold to you our views of this case, as to the non-union
of the fractured bone, and account for it upon physiological prin-
ciples. In this case we claim to have succeeded. We also had a
right to show what, in point of fact, was the treatment of this
case by Dr. Pratt, and thus establish the negative, or disprove
the facts alleged by the plaintiff. To do this, the consumption of
considerable time was indispensable.
We wished to lay all the facts before you—not only as to the
actual practice—but everything connected there with, and having
a probable bearing upon the case. There is in this case, nothing
which even borders upon truth, that Dr. Pratt had, or has any
reason to fear, or to shrink from.
§ Therefore, we had no hesitation in presenting to your consider-
ation, every question in the fullest form, which can with any
propriety, be said to throw light upon the case. Men differ very
widely upon subjects of this kind. But in these cases there are
certain phenomena, common to them all, of which a man should
have an opinion of his own, founded, to a great extent, upon his
experience—broader or narrower, as his observations may have
been limited or extended. The mind may be capacious. It may
be attentive and discriminating, or it may not.
There is a greater variety of opinion in the medical world than
in any other branch of science. It is natural that this should be
so. There is no mechanism so wonderful and so nicely adjusted
in every part as the human body. There is here a wide lati-
tude for difference of opinion.
I think that this complexity of mechanism, in a somewhat sat-
isfactory manner, accounts for this great diversity of opinion. I
mean upon the hypothesis that men who have investigated this
subject, have endeavored to do so without prejudice, and for the
purpose of ascertaining the truth. There is another theory which
will aid us in accounting for this diversity of opinion. Men
sometimes make up their minds, or adopt some theory at the com-
mencement of their investigations, and never probe the matter
any farther, or if they do, they make every new fact bend to the
153
the support of preconceived opinions. Previous opinions control
them, perhaps, unconsciously. Others investigate with no pre-
diletions for opinions once formed, but disarmed thereof; and
the consequence is a change of opinion—mayhap very suddenly.
Hence, it is said that wise men sometimes change their opinions,
but that fools never do. &
Now, gentlemen, the question of different theories of medical
practice, known as Homoepathy and Allopathy having elicited
considerable discussion, and some examination of medical gentle-
men, I doubt not you will be told that I believe in Homoeopathy.
I do not want this matter left to conjecture, nor do I wish the
counsel on the other side to get the start of me upon this matter.
I assure you, gentlemen, that I do firmly believe in the Homoeo-
pathic theory of practice. It is based upon experimental knowl-
edge, and I have often demonstrated the efficiency of this theory.
My brother, Miller, talks very flippantly about the ten thous-
andth part of nothing as a Homoeopathic dose of medicine; and
that common sense will tell any man that these small doses can
produce no effect upon a human being. He also assures you that
he is a common sense man. I do not know whether I am or not.
I am a poor judge of myself. I shall pretend nothing of the sort.
I shall leave this matter of common sense to you, so far as I am
concerned.
Mr. Miller further says that there is nothing in the Homoeo-
pathic theory that he can understand or comprehend. If we
were to ignore every thing which he does not comprehend or
understand, our stock of knowledge might not be very extensive.
But, gentlemen, I trust that I shall be able to illustrate to you,
in some degree, how it is that these infinitossimal doses may
produce great effect upon the human organism. I propose to do
this, so that it shall be obvious to your mental vision. t
It is said that these doses are too small to produce any effect.
This is mere assertion. How gentlemen can, with propriety,
make that assertion, who have never tried the experiment, is more
than I know. It is mere speculation.
Have you ever heard, or known of a person having a disease
called the small pox 2 If you have, you have heard of, or known
one of the most loathsome diseases to which the human body is
subject. Take a subject with confluent small pox in its worst
form, and what an object for the human eye to rest upon l His
whole visage black and bloated to the full,—his body not dotted
*-------, - -
10
154
with sores, but the whole frame one grand mass of corruption.
Can you tell me how much of the small poa, virus entered the
system by olfaction, or otherwise, in order to produce this awful
disease—to produce this great effect upon the body ? I appre-
hend not. Yet, the quantity must be greatly less than a Homoeo-
pathic dose of medicine, which is sufficiently large to be seen.
Not so with this small pox virus. This illustration proves the
fact, that these small quantities will produce an effect upon the
human organism, although the quantity is so small that the gen-
tleman, by way of derision, says that it is the ten-thousandth part
of nothing.
Gentlemen, neither you nor I know how small must be the
quantity of a virulent poison, administered to a person so that it
shall produce no effect upon the system. I mention this because
you must understand that all the remedies given by physicians,
whether mineral or vegetable, are poisons. It matters not
whether they are Allopaths, Homoeopaths, Eclectics, Thomson-
ians, or what not. Disease is a morbid or poisoned condition of
the system. It would, therefore, it seems to me, require a poison,
or antidote to the disease, in order to remove it.
Now, upon this subject, gentlemen, you may remember that
Mr. Turner told you, in opening this case, that his client had no
prejudices upon this subject, nor antipathies to any system of prac-
tice, and that upon their side they should not raise any question
about different systems. I made no promises, not knowing what
might occur. We did not open this question. But the other
side did, notwithstanding their engagement not to do so.
We have been favored with quite a number of thrusts from
counsel, as well as from the professional witnesses upon the part
of the plaintiff. They were, however, quite modest until they
came to cross-examine Dr. Beebe. Then the door was thrown so
wide open that Mr. Turner will not be able to shut it. That this
field is open to inspection is not our fault.
When I come to this point of the testimony as applied to the
subject matter of this case, I shall present my views, as well as
upon all the other points involved, and I hope to so conduct this
discussion that you will have a clear understanding of the facts
developed by the testimony and the law appliable thereto, as
given in charge by the court. I must also inform you that, as I
go along I shall read from books upon surgery, which are looked
upon and conceded by the other side to be, good authority. Yes,
155
I shall read from the works which their medical witnesses testify
are the sources from whence they derive their knowledge, so far as
the principles of surgery are concerned. I shall read from these
books for the purpose of showing the relative value of the testi-
mony of the professional witnesses. And if it shall appear that
our professional witnesses have testified in line with these author-
ities—the common source from which they all get their knowledge;
—then we shall properly claim that the testimony of our wit-
nesses is entitled to credit, and that that of theirs is not, if
opposed to these authorities. The opinions of professional wit-
nesses are valuable in the proportion that they coincide with
those authorities which contain a collection of the experience of
those who have given attention to, and have had great experience
in, the matters treated of
I propose to discuss this case in a somewhat connected and
logical manner—going through with one point at a time. In this
way, I think you will much better understand me than you would
were I to run from one point to another, and discuss them piece-
meal, as my brother Miller did. He ranged the field with much
rapidity, and threw out, what seems to me, many curious notions.
I shall endeavor to present the case in its true light and com-
are one part with another, so that we may have the value of
the whole and of the various parts.
You are to judge of the credibility of the witnesses. In deter-
mining what weight should be given to the statements of a wit-
ness, which are mere opinions, you must take into consideration
the amount of information which he possesses upon the subject
matter whereof he ventures an opinion. A witness of unques-
tionable integrity must have the opportunity, as well as the ability
to see and learn ; and after having had the opportunity, it must
have been improved and something learned. Rare opportunities,
even without being improved, will not do. That opportunity
has been presented and improved, must be gathered from the
opinion expressed, as coincident with human experience. I had
designed briefly to have reviewed some of the positions assumed
by Mr. Miller ; at least those of most interest, but I shall content
myself, by giving them attention as I proceed with the discus-
sion of the case—having regard to the testimony, and particu-
larly as to the different modes of treatment of injuries of the
character now in question. Mr. Miller said, with great emphasis,
that Dr. Pratt told the father of the plaintiff that he was compe-
#56
tent to treat this case, and that they had nothing to do with any
particular “pathy.” ?
It is well that you understand, that we do not deny that Dr.
Pratt did so say. On the contrary, we concede it, and now say
that he was competent. And not only competent, but that he,
as established by the testimony, did treat the case in all its phases,
in the most approved manner known to modern surgery, and as
much as was practicable for any surgeon in this country, or in
any other. This is precisely what we do claim. Another thing
that Dr. Miller complains of, and for which I may owe him an
apology, is, that in my opening remarks I said that the case was
taken out of the hands of the defendant and placed in charge of
Dr. Miller, a brother of one of the attorneys of the plaintiff; so
that Dr. Pratt was not permitted to resort to all the modes known
to the surgical art which promised success. Mr. Miller seems to
think disrespect was intended by this remark. Certainly, I had no
such intention. I made the reference as one of identity of the Dr.
Miller to whom the case was entrusted, not knowing but there
might be more than one Dr. Miller in this region of country.
Again, Mr. Miller says that he cannot see any reason why the
bone of the arm did not unite, as the boy was perfectly healthy
all the while. I may not see, you may not ; yet this does not help
the case of the plaintiff. He is not to maintain an action upon
the ground that all the world cannot see why the bone did not
unite. But he must show, by competent, testimony that it failed
to unite because Dr. Pratt did not properly set this bone, or, in
surgical parlance, properly reduce the fracture. If, during all the
time that Dr. Pratt was attending the plaintiff, he was in good
condition and healthy, so that his general condition cannot be
assigned as the cause of the non-union of the bone, then another
theory of the other side—namely, that the boy was so reduced by
a low, stingy diet as to essentially prevent re-union—must fall to
the ground.
This cannot be true, if, as the father and mother and a sister
of the mother all testify, the boy was in good condition and per-
fectly healthy during all the time that Dr. Pratt treated him.
This testimony coming from the side of the plaintiff, annihilates
the theory of improper treatment by Homoeopathic medication
and diet, and speaks highly in favor of both the medication and
diet. Think of the boy with his right hand torn to pieces, the
thumb dislocated, and bone fractured, a considerable wound upon
157
the head, the arm broken in two places, and one of the fragments
protruding through the skin, thrown from the wagon and taken
up for dead, recovering, save one fracture of the arm, without
any serious inflammation, or other difficulty. If this does not
disprove the idea and assertion that Dr. Pratt was guilty of
unskilful treatment, it will be difficult to divine what will. But
not only do these witnesses testify to these facts; they go further,
and say that the boy never complained of any pain from the time
he was injured until he passed from under the charge of the
defendant. This is certainly extraordinary, and contrary to the
general rule. I hardly think one of you could be subjected to
the infliction of such severe injuries with so favorable a result.
The plaintiff has utterly failed to show any reason why this arm
bone was not repaired long ago. If the low diet so much dwelt
upon was kept up a sufficient length of time to injure the patient,
by impairing the health so as to prevent the reproduction of bone,
then different results would have followed than those which have
been detailed by the witnesses. They have taken much pains to
elicit testimony upon the dietetic part of the treatment. I may
as well discuss this part of the testimony right here.
You will recollect that I was particular in asking the sister of
the mother to give the language used by Dr. Pratt when he
designated the kind of food the plaintiff might eat, or, in other
words, how he might be fed. Her words were, “that the boy
might have some toast, crackers and gruel.” You will remember,
gentlemen, that this is precisely what she said in answer to my
question as to what Dr. Pratt did, in fact, say. These are the
articles or kind of food prescribed by the Dr. But what has this
to do with the quantity of food to be taken The article and
guantity of food are very different things.
Dr. Pratt said nothing about quantity. That was left to the
parents, or those who attended the boy. Is there any evidence
that the Dr. e.vinced a disposition to starve the plaintiff? None
whatever. They would have you believe that the defendant had
been trying to starve his patient.
Is it reasonable, or do you suppose that the Dr., who gets his
living and acquires his wealth by the practice of his profession,
would adopt the mode of starving his patients, or that he would
prescribe so small a quantity as to materially interfere with the
process of re-union of the bone—that he would be guilty of an
act that would be suicidal to suecess? Why, his own selfishness
158
would prompt him to an opposite course. He would naturally
allow him food in sufficient quantity to facilitate, and not prevent
a cure. Is it reasonable to ask you to believe that Dr. Pratt gave
any such orders about quantity of food as is contended for here?
If so, where is the evidence of the fact, or where is the evidence
that the boy was so reduced by lack of food that union of this
bone would not take place 2
The young woman and the mother testify that the boy cried
for food. Was it strange that he should It requires no evi-
dence to establish the fact that an active boy driving about the
country, chopping, plowing and hoeing, in the constant habit of
eating much hearty food, would ery for food when not allowed
his accustomed meals. Even the taking a considerable less quan-
tity of the same kind of food would leave a craving appetite for
more. These two ladies also testify that when the Dr. was
informed that the boy wanted, or cried for more food, that he
asked the boy whether he would not rather have a good arm and
eat less, or eat more and have a bad arm 2 To this, the boy and
the parents yielded. If they did not, they should.
The Dr. seems to have been very attentive to this case. Accord-
ing to the testimony of the mother and sister, he was there on
Tuesday, the third day after the accident, then on Tuesday, and
again the next week.
This was the time when the boy cried for food. The very time
when there was the greatest danger to be apprehended from
inflammation. However, some of the professional gentlemen who
have testified for the plaintiff, seem to think that the usual diet
should be allowed, and that, too, however severe the injury. Such
would be their practice, unless they found inflammation pressing
upon the patient with much violence—then they would order a
low diet. -
Does it require any greater means to prevent inflammation by
commencing early, than it does to remove, or cure it, after it has
fairly laid hold? When inflammation is upon the patient, the
physician must resort to more stringent measures to arrest it than
would be requisite to prevent it.
It is much better to prevent an injury or disease than to cure
it after it has become seated. Then, Isay it was highly proper for
Dr. Pratt to order this kind of diet in the outset, with a view to
prevent inflammation to as great an extent as possible. No per-
son could reasonably expect repair when the injury was so severe
159
as was this case, without some inflammation. The precaution
taken was highly commendable. In such injuries, means to pre-
vent inflammation, should always be instituted at the earliest
practical moment. -
In this case this was promptly done. But independently of
reasoning, I assert that they have totally failed to show anything
more upon this subject, than that Dr. Pratt prescribed the kind
of food to be used by the boy for two or three weeks, without
saying one word about the quantity to be given. That was deter-
mined by his parents. But take their theory—that it was the diet
that prevented the restoration of the arm—and in this connection,
let us admit that the boy was fed as their witnesses testify; and
that the defendant ordered them to do precisely as they did. Yet,
this does not show that this was, or is the cause why the bone
did not unite. Even Mr. Miller cannot account for the thumb
and all the other wounds healing kindly in the usual time, if the
diet caused non-union of the arm bone. -
How is it possible that the kind of food furnished, was given
in sufficient quantity to supply the tissues and cause the other
wounds to heal so rapidly? or, how could this diet supply one
tissue, or one part of the body and not all be supplied ? The
external wound at this point of non-union, however, must have
been supplied, because their testimony is, that this was healed in
about three weeks, which was quite as soon as the wound of and
around the thumb was healed.
No particular part of the system is therefore shown to have
been better supplied than the other. But next comes their theory,
that to have, or to reproduce bone, the patient must have animal
food. Dr. Porter seems to be of this opinion, and for the reason
that animal food contains (as he thinks) more phosphate of lime
than vegitable food. Is this a fact? A
Look at the testimony and illustrations of Dr. Beebe. He says
that the blood contains the material out of which the bone-cells,
or bone are formed, or manufactured out of the food taken into
the stomach ; and that by this process bone tissue and every
other tissue is kept up and nourished from day to day; and that
this condition is well maintained by vegetable diet alone. How
much more vegetable food does a person eat than an ox.” Does
an ox eat animal food, such as meats 2 You know that he does
not. And has the ox bones of less size and strength than man 2
The reverse is the fact. Here, then, is a demonstration that veg-
160
etable diet alone is adequate to the formation of bone. Not only
the bone, but the muscle and flesh of the ox, the horse and the
sheep are formed from vegetables. When we eat the meat of the
ox for bone material, we eat vegetables, as it were, second-hand.
But Mr. Turner seemed to think, when cross-examining our
medical witnesses, that he would non-plus the doctor upon the
theory that a purely vegetable diet was all sufficient for the
production of bone tissue, or reproduction of bone. So the
counsel confidently says: “A dog eats meat or animal food, how
can this food keep up the bone tissue if it does not contain the
bone material P”
The doctor replies: “The dog eats bone with the flesh suffi-
cient, perhaps, to give him all the phosphate of lime and other
bone material that his system needs. But not only this, the ani-
mal whose flesh the dog eats is sustained by vegetable food.”
The doctor also said that all carniverous animals consumed bone
with the flesh eaten. That what was true of the dog, in this
respect, was also true of the lion and tiger. Is there any doubt
whatever upon this subject 2 The dog swallows the bird, bone
and all. Take the hen. She does not ordinarily, eat a large
amount of meat. Her food is mainly vegetable, yet she has bone.
Another theory (Dr. Porter's) is, that you can tell that man is
an animal that requires beef and vegetables, that he is omniver-
ous. That the kind of food that animals should eat is ascertainabe
from the form of their teeth. When I asked the doctor what con-
clusion should be drawn as to the food of a man who should be
born without, and remain without teeth, his reply was, that he
should consider him lusus naturae—a monster—something out of
the ordinary course of nature. That was an extremely clear
elucidation. When I carried the doctor’s theory a little farther,
and asked him how we could determine the proper food for the
crow, or the hen, who have no teeth, his best answer was his
silence. The crow can and does eat animal food, and that, too,
after decomposition has been carried to very considerable extent.
This saves him in the operation of digestion. Mainly the food of
the crow is meat; that of the hen is vegetable. Now, if you can
tell, on Dr. Porter’s theory, what is the proper food for the crow
and the hen, by the different formation of their teeth, you can do
more than I can comprehend. ~
I think, gentlemen, that whoever started this “ teeth theory”
had very little base to stand upon. Animals which eat vegetables
161
and meats simply use their teeth to masticate—and this as well
with one kind of food as of the other. And such animals have
teeth as well adapted to the eating of vegetables as of meats.
Take the dog—his teeth have a somewhat different form from
those of man; yet he will eat meat or bread as readily as man.
I remember that my father once had a dog that hardly ever ate
anything but bread and milk. Bread is vegetable diet, most cer-
tainly.
I do not, upon the whole, see how you can tell, from the forma-
tian of man’s teeth, what kind of food he should eat. I take it
that the reason why the lion and tiger do not eat bread is, that
they cannot get it. Man will eat meat as exclusively as the lion
when he can get nothing else, and in time would be quite as averes
to vegetable food.
The climate has, I think, more to do with what a man’s diet
should be than the formation of his teeth. Under a vertical sun
he should eat no meat, or very little, for the reason, that there is
too much carbon in it, which would of necessity produce sick-
ness. In the cold region of the north, the inhabitants must use
highly carbonaceous food to keep up the equilibrium of the body
with the surrounding atmosphere. Hence, they make food of
tallow and the oils of the whale and seal. Their teeth are good,
but they have little use for them. In the temperate zones, a mix-
ture of animal and vegetable food, if not the best, is certainly
less objectionable than in the frigid, or torrid zones.
But the theory that you can tell by the formation of the teeth
of men, even in this temperate climate, that he must have ani-
mal food in order to maintain or reproduce bone, has been abso-
lutely proved unfounded as a fact, by great numbers of vegeta-
rians, who will eat nothing but vegetable diet. They discard
all animal food, and yet have good bone and less disease, gener-
ally, than their neighbors, whose diet is partly animal and partly
vegetable. This proves that there is sufficient phosphate of lime
in vegetable diet for the maintenance and reproduction of bone,
or bone tissue in man, which must end the theory of the counsel
and witnesses of the plaintiff, that the non-union of the bone of
the plaintiff’s arm is attributable to his vegetable diet for three
weeks after the accident. -
It is, perhaps, sufficient for me to say, that this young lad, as
shown by the testimony, had food enough, and of the requisite
kind, to supply the tissues of his body, so that the serious wounds
162
upon his head and hand were healed in the usual time. From the
testimony it is evident, that the external wound on the arm at the
seat of fracture, healed in a remarkably short time.
It is next to impossible that all these extensive injuries could
have gone on in the work of repair in the orderly and timely
manner shown by the proofs, if the boy had been starved, or not
allowed the proper kind or quantity of food.
The recuperative forces worked well, which shows proper diet.
The results entirely disprove the starving or dietetic theory of
this case. Upon the hypothesis that this part of the treatment
was kept up three or four weeks, (and there is no pretence of any
longer period,) and that these torn wounds all healed in this time,
it is quite evident that no injury resulted from the diet allowed.
The cicatrix at the point of the external wound on the arm
shows that it was not made with a sharp instrument. You saw
Dr. Beebe take up the flesh at this point, and thereby exhibited
the fact by a sort of string or pipe, that the wound extended to
the bone, and that it must have been of the same severe character
as that of the thumb. No more is necessary to show the incor-
rectness of this theory of the professional gentlemen who say
they never change the diet, unless there is a high state of inflam-
mation.
However, none of them have come up to the point of denying
that diet has a very decided effect, or is important in case of
inflammation. When that exists to any considerable extent they
would all change the diet and order a “low diet.” They would,
therefere, not take precaution to prevent inflammation, but would
wait until the disease was, at least, quite firmly seated, and then,
to aid removal, would put the patient on low diet. I apprehend
it requires but little common sense, to determine which mode is
preferable, and that their own testimony sufficiently disposes of
this question in our favor. - - -
But when you take the testimony of Dr. Wales upon that sub-
ject, who says that Dr. Pratt told them they could let the boy
have any ordinary kind of food on the 10th day (as I remember
his testimony) from the Tuesday next after the accident, which
would make thirteen days in all, then it was the fault (if fault
there be) of the parents, that the boy was kept on the diet
ordered in the first instance, for three weeks, or for any time
beyond thirteen days. -
This was not, and by no possibility could be, the fault of Dr.
163
Pratt—that is, if you believe Dr. Wales. This you should do
unless you believe that he has committed perjury, or that he, at
least, is wholly mistaken. But, however you may think about
this testimony, they prove the fact that all these severe wounds
healed, as already remarked, at farthest in four weeks. To do
this, general good health was absolutely necessary; which could
not well be the case with a person who was (to use their own
language) “starved.” .
Another thing they complain of, and about which their wit-
nesses testify, is that Dr. Pratt gave the boy aeonite. Now, gen-
tlemen, as all the professional witnesses on our side testify that
the giving of aeonite was proper, and not one of theirs testifies
that it was improper, I would like to know how they can, with
any propriety, claim, or how you can believe, that this part of
the treatment was improper. - .
Have they brought a single witness to, or who does, testify that
aconite will not have the effect to prevent, or remove inflamma-
tion, as testified by Drs. Beebe and Ludlam? No, gentlemen,
there is no such testimony. They have not even attempted to
prove any such fact, which is evidence most convincing, that they
could not. Drs. Beebe and Ludlam testify before you that
they know that aconite will produce the effects they detail in
reference thereto, and that they know this from actual personal
experiments. One well attested fact by experiment is worth
more than a thousand untried theories. I would rather have one
grain of experiment than all the theories in the world. Dr. Lud-
lam informs you, in answer to their cross-interrogation, that
aconite acts directly upon the nervous centers, controls capillary
action and moderates the motion of the blood as it circulates
through the body, thus preventing or removing inflammation or
congestion. . -
But here Dr. Porter comes to their aid, and prompts the coun-
sel to ask Dr. Ludlam how digitalis acts, or upon what it acts if
aconite acts thus upon the nervous centres, and controls capillary
action, &c., and whether digitalis does not act in a similar man-
ner upon the nervous centres, &c. Dr. Ludlam readily answers
that it does not ; that there is around the heart a set of nerves
called the ganglionic, and that digitalis acts peculiarly on this
bundle, or set of nerves. This explains why digitalis is so fine a
remedy, and so very useful in diseases of the heart—for instance,
in palpitation of the heart. Now, the testimony of Drs. Ludlam
164
and Beebe upon this subject stands before you wholly uncontra-
dicted. No one has attempted to contradict them ; no one has
even dared to insinuate that their testimony is not true. They
have, in their testimony, established the important fact, that they
are highly educated in their profession. They talk about things
they know. They can give you, on all occasions, a good reason
for any fact to which they depose, or for any opinion they give.
I am sorry that I cunnot truthfully say this of the professional
witnesses brought forward by the counsel for the plaintiff.
There not having been even an attempt made to contradict, or
in any way to discredit, Drs. Beebe and Ludlam, we are bound to
take their testimony as facts. Mr. Turner asked Dr. Ludlam if
aconite had not been used by physicians before the system of
Homoeopathy existed. .”
The answer was, that it had been ; but not for the purposes or
with the view for which Homoeopathic physicians use it. That
its great specific virtues were unknown to the medical world
before the days of Homoeopathy.
They got this answer, and do not attempt to contradict it. This,
too, stands before you with the force of a conceded fact. Could
they have contradicted this statement, they most assuredly would.
No, gentleman, until the days of Samuel Hahnneman, (who was the
founder of Homoeopathy),the great virtue of aconite was unknown.
Its virtues, or the effects which it would produce, were ascer-
tained by experiment—by taking large doses at intervals. This
was done by Hahnneman, when in a healthy condition, and the ef.
fects were noted. Any other vegetable may be proved in the
same way. It makes no difference whether it is aconite, bella-
donna, hyosciamus, digitalis, or anything else.
When it is ascertained what effect any particular medicinal
agent will produce upon a person in health, then we know wheth-
er it will do to administer it to a person laboring under disease.
By this mode we learn not to administer as a remedy, something
that can do no good, but may do harm in a given case.
Now we have proved that it was proper to give aconite in this
case, to prevent undue inflammation. They have not proved that
it was improper. Yet, this is what they must prove before they
can claim damages at your hands, on the score that the giving of
aconite was unskillful or improper treatment. We say that the
propriety of giving this remedy was demonstrated by the results.
165
Their witnesses swear that the boy was in good health all the
while. Inflammation is not a state of health, but of disease.
Severe inflammation is likely to follow such injuries as the
plaintiff had inflicted upon him. As this did not follow in this
case, and as we have proved that the effect of giving aconite
would be to prevent this inflammation, which is wholly uncontra-
dicted, it is but a rational inference that aconite prevented the
suffering of the plaintiff from severe inflammation. To prevent
such suffering would certainly be proper treatment. -
It is true that Dr. Porter contends, or rather testifies, that there
can be no reproduction of bone so as to obtain reunion, in case of
a fracture, without inflammation. How much there must be, he
does not tell us. But, upon this theory, he does not testify, nor
does any other witness, that there was not sufficient inflammation
to induce union of the fracture by the production of new bone.
This proof must be made in order to make this theory available
to the plaintiff; and they would have to go farther, and prove
that this lack ºf inflammation was produced by the giving of
aconite, or by some other act or order of Dr. Pratt; and that
such action by Dr. Pratt was not skillful surgical or medical treat-
ment. In these things they have failed in toto. But Dr. Porter
goes farther; he swears, positively, that there can be no forma-
tion of provisional callus without inflammation, and that without
provisional callus there can be no re-union of bone; and that this is
so, as to every bone in the human body. You will remember that
I pressed this subject particularly upon the attention of Dr. Por-
ter; and that in his answer he was very positive that, in case of
the fracture of any bone, there must be provisional callus, or that
there could be no re-union of bone; and that there could be no
provisional callus without inflammation. He testifies, also, that
there could be no re-union by definitive callus. In fact, he did
not seem to know much about definitive callus, which, as I shall
show by authors on surgery, that he concedes are good authority—
particularly Miller,-is the material, he great and absolute necessary
thing. And by the same author I shall show, as testified by Drs.
Beebe and Ludlam, that neither inflammation nor provisional callus
are necessary to the re-union of bone in case of fracture. And I
shall go further and show that, in case of a fracture of the femur
or thigh bone at the point called the capsular ligaments, there can
be no re-union, except by definitive callus alone. That at that
point there can be no provisional callus. This provisional callus
166
is a sort of cartilaginous, or (if I may be allowed the expression)
semi-cartilaginous substance, that clasps the bone at the point of
fracture, in similitude; as the hoop clasps the barrel. This may
well be in the long or round bones; but you will readily perceive
the danger to the brain by pressure of provisional callus in any
considerable quantity in case of a fracture of the flat bones of
the head, and the entire impossibility of this formation in the
thigh joint. x-
But no more at present, of this theory of Dr. Porter’s as to the
reproduction of bone. -
Their theory of diet, in this case, and the giving of aconite is
not maintained by evidence, or otherwise ; but the propriety of
both stands forth with all the boldness of truth. The counsel for
the plaintiff sneeringly talks about the wash for the head and
hand. The sister of the mother of the plaintiff says that it was
arnica. Dr. Wales, who was present when it was ordered and
dealt out by Dr. Pratt, testifies that it was what is called calen-
dula, or marigold. It matters not which it was, as both have
been proved, again and again, to be very efficient in the healing
of wounds of the kind inflicted upon the plaintiff. Their vir-
tues, and particularly arnica, in such cases, stand conceded by
all intelligent physicians, no matter to what school they belong.
The effect of arnica is no matter of doubt. It stands as a fact,
as much as does the curative power of bellodonna in scarlet fever.
Allopaths have been compelled to yield both, and to use them in
their practice. . - w .
However, there is no proof, nor is there even a surmise, that
any injury resulted from the use of the wash ordered.
From the speedy healing of these terrible wounds, we have the
right to infer that good came by the use of the ordered wash,
whatever it was. Then, on this part of the treatment, we have
nothing to sustain, but something to defeat the plaintiff.
On the part of the plaintiff, they have not dared to ask a single
witness whether washing these wounds with arnica or calendula
was proper or improper treatment. Nor have they asked any
witness whether it was improper to give aconite to a patient in the
condition the plaintiff was, or in any condition. Upon these
points they have no evidence whatever. But we have proved the
propriety of Dr. Pratt's treatment in all these particulars. Nor
have they proved by, or asked a single witness, whether the non-
union of the arm bone is to be, or can be, attributed to the whole
167
or any of this treatment. That this can not be the case, is estab-
lished by the fact, so far as material for the defendant, by our
proof that this part of the treatment was proper. This is further
demonstrated by the favorable results, as to all the injuries except
this of the arm. g
Next in order, let us consider the question whether the disloca-
tion of the thumb and the fractures were properly reduced, or
set and dressed.
To the end that there may be no confusion, and that you may
clearly understand how the matter stands, I will consider one at
a time, fully, before touching the other. And first, as to the thumb.
What is the testimony ? -
Dr. Wales says he thinks the arm was first dressed, but he is
not positive. It is quite immaterial whether the hand or arm was
first dressed. Two witnesses who were present, the Morrises, say
that the thumb was first dressed. We find, however, which-
ever was first dressed, that the whole was well done. Neither of
the Morrises, nor the father or mother of the plaintiff, say that
the dislocation, or fracture of the thumb was not properly set,
reduced, or dressed. Nor do they state any fact from which it
can be inferred that the thumb was not properly arranged and
dressed in all its parts. Dr. Wales testifies that he assisted Dr.
Pratt, and that the fracture and dislocation were properly reduced
and then dressed. That flexible splints were applied so as to
keep the fragments in proper place. That these splints were
made of strong cloth, saturated with gum-shellac. That they
were warmed with a flat iron, on a table, or board, so that they
would readily conform to and fit the parts. That they would
soon cool and become stiff, and were eligible splints, to be used
upon this thumb. He also testifies that this lacerated wound of
the ball of the hand, was well arranged and dressed.
This fractured thumb bone is called the metacarpal bone.
You do not need the superior skill of a surgeon to know that it
must have been very difficult to keep the joint and broken bone
of the thumb in proper place. The ball of the hand, including
the web, or skin between the thumb and fore finger com-
pletely torn to pieces. Here was a very bad wound; and when
the bandages were removed, muscular action alone would be
sufficient to displace the fragments and permit dislocation of the
joint. And this would very likely be the case with the bandages
on as tight as the patient could bear. There is a great diffierence
168
between a simple fracture, or dislocation and there combined with
such a severe lacerated wound as the plaintiff had. I must think
as Dr. Beebe testifies, that he should be gratified to have so
good a thumb when the injuries were so severe as those of the
plaintiff. Not as Mr. Miller says, that “He would be proud of
such a job,” but that he would be proud that it was in no worse
condition. }
There has been no evidence,—not one word, that any part of
the treatment of the hand and thumb was unskillful, or evidence
which establishes the fact that the treatment was not proper and
highly skilled. Yet the law only required the evidence of ordi-
mary care and skill. The results demonstrate the exercise of skill
much above the ordinary grade.
Upon the opposite side, none of the witnesses have said any-
thing about a fracture of the thumb bone. Their medical wit-
nesses have not discovered that there had been a fracture; but
they say there is a partial dislocation of the joint. Dr. Porter
tells you, upon the stand, that he has examined the thumb before,
and that there is partial dislocation. Drs. Beebe and Ludlam
both testify that the joint is in proper place and no dislocation.
Now, gentlemen, I want you to exercise your common sense
on this occasion. Here is this part of the human skeleton, (hold-
ing the same before the jury). Now look at the articulating sur-
face, and see if you can tell how there can be partial dislocation
of this joint. How this joint can be partially out, and yet the
boy be able (as he can and has, in your presence) to move this
joint at pleasure; I confess I cannot imagine how this can be.
If you can discover this, you will exceed in discrimination the
professional gentlemen who have been before you. It is true,
some of those called by the plaintiff have asserted that it was so,
but have given no clue to means whereby it can be done. Dr.
Porter tells you he finds partial dislocation, but discovers no other
injury. But when Dr. Beebe came to examine the thumb, he
said that the joints were all in correct position,-so said Dr. Lud-
lam. Moreover, Dr. Beebe said that there had been a fracture of
the bone from the joint obliquely, and that one portion of the
bone had slipped down from the other portion. You could see
how that was, from the articulating surface, as he exhibited to
you. Now, Dr. Porter, with all his surgical skill or knowledge,
never discovered this fact. Dr. Beebe, with the skill of the prac-
tical surgeon, detected the injury at a glance. Dr. Pratt had the
169
skill to detect this, because, when he went and examined the
thumb after the lacerated wound was healed, or nearly so, he
asked the privilege to properly fix it, and the parents would not
permit him to do so. The testimony of Frisby is, that he never
attached any blame to Dr. Pratt on this account, or for the
thumb being in its present condition.
They dare not attempt to show you from their examination of
the thumb, that Dr. Pratt did not properly treat it. It makes no
difference how much knowledge of surgery a man has—he may
be as skillful as Sir Astley Cooper, who is the father of surgery,
as Dr. Porter tells you—if he is not allowed to exercise that know-
Hedge. -
The parents of this boy would not allow Dr. Pratt to exercise
his skill, or any skill, in order to make this thumb better than it is.
How could Dr. Pratt cure, when prevented by his parents You
have got to conclude that he could, in order to convict Dr. Pratt,
so far as the thumb is concerned. Gentlemen, you will do no
such silly thing, if you are the men of common sense, which Mr.
Miller says you are. You have only to exercise a small portion
of this common sense to determine this question. *
This application will be sufficient, without referring to the
testimony of Drs. Beebe and Ludlam. This is a matter so simple
and plain.that you can all readily understand it. Dr. Beebe was
the only man who, before you, gave the thumb a critical exami-
nation, and he has the requisite knowledge to give an opinion
upon which reliance can be placed.
And here, I must do Drs. Beebe and Ludlam the justice to say,
that of all the professional gentlemen I have examined as wit-
nesses, (and I have had the pleasure of examining a good many,)
they are the best posted in all the details and minutiae of their
profession I have ever seen upon the witness stand. They are
perfectly at home upon every question and subject, and can give
a good reason, and explain the philosophy of everything upon
which they venture an opinion.
I think I ought to know something of surgeons, as I have,
among others, had the honor frequently to examine Dr. George
W. Lee, of Wisconsin—who was formerly Demonstrator of
Anatomy in the La Porte Medical College—and who is one of
the best and most successful surgeons in the Northwest. Drs.
Beebe and Ludlam came here at our request, without previous
expectation that they would be called upon so to do, and knew
11 ſ
170
nothing of the case until so requested. You could see, gentle-
men, that they are thoroughly acquainted with their profession,
and I ask you to bear in mind that they both testified that the
joints of this boy's thumb were in proper position. But indepen-
dently of their testimony, the action of the joints, if, indeed, any-
thing more were needed, is conclusive evidence that the joint is
in proper position, and not partially dislocated. If it was par-
tially dislocated, the motion of the joint which you have seen
would be impossible.
This fact, with the testimony, shows that, instead of there being
any lack of skill, that the treatment of Dr. Pratt may be con-
sidered a very rare exercise of great surgical skill.
We do not need to say much about splints. As already remarked,
they were made of heavy cloth, saturated with gum shellac.
They were warmed to pliancy before they were applied, and
when cold they were excellent splints. We claim that these were
proper splints to have used, and there is no testimony that they
QDere 770t.
There is another matter I will notice here, and that is, that the
sister of the mother says that Dr. Pratt used the hot flat iron on
the thumb in putting the splints on, and that it was so hot that
the thumb was blistered. But from other testimony we find that
this splint-cloth was put on a press-board, or table, and prepared
before attempting to put it on the thumb; and that the Dr. had
to handle it before, and when putting it on. How much more
heat could Dr. Pratt stand, whose hands are tender, than the
boy, whose hands are tough Dr. Wales saw nothing, nor did
he hear of any blistering or burning of the boy. There was no
heating, except to make the splints pliable, before being applied.
Is it reasonable to suppose that Dr. Pratt's hands are harder than
the boy’s, who had been inured to chopping and plowing 2 If
the Dr.’s hands were not burned, it is not likely that the boy’s
thumb was blistered.
It violates human probability to suppose that the boy was
injured by being blistered. Why was there no evidence of such
burning when Drs. Wales and Burbank examined the thumb.
Upon this subject we do not understand that the testimony makes
against the defendant. This statement of this lady witness is
purely imaginary. There is no pretence that the boy suffered any
inconvenience from this alleged burning. It is possible that the
splints were warm enough to make the skin of the thumb red.
(171
If so, this may have been sufficient for the woman to believe that
the thumb was blistered.
I think this will sufficiently account for her statement without
impugning her motives for the strange testimony which she gave
upon this subject. I think I possess a reasonable degree of charity,
and would rather explain her testimony in this way than charge
her with a wilful intention to falsify. When she was testifying I
understood that Dr. Pratt laid the cloth on the thumb, and then
applied the hot flat iron, and thus produced pliancy of the splints.
But subsequent testimony shows that this was done, as before
remarked, on a board or table. But so far as the thumb is
concerned, it was, perhaps, not necessary for me to have said any-
thing, but to call your attention to the testimony of Drs. Wales,
Burbank, Beebe and Ludlam, and that of the father, that they
would not let Dr. Pratt do anything more with the thumb, and
that he never attached any blame to the Dr. as to that thumb.
All the witnesses agree as to the kind of splint applied to the
thumb. Upon this subject there can be no doubt, and there can
be no doubt that there is no testimony showing, or tending to
show, that they were not proper. If improper, it was incum-
bent upon the plaintiff to prove the fact. That this has not been
attempted, is tacitly admitting that they were proper, as we have
proved.
Now, having disposed of this part of the case, we come next to
the wound of the head. We say the treatment was proper. The
wound was healed in a short time. In fact, there is no particular
complaint that the head was not properly treated; and it is not
necessary to spend any time upon this matter.
We will next take up the question of the arm, and as to this, as
well as the thumb, let me say, that I shall contend that the plain
tiff is confined to the allegations of his declaration; that beyond
these he cannot be permitted to go. In the declaration there is
no allegation that there was any unskillfulness, want of care, or
improper splinting, bandaging, dieting or medication. These, I
say I shall contend, are wholly out of the case. The gravamen
of the charge in the declaration is, that the defendant did not
adjust and set the broken bone properly, and that in consequence
thereof, the bone did not, and would not unite; and thereby, and
by reason thereof, the plaintiff has lost the use of his arm, or that,
to speak more closely to the averment, he has been greatly delayed
in the cure and useful restoration of the arm. The only point,
172
therefore, is, whether the usefulness of the arm has been lost, or
the cure delayed in consequence of the broken bone not being
properly adjusted or set, or whether there was not a proper
adjustment of the fragments. -
The plaintiff alleges that there was not. He is bound to estab-
lish by testimony this negative, and we are not bound to prove
that there was a proper adjustment. But not knowing what may
be the charge of the Court upon this subject, I shall discuss the
case upon this theory, and also upon the theory that the whole
field is open to the plaintiff, and that he may ask at your hands,
a verdict on the ground that the arm was not properly bandaged,
or splinted, or in any other respect improperly, or uuskillfully
treated. And I shall claim, and have no doubt I shall show, that
upon no hypothesis can this action be maintained. .
First, then, the fact that they have got to maintain by proof is,
that Dr. Pratt did not properly set, or adjust, the fragments of
this arm bone, or in other words, that he did not properly reduce
the fracture. No other want of care, or skill is alleged. There
is no pretence in the declaration that it was not properly ban-
daged, or that the quantity of bandage was not sufficient, or that
it was not applied low enough upon the arm, or that the arm was
bandaged too loosely, or too tightly, or that there was not put
upon the arm a sufficient number of splints, or splints of the
proper kind or length. No witness has testified that Dr. Pratt
did not properly adjust or set the broken bone. This, it seems to
me, ought to forever end this case, so far as the arm is concerned.
But we have proved by Dr. Wales, who was present, and assisted
Dr. Pratt, that this bone was properly adjusted by bringing the
fragments in correct apposition, and that the arm was well
splinted and bandaged from the hand to the shoulder. That
besides short splints, there were two long splints made by one of
the Morrises, one of which was applied to the back of the arm,
which extended from the point of the elbow to the shoulder; and
the other on the inside, which extended from the bend of the
elbow to the arm-pit; on the top and bottom of the arm, between
these long splints, were placed these shorter ones, which have
been paraded before you on the part of the plaintiff. -
Dr. Burbank testifies that when he examined the arm, some
two weeks after the accident, he found the arm thus bandaged
and splinted. He further testifies that on that occasion he
examined the arm and found the fragments in proper apposition;
173
and that they were particular, and went so far as to measure the
boy’s arms, and found that the fractured arm was of the same
length as the other.
We have, then, established the fact affirmatively, that this arm
was properly set, or the fracture properly reduced or adjusted.
And this is all that you have to enquire about, unless you can be
permitted to go beyond the allegations of the plaintiff. This, I
contend, you cannot be allowed to do. The proof upon this point
annihilates the entire substratum of their case. Without founda-
tion, they can have no superstructure, and the defence is com-
pletely established. - x
However, I will discuss this case as though the declaration was
broad enough to permit enquiry to the extent as now claimed for
the plaintiff, and then we shall find that Dr. Pratt has been right
in his treatment. Take it for granted that he possessed the
requisite amount of skill, and that he did put in proper apposition
the fragments of the broken bone; and that there is mere non-
union; then you have nothing upon which to found a verdict for
a false joint. There is no evidence that the result is the effect of
improper treatment. And we have seen that there might be
union of fractured bone where the parts were not placed in proper
apposition. -
So that the fact of this non-union is not established to have
been eaused by the parts not having been properly put in apposi-
tion. Again, there may be non-union of the bone, or false
joint, where the parts have been put in the most complete apposi-
tion, and kept in this position long enough to have had a most
perfect re-union of the fragments, as a general rule, or even
much beyond this time, and yet union may not take place. So
that we cannot predieate non-union of bone, or false joint, upon
either placing the fragments, or not placing the fragments in cor-
rect apposition. - .
When done, there may be no union, and there may be false
joint. When not done, there may be union of the fragments,
although in this case there would be more or less deformity.
That these results might not follow is not the subject of doubt.
They have not had a single medical witness who has even
attempted to swear that such results might not take place.
If mere non-union or false joint was sufficient to establish the
fact, that the surgeon was unskillful in his treatment, then he
would be liable, although he treated the case throughout with the
j'74
highest skill known to the art. We have proved by our medical
witnesses, and by some of theirs on cross-examination, that there
may be false joint, or non-union of bone, when the fragments have
been put in proper apposition, and retained in this position so
long that it is certain that union will not take place by the ordi-
nary mode of treatment; and when the treatment and all its parts
has been the highest and most approved known to the surgical
art. Something more than mere non-union of bone, or false joint
must, therefore, be shown by testimony in order to maintain an
action against a surgeon. The great fact must be proved, that the
treatment was not what it should have been ; and that such impro-
per, or unskillful treatment might culminate in non-union or in
false joint. In all this proof, the plaintiff has most signally failed.
On the other hand, we have proved that we properly set, ban-
daged and splinted the arm, and pursued the ordinary course of
treatment until the case was taken from us; and this proof of ours
is in no particular done away with, or contradicted. -
The plaintiff’s case rests solely on the fact of non-union of bone.
But why this non-union exists is not made to appear. The fact
that no one can tell why this is so, is not sufficient. There are a
great many facts that we cannot, nor can any man give a satisfac-
tory reason why they do exist. But this inability does not prove
the non-existence of the fact, nor does it authorize us to assign
any particalar reason for the facts, or fact. There is a class of
animals called the polypus, which (it is said) if cut into a thous-
and pieces, each part is replete with life, and becomes a new
animal, like the whole of which it was once a part. The fact
that I do not see, or that you do not see, how this can be, does
not disprove this strange fact. We should endeavor to under-
stand what we know to exist; and we are not authorized to ignore
or dispute the existence of facts which we do not understand.
We know that there is non-union of the bone of this boy’s arm.
We are not to dispute this fact, because we do not understand, or
cannot tell why it is so. While, however, we know the fact of
non-union, we do not know the cause or reason of the fact. No
witness has attempted the task of telling the cause.
When no witness, professional O}” non-professional, has told
you what the reason or cause of non-union is, can you say that
you know the cause? If you know, you have a knowledge not
based upon the evidence, and upon evidence alone you are to
‘AOuxi upo IO “Aoux no& Aoû no& Sist, au Jai ºngſ ‘sºot] ouguayap
175
that there is non-union of this bone, because Dr. Pratt did not
properly adjust it; or because he did not properly splint or band-
age it; or because anything else which he did, or omitted to do,
was improper or unskillful ? I assure you, gentlemen, you do
not and cannot know this fact because of all or any of these
things.
As you do not and cannot know the cause of this non-union,
let me ask you whether you believe that it exists because the
bone was not properly set by Dr. Pratt 2 If you answer yes, I
ask you how comes this belief, when Drs. Wales and Burbank
both testify that it was properly adjusted, and no one swears to
the reverse of this. You must, as reasonable men, say that you
do not believe that this fact exists from that cause. If I ask
whether you believe the cause of this non-union was not properly
bandaging or splinting, still your answer must be, that you do
not. Upon this subject I shall speak more at large hereafter. I
here say, that the extent of their medical testimony is, that they
do not know what was or is the cause of this non-union. And I
do not see why this should not be a sufficient answer to their
whole case, without any other being given. But I shall not stop
here. I shall be able to give you satisfactory reasons, before I
get through, why this bone did not unite, or rather, why it is not
now united. These reasons will be founded on the testimony of
the witnesses—both professional and non-professional. They
show that there was a refracture of this bone at the point of non-
union, after it was once well united, so that the boy could move
the arm in any direction.
The professional witnesses on our side who have spoken upon
the subject, say that this would materially interfere with, or lessen
the chances of re-union. Now, this, of itself, is a complete explan-
ation of this whole difficulty. Dr. Ludlam tells you that if there
was a refracture of this bone shortly after it was once united,
it might not unite under the treatment of the most skillful
surgeons.
I put the question to the surgeons on the other side, whether it
would not make a difference with the proper union in case of
refracture, or whether at this time they could tell that the non-
union of this bone was occasioned by unskillful or improper treat-
ment, or whether they could tell whether the treatment had, or
had not been proper. They answered, that they did not think
that refracture would make much difference. What we are to
176
understand by this much difference, I do not know, but I appre-
hend that it is admitting that a difference might result, but that
they did not know. This is not equal to testimony that it would
make a material difference; nor does it in any way contradict this
testimony; but gives force to it, if it has any effect whatever.
The plaintiff’s professional witnesses all testify that they cannot
tell, by an examination of the arm, what the treatment has been,
or that the present condition of the arm is attributable to unskilf-
ful treatment or want of proper care. This is simply saying that
they do not know what is the cause of the arm being in its
present condition ; but this is far from establishing the fact that
this non-union is the result of lack of skill or want of care in Dr.
Pratt.
Here, again, their case obtains no strength, but remains
unproved. Their witnesses do not pretend that they ean tell
whether the arm had been refractured. I assure you, gentlemen,
that there is no man on earth who, in his normal condition, can,
by an examination of that arm (such as their witnesses have made),
tell whether there had been a refracture at the point of non-union,
nor can he tell by any such examination, what the treatment of
Dr. Pratt was, whether proper or improper—nor what was the
condition of the arm during the period of Dr. Pratt's treatment;
nor whether the non-union was the result of want of skilf and
care upon the part of the defendant, or what is the cause of this
mºno-union.
Ask any man to look at that arm, now—no matter how skillful
he may be, and he cannot tell, from the mere fact of non-union,
whether the treatment has been skillful or not. Most, if not ałł
the professional witnesses on the other side admit this. Had this
case been placed in the hands of the most skillful surgeon, this
non-union might have occurred; so that it does not follow that
the treatment has not been proper or skillful, from the fact of
non-union. You are not to convict Dr. Pratt for what their med:
ical men cannot see, or do not know. He is in no wise liable for
what they do not know. When the attending surgeon or physi-
cian has not been actually guilty of not exercising ordinary skill
and care, he cannot be liable, even on their theory of the case.
Nor can he be convicted of want of proper skill and care when
it is not shown in what that lack of skill and care consisted. We
apprehend that when we show the surrounding circumstances, we
show a reason over and above, and better than their want of
177
knowledge, why this bone should not have united. But when we
get at, and consider the fact, that when re-union had once taken
place, there was a refracture, or loosening of the parts, (it
makes no difference whether you say there was a refracture, or
that the union was loosened,—either shows a rupture of the newly
formed bone,) then the cause of the present non-union of the bone
is still more apparent.
It is also proper that, we should understand what amount of
force would be required to thus loosen the recently united bone.
With this view, I interrogated Dr. Ludlam. He testified that
sometimes it would occur without ańy apparent cause ; that
sometimes a bone may be fractured that was never before frac-
tured, by mere muscular action. And he mentioned the fact,
that he once knew a clergyman, while preaching, to fracture the
humerus by the motion of his arm in gesticulation.
Medical books abound in still more extraordinary cases. If
bone can thus be broken without being previously injured, we
can readily conceive how easy it would be to re-break, or loosen
a bone recently united, as in this case. It is but reasonable to
suppose that it would require but little to produce refracture.
But we have shown that there was something beyond muscular
action to produce the refracture of this boy’s arm. But the ques-
tion may be asked, Was there a refracture ? Mr. Miller could not
deny this, but he says that he thinks there was only a little loosen-
£ng of the parts, but no refracture. This concession is the same
as admitting a refracture. When the parts are loosened all the
troubles of fracture must be expected. -
This admission answers the question whether there was a
refracture, and shows a reason why the bone is not now united.
The gentleman says that I stated, in my opening, that this exter-
nal splint was split, as would be shown to you, but that the proof
shows that it had been split farther up since. I may have said
this, and the testimony may be taken as true. Yet the fact
stands before you, that the splint was split by a fall or blow when
the boy played ball, some nine or ten weeks after he was first
injured.
This splitting is proved by their own witnesses. When the
boy came in from out doors, where he had been playing, as he
went up stairs, his mother (as she says) noticed the splint being
split, being on the outside of the bandages, and fastened at each
end with straps to keep the arm in place.
178
This splint, as shown by the testimony, was not necessary, but
was put on by Dr. Pratt, out of abundant caution. It was so
fastened that it would break before it would let the arm give way.
A fall upon the ground or against a fence post, with this splint at
the angle which was braced across must, almost of necessity, refrac-
ture the arm or loosen the newly formed bone. The young lad
that was playing ball with him says that he threw the ball to him,
and as young Frisby kicked at the ball and bent forward, he lost
his balance and he was thrown against a fence post and hurt
his arm. Of necessity, he must have went against the fence post
with a good deal of force. This must have been the result
from his attitude and motion.
There it was that this arm was hurt and this splint was broken.
The breaking of the splint he admitted to his parents, at least
to his mother. After this injury he went directly into the house,
and as he went in, went up stairs immediately. His mother notic-
ing that the splint was broken, was led to inquire of the boy what
he had done,—but she says that it was not broken, or split as
much then as it is at present; that there was only one crack
instead of the two. But, gentlemen, some of you must have some
mechanical knowledge, and hence, must know that, if that was
broken by a blow at the lower end, screwed and glued together
as it is at the elbow, or angle, it would be impossible to split
it by one crack and not make both. But take one of these splits
and then it must have yielded so much that the arm must have
been refractured. The end is where it received the blow, or
where it came in contact with the fence post, as demonstrated by
the splint.
There would have been no tendency to break on one side and
not on the other by a blow at the elbow. Had the blow been
there, then the lower, instead of the upper piece, would have
been split inwards, instead of outwards, as we find it. The blow
being at the end of the splint, became a lever with the elbow for
a fulcrum, and was amply sufficient to separate the bone of the
arm again. And such must have been the result, had the boy put
forth the arm to prevent himself from falling. You readily per-
ceive, gentlemen, that if this splint was split no more than they
now claim, the arm must have been re-broken, or the newly
formed bone must have been separated by the accident in falling
against the fence post. But I do not see how this splint could
be split on one side, by a blow or fall, and not on the other. If
179
you are mechanics, and by natural philosophy can do this, you
are ahead of my capacity.
You can readily perceive that the injury of refracture must
have occurred whether the splint was split as much as now, or
only so much as they claim. If the arm was not injured in the
way we claim, and to the extent, can you, upon any rational hypo-
thesis, explain why the parents wished to withhold this splint
from Dr. Pratt 2 The reasonable explanation of their attempt to
keep the splint is, that they wanted to keep from the Dr. one of the
instruments of evidence that would injure their chances of main-
taining an action. They must have felt that the injury of the
boy was so great that it was material to keep the evidence of that
injury out of the way. Why was it that the father directed his
wife to keep this splint and not let the doctor have it if called for 2
He knew that this would be tangible evidence of the refracture
which he knew had taken place. Do you suppose that he, or any
of his family had the idea of keeping this splint so that they would
have it to use, should any of them break their arm 2 You can
not believe that this was the object. There was no thought of a
general system of breaking arms in the family. Refusing to let
the Dr. have his own splint, upon any other hypothesis than that
he wished to retain the instrument, which would be evidence of a
refracture, would be palpable folly. I must confess that I can
See no other good reason.
But I readily perceive that the counsel, in the exercise of his
ingenuity, may say that, if this was the object, why did the father
not burn the splint, and thus absolutely destroy this instrument of
evidence, so that it would never appear in court 2 I will tell you
why. He was fearful that should it turn out in evidence, that
they had burned the splint, when we could prove the injury and
fall by the boy who was at play with the plaintiff-he was fear-
ful, I say, that a jury would conclude that the fact of burning was
conclusive evidence of their being wholly in the wrong, and that
an action might more certainly be defeated thereby than by an
exhibition of the splint, with the family to swear that it was not
as badly split by the fall as it now is. In other words, he con-
cluded that the presence of the splint would not operate as badly
as its destruction by willful burning.
It was matter of sagacity in the father to preserve the splint
from destruction. But the attempt to withhold it is very conclu-
180
sive evidence that he was fearful of it as an instrument of evi-
dence on the question of refracture of the arm bone.
It seems to me that their own witnesses conclusively show that
the bone was re-broken ; that their testimony is sufficient to sat-
isfy any reasonable mind of that fact. But we do not stop here:
or at the point of the evidence by young Shaffer.
You will recollect that the testimony unfolds different conver-
sations about the arm being re-broken It was talked of by the
father and mother in the presence of Dr. Belding and Mrs. Beld-
ing. Dr. Pratt and the plaintiff were also present. On this
occasion Dr. Pratt, in alluding to it, said that he had broken the
arm a second time, playing ball; and told him if that was not the
way, to tell how it was ; and the boy said, “That was the way it
was done.” Remember, this was stated in the presence of the
father and mother, and of Dr. Belding and his wife. The two
last named, both testify that this conversation occurred. And
Mrs. Belding testifies, also, that when she was talking with the
mother, remarked that she should think that it must have hurt
him very bad; and the mother replied that he did not complain
much, but she thought that it hurt him more than he pretended,
or would admit. The mother, in this, was undoubtedly right. It
was very natural for the boy not to disclose his feelings after what
he had done, as he undoubtedly thought that he had done wrong,
and that he would get scolded if he owned up fully. We were
all boys once, and then we were shy about disclosing what we
had done. I know that was the case with me when the results
were bad. You are all aware of this disposition in boys. Some
boys would have dreaded a talking to more than others would a
whipping. I do not know how this was with this boy. It is
enough for me to know that it would be natural for him to keep
a knowledge of the worst facts from his parents. If neither the
boy nor the parents anticipated a second breaking of the bone,
why was he so silent, and they so particular to interrogate him
respecting the matter 2
I think the statement of the mother to Mrs. Belding was very
natural; and it was not singular that she should make that remark
on that occasion. Yet she says that she did not make this
remark, nor anything like it, on that occasion, either to Mrs.
Belding or to any one else. She goes further and says that she
did not talk with Mrs. Belding, nor even see her that day. I
mean the day of the consultation over the arm at Dr. Belding's.
181
Dr. Freas does not recollect anything but the bare fact that she
was there on that occasion. But Mrs. Belding recognizes the
mother here in court, as the lady who was introduced to her, at
her house, the day of the consultation, as Mrs. Frisby. She
swears positively to the fact of this conversation. The mother
either has forgotten, or she does not, on this trial wish to remem-
ber. - . .
The fact that Dr. Freas does not recollect hearing anything
about the arm having been refractured, in no sense impugns or
weakens the testimony of Mrs. and Mr. Belding, who testify
that they did hear it. But Dr. Belding and his wife are not the 4.
only persons who have been present when the fact of the re-break-
ing of this bone has been talked of in the presence of the boy, or
of the father, or both. - . .
The young man, Hodgeson, swears that in the conversation
about the boy injuring his arm, at Dr. Pratt's office, the father
made the remark that he did not think the boy had hurt his arm
as bad by putting on his boots as he did when he fell against the
fence, in playing ball. And here, too, the father says, that he never
made any such statement. Do you suppose that this young man
made up this story 2 , -
How unnatural. Why should we believe these denials of the
father and mother, to the exclusion of the testimony of these dis-
interested witnesses. The more charitable view is, that the father
and mother have forgotten. But we cannot, to accommodate
them, believe that young Hodgeson, Dr. Belding and his wife
have all sworn falsely about these conversations. I take it, that
Hodgeson is a young man of fair mind, although he could not
tell much about the sermon, or discourse he listened to some time
ago. But this proves nothing against his capacity to comprehend,
nor against his character for truth. I have known many good
and intelligent people, who, upon returning from church, could not
even tell what or where the text was, much less what the sermon
Wà.S. * - - -
Is it remarkable that this young man, who hears two or three
sermons of a Sunday, should not be able to state much or any-
thing that was said in a particular sermon, and should yet remem-
ber what he testifies Mr. Frisby said at Dr. Pratt's about his boy
hurting himself? Not at all. It is all very probable. Is it not
more probable that he would remember what was said about such
an arm as this, than what was said in a sermon It would be
182
very singular if he did not. He remembered that at church they
sung “Dundee,” and also “ Old Hundred,” which was such a
favorite of Elder Brewster that he expected to hear it sung by
the angels when he got to heaven.
, The counsel was so particular in his enquiries about what
occurred at the meeting alluded to by young Hodgeson, that I
expected to hear him ask the witness to sing one of the Psalms.
That would have tested the accuracy of his statement that he
helped sing, especially, had it turned out that he could not sing.
. Like some persons who claim to have signed documents, as wit-
nesses: we sometimes test them by having them try to write
their names, and find that they cannot do it. But, I ask, do you
anticipate that this young man made up this story 2 Is the story
not probable It is more likely that he should be right in his
recollection of what the father said, than that the father should
be right when he says he did not make the statement. This is a
mere want of recollection, if the father, in this particular is truth-
ful. Want of recollection is not equal, as evidence, to recollection.
The young man recollects the fact and testifies to it.
The boy was present when this conversation occurred, about
his falling against the fence post and hurting his arm, and he does
not deny the fact. Mr. Morris, who was at the neighbor’s, also
heard that the boy had fell and hurt his arm. But independently
of these conversations, the refracture is clearly proven. We
prove by Dr. Wales, that at the end of eight weeks from the time
the boy was first injured the arm was examined in his pres-
ence, and with his assistance, by Dr. Pratt. All the dressing was
removed from the arm. On this occasion the boy could raise his
arm and move it about, Dr. Pratt simply steadying it by taking
hold at the hand to prevent any injury in case the union should
not be so firm as it appeared. There was no action, or motion
at the seat of fracture, but it was intact and firm, with no deform-
ity, but natural. - -
But the counsel asked Dr. Wales how he knew that Dr. Pratt
did not lift when he had hold of the boy's hand P Do you sup-
pose it reasonable that Dr. Pratt would have done this when the
object was to see whether this boy could move the arm by his
own muscular power? We should form the reasonable conclusions
from acts when there is nothing to warrant a conclusion the
reverse of ordinary conclusions. But if Dr. Pratt had raised the
arm by taking hold of the hand, then motion would have been
183
discovered at the point of fracture, if the fragments of bone were
not united. If the Dr. thus raised the arm and no motion was
perceivable at the fracture point, then it is clear that union had
taken place. -
If the boy could and did raise the arm himself, without Dr.
Pratt lifting, then it was also clear that there was union of the
bone. As there was no motion at the seat of fracture on this
occasion, it makes no difference whether Dr. Pratt did or did not
raise the arm, or lift. The lack of motion in either case proves
the union of the bone. It would, however, be passing strange,
that a surgeon should do more than steady the arm when the
object was to test the fact, whether the bone was united. How
are you to account for such an act upon ordinary principles of
human action? Certainly the boy would know if the Dr. raised
or moved the arm. Yet he says nothing of the kind, which he
should, had such been the fact. I assert that no surgeon would
have done any such thing. Had the doctor done this, is it not
very singular that he should have called the mother to see that
the boy could move his arm 2 ſ' ..
He did this, according to the testimony of Dr. Wales; and
when she looked at the arm, it was exposed to the skin, and she
could readily have detected the fact of non-union, had such been
the fact, whether Dr. Pratt raised the arm or not.
Upon any reasonable hypothesis you will have no difficulty in
appreciating the fact that Dr. Pratt did not lift the arm on that
occasion. He must have felt proud of the success of his treat-
ment, and wanted to test the accuracy of his opinion that the arm
was united, by an examination and exhibition of it. He found
the arm in such good condition that he talked of leaving the
splints off; but finally, out of excess of caution, he replaced the
bandage and splints. Even this outer splint was again put upon
the arm, and the boy was permitted to go out of doors. This
was well enough, if the body was properly protected from the
cold, and he was careful not to injure the arm, the fresh air
would be beneficial. How many times he was out of doors
besides the occasion when young Shaffer played ball with him,
we do not know. He may have been out many times before and
after this. The boy was not in our custody, and the evidence of
such facts are, of course, beyond our reach. And we have to pro-
tect ourselves against this false accusation by such incidents as
have come to our knowledge. --
184
One thing, however, is very certain, and that is, that the boy
played with young Shaffer after the examination of the arm, in
the presence of Dr. Wales, when the union of the bone was de-
monstrated. It may have been less or more than two weeks after
that time. We do not know the time exactly. But it could not
have been far from that time. This examination took place about
the twentieth of February, about two months after the fracture.
You will remember that on cross-examination, Dr. Wales says
that he knows the time, from the fact that it was the day he made
a passing visit to Seymour Downs', and that his books show that
that visit was on the 20th of February. And his recollection is,
that it was about that time. - - . .
To contradict Dr. Wales, they call the mother, who says he
never did anything with the arm. Just contrast that statement
with her testimony in chief. She then said that he only occasion-
ally came there and dressed the arm. I asked her if she recol-
lected that he ever came there and dressed the arm, and took the
bandages all off. She said she did not pay any particular atten-
tion; and did not remember that the dressing was all taken off
on any occasion,-sometimes she did not look. How is it possi-
ble to reconcile her own testimony with itself, or with that of Dr.
Wales? She says he did not take any part, or do anything in
dressing the arm. He says he did. Do you not suppose that he
knows what he did in that behalf? They wish to contradict
everything testified to by Dr. Wales. And in a number of par-
ticulars which the court ruled out. They attempt to carry the
joke too far when they put the question to her so as to have her
answer as echo to the question. - . . *
It is probable that she would answer any question put by Mr.
Turner to suit him, when, from the question, she could see what
answer they desired. But is it probable that Dr. Wales would
go upon the stand and commit perjury, by swearing positively to
certain facts if they had not taken place 2 - . . .
I am glad to see that the father and mother prove that they
have an interest in the boy. Still, I think it improper for his
counsel to so interrogate them as that the answer is plainly indi-
cated. Nor do I think such evidence worth much. Such has
been the case, however, of the other side. And they have sought
mere supposition for facts. - . . . . . . . . . .
With what charity I possess I cannot reconcile such statements
as have been made by these witnesses with the ordinary occur-
185
rences of human life. I do not attribute this disposition to a bad,
or depraved nature. It is not necessary that I should. I attrib-
ute it to an undue desire to have the boy gain this case at all
events. In this attempt they have sworn to a little too much for
ordinary credulity; and that, too, in reference to matters which
could not have much, if any thing to do with the case.
I cannot be made to believe that Dr. Wales would swear that
he made the visits and did what he says, unless such were the
facts. He says he was present and assisted Dr. Pratt on the first
occasion. Then in about two weeks from that time.
On one occasion when Dr. Pratt was not there, when he gave
the mother some medicine for a sore throat. That he was there
and assisted Dr. Pratt in examining the arm, on or about the
twentieth of February. He made no memorandum of these visits,
but remembers the number. He also says that he saw the arm
after it was refractured.
You will remember that Dr. Wales testified that he took hold
of the arm and examined it himself at the visit of February
twentieth, and found the bone in proper place and united ; and
that after he had done so, the arm was re-dressed and the splints
replaced. We then have his statement of union of this bone, and
of the fact of refracture.
They wish you to disbelieve Dr. Wales upon this subject, and
believe the mother, who stands contradicted relative to the mat-
ter of refracture, by two other witnesses, namely, Dr. Belding
and his wife. They also want you to disbelieve the witnesses,
Hodgeson and Morris, upon this point. Do you believe that these
five witnesses have all sworn falsely To ask you to believe this,
is asking a great deal, and more, I apprehend, than you will do.
But their anxiety upon this subject shows that they consider the
fact of refracture a circumstance that must weigh heavily against
the plaintiff and strongly in favor of the defendant.
This anxiety is well founded. But Dr. Wales' statement that
he found the arm in proper position on the twentieth of Febru-
ary, is sustained by the testimony of Dr. Burbank, who had pre-
viously examined the arm. He says that enough of the dressing
was removedd, so that he could feel an discover that the fracture
was properly reduced. He did this, and lest there might be a
possible doubt from feeling, he measured both of the boy's arms
from the shoulder to the point of the elbow, and found them both
of the same length. They must ask you to believe, and you must
12
186
believe, that Dr. Burbank and the other five witnesses all swear
falsely to make the shadow of a case for the plaintiff, even if we
were obliged to show affirmatively, that we had properly reduced
this fracture, and had in no respect been guilty of want of proper
care, or skill. I can see no reason or motive for their testifying
falsely. But I say, gentlemen, that, taking the testimony of the
father and mother, about the splitting of this external splint, and
then not more than one case in a thousand could result in any
other way than refracture, or rupture of the newly formed bone.
As I have already remarked, Dr. Pratt seemed to desire that the
boy should correct his statement as to how the arm was re-broken,
when he was playing ball; and told him that if that was not the
way it was done, to state how it was done. And the boy promptly
replied, that was the way. Do you suppose the boy then told a
falsehood, or that he did not know the fact that his arm had been
broken a second time? Now let me repeat, this conversation
occurred at Dr. Belding’s, in the presence of the father and
mother, and of Mrs. and Mr. Belding and Dr. Freas, who says he
does not recollect this conversation, nor has he much recollection
of what was said on that occasion. I do not now recollect that
I questioned the father about this conversation. But I do recol-
lect interrogating the mother about it; and also whether she did
not, on that occasion, converse with Mrs. Belding about the boy
breaking his arm a second time; and she swore positively that
she did not, and further, that she had no conversation at all with
Mrs. Belding, and did not even see her while she was at Dr.
Belding's. Is this woman to be believed when, contradicted by
so many credible witnesses, in preference to them; when no one
contradicts their statements but her alone? It cannot be. Upon
all the evidence there can be no doubt that this arm was broken
a second time. ~
Again, the father and mother testify that the few short splints
which they have paraded in court, are the identical splints that
Dr. Pratt put on the boy’s arm, and their medical witnesses all
testify that they alone would not be sufficient to keep the frag-
ments in place, excepting Dr. Miller—he thought that they might
be sufficient with the external splint. But look at the disposition
of the parents, testifying that these are the identical splints used
on the boy’s arm, without disclosing the fact, that there were also
two other long splints made by the witness Morris—one of which
was put upon the outside of the arm, which reached from the elbow
187
to the shoulder; and the other on the inside, which reached from
the arm-pit to the bend of the elbow.
The making and putting on these long splints we have proved
by too many witnesses to have the fact doubted. It is true, the
mother and the father do not swear that these short splints were
all that were enclosed within the bandage. -
Yet, the only inference that could have been drawn from their
testimony was, that these short splints were all that were put on,
besides the external one. It was a clear attempt to color the
testimony and suppress a fact that would be material to the plain-
tiff if, in the hurry of the trial, we should forget to prove the fact
that other splints were put upon the arm. -
Dr. Pratt has never pretended to think that these short splints
alone were sufficient to properly protect the arm, although, as I
have already intimated, Dr. Miller thought one long enough for
the outside of the arm, and the other for the inside, and sufficient,
with some of the others, for intermediate splints.
If there was no intention to deceive, why were they so particu-
lar to parade and prove the use of these splints, and not bring in
the others, nor say anything about them 2 • *
That is a question, gentlemen, for you to solve. But the young
lady (she will pardon me for calling her young, as ladies seldom
object to being called young,) testifies, that these short splints
were all that were put upon the arm, except the external one.
She is for closing up every avenue. However, I have come to
the conclusion that she was greatly mistaken, although she testi-
fies to the fact with much emphasis. Dr. Wales and the two
Morrises testify to the fact of these long splints (which were made
by one of the Morrises) being put upon the arm, one upon the out-
side and the other on the inside, and of their reaching from the
elbow to the shoulder. This lady is too flatly contradicted by too
many witnesses to be believed. :
But again, Dr. Burbank found these long splints upon the arm
at the time he examined and measured it. He tells you that one
was on the back side, and the other on the inside of the arm, and
he agrees with our other witnesses about their length. Dr. Beld-
ing also testifies that these long splints were upon the arm at the
time of the consultation at his house. *
Here are five witnesses, all swearing positively and affirmatively
to the fact that these long splints were upon the arm. Yet, this
lady testifies that there was another splint on the arm, and it got
188
broke, and Dr. Pratt brought another, and that the father cut it
off by the Dr.'s directions.
We have proved to you how these splints were put on, and that
they were entirely sufficient to keep the parts in apposition with-
out this external splint. Dr. Ludlam tells you that this splint is
of modern invention.
That these other splints which we have proved to have been
put on the arm, were entirely sufficient without this newly invented
splint. The putting on of this angular splint was merely a matter
of extra caution.
Dr. Beebe says the same thing; you cannot believe that all of
our witnesses have sworn falsely about these splints. The entire
medical fraternity testify that splints of the length, kind and num-
ber which we have proved were put on, are proper and sufficient.
Do not do yourselves and Dr. Pratt the injustice to decide other-
wise.
[Here the court took a recess, and upon again meeting Mr.
Knowlton continued his argument.] - a”
Gentlemen of the Jury—At the adjournment of the court, I was
about to approach the subject of bandaging. Upon this subject,
the witnesses on the part of the plaintiff, all agree that the band-
age commenced in the first instance, at the wrist, and was car-
ried, or continued from there to the shoulder. This is all for the
purpose of keeping the bone in place, and the muscles at rest.
When the muscles of the fore-arm, which are connected with this,
the lower portion of the humerus, which was fractured, are suffi-
ciently bandaged to prevent motion, and so as not to disturb the
bone in the fractured portion, it is sufficient.
Some of the time they seem to want to insist, or contend that
there was too much bandaging, and that it was so tight as to turn
the hand black. It seems that Dr. Pratt's attention was called to
that fact, and that he ordered the hand to be rubbed.
The medical witnesses testify that this is not unusual, and that
it sometimes becomes necessary to loosen the bandage on account
of swelling, and that as the swelling diminishes, it can then be
readily tightened. As I understand the point about the band-
aging, they do not expect to make anything out of it specially,
except its necessity to keep the parts in apposition. They have
attempted to prove that the bandaging should commence at the
point of the fingers, and carried from there to the shoulder. I do
not know but they will contend that the arm should have had,
189
like the ancient Egyptian mummies, an envelop of seventy wind-
ings, in order to prevent muscular action. We have proved that
it is not necessary to bandage lower down than the wrist, in order
to prevent undue muscular action. Some authors direct the ban-
daging to commence at the wrist, and others at the fingers.
There is a difference of practice upon this subject among emi-
nent surgeons. The point is not at all settled, so that either mode
cannot be improper or unskillful practice. The point made by
good surgeons is, that the bandaging should be sufficient to keep
the fractured parts in apposition, so that the process of re-union
may go on. On the part of the plaintiff, it is contended that the
bandage should go lower down than the wrist, so as to prevent all
muscular action. Mr. Turner interrogated Dr. Ludlam very par-
ticularly upon this subject, and his answers negatived their whole
theory of bandaging. - * -
Upon its tightness he said, that this could do no harm unless it
materially impeded circulation. That this had not been the case
is proved by the fact, that the external wound at the seat of frac-
ture healed in the usual time. This could not have occurred, had
the circulation been materially impeded. Healing progressed,
and the fragments were found in apposition, or in proper place
when Dr. Burbank examined and measured the boy’s arms some
three or four weeks after the injury. Again, at the end of about eight
weeks after the arm was first set, Dr. Wales testifies that the bone
was properly united. The evidence abundantly shows that the
bandaging was such as to secure all the important objects enumer-
ated as essential. -
It is nonsense, then, to contend that there was not a sufficient
amount of bandage, that it was too tight, or too loose, or that it
was not put on low enough down. What more do they want, or
could they have from bandages than to keep the bones in proper
place and the process of repair to go on ? }
When these are the facts, where is the propriety of contending
that the bandaging should have commenced at the ends of the
fingers? But they say that the old man, Yeoman, testifies, that
on the third of February, the bone was not united, that he then
assisted in holding the arm of the boy. He says that he was behind
the chair in which the boy was sitting, and with his arms around
the body of the boy, he held him to the back of the chair, while
his wife had hold of the boy’s elbow with one hand, and of his
hand with her other hand. That that arm of the boy was bent f
190
to the extent he shows us, which would be an angle of about forty-
five degrees, and that his wife pulled about one hundred pounds.
This he judges from the amount of strength he exerted to keep
the boy up against the back of the chair.
Now, it is obvious that he might have exerted strength enough
to have raised two hundred pounds, or even more, and yet he
could not tell from that whether his wife pulled even one pound
—for the reason that the back of the chair was between him and
the boy, and he may have held him very snugly against this chair
back, when not an ounce was pulled on the arm.
But, further, he shows you that one of the hands of his wife
was under the elbow, as if to hold it up, and the other hold of the
hand of the boy, and that the boy’s arm all this time was at this
angle. Now, gentlemen, if you or any other human being can
tell how it was possible for this woman to have pulled enough
to raise one hundred pounds, with her hands in the position des-
cribed, and that, too, without straightening the arm from the
angle it was in, you can do more than I think is within the power
of mortal man. The thing is a physical impossibility, and that
the old man could tell how much his wife was pulling is a flat
absurdity. - -
He says that he and his wife performed this service to aid Dr.
Pratt in setting the arm—as the bone was then not in the right
place, and that the bone was then set. Now, as to all the other facts
testified to by this witness, and which bear upon this case, I
have, as I think, shown that his statements are flatly absurd.
This being so, I do not see how any confidence can be placed in
his other statements. º . -
But the other side think his testimony very important and reli-
able. Upon the hypothesis that the witness tells the truth, when
he says Dr. Pratt set this arm bone on that occasion, does it estab-
lish anything in their favor, or in ours? Let us consider this.
First, then, he swears that Dr. Pratt set the arm. It is not impos-
sible that the small pieces of bone may not have been in exact
apposition, and needed adjustment. It is this possibility that
renders the statement of the witness probable. If such were the
fact, then the evidence also shows that the surgical eye of Dr.
Pratt readily detected the displacement; and that he immediately
set it, or put the fragments in place, shows his good attention, care
and skill. This witness does not pretend that the bone was not
properly set on this occasion. --
191
No want of skill, no want of care, no want of attention is here
shown, but the very reverse of all of these. We prove, by Drs.
Beebe and Ludlam, that this bone might have been set at this
time, and have become well united by the twentieth of the same
month—that is, in from fifteen days to three weeks. As late as
the third of February the formation of new bone must have been
well under way, and fifteen or eighteen days more might well
make the work of repair complete. It was on the twentieth day
of February that Dr. Wales testifies that he, in company with
T}r. Pratt, examined the boy's arm, and found it well and properly -
united. So that this testimony of the old man Yeoman, if true,
is in our favor, and in no particular against us. This testimony of
our professional witnesses, namely, that this bone may have been
set on the third of February, and firmly and well united on the
twentieth, is not contradicted, nor attempted to be contradicted
by any witness. -
It must therefore be taken as true, as much so as though the
fact had been admitted by the other side. I care not how you
measure this testimony, whether by the Ell-Flemish, or the Win-
chester Bushel. It all ends in the same thing, when contrasted
with the other testimony. * . - e
You may take all the theories and all the testimony about
bandages, splints and everything else, and yet you must conclude
that the bone was united on the twentieth of February, as stated
by Dr. Wales. No one has testified that union was not complete
then, nor that the boy could not then move his arm in any direc-
tion, as Dr. Wales has testified, so that it makes no difference
whether you believe, or do not believe the statements of the old
man Yeoman. If the bone was out of place, it was proper to
put it in place whenever that fact was discovered. From the
testimony I have no doubt that the bone was united on the
twentieth of February, and the attention of the mother called to
the fact, and that she expressed herself gratified. She says she
does not recollect anything about it. Very well, suppose she
does not recollect; Dr. Wales does recollect and swears to it, so
that the fact is established and in no way contradicted.
She says that she never, at any time, saw the arm undone to
the skin, but that she was always present when anything was
done to the arm. They do not interrogate her as to the facts
sworn to by her father—the old man Yeoman, who saw the arm
naked, and could see that one piece of the bone was higher up
192
than the other; and he also saw Dr. Pratt manipulate the arm so
as to get the fragments in proper place. They bring the old man
upon the stand, who swears to a set of facts not maintained by
any other witness—not even by his wife, who tugged at the arm
and pulled a hundred pounds, as the old man says. The mother
always present, and yet not one word from her about this matter
sworn to by her father. There is something singular about this
matter, to say the least. '
The fact that Dr. Pratt manipulated the arm, as stated by this
old man, might well have been done for the purpose of seeing
whether the fragments were in proper place, for it is next to
impossible to get them in exact place.
I now wish to read from page 240 of Hamilton on Surgery.
The reading is:
“At a very early day, so early, indeed, as the seventh or eighth
day the splints should be removed, and, while the fragments are
steadied, gentle, passive motion should be inflicted upon the joint.
This practice should be repeated as often as every second or third
day, in order to prevent, as far as possible, aruchylosis. If much
swelling follows the injury, it is my custom to open the dressings
without removing the splints—on the second or third day after
the accident, or at any time when the symptoms admonish of it
necessity.” -
I also call your attention to the book alluded to by Mr. Turner
last night called Homoeopathic Surgery, 2nd part, page 105:
“The treatment, when the shaft of the bone is broken is sim-
ple. The proper extension has first to be made by drawing up the
wrist or elbow, the fore-arm being about half bent, and the adjust-
ment then accomplished by comparing the length and appearance
of the limb with its fellow. If it be an oblique fracture, great
care must be taken not to let the ends of the bone slip by each
other, and thus render the arm permanently shorter. The mus-
cles materially tend to bring about this result. Have the parts
held, when once in proper juxtaposition, by an assistant, while a
roller is applied, rather loosely from the shoulder. Then place
one splint about a quarter of an inch thick and of convenient
width, so as to cover nearly the whole surface of the arm. Let
them be nearly as long as the humerus itself, the inner one being
a little the shortest, so as to allow the elbow to be bent. Then
continue your roller, bringing it down again over the splints from
one end to the other a sufficient number of times to fix them firmly
193
to the arm, and prevent any motion or contraction of the mus-
cles.”
I do not know why this author is not entitled to as much credit
as other authors. There appears to be a considerable variety of
splints, as well as diversity of opinion, as to which is best; as
well as considerable diversity of opinion upon the subject of
bandaging. The latest, and perhaps the best author we have is
Hamilton.
From all we have been enabled to learn, there does not appear
to be the least want of skill, care, or attention in Dr. Pratt, as to
setting the limb, in splinting, bandaging, or in any other particu-
lar. The fact deposed to by Dr. Wales, that Dr. Pratt made
slight motion of the elbow so that it should not become stiff by
continuing in one position, was certainly commendable practice.
This elbow joint is, to all appearance as good as it ever was. Its
motion is free and perfect. This, with the fact that the arm has
not wasted away, proves that it was properly cared for by Dr.
Pratt while he had it in charge. True, Dr. Porter says the mus-
cles have become relaxed. But Dr. Belding tells you that such
was not the case when he saw the arm in May, on the occasion of
the consultation. This relaxation of muscles is the effect of
abandoning the care of the arm, which was bestowed upon it by
Dr. Pratt. They have left the arm to dangle about without any
splint, bandage or other support of the muscles. Remember that
the longer the arm is left in this situation the more the muscles
become relaxed. Measures should be taken at once to make it a
good arm. *
Had the arm been treated as recommended by Dr. Pratt, the
arm would undoubtedly have been a good one long ago. We
have proved that this can yet be made a good arm, and that the
operation is a simple one, and not very painful.
As to when this angular external splint was put upon the arm,
for the first time, is not positively and definitely settled by the
testimony. The father says it was put on the day after the injury
was inflicted. The mother says she sent the boy after it, and
she thinks it was not put on until the second week. The sister of
the mother puts it at a different time from that stated by either
the father or mother. Here are three persons in the same family
and no two hit upon the same time as to when this splint was put
on. This conflict shows that their statements are not to be relied
upon, because, if so, which is right? We have shown that this
194
angular splint was put on, on account of the restlessness of the
boy, and that it would not have been necessary in an aged person.
All the surroundings show that it must have been put on at an
early period; and such is the testimony of Dr. Wales; and such,
too, is the testimony of Frisby—the father. He says that he
thinks it was put on to take the boy home, but he will not be
positive about it. But Dr. Wales says that it was on when he saw
the boy, on the Tuesday following the Saturday when the injury
occurred.
Some of the witnesses say that there was other protection put
upon the arm when he was taken home. So that there is nothing
to be made out of the pretence that the arm was not properly
protected at the time the boy was removed home. They have
struggled hard to make something out of this point; their load,
however, is greater than Samson’s when he shouldered the gates
of Gaza.
Now, gentlemen, there is another important matter to which I
wish, right here, to call your attenion, and that is, the last started
pretence that the boy’s arm and thumb are incurable, and that
they were rendered so by Dr. Pratt. Now, it so happens that
there is no such testimony. There is not a single witness who
swears to the incurability of either the thumb or the arm. But it
is a waste of time to talk about this thumb, when their own wit-
nesses swear that, at an early day, the parents would not allow
the defendant to reduce the thumb to better position. And, as to
the arm, we have proved by skilled surgeons, that, even at this
late day, there is no difficulty in making this broken arm a good
one. They were evidently aware that this could be done, when
the declaration was drawn, and hence, the cautious language
used in the pleading. In this, they simply aver that the plain-
tiff has been “delayed” in the cure of the said arm and thumb.
This averment of delay is tacitly an admission that the arm and
thumb are curable. To contend that the arm is incurable, and to
recover damages for such incurability, they must aver the fact in
the declaration. This they have not done; and they cannot go
beyond the scope of their own declaration. However, we have
proved that this arm is curable, and no one has sworn that it is
not. The curability of this arm, therefore, stands forth with the
force of an admitted fact. They wish you to give them damages
for incurability, but only allege in the declaration that a cure has
been delayed. -
195
This is the only actionable averment. All the balance is mere
inducement, or mere form. As to the anguish, it is not possible
that there was much. All the witnesses who speak upon the
subject, say that the boy has never complained of any pain from
the outset. Without pain from these wounds, there could have
been no pain and anguish, or anguish alone. ' ' .
Here we have a case of delayed union of the arm bone. In
this state of the case the arm should not be abandoned, but other
means should be resorted to, for the purpose of effecting a cure.
There are a number of methods which surgeons adopt as promis-
ing success. Among these we have proved that of the Seton ;
that of silver, or ivory pegs; that of resection of the bone; that
of acapuncturation. That the three last named at least promise
great success. The mode of acapuncturation is now more gen-
erally called Brainard’s plan. Our professional witnesses have
explained to you, the manner of operating in each plan. We
have also proved that none of these operations are difficult to
perform, nor are they very painful.
We have also proved by the medical witnesses, that no case of
non-union like that of the plaintiff’s should be considered or
given up as incurable, until all these means have been tried and
have failed. No witness testifies to the reverse of this. None of
these last enumerated modes have been resorted to. Yet Dr.
Pratt wished to do so. From the very nature of his employment,
and undertaking, he had a right to resort to any, or to all of
these modes of treatment. They are all recognized by eminent
surgeons as proper; while some prefer one mode, and others
give the preference to a different one. There is a diversity of
opinion which of all the different plans is best. But Dr. Pratt
was not allowed to resort to any of these plans. Nor would
the parents of this boy allow Dr. Pratt to bring a surgeon from
Chicago to perform any of these operations. This he offered to
do, and upon the basis, too, that it should not cost them any more
than as though he performed the operation himself. Dr. Pratt,
however, did not stop here, but he offered to go with them and
the boy to Chicago, and have any good surgeon perform any
operation which might be considered preferable, and that he
would defray his own expenses without charge to them. There
was Dr. Brainard, Dr. Smith, Dr. Beebe, Dr. Ludlam, and Dr.
Boardman,—any one of whom, under this offer of Dr. Pratt's,
they might have had to perform this operation, with no extra
costs except their own traveling expenses. ...’
196
It is not to be doubted, that among the Chicago surgeons
named by me, there are those of skill quite equal to any on this
continent. It is certain that Dr. Brainard has a world-wide rep-
utation as a surgeon. But none of these would do ; none of these
received favor. On the contrary, all were rejected, and the case
was entrusted to Dr. Miller—who, to this time does not appear to
have taken any measures to effect a re-union of this un-united
fracture. At all events, no progress has been made in that direc-
tion.
Gentlemen, what more could be asked of a poor human being
than was done by Dr. Pratt 2 He offered to perform the opera-
tion himself. This was not allowed. Then he offered to have
the operation performed by as good a surgeon as there was in
Chicago, with no additional costs if the operation was performed
here. And if performed in Chicago their own expenses was all
the excess.
Now, gentlemen, I wish to ask you this pertinent question : If
you had a nice surgical operation to be performed, at the same
cost, would you have it done by one of your home surgeons, or
by Drs. Beebe or Ludlam 2 They have all appeared before you,
and you have had an opportunity of forming an opinion of their
capacities respectively. In this list of home surgeons, I do not
intend to exclude Dr. Porter, who, with all his stump speeches
on the witness stand, is chiefest among them all, as Paul said he
was among the sinners. I do not know what you would do, but
if I had such a case I would sooner trust the operation to Dr.
Ludlam or Dr. Beebe than to all the doctors examined on the
other side combined. -
But perhaps some of you would be extreme in your notions.
If so, you might prefer Dr. McPherson, who set there fully five
minutes under the solemnity of an oath, and could not tell where
he graduated. He finally testifies that he never graduated at all.
Did you ever before hear of a person forgetting a fact that never
existed ? º,
He is the surgeon who would resort to friction in four weeks
after fracture, if at that time union had not taken place. Then,
in two weeks more he would try friction again, if he found the
bone had not united. What a surgeon, and what a man l l Their
other surgeons, who have spoken upon the point (except Dr.
Miller, who may be a good practical surgeon), all testifiy that there
can be no union of fracture without provisional callus. I will
197
venture the assertion that these other surgeons took their clue
about provisional callus from Dr. Porter. He leads off, and testi-
fies so positively, and with such emphasis, that there can be no
union of fracture without provisional callus—that the thing was
impossible as to any bone. And he was just as positive that
there could be no provisional callus without inflammation. Inflam-
mation was necessary to produce provisional callus, and provis-
ional callus was necessary to produce union of fracture.
This positive and emphatic manner of Dr. Porter might well
produce the like opinion with these young men who were not
thoroughly posted, and, if possessed of but little firmness, might
be easily led astray. This is rendered probable, as Dr. Porter
ranged out in the most glowing terms about beneficent Nature and
her unlimited wisdom. With such a fulmination they must have
seen and felt that his knowledge was most extensive and accurate,
and that they were ignorant. I venture to assert, that from his
frequent reference to authors, they would take what fell from his
lips as true, instead of consulting those authors. Oh, they are a
hopeful family, as Paine said of the Royal family of England.
Professional gentlemen, who claim to be surgeons, should be
tolerably well acquainted with what is contained in works treat-
ing upon that subject. Here, they all concede, they have to go
to determine the modes of treatment.
Some of these young men, under Dr. Porter's training, would
wait six or seven days after trying friction, and then they would
try it again.
They speak of the seton as one of the plans to be adopted
when the ordinary means have failed, and friction has also proved
abortive. Beyond this they seem to know but little, if anything.
Yet, first class surgeons have other and better modes than the
seton, which has nearly disappeared from practice. Upon this
subject you have the testimony of Dr. Ludlam. He mentions
resection of bone, ivory pegs, and puncturation. He says that all
these modes have merits, and so does Dr. Beebe; and no witness
denies the fact. Which should be resorted to would depend upon
the particular case and its surroundings? In the case of this boy,
Dr. Ludlam says that, in his opinion, the mode of resection would
be the most promising of success of any of the whole catalogue.
And he further says that he has no doubt that the plaintiff’s arm
can be made a good one.
The professional witness from Freeport did not seem able to go
198
beyond the seton and ivory pegs. He seemed to know nothing
about resection or the system of Brainard. I think there is some
opportunity for him to read yet.
Why, gentlemen, you can hardly open a book on modern sur-
gery which does not treat of these different modes of treating
non-union of bone.
That gentleman would try friction, although not so soon as some
of the other of these learned gentlemen. Dr. Miller would wait
eight weeks and then try friction. If no union then followed, I
do not know how soon he would resort to friction again. Very
few of these gentlemen have stated what they would do before
resorting to friction. They thought it a very long period to wait
from the twentieth of December to the last of February, or the
first of March, before resorting to friction. But Drs. Beebe and
Ludlam think from five to eight months not too long. Dr. Lud-
lam tells you that he thinks that a cure is or may be retarded by
this much haste in hurrying the treatment from one mode to
another. He says the test as to when friction or other stronger
modes should be resorted to, is the smoothness of the ends of the
fractured bone, by the growth of a sort of cartilaginous substance
over them; that, rubbing the fragments against each other, non-
union may be detected when no crepitus is discovered, and that,
when this is found to be the condition, it would not be improper
practice to keep the fragments for a time in close contact. So
that in no way that we look at the testimony, can any other con-
clusion be arrived at than that they have utterly failed to show
that this arm is incurable, or that it was not properly treated by
Dr. Pratt, *
You will find that after this case is over they will go to work
and have this arm made a good one. -
This they have delayed for the purpose of getting a verdict of
heavy damages in this action. I insist that on the facts developed,
this action cannot be maintained, inasmuch as that the case was
taken from Dr. Pratt, and he not allowed to do what he wished
to do, namely, try other modes of treatment which promised suc-
cess, and which are regarded as proper by skillful surgeons.
Upon the subject of difference between a simple and a com-
pound fracture, the medical gentlemen on the other side who
speak upon the subject, think there is not much difference as to
the probabilities of union taking place, that is, that union is nearly
as likely to occur in compound as in simple fracture; and some of
# 199
them think there would not be any difference. They do, how-
ever, all admit that a compound comminuted fracture is more
dangerous, and less likely to unite than a simple fracture ; and
that when it is complicated with other wounds, the chances of
recovery are rendered still less certain. While upon this subject,
I again call your attention to the testimony, that the humerus was
fractured transversely above the nutritive foramen, and obliquely
below the foramen, severing one branch of the nutrient artery;
that there was an external wound leading to, or communicating
with the fracture; then there were the wounds of the head, the
thumb and hand. This testimony shows beyond doubt, that this
was a compound comminuted complicated fracture.
Even upon this trial Dr. Beebe exhibited the evidence of the
character of the fracture; and herein are presented the difficulties
besetting, if they should not prevent union.
But under the judicious medication and care of Dr. Pratt, we
find, that after the lapse of eight weeks from the time the injury
was inflicted, all these wounds were healed, and the fracture com-
pletely united. What better results could have been anticipated 2
Obviously, no better could have been hoped for. Subsequent to
this time it was again fractured, or the fresh union ruptured. This
second separation of the parts greatly reduced the chances of
re-union by the ordinary modes of treatment. If the result was
favorable it would be an exception and not the rule.
The probabilities were, that it would not again soon or readily
unite. Dr. Beebe mentioned a case within his knowledge of a
re-fracture of a compound comminuted fracture, where it again
united at the upper fracture, but refused to unite at the lower
point of fracture, within the same time, but was greatly delayed;
and whether it would finally unite was not yet known.
He mentioned another case, which was a fracture of the hume-
rus. In this case there was a re-fracture, and it not only refused
to unite but the whole bone was removed by absorption. A simi-
lar case is mentioned in the books, which has also been alluded
to, but which I will not now take the time to read. These facts
are not denied, and there is no doubt of their truth. There is no
chance for caviling. - -
It is to my mind a very grave question, whether, under the law,
the plaintiff can recover damages for being merely delayed in the
restoration or cure of the arm, which is the only injury complained
of. The father has planted himself on the ramparts of the law,
200
and claims to recover damages for this delay in an action now
pending, undetermined in this court.
If the father is right in his action, then it is impossible for this
plaintiff, who is a minor, to maintain this action. However, it is
quite immaterial what they contend for, as upon no hypothesis are
they sustained by the evidence.
There is another important feature in the testimony of their
professional witnesses. They all know, or have heard something
of provisional callus, or provisionary callus, as Dr. McPherson
calls it. But they appear to be wholly ignorant of any other
callus. r
They know nothing of the humerus being less likely to unite
in case of fracture than any other bone in the human body. Yet,
authors of the greatest merit, say that this is so, and they give
statistics to prove the fact.
Again, these authors say that definitive callus must invariably
form in order to complete a permanent union of the parts; of
this, these gentlemen appear to be ignorant. That provisional
callus is passing away, while definitive callus is forming, is another
thing that these learned gentlemen are ignorant of They go so
far as to deny that provisional callus ever disappears, and say
that it lasts through life, and that, should a man live to the age
of Methuselah, traces of this provisional callus could be detected.
The books teach the very reverse of their doctrine, and Drs.
Ludlam and Beebe both tell you that this is not the case. Dr.
Ludlam tells you most distinctly that provisional callus is being
removed while the definitive is forming; that when provisional
callus is slight it soon disappears; and when there is much of it,
it may last a long time.
Dr. Freas does not recollect whether, as Dr. Belding testifies,
that they found provisional callus or not, on the occasion of the
consultation in May. This consultation was held a long time after
the re-fracture.
Dr. Freas says that Dr. Pratt spoke about the provisional callus
being there at that time, but he does not remember that he men-
tioned it himself, but thinks he did not. Dr. Belding says that
Dr. Freas did mention it, and that it was then perceptible to the
touch. Dr. Miller did not find any when he examined the arm,
which was some time after. I do not remember any other pro-
fessional testimony upon this point. The sum total as to Dr.
Freas is, that he does not remember what he did say, or how the
201
fact was ; while Dr. Belding does remember what the fact was,
and what Dr. Freas said about that fact.
Dr. Freas does not remember whether there were other splints
on the arm than those produced here in court. But he recollects
that there was conversation about splints, and about resorting to
friction ; and that Dr. Pratt had previously tried friction, and was
willing to try it again. Dr. Belding does remember that there
were two other long splints on the arm. This occurred about the
tenth or thirteenth of May, 1863; and the case was taken from
Dr. Pratt on the thirtieth day of the same month.
At this time Dr. Pratt thought a further operation than friction
should be performed, but yielded to the suggestions of others, and
consented to again try friction. Dr. Miller thought an operation
ought to be performed, but advised waiting until cold weather
before proceeding to operate.
They do not deny that an operation should have been per-
formed, as suggested by Dr. Pratt, but they propose to defer this
until this experiment of damages is through with. Then, I have
no doubt, the operation will be performed.
So far as the professional testimony goes to the matter of treat-
ment, I think I have touched upon all that is material, as well as
all that relates to general subjects which are incidentally connected
there with, or at least, that I have done so so far as is necessary
to a correct understanding of the case ; and so far as is necessary
to test the amount of knowledge possessed by the professional gen-
Itemen whose opinions have been given in this case. And for the
purpose of contrast, and of fortifying the views which I have ex-
pressed, I shall hereafter read from standard authors on Surgery.
I now propose to consider the testimony of their professional
witnesses, as to the mode by which the reparatory process is car-
ried on so as to produce union of fracture. And propose to see
how far they are sustained by the authors who are conceded to
be standard authority, in all medical schools of whatever practice.
First, upon the subject of provisional callus. This, gentlemen,
is a book that Mr. Turner seemed to be anxious to show was
orthodox. That it was, we admitted. It is Miller's Principles of
Surgery, and I read now from page 624 :
“In some cases, no splints are required; coaptation being both
effected and maintained by mere relaxation of muscles, and
attention to position; as in fractures of the clavicle and patella.
“Prevention is best achieved by duly carrying out the just
principles of reparation; keeping the fragments rightly adjusted,
13 -
202
preventing motion, and taking care that bandaging is never too
tight at any part of the limb. The limb, it has been stated, is to
be kept in a posture favorable to muscular relaxation, and conse-
quently conducive to the feeling of comfort. Besides, it should
be placed so as to favor venous return, while an opposite influ-
ence is exercised towards arterial influx ; the fore-arm, for exam-
ple, is slung, with the hand raised; and the lower limb is kept
on the same level as the rest of the body, with the foot elevated.
“Undue motion and over eaccitement are the opponents of union,
and either is quite sufficient to prevent it wholly. Inflammation
having occurred, exudation is aplastic, the pouch becomes that of
an abscess, an opening is necessary, the case becomes compound,
and cure may be indefinitely delayed. During the first few days,
it is consequently our object to watch the indications of local
excitement; and to take every precautionary means in our power
to prevent its excessive advancement. At the first, we have con-
tributed much towards the object in view, by gently, yet at once,
effecting reduction and maintaining it undisturbed; the main cause
of inflammation has thus been taken away—and that timously.
Diet is low, yet not strictly antiphlogistic ; unless suspicious
symptoms arise. The bowels are regulated; but purgatives are
never expedient, the manifold motion which they necessarily occa-
sion tending to much injury. In hospitals, the fracture bed is
useful, by preventing evacuation of the rout bowels without move-
ment of the limb. If sensations of heart, pain and throbbing
occur in the part, restlessness (this boy was restless), flushing of
the face, and acceleration of the pulse, blood may be taken from
the arm in the robust and healthy; antimony, or aconite is admin-
istered, (you see this author recommends aconite,) and diet is
brought down to the strictly antiphlogistic scale. And antiphlo-
gistics will be especially active, and early in those cases in which
fracture is in the near vicinity of important parts; as in the case
of the ribs and calvarium. If there be much involuntary spasm
of the implicated muscles, jarring the fragments, opiates may be
useful.
“If the signs of inflammation are distinct and advancing, not-
withstanding the ordinary precautions, the retentive apparatus
must be undone, and discontinued at the part; to admit of leeches
and fomentation. But this casualty is of rare occurrence, in the
simple fracture, when ordinary treatment is duly conducted.
Should abeess form, it must receive the common treatment; an
early and dependent opening. After the first eight or ten days,
the risk of the inflammation may, under ordinary circumstances,
be said to be past.
“Diet, accordingly, is gradually improved ; for it is essential
to maintain considerable vigor in the frame, in order to obtain a
due and early completion of the process of union. And this
ulterior necessity should never be lost sight of, in the earlier part
of the case; more especially when antiphlogistics have unfortu-
nately become expedient.
203
“The retentive apparatus is undone and re-applied, as seldom as
possible.
“At each change, the condition of the fracture should be care-
fully observed ; more especially as regards accuracy of adjust-
ment. If the survey prove satisfactory, the apparatus is simply
re-applied as at first.
“If distortion exists, the splints and bandaging are to be so
arranged as to obviate this ; gradually restoring the normal posi-
tion. At the end of the fourth or fifth week—sooner in a young
and healthy, later in those in advanced years and debilitated
frame—union, to a certain extent, by soft and new formed bone
has occurred; and our substitutes may be discontinued. If a y
oedema exist in the distal extremity of the limb–as sometimes
happens, notwithstanding all our care to the contrary—friction is
to be employed, with continuance of the bandage, uniformly
applied. But so soon as oedema has gone, let all bºndaging be
thrown aside, otherwise atrophy and permanent debility of the
limb may ensue. The joints, by friction and passive motion, are
then gradually brought to their accustomed freedom of play; and
when a joint is in the near vicinity of a fracture, it is well to
practice passive motion of it very carefully, at an earlier period,
at each undoing of the retentive apparatus, that stiffness may be
avoided.
“Use of the part must be resumed very gradually ; more
especially in the lower limbs. Many a fractured leg has been set
free, at the ordinary time, of proper length, and void of all
deformity; which, nevertheless, soon becomes both shortened and
bent, to an extent which impaired both its symmetry and func-
tion. The callus is soft and pliable at first, as has been already
observed; and the motto of the convalescent should be “Festina
lenſe.’” -
Again, this author, speaking of compound fracture, on page
627, says: º
“And the splints and bandage should be so arranged as to
leave the wound capable of being readily exposed, for the pur-
pose of inspection and dressing, without any undoing of the gen-
eral apparatus. At first, antiphlogistic regimen is more especi-
ally necessary than in simple fracture; both the likelihood and
the hazard of inflammation being greater.”
On page 616 this author says: ** -
“The mode of union, or preparative progress, is a subject of
much importance; on the right understanding of which the indi-
cations of treatment depend. It may be conveniently divided
into the following stages; understanding that the fragments have
been duly readjusted and are so retained:
“1. Blood is extravasated at the site of fracture; and, accum-
ulating, disteads the surrounding parts into a kind of pouch, in
which the fractured ends are laid; and the cavity of this pouch,
204
is occupied by the extravasated blood, partly fluid, partly coagu-
lated. The surrounding parts are condensed ; and, obeying the
stimulus of the injury and displacement, become more energetic
in their circulation—prepared for the usual effort in nutrition
which is about to be demanded of them.
“2. The extravasated blood is absorbed ; and the ends of the
fractured bone also undergo alterations, being deprived of their
earthy matter to a great extent, and so prepared for higher efforts
as a vascular tissue. Liquor sanguinis is exuded from the parietes
of the pouch, from the ends of the bones, and from the perios-
teum which invests them ; and this plasma assumes the position
which the blood occupied. The pouch, however, has somewhat
contracted from its first dimensions, by tumescence of the parietes
—favored, or at least permitted, by gradually decreasing extrava-
sation. It has been a source of hot dispute, to determine from
from what tissue this plasma proceeds. Probably it is the off.
spring of every tissue implicated; exuded from bone and from
periosteum, and also from the texture constituting the parietes of
the containing pouch, whether these be muscular, fibrous, fatty,
or areolar. Perhaps it may be held enough for the practical
inquirer, that there is the plasma, come whence it may. The
lasma, having been exuded, consolidates; its serous portion is
absorbed ; the fibrin remains, and becomes organized. And this
organizing plasma not only occupies the pouch, but is also situate
between the fractured ends of the bone, and in their interior. At
the same time, fibrinous exudation is taking place in the soft tis-
sues exterior to the pouch, whereby they are still further con-
densed. A portion of this is imperfectly organized ; and remains for
a time—sometimes of considerable duration. The rest is absorbed
previous to organization, on subsidence of the vascular excitement
by which it was exuded. This is a part of the inflammatory pro-
cess; but only a part. It never raises higher than active conges-
tion ; otherwise the process of repair would be arrested and
wndone.” (This is the very reverse of Dr. Porter's theory, that
inflammation is necessary to the repair of broken bone).
“3. The period of plastic exudation may be said to have
passed, after eight or ten days.
“Then the process of organization advances. The plasma
sometimes passes into the transition state of fibrous tissue; at
others into fibro-cartilage, or even true cartilage. The first of
these is most common in the human subject; the last rare, but on
the other hand, common in the lower animals.
“4. The organized and transetional mase contracts, by inter-
stitial absorption ; increases in density; and gradually passes
into the condition of bone. At the same time, the surrounding
parts, where immediately in contact with the ossifying mass, are
more and more condensed ; they become continuous with the
ruptured and engorged periosteum, and assume the general char-
205
acters of that tissue, as well as its function of investing and
administering to bone.
“5. Ossification advances from the periphery. The most
exterior part of the plasma is that first ossified ; and thence ossifi-
cation gradually approaches the interior. In obedience to the
law formerly noticed, (p. 175), the first act in the process would
seem to be that Cf the parent bone. Nodules of new osseous
matter form on it where, in contact with the ruptured periosteum,
the rough extremities at the same time undergoing an opposite
change; parting with a large share of their original earthy mat-
ter, as already stated. These nodules would seem to constitute
the nucleus or base of the new bony structure; and are found on
each fragment, and on its every aspect.
From these nuclei the ossification advances, and a case of bone
forms on the exterior of the plasma; advancing from each frag-
ment, and meeting near the centre of the space; the ossification
begun by the original bone, continued and maintained by the soft
parts, first, by the original periosteum, and then by the ordinary
tissues, which by condensation and other change of structure,
have come to assume not only the appearance, but the function of
the investing membrane of bone. Where the original periosteum
is deficient, there is no corresponding hiatus in the new bone, as in
the case of necrosis (p. 396); for the ordinary soft tissues are not
in a state of true inflammation, and all their exudation is plastic.
As ossification advances, the mass contracts more and more ;
ultimately forming a firm osseous ferrule, by which the fractured
ends are clasped ; and the continuity of bone is apparently
restored. This ossified mass is termed provisional callus, and
the period of its formation averages from four to six weeks. At
the end of this time, the bone feels firm, for the fractured ends
are tightly held together by the ferrule. It is probable, however,
that between the fractured ends ossification may not yet be com-
pletely accomplished.
6. Definitive callus is that which is formed between the ends of
the bone, and which constitu'es the final medium of incorporation of
the ends. Its organization and ossification are accomplished by a
more slow and gradual process than that of the provisional callus;
apparently in obedience to the general law, that whatsoever is
destined for an enduring existence, is constructed leisurely and
well. By the definitive callus, the ends are firmly glued together ; and
the fracture is truly united. In proportion as construction of defin-
itive callus advances, the provisional callus gradually diminishes by
absorption ; the latter being merely subservient to the former. The
provisional callus, indeed, may be termed nature's splint, whereby
the parts are kept in close and undisturbed contact, until their
real consolidation shall have been completed.
“When tuis has been achieved by definitive callus, all neces-
sity for the presence of provisional callus has gone by ; and con-
sequently it is soon thereafter removed by absorption.
206
Practically, it is important to remember that provisional callus
remains to a certain extent soft and pliable, during the first few
weeks of its existence; not so yielding as to admit of motion
between the fractured ends, under ordinary circumstances; yet,
pliable enough to admit of mal-adjustment being gradually recti-
fied by pressure duly applied ; also pliable enough to permit
serious and untoward binding, if the functions of the part be too
soon and too freely resumed. A broken leg must be warily used,
for some considerable time after apparent consolidation; and a
broken bone anywhere may have its contour remedied, if need be,
by suitable pressure, applied even after the process of reparation
seems to have been completed.
In some fractures, as in that affecting the neck of the femur,
within the capsule there is no opportunity for the formation of pro-
visional callus. The recipient pouch cannot be made ; and there
are no surrounding textures to supply the required plasma. And
this is the main reason why union at that part is so difficult and
rare; the latter and more tedious half of the process only being
obtained. In like manner, the flat bones, more especially the
cranium, have a deficiency of provisional callus. -
“And it is well that such is the all wise-arrangement. For
were a cranial fracture to unite through the aid of a bulging hard
matter on each aspect, the functions of the brain would assuredly
be interfered with to a dangerous extent. In these bones, re-union
7s by definitive callus alone; and this, if the intervening space be not
great, very efficiently repairs the breach; usually at no distant
eriod.
Should, however, the hiatus between the fragments be at all
considerable, Osseous reproduction is incomplete; it advances
only a certain way; and the remainder of the plasma is converted
into a dense fibrous substance.
Sometimes this fibrous re-union is desirable rather than other-
wise, as in the case of the patilla.”
On page 663, on the subject of displacements, this author says:
“Occasionally it is found very difficult, notwithstanding every care
to keep the bone in opposition ; muscular action being constantly at
fault.
“Under such circumstances, it has been proposed, and not
unreasonably, to have recourse to tenotomy. For example, in
fractures of the leg, which may not otherwise be kept duly
arranged, subcutaneous division of the tendo Achillis may be
practiced ; with immediate and decided advantage, as regards
the fracture, and with impunity as regards any ulterior result.”
Upon the subject of false joints, ununited fracture, and dis-
wnited fracture, Miller, page 629, says:
“A fracture may fail to unite from various causes.
“l. If motion be permitted, and still more if it be made
daily, or even occasionally, the formation of provisional callus
207
will be disturbed, and the definitive is likely to be altogether frus-
trated ; the part will probably remain pliable.
“2. Or the parts may be duly adjusted and retained, and
re-union may fail by excess of the inflammarory process, in any
way induced; true inflammation being quite as adverse to the
process of healing in bone, as it is in a wound or ulcer of soft
parts.
“3 From constitutional defect, or atmospheric accident, there
may be a want of effort in the part; plasma is deficient; and
what is produced is but imperfectly organized ; just as indolent
ulcer of the leg refuses to heal.”
Next of disunited fracture.
“A fracture, having been consolidated in the ordinary way,
may again become loose and movable. This may be the result of
fresh mechanical violence, occasioning immediate disruption of
the connecting medium.
“Or it may be a more tardy but equally certain process, the
result of inflammation; induced by a less degree of external vio-
lence, or by any other cause ; as a wound, recently united by adhe-
sion may be made to gape wider than before, by accession of
inflammation, suppuration or ulceration.
“The false joint which results either from disunited, or from
wn-united fracture, bears no true resemblance to normal articula-
tion. There is neither articular cartilage, nor synovial apparatus.
“The ends of the bone taper somewhat, and are rounded off;
they are invested by a dense fibrous expansion; and by a similar
texture of less density, they are joined together. º
“To undo the apparatus of a fractured limb, at the end of four,
five, six, seven or eight weeks, is no demonstration of the expected
union having altogether failed. It may be that the formation of
definitive callus is yet in progress; and, if undisturbed by move-
ment of the limb, this may be completed in no unreasonable time.
The provisional callus has, doubtless, failed; but in truth, this is
not essential to osseous re-union. When it does exist, it is but a fer-
rule or clasp, tightly embracing the broken part, rendering it
immovable, and seeming to restore its actual continuity, as a like
binding agent may give continuity to two pieces of wood and
make them one. But, so far as the binding agent is itself con-
cerned, there is as little actual restoration of continuity of texture
in the bone as in the birch.
“Provisional callus only enacts the part of a steady splint,
until the process of true consolidation has been completed by
elaboration of the definitive callus, whereby there is, as it were,
an interweaving of texture between the broken ends. It takes
some time to construct this splint, and to apply it with due tight-
ness; four, six or eight weeks, as may be. During its construc-
tion it is necessary to steady the parts by external means; and
that is the province of the surgeon.
208
“After it has become firm in itself, and tightly applied to the
bone, then it is capable alone of restraining motion, so as to per-
mit of true consolidation of the broken ends; and the surgeon’s
splints may be now taken away. In short, under such circum-
stances, there are three distinct means towards the final cure :
1. Surgical splints to steady the parts until provisional callus is
formed and completed. 2. Provisional callus, or nature’s splint,
to secure perfect immunity from motion, until the definitive callus
has been constructed. 3. This definitive callus, by whose gradual
elaboration and modification, true continuity in every part of the
texture is ultimately restored. When No. 2 is furnished, No. 1
is useless, and is taken away by the surgeon’s hands; when No.
3 is complete, No. 2 is removed by the busy labor of absorption;
No. 3 remains, but is ultimately much modified also by absorp-
tion. Neither No. 1 nor No. 2, however, are absolutely essential in
themselves to the formation of No. 3 (p. 619); and if No. 1 be
present, No. 2 may all the more be dispensed with.
“Of the series, the only one which is truly essential is the last.
Bones may knit by provisional callus, though no surgeon is by,
and no splint is applied—though not so well; and they may also
wnite—pºn hºps not much after the ordinary period—though pro-
visional callus may have proved either faulty or altogether de-
..fective.
“That is, union may take place, independently of the splints,
both of the surgeon and of nature. Flat bones, such as the cran-
ium, nonife mainly, if not solely by definitive callus; and fractures
of the neck of the femur, within the capsule, if it unite at all, can
do so in no other way. The process of union, no doubt, is favored
by the presence of both splints in due succession, first the sur-
geon’s and then that of nature; but still it may be completed, in-
dependently of one or other of them, or of both.
“Supposing then, that on removal of our splints, at the end of
the accustomed period of probation, we find the broken ends
still movable on each other, it is manifesſly our duty to re-apply the
retent 've apparatus with still greater care than formerly, and to
heep it so applied for a considerably greater period than was at first
contemplated, it having now a new duty to perform ; not to keep
the parts steady till provisional callus clasps them tight; but to
take the place of this callus and to keep the parts steady for a longer
period than before, so that the definitive callus now supposed to be
in progress, may duly advance to completion.
“And not until a reasonable period of probation—say four, five,
or six months—for the construction of this, the essential part of
the uniting process, shall have passed away does the surgeon
abandon either the careful use of his simple retentive apparatus, or
the hope of cure.
“In regard to this form of “un-united fracture,” there need be
no two opinions as to the right mode of treatment; namely, to put
up the limb afresh, to keep the parts immovable, and to maintain
209
the general health and powers of system, in as vigorous a condi-
tion as possible. Starch splints are here extremely suitable. At
the same time, the general health is attended to ; diet is generous
and stimuli may also be necessary—to maintain energy of system
for duly sustaining iocal repair.
“But when, at the end of four, five, six months, or more, we find
the limb still loose and movable at the site of fractute, it is a sign
that the ordinary process of re-union has failed in all its parts.
And the same conclusion is forced upon us in cases of an earlier
date—six or eight weeks only, it may be, after the accident-in
which mobility is great, in which a space, defective in everything
like restorative means, can be felt between the ends of the bones,
and in which these can be plainly felt blunt, tapering, and rounded.
In such cases it is that difference of opinion prevai's as to the
best modes of treatment, and latitude exists as to their selection.”
Speaking of the different modes of strong treatment, on page
632–first of “subcutaneous incision,” he says: f
“My experience, as far as it goes, speaks in favor of the pract
tice. Lately, this method succeeded, quite beyond my expecta"
tion, in consolidating an un-united fracture of the humerus, which
had sustained compound injury, about ten months before. The
bones over-lapped, and could not be adjusted. Altogether the case
was so very unpromising as led me to remark, while performing
the subcutaneous puncture, that it was an unfair test of the prac-
tice ; and that, under such circumstances, a successful issue could
hardly be expected. Yet, on the first undoing of the splints, five
weeks after the fracture, the parts were found quite firm. (Note 2.)
“It is surely better than—though somewhat like—the practice
of John Hunter, whose treatment of an un-united fracture of the
humerus, Mr. Samuel Cooper tells us, was as follows:– There
was an artificial joint, and he made an incision into it; and then
having introduced a spatula, he irritated the whole surface of the
artificial joint. This brought on considerable inflammation, which
ended in anchylosis, and the patient was cured.’
“White's severe operation of cutting down and sawing off the
ends of the bones, was not only hazardous to life, but not unfre-
quently failed to accomplish the end in view; in some cases it
proved fatal. Dr. Physick’s seton is less formidable than the
saw ; but chance of failure with it is not slight, and in fractures
of the lower eactremity, indeed, its success may be regarded as
only the exception to the rule.
Dieffenbach exposed the bone by incision, drove a peg of ivory
into each extremity about half an inch from the line of fracture,
and then by wire firmly and closely connecting the two ; expect-
ing that the foreign body would rouse a plastic exudation which
would abundantly suffice for consolida ion of the fracture now so
accurately retained. Experience has spoken favorably of this
practice; an Ossific process being established similar to what
210
takes place in necrosis. Should the method by seton be preferred
a caoutchouc tape, or skein of silk or cotton, is inserted between
the ends of the bone, and permitted to remain there for some days,
until sufficiency of plasma has been exuded around in the shape
of the organizable fibrin which always attends more or less on the
lodgment of such a suppurative agent.
“On the whole, perhaps the following statement will express
the right sequence of practice. In recent and favorable cases,
place the limb in strong bandages with or without subcutaneous
puncture.
“In more advanced and determined, but yet favorable cases,
employ subcutaneous puncture, freely, and perhaps with repetition.
In the least favorable cases—more especially if these other means
have failed—employ either the Seton or the ivory pegs.” Page
634, Miller. {
You will observe that this author does not speak favorably of
re-section of bone, while Gross does. I shall hereafter read to
you from this author upon the suºject.
Eminent practioners and authors differ very much as to which
is the best mode of treatment when the ordinary means fail. And
even in some matters of ordinary treatment they differ somewhat
—particularly upon the subject of bandaging, the most eligible
kind of splints, and the effect of motion, as conducing to, or inter-
fering with the re-union of bone. As you have already seen, this
author, Miller, is against permitting any motion of the fractured
limb. He makes no distinction upon this subject between differ-
ent bones, while Hamilton (who is, I believe, the latest writer of
any note that we have, and very eminent in his profession) does.
And upon this subject and other matters I now read from Ham-
ilton, commencing on page 64. He says:
“In order to hasten the consolidation when it is simply delayed,
we resort to all of those expedients which are calculated to invig-
orate the general system ; and for this purpose the employment of
a nutritious diet and the use of mineral or vegetable tonics may
not be properly omitted; that in our experience nothing has proved
so efficient as encouraging the patient to leave his bed and get
out into the open air; for which purpose, if the fracture is on the
lower extremities, crutches will be necessary.
“As local means we may enumerate, first, the removal of these
local causes which seem to have interfered with the consolidation
or with the union. If the fragments have been officiously dis-
turbed, it may be sufficient to impose upon the limb absolute rest
for a certain length of time; and the fragments may be more
closely pressed against each other; in other cases it will be .
found necessary to expose the limb freely to the light and air at
211
least once or twice daily, and to rub it gently with the dry hand,
or with some moderately stimulating oil, so as to induce a more
healthy condition of the soft parts, and encourage the natural
circulation.
“Moving the fragments freely upon each other, sufficient to
determine a degree of excitement in the adjacent tissues, and upon
the opposing surfaces of the bones, and then confining them during
one or two weeks in firm and well fitting splints, will often suc-
ceed when other means have failed.
“Indeed, I may say that by one or another of the simple
methods now enumerated, I have never failed, sooner or later, to
effect consolidation in recent fractures; and it has only been in
fractures of at least four, six or eight months’ standing, that I have
been compelled to resort to more extreme measures.
“As a means of combining immobility with compression and
healthful exercise, the “apparatus immobile,” in many of its forms,
is peculiarly adopted. White, of Manchester, employed a firm
leather sheath for the thigh. H. H. Smith, of Philadelphia, recom-
mends a more complex artificial support, upon which the limb
may be allowed to rest while in the act of progression. With
some surgeons the object of allowing the patient to walk in frac-
tures of the thigh or legs is chiefly to excite, in the tissues adjacent
to the seat of fracture, some degree of inflammatory action, but
which, as the result in one of White's patients was sufficiently
shown, may be carried too far, and even determine a suppuration.
Blisters, mustard cataplasms, the tincture of iodine, caustics, &c.,
applied externally over the seat of the fracture, can have no other
effect than to increase moderately the congestion of the tissues,
and in so far this may aid in the accomplishment of the bony
union ; but in this respect they are inferior to the violent twist-
ings, or flexions and rubbings of the broken ends of which we have
already spoken.
“Electricity was first employed by Mr. Birch, of Tondon, but
Dr. Mott obtained no effect from it in two cases where he stems to
have given it a fair trial. Lente, of the New York Hospital, has
more recently furnished an account of three cases treated in that
institution by electricity in connection with acapuncturation ; the
mode of using which was to pass a needle down to the periosteum
on each side of the bone, and to attach the poles of the battery to
these opposite points. Lente thinks that electricity, employed in
this way, is much more efficient than when the poles are merely
applied to the surface. He informs us also that other cases than
these now reported, have been treated successfully in this hospital
by means of electricity.
“Mercury, urged to ptyalism, will no doubt, prove serviceable
occasionally by virtue of its powers as an anti-syphilitic, but its
beneficial influence in other cases is far from having been estab-
lished.
“The seton is said to have been first suggested by Winslow, in
212
1787; but what is of much more consequence, the credit of its
first successful application, and its general introduction into prac-
tice, is due to Dr. Philip Syng Physick, of Philadelphia, by whom
it was employed in 1802.
“Physick used for his seton, generally, silk ribbon, or French
tape; and this he introduced by means of a long seton needle
between the ends of the fragments. He recommended that the
seton should remain in place four or five months, and longer if
necessary, and it was his opinion that the failures were generally
due to its being removed too early. At the present day, however,
surgeons who employ the seton think it serves its purpose better
where it remains in place but a few days, not longer, perhaps, than
ten or fifteen, always taking care that it is removed before exces-
sive suppuration is induced. It has been found especially valuable
in fractures of the inferior maxilla clavicle, and upper extremi-
ties generally ; but in case of the femur, it has so frequently
failed, that Dr. Physick himself did not recommend its use.
In case the seton cannot be passed directly between the
opposing fragments, as recommended by Physick, we may adopt
the practice suggested by Oppenheim, and carry the setons, one
on each side, close to the bone.
“Somme, of Antwerp, preferred a loop of wire to the silk seton
employed by Physick. Sarig passed a ligature around the liga-
mentous mass connecting the two fragments, and then proceeded
to tighten the ligature until it fell off. Dr. Hulse, of the U. S.
Navy, employed stimulating injections with success in a case of
non-union, accompanied with an external and fistulous opening.
In 1848, Dieffenbach recommended that ivory pegs be introduced
into holes previously made in the bone by means of a gimlet or
drill; and Mr. Stanby has succeeded once by this method. Mal-
gaigne, in 1837, tried to introduce acapuncture needles between
the ends of an un-united fracture, but although he thrust the
needle down to the bone thirty-six times, he was unable to make
it pass once between the ends of the fragments. Niesel succeeded
better. In a case of un-united fracture of the ulua of nine weeks’
standing ; having passed two needles between the fragments at
the end of six days the needles being removed, consolidation
rapidly ensued. This practice does not differ essentially from the
metallic loop of Somme. It is only a modification of the seton.
“Brainard, of Chicago, has attempted to show that setons of any
kind, whether of wood, ivory or metal, placed in contact with the
bone, occasion absorption, caries and necrosis, but that they
never directly give rise to bony callus; and that the occasional
success of the seton, which success he believes to have been
greatly exaggerated, has not resulted from any tendency to favor
the formation of callus, but from the induration and tenderness
of the soft parts, produced by it; circumstances which, by con-
ducing to rest, indirectly favor the consolidation.
213
“In May, 1848, Miller of Edinburgh, reported five cases treated
successfully by subcutaneous puncture. The operation consisted
in passing the point of a needle or small tenotomy bistoury down
upon the ends of the bone and freely irritating the surfaces at
several points. George F. Sandford, of Davenport, Iowa, has
successfully imitated this practice in two cases.
“Brainard employs for this purpose a strong metallic perforator,
consisting of a handle, into which points of different sizes may be
inserted, and which have been hardened so as to penetrate the
hardest bone, or even ivory, in every direction easily. The points
are “somewhat awl shaped, but more pointed in the middle rather
than like a drill, which leaves chips.” His manner of using this
instrument is as follows: In case of an oblique fracture, or one
with overlapping, the skin is perforated with the instrument at
such a point as to enable it to be carried through the ends of the
fragments to surround their surfaces and to transfix whatever tis-
sue may be placed between them. After having transfixed them
in one direction, it is withdrawn from the bone, but not from the
skin, its direction is changed, and another perforation made, and
this operation is repeated as often as may be desired. Dr. Brain-
ard, who has already succeeded by this procedure in a number of
cases of un-united fracture, thinks it is better to commence in most
cases with not more than two or three perforations, in order that the
effect produced shall not be too severe. It is scarcely necessary
to add that, after the punctures have been made, the limb should
be put completely at rest in appropriate splints or in apparatus of
some kind.
“Scraping or rasping the ends of the bones is a practice which
dates from a very early period. Mr. Brodie scraped the ends of
the bones, and then interposed a bit of lint ; Mayor, in 1828, con-
trived to introduce an iron, previously heated in boiling water,
through a canula, and thus brought heat to bear directly upon the
ends of the fragments, and by repeating the application several
times a cure was effected.
“Re-section of the ends of the bones first brought into notice by
White, of Manchester, in 1760, and opposed by Brodie as danger-
ous, and by Malgaigne regarded as generally useless or unneces-
sary, has still been practiced a great number of times with more
or less success. It is especially applicable to superficial bones, and
in cases where the bones overlap.
“Roux practiced resection in one instance and then managed to
engage the point of one of the fragments in the medullary canal
of the other. 4.
“White, of Manchester, Henry Cline, of London, Hewson, of
Boston, and Norris, of Philadelphia have applied caustics directly
to the ends of the fragments, after having exposed them by a free
incision. Pelit applied the actual cautery.
“Tying the fragments together by means of metallic ligatures, is
as old as the days of Hippocrates; but in 1805 Honore adopted
214
the same procedure in a case of un-united fracture. J. Kearney,
Rodgers, Mott and Cheeseman, of New York, Flautert, of Rouen,
and N. R. Smith, of Baltimore have repeated the operations with
complete success. The operation is not, however, without its
hazards. Norris has seen one case in which a broken patella
was wired together and a fatal result followed on the fourth day.
“Finally, having thus brought rapidly before us all of the various
modes of treatment which have been suggested and practiced
for the non-union of broken bones, we are prepared to affirm the
following conclusions or summary of what we believe ought to be
the general course of procedure in these cases.
“First, Improve the general condition of the system.
“Second, Remove, as far as possible, the localimpediments, such
as a separation of the fragments, local paralysis, local scurvy re-
sulting from long exclusion from light and air, congestions, &c.
“Third, Increase the action of the tissues immediately adjacent
to the fracture, upon which tissues rather than upon the bone, as
Malgaigne thinks, the formation of callus depends. A theory
which, as applied to old and un-united fractures, we are not pre-
pared to deny. This may be accomplished by friction, and violent
flexions of the limb at the seat of the fractures; possibly in some
measure by the application of vesicants or of other stimulants to
the skin itself. ;’ -
“Fourth, Employ again compression, and rest from a period of
from two to four or eight weeks.
“Fifth, Resort to the practice recommended by Brainard, namely,
perforation of the soft parts and bone with an awl.
“Sixth, If in the lower extremity, allow the patient to walk ,
about after the plan of White or Smith. !
“Seventh, If the fracture is not in the femur, and as an extreme
measure, employ theseton.
“Eighth, Re-section is applicable only to superficial bones, and
in cases of overlapping.
“When these measures have failed, after a fair trial, we should
either abandon the case as hopeless, only supporting the limb by
such apparatus as may be found most serviceable, or we should
recommend amputation.”
You see that this author is very critical upon this subject gener-
ally. And upon the subject of treating the fractured humerus,
he is probably the most accurate of any author. Upon this subject
I read from his work commencing on page 224. He says:
Fractures of the humerus—causes.--In a record of eighteen cases
in which the cause of the fracture is stated, I find this portion of
the shaft broken, from direct violence eleven times; from indirect
blows, the concussion being received upon the elbow, twice;
once it was a consequence of tertiary lues, once it occured during
birth, and three times in the same patient it has been broken from
215
muscular action alone, each consecutive fracture occuring at a
different point. The records of surgery furnish many examples
of fractures of the shaft of the humerus from muscular action, as
in throwing a stone, or a snow ball; but the most singular exam-
ples are those in which the bone has been broken in a trial of
strength between two persons, by grasping the hands, palm to
palm, with the elbows resting upon a table, and twisting, when
the humerus has suddenly given way a little above the condyles.
I have seen one case of this kind, which was under the
care of Dr. Winne; and Malgvogne has collected five other simi-
lar cases, two of which were reported by Lonsdale.
“The example of fracture during birth, to which I have referred,
occurred in a healthy female child, whose parents were also
healthy. The mother was in labor six or eight hours, but the
labor was not severe. She was attended by a midwife, and does
not know whether violence was employed or not. Dr. Lock-
wood, of Buffalo, was called on the third day, and found the arm
broken a little below its middle, and moving as freely as it did at . .
the elbow joint. He applied lateral splints, with bandages, &c. I
saw the child, on the seventeenth day after its birth, with Dr. Lock-
wood. There was then a perfect ferrule of ensheathing callus sur-
rounding the fragments, and which, owing to the softness of the
flesh, could be easily detected and defined. The fragments were
firm, and had been at least three or four days. Nearly a year
after, I again examined the arm, and could not discern any traces
of the accident.
“Dr. Lowenhoutt has also reported a case in which the evidence
was conclusive that the fracture was caused solely by the contrac-
tions of the luterus, which forced the arm against the pubes, the
arm being heard distinctly to snap when it was passing this point,
and while the hands of the accoucher were not aiding in the
delivery. In that case the humerus was broken in its upper third.
“Seat and direction of the fracture.-The seat of the fracture is
more often below than above the middle of the bone ; thus, I have
found thefracture eight times near the middle, and the same number
of times below the middle third, but only seven times above the
middle third. The observations of Norris, who found four fractures
of the shaft above the middle and nine below, correspond with
my own ; but M. Guereten, in the same number of fractures, found
nine above the middle and four below. The line of the fracture
is generally oblique, but more often transverse than in the frac-
tures of the clavicle, femur or tibia. -
“Displacement.—The direction of the displacement depends, no
doubt, sometimes upon the precise point of the fracture and upon
action of the muscles operating upon the two fragments; thus, if
the fracture takes place just above the inscrion of the deltorid,
the lower fragment is liable to be drawn upwards and outwards,
in the direction of its fibers, while the upper fragment is carried
toward the origin of the pectoratis major, &c.; but, in a great ma-
216
jority of cases, the influence of these muscles is more than coun-
ter-balanced by the direction of the force and by the direction of
the fracture. Practically, therefore, it is seldom of much impor-
tance to determine the exact point of fracture, as to whether it is
just above or below the insertion of a particular muscle; nor in-
deed is it generally very easy to ascertain this point with much
precision. The amount of displacement varies considerably in
different persons, and in fractures at different points, but it will
average about three quarters of an inch. When the fracture is
produced by muscular action alone, it is generally transverse, and
displacement seldom occurs. Such was the fact in every instance
when my own patient broke the arm three times consecutively at
different points, and union was speedily accomplished, and with
no deformity. Dupaytren, however, saw a case which constituted
an exception to this general rule. The fragments became com-
pletely separated, and were so movable that union could not be
effected, and he was compelled, after three months, to resort to
resection.
“Results.-In twenty-three examples, the average shortening is
about one quarter of an inch, but of these, thirteen are not short-
ened at all, so that the average of shortening in the remaining
ten is three quarters of an inch, the amount of overlapping vary-
ing from one quarter of an inch to one inch and a quarter.
“In thirty-one examples, I have twice seen the humerus refuse
to unite, once when the fracture was in the lower third of the shaft.
This was an oblique compound fracture, and no union had taken
place at the end of five months. The man was intemperate, but
in pretty good health. In the second case the fracture had occur-
red a little below the middle of the bone, and it was simple. Five
months after the accident this patient consulted me, when I found
the elbow enchylosed, the fore-arm being fixed at right angles
with the arm. Neither of these patients had been under my care
previously, but I learned that an intelligent Canadian surgeon had
treated one of them, and the other had been seen and treated by
several surgeons. -
“In two other cases the elbow remained somewhat stiff a long
time after the splints were removed; in one case, complete free-
dom of motion was not restored at the end of fifteen years.
“Generally, however, the motions of the elbow joint have been
very soon restored after the removal of the splints and sling.
“I ought to mention that not unfrequently, fractures of the
shaft of the humerus, and especially when they are occasioned by
dead blows, are followed by great swelling, and sometimes by
abscesses. In one instance, the fracture having taken place
within the insertion of the deltoid muscle, the sharp extremities
of the lower fragment was made to penetrate the flesh, causing
an abscess and finally titanus, of which my patient soon died.
“The following remarks of Malgaigne are too pertinent to be
omitted in this connection. When there is obliquity with
217
overlapping, or a fracture with splintering, or a multiple fracture,
a certain amount of deformity is inevitable, and the formation of
callus demands one or two weeks more. With the inflammation
comes also the danger of suppuration, and, later, a rigidity of the
articulations difficult to dissipate. In short, we must not forget
that of all fractures, those of the humerus are most liable to fail
of consolidation. - -
“On the other hand, we shall find in the case of this bone, as
in all others, some remarkable exceptions when, although the
fracture may be compound and badly comminuted, yet the limb
has been saved and made useful. Ayres, of New York, reports
a case of this kind, in which he removed a portion of shaft; and
although the brechial artery was probably obliterated, a good
union took place; and Walker, of Boston, has noticed two or
three similar examples. For an account of the remarkable cases
of compound fracture of the shaft of the humerus, illustrating the
powers of nature in childhood, in the restoration of broken and
comminuted bones, the reader may consult, in the New York
Journal of Medicine for November, 1864, a paper entitled, “Am-
putations and Compound Fractures,” by John O. Stone, Surgeon
to Bellevue Hospital. The accidents occurred in children, one of
whom was four, and the other six years of age, both of whom
recovered with useful arms.
“Treatment.—(Shows the jury a plate.)—‘You see, gentlemen,
by the plate that the bandaging commences at the hand, and not
at the ends of the fingers. This is the mode which Dr. Pratt
adopted.” [Reads.] In the treatment of fractures of that portion
of the shaft of the humerus under consideration, I have preferred,
generally, a broad, thick splint of gutta percha—felt or sole
leather may answer nearly as well—sufficiently long to extend
from the neck to the wrist, moulded accurately, and applied to
the outside of the shoulder and arm, while the limb is flexed to a
right angle, and while the extension is being made upon the
humerus. This being properly padded, and secured in place by
rollers, I place the arm in a sling beside the body. The sling
must, however, be so arranged, by being looped under the wrist,
and not under the elbow, as that the weight of the elbow and
lower part of the arm may aid in making extension. Welch's
splint will answer the same purpose; or these splints of different
lengths may be used, but I do not find them so convenient as
Welch's, or gutta percha, applied as I have directed done.
Other surgeons have sought to make permanent extensions in
certain other fractures of the humerus, by various contrivances.
Mr. Lonsdale constructed an instrument which might be length-
ened or shortened to suit the case; it was made of steel, and was
worked with a screw operating upon cogs in a sliding bar, resem-
bling in some respects the arm portion of Jarvis’s adjuster. In
the second London edition of a series of plates illustrating the
action of the muscle in producing displacement in fractures, by
14 *
218
S. W. Wind, is a drawing of an apparatus invented by the author
for the same purpose, which is very simple, and in some respects
more complete than Lonsdale’s, and which may be easily adapted
to almost any form of arm-splint. Indeed, nothing more is neces-
sary than to attach to the ordinary long splint a moveable crutch.
“I believe that all these contrivances may prove occasionally
useful, but the common experience of surgeons has shown how
difficult it is to accomplish much extension by means of pressure
in the axilla; a mode, too, which I think must tend to displace
the fragments upon which they act inwardly, and which seldom
can be applied with much force to fractures near the condyles, on
account of the probable existence of inflammation and swelling
about the joint. *
“Malgaigne, when speaking of the apparatus of Lonsdale,
remarks: “But the surgeon should never lose sight of the fact that
permanent extension is a resource always dangerous, often use-
less, and which demands in its application much caution and
watchfulness.’”
The following example will illustrate the practical difficulties
of employing permanent extension in fractures of the humerus:
“A laborer, aged thirty, was admitted into the Buffalo Hospital
of the Sisters of Charity, on the second day of October, 1853,
with a simple oblique fracture of the humerus, which had occurred
three days before. The fracture was situated within the insertion
of the deltoid, and having been caused by the rolling of a log
upon the arm, the whole limb was much swollen. The night
following his admission, in a fit of delirium tremens, he removed
all the dressings. When I visited the wards in the morning, I
found the fragmeats displaced and the muscles contracting vio-
lently. The ordinary dressings were applied, and continued until
the fifth day, when, as the delirium had not ceased, and the mus-
cles continued to contract with great violence, it was determined
to attempt permanent extension. For this purpose we lifted the
elbow upwards and outwards, to relax the deltoid, and then,
having made extension with the fore-arm, we fitted carefully a
large gutta percha splint to the fore-arm, arm, axilla and side, in
such a manner that when the splint was secured to these several
parts, the arm could not fall to the side of the body completely,
and in proportion as it did fall downward, it would make exten-
sion upon the arm. This splint was well padded, and secured in
place by rollers.
“On the sixth day the delirium had ceased, and never returned.
The dressings were all in place, and seemed to accomplish the
indication we had in view ; but, on the seventh day, although he
had kept very quiet, everything was disarranged, and the whole
had to be re-adjusted. On the eighth and ninth, the same thing
occurred. During this time we had varied the dressings, position,
&c., each day, to meet, if possible, the difficulties, but it was at
219
length deemed unwise to pursue the attempt any further, and we
returned to the use of the ordinary splints, laying the arm against
the side of the body. The union was finally completed without
either overlapping or angular displacement.
“Something may always be accomplished when the patient is
walking about, by allowing the elbow to escape from the sling, so
that its weight shall make constant traction on the lower frag-
ments, and the plan I suggested some years since of treating cer-
tain cases of delayed union of the humerus, namely, extending
the arm at full length by the side of the body, so that the lower
fragment shall receive the whole weight of the fore-arm and hand,
might occasionally prove reliable in recent fractures, where the
tendency to override was very great. In two instances I have
already put this plan sufficiently to the test to determine its safety
and ability. * -
“The precise plan, and my reasons for its adoption in certain
cases of delayed union, were set forth in the following paper,
read before the Buffalo City Medical Association, and published
in the Buffalo Medical Journal for August, 1854:
“‘I have observed that non-union results more frequently after
fractures of the shaft of the humerus, than after fractures of the
shaft of any other bone. Comparing the humerus with the femur,
between which, above all others, the circumstances of form,
situation, &c., are most nearly parallel, and in both of which non-
union is said to be relatively frequent. I find that of forty-nine
fractures of the humerus, four occurred through the surgical neck,
twelve through the condyles, and twenty-nine through the shaft.
In one of the twenty-nine the patient survived the accident only
a few days. In four of the remaining twenty-eight, union had not
occurred after the lapse of six months, and in many more it was
delayed beyond the usual time. Two of the four were simple
fractures, and occurred near the middle of the humerus. The
third was compound, and occurred near the middle also ; the
fourth was compound, and occurred near the condyles.”
“‘This analysis supplies us, therefore, with four cases of non-
union, with a table of twenty-eight cases of fractures through the
shaft. Of eighty-seven fractures of the femur, twenty occurred
through the neck, one through the trochanter major, and one
through the condyles. The remaining sixty-five occurred through
the shaft, and generally near the middle, and not in one case was
the union delayed beyond six months.
“‘To make the comparison more complete, I must add, that of
the twenty-eight fractures of the shaft of the humerus, six were
compound, and of the sixty-five fractures of the shaft of the
femur, six were either compound comminuted, or both com-
minuted ; the six compound fractures of the shaft of the
humerus, two cases of non-union ; the six cases of either com-
pound or comminuted, or compound and comminuted fractures
of the femur, furnished no case of non-union. I beg to suggest
{}
220
to the society what seems to me to be the true explanation of
these facts.
“‘It is the universal practice, so far as I know, in dressing frac-
tures of the humerus, to place the fore-arm at a right angle with
the arm. Within a few days, and generally, I think, within a
few hours, after the arm and fore-arm are placed in this position,
a rigidity of the muscles and other structures has ensued, and to
such a degree that if the splints and sling are completely removed,
the elbow will remain flexed and firm ; nor will it be easy to
straighten it. A temporary false anchylosis has occurred, and
instead of the elbow joint, when the fore-arm is attempted to be
straightened upon the arm, there is only motion at the seat of the
fracture. It will thus huppen that every upward and downward
movement of the fore arm will inflict motion upon the fracture;
and inasmuch as the elbow may become the pivot, the motion at
the upper end of the lower fragment will be the greater in pro-
portion to the distance of the fracture from the elbow joint.
“‘No doubt it is intended that the dressings shall prevent all
motion of the fore-arm upon the arm ; but I fear that they cannot
always be made to do tuis, I believe it is never done when the
dressing is made without angular splints, nor is it by any
means certain that it will be accomplished when such
splints are used. The weight of the fore-arm is such,
when placed at a right angle with the arm, and encumbered
with splints and bandages, that even when supported by
a sling it settles heavily forward, and compels the arm-dress-
ings to loosen themselves from the arm in front of the point of the
fracture, and to indent themselves in the skin and flesh behind.
By these means the upper end of the lower fragment is tilted for-
wards. If the fore-arm should continue to drop upon the sling,
nothing but a permanent forward displacement would probably
result; the bones might unite, yet with a deformity. .*
“‘But the weight of the fore-arm, under these circumstances, is
not uniform, nor do I see how it can be made so. It is to the
sling that we trust mainly to accomplish this important indica-
tion. But you have all noticed that the tension or relaxation of
the sling depends upon the attitude of the body, whether stand-
ing or sitting, upon the erection or inclination of the head, upon
the motion of the shoulders, and in no inconsiderable degree upon
the actions of respiration. Nor does the patient himself cease to
add to these conditions by lifting the fore-arm with his opposite
hand whenever provoked to it by a sense of fatigue.
“‘This difficulty of maintaining quiet apposition to the frag-
ments, while the arm is in this position, at whatever point it may
be broken, becomes more and more serious as we depart from the
elbow joint, and would be at its maximum at the upper end of
the humerus, were it not that here a mass of muscles, investing
and adhering to the bone, in some measure obviates the difficulty.
Its true non-union is, therefore, near the middle, when there is
221
less muscular investments, and when, on the one hand, the frac-
ture is sufficiently remote from the pivot or fulcrum to have the
motion of the upper end of the lower fragment multiplied through
a long arm, while, on the other hand, it is sufficiently near the
arm-pit and shoulder to prevent the upper portion of the splint
and arm-dressings from obtaining a secure grasp upon the lower
end of the upper fragment. -
“‘It must not be overlooked that the motion of which we speak
belongs exclusively to the lower fragment, and that it is always
in the same plane forwards and backwards, but especially that it
is not a motion upon the fracture as upon a pivot, but a motion of
one fragment to and from its fellow. This circumstance I regard
as important to a right appreciation of the difficulty. Motion
alone, I am fully convinced, does not often prevent union, as sur-
geons have generally believed. It is exceedingly rare to see a
case of non-union of the clavicle. Of forty-seven cases of fracture
of the clavicle which have come under my observation, and in by
far the greater proportion of which considerable overlapping and
consequent deformities ensued, only one has resulted in non-union,
and in this instance no treatment whatever was practised ; but
from the time of the accident the patient continued to labor in
the fields and hold the plough, as if nothing had occurred. I
have, therefore, seen no case of non-union of the clavicle where a
surgeon has treated the accident.
“‘Indeed, what is most pertinent and remarkable, its union is
more speedy, usually, than that of any other bone in the body of
the same size; yet to prevent motion of the fragments in a case
of fractured clavicle with complete separation and displacement,
except where the fracture is near one of the extremities of the
bone, I have always found wholly impracticable. Whenever
bandages or apparatus has been applied, I have still seen always
that the fragments would move freely upon each other at each
act of inspiration and expiration, and at almost every motion of
the head, body or other extremities. It is probable, gentlemen,
that you have made the same observation.
“‘From this and many similar facts I have been led to suspect,
for a long time, that motion has had less to do with non-union
than was generally believed.
“‘I find, however, no difficulty in reconciling this suspicion with
my doctrine in reference to the case in question ; and it is pre-
cisely because, as I have already explained, the motion, in case
of a fractured humerus, dressed in the usual manner, is peculiar.
“‘In a fracture of the clavicle through its middle third (its usual
situation), the motion is upon the point of the fracture as upon a
pivot; although, therefore, the motion is almost incessant, it does
not essentially, if at all, disturb the adhesive process. The same
is true in nearly all other fractures. The fragments move only
upon themselves, and not to and from each other. I know of no
complete exception but in the case now under consideration.
222
“‘Aside from any speculation, the facts are easily verified by a
personal examination of the patients during the first or second
week of treatment, or at any time before union has occurred both
in fractures of the humerus and clavicle. The latter is always
sufficiently exposed to permit you to see what occurrs, and as
soon as the swelling has a little subsided in the former case you
will have no difficulty in feeling the motion outside of the dress-
ings, or, perhaps, in introducing the finger under the dressings
sufficiently far to reach the point of fracture, I believe you will
not fail to recognize the difference in the motion between the two
cases. Such, gentlemen, is the explanation which I wish to offer
for the relative frequency of this very serious accident, non-union
of the humerus.
“‘I know of no other circumstances or condition in which this
bone is peculiar, and which, therefore, might be invoked as an
explanation. Overlapping of the bones, the cause assigned by
some writers, is not sufficient, since it is not peculiar. The same
occurs much oftener, and to a greater extent, in fractures of the
femur, and equally as often in fractures of the clavicle; yet in
neither case are these results so frequent. Nor can it be due to
the action of the deltoid muscle, or of any other particular mus-
cles about the arm, whether the fracture be below or above these
insertions, since similar muscles, with similar attachments, on the
femur and on the clavicle, tending always powerfully to the
separation of the fragments occasion deformity, but they seldom
revent union.
“‘If I am correct in my views, we shall be able sometimes to
consummate union of a fractured humerus when it is delayed, by
straightening the fore-arm upon the arm, and confining them
to this position. A straight splint, extending from the top of
the shoulder to the hand, constructed from some firm material,
and made fast with rollers, will secure the requisite immobility to
the fracture. The weight of the fore-arm and hand will only tend
to keep the fragments in place, and if the splint and bandage are
sufficiently tight, the motion occasioned by swinging the hand and
fore-arm will be conveyed almost entirely to the shoulder joint.
Very little motion, indeed, can in this feature be communicated
to the fragments, and what little is thus communicated is a motion
which experience has elsewhere shown not disturbing or perni-
cious, but a motion only upon the ends of the fragments, as upon
a pivot.
“‘I do not fail to notice that this position has serious objections,
and that it is liable to inconveniences which must always, prob-
ably, prevent its being adopted as the usual plan of treatment for
fractured arms. It is more difficult to get up and lie down, or
to sit down, in this position of the arm, and the hand is liable
to swell. But I shall not be surprised to learn that experience
will prove these objections to have less weight than we are dis-
posed to give them. Remember, the practice is yet untried—if I
f
223
except the case which I am about to relate, and in which case, I
am free to say, these objections scarcely existed. The swelling
of the hand was trivial, and only continued through the first fort-
night, and the patient never spoke of the inconvenience of getting
up or sting down, or even of lying down.
“‘The following is the case to which I have just referred:
“Michael Mehar, laborer, aet 35, broke his left humerus just below
its middle, Dec. 14th, 1853. The arm was dressed by a surgeon
in Canada West, and who is known to me as exceedingly ‘clever.”
After a few days from the time of the accident, the starch band-
age was put on as light as it could be borne, and brought down
on the fore-arm, so as to confine the motions of the elbow joint.
Six weeks after the injury, Jan'y 29th, 1854, Maher applied to me
at the Hospital; no union had occurred. The motion between
the fragments was very free, so that they passed each other with
an audible click. There was little or no swelling or soreness. In
short, everything indicated that union was not likely to occur
without operative interference. The elbow was completely
enchylosed. I explained to my students what seemed to me to
be the cause of the delayed union, and declared to them that I
did not intend to attempt to establish adhesive action until I had
straightened the arm. They had just witnessed the failure of a
precisely similar case, in which I had made the attempt to bring
about union without previously straightening the arm.
“‘On the 2d of February, 1854, we had succeeded in making
the arm nearly straight. I now punctured the upper end of the
lower fragment with a small steel instrument, and, as well as I
was able, brought it between the fragments. Assisted by Dr.
Boardman, I then applied a gutta percha splint from the top of
the shoulder to the fingers, moulding it carefully to the whole of
the back and sides of the limb, and securing it firmly with a paste
roller. March 4th, (not quite four weeks after the application of
the splint,) we opened the dressings for the second time and care-
fully renewed them. March 18th, we opened the dressing for the
third time, and found the union complete. This was within less
than forty days. The patent was now dismissed. On the 29th
of April following, the bone was re-fractured. Maher had been
assisting to load the “tender’ to a locomotive. As the train was
just getting in motion he was hanging to the tender by his sound
arm, while another laborer seized upon his broken arm to keep
him on the car, and with a violent and sudden pull wrenched him
from the tender and reproduced the fracture. The next morning
I applied the dressings as before, and did not remove them during
three weeks; at the end of which time the union was again com-
plete. The splint was, however, re-applied, and has been con-
tinued to this time, a period of about six weeks.”
“‘Since the date of the above paper, I have twice had opportu-
nities to test the value of this mode of treatment in cases of some-
what delayed union of the humerus, and in each case with the
same favorable result.’”
224
By the authority I have read, you perceive that inflammation
is not the condition desired for repair of bone.
And not only this, but that true inflammation will prevent the
cure. That when it exists it must be allayed and removed, or
restoration is impossible. This is in accordance with the testi-
mony of Drs. Beebe and Ludlam. They testify that inflamma-
tion is a diseased, and not a healthy condition; that this is not
the desired condition, but it is rather the almost inevitable conse-
quence of the fracture.
Dr. Porter, and those who follow in his wake, contend for the
very reverse of this. Every person's common sense ought to
teach him that the more perfect the patient’s health, the more
rapid will be the cure.
By this authority we also show that, when there is an external
wound of the soft parts, as in the case of this boy, an opening
should be left in the bandaging, so that the wound may be dressed
without removing the bandage. We have proved that Dr. Pratt
dressed this arm in that way.
In case of a compound comminuted fracture, as was that of
this arm, this author (Miller) recommends the anti-phlogistic diet
as an essential from the very outset. So testify Drs. Beebe and
Ludlam, and such was the practice of Dr. Pratt.
In no particular has it been shown that Dr. Pratt did not treat
this case as laid down by the standard authors from whose works
I have read, but, in every particular, in accordance there with.
Now, gentlemen, let us more closely approach the subject of
false joints and un-united fractures. Dr. Porter and the other
witnesses of the plaintiff tell you that the case in hand is one of
false joint. Drs. Beebe and Ludlam tell you that this is not a
false joint, but is merely a case of non-union of the bone not being
false joint.
Mr. De Wolf has, perhaps, sufficiently read from the authors,
and explained to you the difference between false joint and non-
union of bone. -
I may, however, remark that, in false joint the fragments, or
ends of the bone, are connected or tied together in sort, by a
species of cartilaginous substance without union of bone, and the
fragments do not play upon each other, as you have seen is the
case with this arm. -
This latter fact shows that their professional witnesses are
wrong in saying that here is false joint, and that ours are right
225
when they say there is not. But I care not whether it be called
a false joint, or merely non-union of bone, as Dr. Pratt is not to
blame for that condition. The fragments are not united by the
interweaving of bone, one fragment with the other.
Another thing that we have shown by this surgical author, (and
coinciding with the testimony of our professional witnesses,) is,
that (among other causes) undue excitement of the patient and
deficiency of plasma, will either of them prevent union of bone.
For aught we know either or both of these causes may have
existed and prevented the cure. We find that the boy was rest-
less, uneasy. This could hardly be without undue excitement.
Either of these causes were more likely to exist after the re-frac-
ture or rupture of the newly formed bone than before. In these,
or in either of them, we have a probable theory for the failure of
union of this fracture. On the other side they have failed to show
any cause, whether constituting a probable theory or otherwise,
why this bone is not united.
A probable theory is to be adopted rather than follow the wild
speculations of imagination, or rather than form opinions without
any defined basis. But to maintain this action the probability or
possibility that Dr. Pratt is to blame for the condition of this
boy’s arm will not do ; they have got to go farther, and prove the
fact that this condition is the consequence of Dr. Pratt’s want of
ordinary skill and care. This is not shown by not showing any
cause at all. . -
Again, we find by the authority before referred to, that to undo
the limb at the end of five or six weeks from the time of the acci-
dent, and finding that union has not taken place, or that the work
of repair is not then going on, is not conclusive that union
will not take place. In such a case (reads the book) the
retentive apparatus should again be applied as in the first
instance, only with more care, and then allowed to remain in this
condition for a much longer period than that previously indulged.
That when this is done, union may take place in no unreasonable
time. Not only this, but we find that union may be delayed from
six to eight months, and not until the lapse of this time is hope to
be lost that cure is out of the question through the intervention
of ordinary means. Now, this applies when there has been no
re-fracture or rupture of the newly formed bone.
When such an unfortunate occurrence is presented, I take it
that a longer, rather than a shorter period is to be allotted count-
226
ing from the date of re-fracture. This case was taken wholly out
of Dr. Pratt's hands at the end of five months and ten days from
the time of the firstinjury, and with in twenty days after consult-
ation had, when other surgeons recommended friction, which
was applied. Time was not allowed even to test the efficacy of
that friction. How stands Dr. Porter, when contrasted with this
authority, upon the question of the time beyond which union
should not be delayed ?
He would have union in six or eight weeks at the outside.
But further, this author says, that when at the end of six or
eight weeks, union is found not to have taken place, provi-
sional callus, doubtless, has failed, but that this is not always
essential to re-union, and that union may yet take place by the
formation of the definitive callus, which is presumed to have com-
menced forming.
Dr. Porter asserts, positively, that there can be no such thing as
union of fracture without provisional callus. This author also
says, that provisional callus is no part of bony or true union, and
that this callus is eliminated by absorption as definitive callus
forms. Dr. Porter says that provisional callus never wholly dis-
appears.
Dr. Porter also will have it that provisional callus is formed
much earlier than as stated by this author, who says that it takes
from four to eight weeks for it to form and become firm ; and that
it is useless when the definitive callus is formed, and when no
longer necessary it disappears in accordance with well known
laws of nature, that whatever is produced for a temporary pur-
pose, is taken away or removed when that purpose has been sub-
served. That the definitive callus is formed more leisurely and
well, being intended for a more permanent purpose than provi-
sional callus.
That the latter is a mere splint to hold the ends of the bone
tightly in apposition, so that the definitive callus may form and
complete true union of bone. And that the surgeon’s splints may
be removed when provisional callus is complete, which is nature's
splint ; and that this splint of nature may be, nay, actually is
removed by absorption, thus giving normal symmetry to the limb
when definitive callus is formed. That this definitive callus is the
only essential thing in the repair of bone, and without which there
can never be true or bony union; and that even this definitive or
permanent callus is much modified by absorption.
227
We show, by our professional witnesses and by standard authors,
that Dr. Porter is wholly wrong in every material point as to non-
unión of bone.
1st. He says that there must be inflammation, or there can be
no provisional callus.
2d. That there can be no union without provisional callus—
that it is the essential thing—that it is the only callus that he
knows of that is material.
3d. That provisional callus forms within four weeks from the
accident.
4th. That provisional callus never disappears.
5th. That there is not less probability of union in the humerus
than in any other bone; or, in other words, that this bone is as
likely to unite in case of fracture as any other bone.
6th. That provisional callus contains about the same quantity
of phosphate of lime as human bone, which he thinks is about
fifty parts in the hundred.
7th. That human blood also contains about the same quantity
of phosphate of lime as bone.
8th. That in case of fracture the ossific particles are deposited
(which form the new bone) at the site of fracture from the blood
as it passes from the heart through the arteries.
9th. That fracture of the humerus at or below the nutritious
foramen and a rupture of the nutrient artery, or one of its
branches, would not cause any delay in the union of the bone.
10th. That bone and every other tissue is in the blood; in fact,
that the whole is blood.
11th. That the flat bones of the cranium, and the femur or
thigh bone at the point of the capsular ligament, must unite by
provisional callus. ~
It is proper that I here concede that Dr. Miller does not speak
with any such assurance as Dr. Porter upon these points, and
upon some of them does not agree with him. But Brother Miller
asks why we did not interrogate all these other Physicians, Drs.
Belding, Wales, Burbank and McAffee, about this provisional
callus and reproduction of bone. *
I ask why we should have called or interrogated any more than
we have? Those we have questioned are quite sufficient without
consuming any more time, when all the standard authors agree
with them, and are against their professional gentlemen,
228
Two well-posted surgeons like Drs. Beebe and Ludlam are
all that we desired. The books I have read from give the general
mode of treatment. But each surgeon and author has some par-
ticular mode of treatment which he considers best in a given case,
when the ordinary mode of treatment has proved abortive. All
the modes are open, and any may be selected without the hazard
of action in case it fails.
Hamilton mentions three cases of re-section, all of which re-
sulted favorably. We find a like favorable result noted by Gross
in a case where Brainard’s plan of puncturation had been tried
and failed; and cure has been effected by re-section after the
lapse of twenty-seven months.
I take it that much depends upon the bone and the totality of
condition, which of these extreme modes is the one promising
most success 2
Hamilton and other good authors, I believe, all agree that the
destruction or rupture of a main artery, whose office is to supply
a bone with blood, greatly lessens the chances of re-union of the
fracture.
So testify Drs. Beebe and Ludlam :—And that a rupture or
division of the lower branch of the nutrient artery, as is the ap-
parent fact in this case, would materially interfere with the
chances of curing the arm. They also agree (particularly Gross
and Hamilton), that in the upper extremities, and when there is
anchylosis or injury of an important artery, that re-section may
be resorted to with reasonable prospect of favorable results.
Hamilton considers this mode dangerous when applied to the
lower extremities, but not so when applied to the upper ex-
tremities.
Here is what Gross says upon this mode of treatment. I read
from page 955, vol. 1:
“Finally, excision of the ends of the fragments, an operation
devised, and first performed in 1760, by Mr. White, of England,
is occasionally employed. Such an operation, however, should
never be resorted to without due deliberation, and until after the
failure of the more ordinary and simple means. To say nothing
of the difficulty of its execution, it is by no means devoid of dan-
ger; indeed it has not unfrequently proved fatal. A very free
incision is made through the soft parts down to the ends of the
broken bone, which are then brought out at the wound and re-
trenched, either with a stout knife, a saw, or a pair of pliers.
Sometimes the mere removal of the cartilaginous crust is suffi-
229
cient for the purpose, an object which may be easily accomplished
by scraping.
“To maintain the freshened ends in accurate and steady appo-
sition, it was proposed by Horeau, in 1805, to connect them to-
gether by means of a wire, and to retain them in this position until
the completion of the cure. The procedure, which has, I believe,
been generally condemned by European practitioners, has been
frequently employed in this country, in consequence, apparently,
of the high authority of Dr. J. Kearny Rodgers, who was the
first to perform it on this side of the Atlantic. It consists, first,
in cutting off the rounded ends of the fragments; secondly, in
drilling a hole through each ; and lastly, in tying them firmly
together with a silver wire, so as to keep them closely and evenly
in contact during the consolidating process. .*
“It is generally imagined that this procedure is necessarily
followed by violent inflammation, jeoparding both limb and life;
but this is an error. If the operation be carefully performed and
the after treatment conducted upon proper principles, I believe
that it will commonly be found to be entirely free from danger,
while the utmost confidence may be placed in its efficacy.
“In the only case in which I have had an opportunity of em-
ploying this method—in a case of un-united fracture of the
humerºus of eleven months’ standing, in a young man of twenty-
two years of age, the patient experienced very little pain, inflam-
mation, or fever, during the stage of the treatment, and the result
was, in every respect, most satisfactory.”
The following is an outline of this case, as drawn up by Dr. S.
W. Gross, for the Louisville Medical Review, July, 1856. It may
be premised that the fracture was situated about three inches
above the condyles, and that various remedies, among others Dr.
Brainard's, had been faithfully but fruitlessly employed for its
relief:
“The patient being placed under the influence of chloroform,
a longitudinal incision, about three inches in length, was made on
the posterior aspect of the arm, through the triceps muscle, over
the site of the fracture. The lower fragment was found to over-
lap the upper about an inch and a half. The ends of the bone
were surrounded by a strong fibrous membrane, which was firmly
adherent to the neighboring parts, and formed a sort of shut sac,
in which the bone was imbedded. About an inch of the lower
portion of the upper fragment, and half an inch of the upper por-
tion of the lower fragment, were removed with a delicate saw ;
but on account of their firm adhesions, and especially the short-
ness of the inferior piece, some difficulty was experienced in
bringing them entirely into view.
“The fragments were conical, rounded, smooth, and invested
with a thick, fibrous periosteum : no synovial membrane or fluid
230
existed. The next step of the operation consisted in drilling the
extremities of the bone, which having been done with a common
gimlet, a piece of wire was introduced, to maintain them in appo-
sition. The ends of the wire were twisted together, and allowed
to protrude from the wound, the edges of which were brought
together by three sutures and adhesive strips.
“Two splints and a roller being applied, the arm was firmly
supported in a sling. .
“There was very little hemorrhage, and no vessel required
ligation. As the patient suffered a great deal of pain, a grain of
morphia was given immediately after the operation. Very little
constitutional disturbance followed. Nearly all the wound healed
by the first intention, and at no time was there much swelling,
discoloration or suppuration.
“At the end of the eighth week, the process of re-union had
advanced so far that there was scarcely any perceptible motion.
“In a fortnight after this, the wire being removed, the patient
went home perfectly restored, the arm being about an inch and a
half shorter than the sound one. It is proper to add, that, by
frequent passive motion, the elbow joint was gradually regaining
its original function.
“In another case, that of a man, aged thirty-two, I treated
with equal success, by an operation of this kind, an un-united frac-
ture of the humerus of twenty-seven months’ standing. The ends
of the fragments were connected by two silver wires, which were
permanently retained. The case is reported at length in the
Morth American Medico-Chirurgical Review for July, 1861.
“The results of some of the above operations have been placed
in a striking and interesting light by the statistics of Dr. Morris.
Thus, in forty-six cases in which the seton was used, thirty-six
were cured, three died, three were partially relieved, and five
received no benefit. -
“Of thirty-eight cases of re-section, twenty-four were cured,
six died, one was partially cured, and seven received no benefit.
“Of eight treated by cauterization of the ends of the fragments,
six were cured. It is worthy to remark that the treatment by
the seton is less successful in fracture of the femur and humerºus,
than in that of any other bones. The danger of the more severe
operations, especially the seton and re-section, follows the same
laws as in amputation, increasing with the size of the limb and its
proacimity to the trunk. When all the known remedies, after a
thorough trial, fail, and the limb is utterly useless, the only re-
source is amputation. Few cases, however, demanding such ter-
rible alternative, will be likely to arise in the present state of the
science.” *. -
It is to be regretted, that in the statistics given by this author
from Norris, no mention is made of what bones were treated by
the different modes named.
231
However, this author very closely agrees with Hamilton. Both
sustain Dr. Ludlam in his opinion, that in this case re-section
would be most promising of success. The statistics given by
Hamilton show that,
“While the femur and humerus are most nearly parallel, and
in both of which non-union is said to be relatively frequent, he
found that of forty-nine fractures of the humerus, four occurred
through the surgical neck, twelve through the condyles and
twenty-nine through the shaft. In one of the twenty-nine, the
patient only survived the accident a few days. In four of the
, remaining twenty-eight, union had not occurred after the lapse of
sia months and in many more it was delayed beyond the usual
time. * ~
“Two of the four were simple fractures, and occurred near the
middle of the humerus; the third was compound, and occurred
near the middle also ; the fourth was compound, and occurred
near the condyles. This analysis supplies us, therefore, with four
cases of non-union from a table of twenty-eight cases of fractures
through the shaft. Of eighty-seven fractures of the femur, twenty
occurred through the neck, one through the trochanter major,
and one through the condyles. The remaining sixty-five occurred
through the shaft, and generally near the middle, and not in one
case was the union delayed beyond six months. To make the
comparison more complete, I must add that of the twenty-eight
fractures of the shaft of the humerus, six were compound; and of
the sixty-five fractures of the shaft of the femur, six were either
compound, comminuted, or both compound and comminuted.
The six compound fractures of the shaft of the humerus furnished
two cases of non-union (one more would have been just half).
The six cases of either compound or comminuted, or compound
and comminuted fractures of the femur, furnished no case of non-
wnion.”
I now read from Gross, vol. 1, page 925, upon the subject of
fractures near the nutrient arteries. He says:
“Fractures situated at or near the entrance of nutrient arteries
unite less rapidly than those situated further off, owing to the fact
that they interfere more or less with the circulation and nourish-
ment of the osseous tissue.
“It is easy to suppose that a laceration of these vessels, as
occasionally happens both in simple and compound fractures,
might be a cause of non-consolidation, especially when conjoined
with other unpropitious circumstances. Statistics show that,
when the supply of blood is cut off, to any considerable extent, so
as to impose upon the periosteum the exclusive duty of nourishing
the fragments, either one or both pieces will become atrophied,
their walls being visibly thinned, and their areolar structure
rarified, f
232
“Want of union is sometimes dependent upon the absorption
of the ends of the fragments, or even of the greater portion of the
fragments themselves.”
On page 953 this writer says that, want of nutritive action and
loss of nervous influence, however induced, are constitutional
causes which interfere with the process of repair. And on page
951, he says that,
“It is practically important that a distinction should be drawn
between a fracture that unites tardily and one that does not unite
at all, or only through the medium of a fibrous, ligamentous, or
fibro-cartilaginous tissue. Slow consolidation is by no means
uncommon; the parts may be both to take on the requisite degree
of ossific action, and the result may be that a fracture that is
ordinarily repaired in four or five weeks, may, perhaps, be still
imperfectly united at the end of twice that period.
“The process of restoration is only held in abeyance, neither
advancing nor receding ; by and by it begins again, and then
often proceeds with its wonted rapidity. Such cases are fre-
quently very trying to the surgeon's patience, but they generally
turn out well in the end, provided sufficient care has been taken
to preserve the parts in their proper relations.”
This doctrine completely sustains Drs. Beebe and Ludlam in
their statements as to the length of time that should be allowed
to elapse before resorting to more than the ordinary, treatment.
That you should be conservative—that you should wait, and not
go from one mode to another too rapidly.
I will now call your attention to some more statistics given by
this author, on page 947, from which you will see the great num-
ber of failures in compound fractures of the lower extremities,
and which are more likely to result favorably than fractures of
the humerus. He says:
“The following account, for which I am indebted to Dr.
Frederick D. Lente, relates to cases of compound fractures of
the lower extremities, treated in the New York Hospital from
January, 1848, to July, 1847, the whole number being 392 frac-
tures of the tarsus and metatarsus not being included.
“Of these, 68 occurred in the thigh and 324 in the leg. Of the
former, 3 involved both thighs, and of the latter, 16 both legs.
Of the entire number, 190 were cured, 182 died, and 20 were
relieved. In 39, or 20.5 per cent., amputation was performed.
“Of the 68 fractures of the thigh, 18, or 26.5 per cent. were
cured, and 2 relieved ; amputation having been performed in 7.
Of the 324 fractures of the leg, 175, or 54.0 per cent. were cured,
and 14 relieved. In 35, or 20.0 per cent. of these, the limb was
removed. Of the whole number of cases of fracture, amputation
ſ 233
was employed in 91, or 23.3 per cent., and of these, 49, or 53.8
per cent. died. Of 301 cases treated without amputation, 140 or
46.5 per cent. died, 3 having refused to Suºmit to amputation.
Of the whole number of fatal cases in which amputation was not
performed, 74, or more than one-half, died within the first week;
in many of these there was no re-action, and death ensued in from
twenty-four to forty-eight hours. Of 45 fractures of the thigh
which occurred at or below the middle, 14 recovered, or 31.1 per
cent. ; while of eleven that occurred further down, 4, or 36.3 per
cent. recovered. - - *
“Of 227 fractures of the leg, occurring at or below the middle,
130, or 58.1 per cent. recovered ; of 30 above the middle, 17, or
over one-half, got well. Of 334 compound fractures of the thigh
and leg, 164 occurred on the right side, and 170 on the left.”
From this showing, this boy, with a compound comminuted
fracture of the arm with the other serious complications, ought to
be thankful that his life was saved. Here we have another evidence
of Dr. Pratt’s correct dietetic, medical and surgical treatment.
And the same thing is also shown from the statistics given by
Hamilton. - - - -
I also wish to read from this author a short paragraph about
union without provisional callus, on page 932. He says:
“There are certain pieces of the skeleton in which in fractures
no provisional callus ever forms. Such are the obcranon,
acromion, patella, and neck of the femur.”
While I have the book in hand, I wish to show you this bit of
bandaging from the wrist upwards which I exhibited last night,
but which you could not well see by candle-light. And this was
the case of fracture of bone in the fore-arm, which certainly would
require bandaging as near the point of the fingers as in case of
fracture of the arm above the elbow. -
Another thing I ought to notice in the argument of Brother
Miller: He says that Dr. Ludlam has had but one case of frac-
ture of the humerus, and Dr. Beebe but two, one of which
resulted in non-union; and he seems to think their practice very
limited. - -
I might answer this by saying that all of their surgeons have
only one case each of fractured humerus, except Dr. Miller. It
is certainly a little remarkable that these doctors have each had
such a case in the short time they have been practicing in these
parts. One would suppose that this was a dangerous region for
that bone. - - -
15
234
As to Dr. Ludlam ; he tells you that he does not now make
surgery a specialty in practice; but that he turns over his surgical
cases to those who make surgery a special business. -
Such is the general course in large cities like Chicago. But
Dr. Ludlam fully understands the science of surgery.
As to Dr. Beebe ; he has had in private practice (now remem-
bered by him) of fractured humerus two cases. He has, however,
had great numbers in his military practice—none of which were
wholly restored when they passed from under his care.
They were, however, all doing well the last he saw of them, which
was, say from four to six weeks after the fracture. Then, these
patients were removed to other quarters. He does not, therefore,
know how many cases resulted in non-union. He tells you that
he has treated fracture of every bone in the body, caused by ball
or shell. That he has had (without stopping to consider) at least
four thousand cases. But in the way he gives you the number in
detail at the different battles, there must have been nearly eight
thousand. . . . •. -
Why, gentlemen, he has already had more experience in frac-
tures than generally falls to the lot of a surgeon in a long life.
From the authors I have read, as well as from our professional
witnesses, you have heard a summary of the different modes of
practice, and the manner of operating in each. Of these modes,
in the main, Dr. Porter and these other surgical witnesses seem
to be wholly ignorant. Still, Dr. Porter tells you that Sir Astley
Cooper was the father of surgery. For aught that I know, he
might as well have been the father of surgery as any man, but we
find that surgery was practiced in the days of Hippocrates, who
lived long before Astley Cooper saw the light of day.
Dr. McPherson says there are two muscles which are inserted
into the fore-arm and attached to the lower third of the humerus,
the action of which would have a tendency to create motion at
the point of fracture. He says that one of these is the “biceps
flewor,” and that its upper insertion is in, or that it passes through,
the occipital groove. I should be pleased to have you tell me how
this can can be when the occipital bone is at the back part of the
head. Drs. Ludlam and Beebe tell you that they do not know,
and never before heard of a muscle by this name in the arm.
The arm has no such muscle, yet this Dr. is one of those who
ventures to give his opinion as evidence.
235
This testimony tests his anatomical knowledge. Gentlemen,
Dr. Pratt has better sense and more knowledge of the human
organism, and of fractures and the mode of repair than their pro-
fessional witnesses; who all, save Dr. Miller, think there is
as much phosphate of lime in human blood as in human bone,
and many other equally strange things. But these young men
merely followed Dr. Porter, this modern Hippocrates, and most
certainly his opinions in point of error have seldom been equalled,
and never surpassed. Now, I happened to bring with me Gard-
ner's Medical Dictionary, not knowing whether I should have
occasion to use it or not. And I propose to read, under the words
bone and blood, as to their constituents as discovered by chemical
analysis, and see how the proportion of phosphate of lime stands.
This author says, that “Bone consists of gelatine, &c., 33. 3;
phosphate of lime and magnesia, 54. 2; carbonate of lime and
other salts of soda, &c., 12, 5.- Berzelius. -
“But the composition of different bones and those of various
animals, differ. - -
“The animal matter may be dissolved out by hot water in a
digester; it yields a soup containing gelatine and fat. On the
other hand, the phosphates and earthy matter may be dissolved
by strong acids, the gelatine remaining in the shape of bone.”
Of blood he says, “ Much attention has been paid of late to the
normal composition of healthy blood for the purpose of obtaining
a standard of comparison to judge of the effects of disease on this
important fluid. The mean of Simon represents healthy blood as
consisting of 80 per cent. water, and 20 of solid residue ; with 2
per cent. of fibrin, and the same amount of fats; 10 to 12 per cent.
of globules; 6 to 7 per cent. of albumen; and 1 per cent. of
extractive matters and salts.
“The salts consist of chloride of sodium and potassium, carbon-
ate of soda ; phosphate of soda, lime and magnesia; peroxide of
iron and sulphate of soda.” -
So you see, as we have proved by our professional witnesses,
that there is not even one part in the hundred of phosphate of lime
in blood, while there is in bone from fifty-one to over fifty-three parts
in the hundred of phosphate of lime. Dr. Ludlam gave you the
relative quantity of phosphate of lime in bone upon a scale of one
thousand as well as upon a scale of one hundred.
What a fund of ignorance their professional witnesses possess
upon the scientific questions whereon they have given opinions !!
236
In discoursing upon these matters brother Miller says, that he
thinks I know more than is written in the good book. I do not
know what he means by the term “good book.” The Moham-
edans call the Koran the good book; most people in Christian
countries by this expression, mean the Bible.
But, gentlemen, that book does not profess to teach surgery,
anatomy, pathology, nor physiology. However, I have been sus-
tained in every position which I have assumed by standard medi-
cal and surgical authors. It fortunately or unfortunately happens
that Dr. Porter and those youngsters who followed him, did not
only not know what was written, but they only knew a few who
had written upon the science of surgery. They were ignorant of
the contents and of the authors of these books. Not one of them
had ever heard of Hamilton, and they seemed to be equally igno-
rant of Gross. They come here with a copy of an old edition of
Miller's Principles of Surgery, containing many errors which are
corrected in the late edition of which we present a copy. You
see, gentlemen, that if blood contained fifty parts of phos-
phate of lime in the hundred, that it would cease to flow
with much rapidity; yet, we know that it flows with great
rapidity throughout the system. Fill it with fifty per cent.
of phosphate of lime, and man would immediately become
a living monument of bone. You now see the difference
between this opinion of Dr. Porter and his lesser lights, and of
scientific men who know what they are talking about. You will
recollect that I asked, in different forms, the question as to the
quantity of phospate of lime in the human bone and in the blood;
and he testified, as his deliberate opinion, that the quantity was
about the same in each ; and the quantity was about forty-eight
to fifty-one per cent. We have proved that blood does not con-
tain even one per cent. of phosphate of lime, and not more than
one per cent. of the insoluble salts combined, and that bone con-
tains at least fifty per cent. of phosphate of lime, and of the insol-
uble salts combined, from sixty-one to sixty-six per cent. Gentle-
men, do you think it possible for a professional man to have com-
mitted more egregious blunders than has Dr. Porter ? He cer.
tainly could not unless he was more voluble, and I think that
would be useless. * . . . - - -
When I questioned him about the repair of bone by the aid of
the nutrient arteries, instead of answering my question he branched
237
out into a regular lecture upon the anastamosing process, and the
beneficent operations of nature. A x
He would have it that the delicately thin membrane, called the
periosteum, which covers the outer surface of the bones, by anas-
tamosis, through the solid bone, supplied the place of the great
nutrient arteries. He says that, in case of a rupture of such
artery, nature sets herself to work and gets up the process of
anastamosis.
He says that anastamosing is the formation of a great number
of small blood vessels distributed over the bone, and that these
vessels supply the part with the requisite amount of blood, sending
the blood into the hard bone. But how these delicate blood ves-
sels managed to penetrate hard bone he left impenetrably obscure.
How plain did he make the subject to you?
I confess I do not understand what he means. If you do, I
think you have accomplished more than most men could effect.
When I asked him how, by anastamosis, he would in aneurism
supply the place of the ruptured artery, and how, in such a case,
he would convey the blood to feed the process of repair through
the solid bone; he said that in aneurism there never was a rupture
of the artery, but a mere dilatation of the walls of the artery; that
were the artery to be ruptured, the man would die almost momen-
tarily. . -
It is, perhaps, not very material whether in aneurism the artery
bursts or not, but for the purpose of testing his knowledge upon
this subject, I read again from Gardner's Medical Dictionary. Of
aneurisms, he says: z
“ There are four principal kinds. 1. True aneurism. 2. False
aneurism. 3. Aneurismal Varix, or Varicose Aneurism. 4.
Aneurism by Anastamosis.” -
Of False Aneurism he says:
“Traumatic Aneurism.— When all the coats of the artery are
ruptured, or wounded, and the blood, escaping into the surround-
ing textures, occasions a pulsating tumor, the case is said to be
one of false aneurism.” -R -
From this you will perceive that Dr. Porter is about as correct
us upon other professional matters. He seems to have a won-
derful aptitude for disagreeing with the standard authors upon
a science which makes up his profession. His disagreement is
not upon some immaterial point, but upon those points which are
essential, fundamental truths. *. -
238
I have demonstrated by this author, that upon the subject of
aneurism he is entirely mistaken, so that what he knows of this
difficulty does not amount to anything. He ought not to be mis-
taken about so important a matter. He ought to have known that
the fact was the reverse of what he testified to. If he did know
better, he ought not to have testified thus loosely. We must not
give credence to his professional opinions. He wished to show
us how much he knew about the reparation of bone. So he tells
us positively that the ossific particles are deposited at the site of
fracture from the blood as it courses through the arteries.
Nature in her kindest mood, has provided that the blood shall
yield a part of its constituents, and deposit particles of phosphate
of lime around the fracture, where it reaches that point through
(as I suppose) the medium of inflammation.
But how these particles can be thus deposited without perforat-
ing or opening the artery, is the question to be solved. What an
idea for a sane man -
Ossific particles of matter are dumped at the point of fracture
like the Irishman’s loaded wheel-barrow.
He says blood makes everything, man is made of blood—
every tissue of the body is made of blood.
Where stands Beckland and other great authors upon this sub-
ject 2 They are nowhere compared with Dr. Porter. Blood
makes man Blood—blood—blood l Think of that for a moment,
gentlemen. -
I assert, without fear of successful contradiction, that he never
read any such theory in any book, ancient or modern.
We at every breath inhale the common air. Do you call that
blood, too? It must be, if blood is and makes everything.
Take the egg; is that, too, all blood P When we expose the
egg to a given heat, a given length of time, a chicken comes
forth with bone, nerve, muscle, blood and blood vessels. Do you
suppose that is all blood Has not the egg all the elements
which constitute the chicken, nerve, bone and every tissue? If
so, how does the gentleman come to the conclusion that blood
creates everything. I assure you, gentlemen, that, to my mind
the proposition is absolutely and supremely ridiculous. -
And, as Dr. Ludlam well says, you could not make a man out
of a tub full of blood. - .
Moses says that man was formed out of the dust of the earth—
not out of blood. Moses had no correct conceptions upon this
289
subject if Dr. Porter is right; for upon his theory it is obvious
that man was made in toto out of blood. r
All that would be necessary in order to people the unnumbered
worlds that float throughout the illimitable regions of space would
be, to have blood occupy those realms.
What an airy absurdity When we go back to the time when
chaos reigned supreme—before worlds were formed or animal
life had its origin, blood filled immensity | What gauzy specula-
tion He repudiates the idea that the bone cells multiply upon
each other, and are pushed out from the ends of the fractured
bone and interweave, and thus repair the injury; or, that bone
tissue reproduces bone from materials manufactured in its own
laboratory. - -
The great Saviour of man, it is said, declared that “men do
not gather grapes from thorns, nor figs from thistles.” But upon
Dr. Porter’s theory he would have taught that you could gather
grapes and figs from blood. - ‘.
When we examine closely, we perceive that everything is pro-
duced by multiplying itself. This is so both in the animal and
vegetable kingdom, and what is true as to the totality of an
organism is true as to each tissue of that organism. Repair or
cure is properly reproduction, or pro-creation. . -
The theory that every tissue is fed or obtains from the blood
the elements of which it is composed, or which it needs to support
and sustain itself, was explained by Drs. Beebe and Ludlam.
- And they illustrated it by the growth of wheat, barley and corn,
side by side upon the same soil—surrounded by the same atmos-
phere, receiving the light and heat of the same sun, and watered
by the same dew and rain—each, according to the wants of its
own nature, as with an intelligent hand, drawing from all these
sources the elements needed for the conservation and complete
development of its whole organism. -
They are generated—grow to maturity—reach the culminating
point—they die and are reproduced in endless succession. Each
tissue of the human body thus produces or reproduces its kind.
It does not draw so much of material from the blood as consti-
tutes that particular tissue; but from the elements thus abstracted
it produces its BEING-CELL, and this cell lives and grows from the
elements which the blood furnishes; not that the blood has these
specific articles on hand already manufactured for deposit in
case an accident should occur which would necessitate their use,
240
as Dr. Porter teaches. The blood is to the forming bone what
rain is to the growing vegetables; each must have the moisture
and the simples or elements of that moisture, in order to attain
perfection; but it possesses its own individuality.
Mr. De Wolf read from an author who shows that the growth
or repair of the bone is consummated by the reproduction or
multiplication of the bone cells. Of this scientific truth Dr.
Porter did not appear to have the most remote conception. He
tells you that if the elements of bone were not in the blood, it
could not deposit the materials for the support of the tissue, and
there would be no such thing as the repair or growth of bone.
We could have no brick houses unless we have bricks. The
brick house is one thing—it is an existing structure; but the ele-
ments out of which it is constructed are very different things.
The brick, composed of clay, sand and water, is not a house; nor
are the elements—clay, sand and water—brick; yet these ele-
ments, manufactured in a given way, make brick. When from
these elements you have the brick, you still must have mortar—
having its constituent elements before you can have the house.
With these materials the mechanic can proceed to the construc-
tion of the house. This illustration was given you by one or
both of our professional witnesses. -
Now, as we have proved blood is made from chyle, yet chyle
cannot be detected in blood; but of chyle as an element, blood is
formed. - -
It is no more singular that bone should be formed from ele-
ments furnished by the blood, than that blood should be formed
from the elements of chyle.
A change is made by which each tissue takes on its own form
of life and structure. I believe the word chyle is from the Greek
“chulos,” signifying “ the juice.” Chyle is formed from food,
and blood from chyle, and yet no food is detected in chyle, nor
chyle in blood. There is a transmutation of substances—a con-
version of material;-and the bone cells are not blood, nor is
blood chyle, nor chyle food. Each differs from the substance or
material out of which it is formed, so you see that the explanation
of Drs. Beebe and Ludlam are founded in nature, and they are
sustained by the highest scientific research. x
I cannot do anything which will illustrate this subject better
than has been done by those gentlemen. - -
You will see from the diagram of the different cells, drawn by
241
Dr. Ludlam, a full explanation of this matter. Thus you see how
differently these cells are shaped. The bone cell has a very dif.
ferent form than that of any of the others. Each form of cell has
its particular tissue. Dr. Ludlam says that he has examined each
cell in the field of the microscope, and that this is no mere theory,
but scientific truth, well settled and defined ; that cells are thrown
out in the manner as somewhat roughly sketched in this diagram
of the repair of bone in case of fracture. These cells, when newly
formed, are soft and yielding, and easily ruptured, even the pro-
nation of the hand might endanger or stop the process of repair.
But, although this repair might be thus impeded, it might, under
favorable circumstances, still go on, and in the end, after a great
length of time, become complete. •,
Provisional callus is very far from being bone, containing only
about 3.3 per cent, phosphate of lime, but hoop-like is
extended around the ends of the fractured bone, in order that
bony union by definitive callus may take place. This is shown
by this diagram of Dr. Ludlam, and he and Dr. Beebe have ex-
plained the whole matter to you, as known to the best surgeons
of the day.
Thus much for the repair of bone under the great natural law,
in opposition to this man of fanciful theories—Dr. Porter. We
have shown, in relation to all his theories, that he is completely
contradicted by standard authors; and Drs. Beebe and Ludlam
are most triumphantly sustained in every position they have taken
by these same authors. - . -
When Dr. Porter took hold of the boy’s arm with such a flour-
ish, and ranged out as though he was to give a lecture on
anatomy, instead of testifying in a court of justice, his manner
was calculated to awe you and the spectators into the belief that
he possessed a vast amount of knowledge connected with the
subject matter of this case. But how does he stand before you
now 2 How different his conduct from the unpretending manner
of Drs. Beebe and Ludlam 2 * > -
But, gentlemen, the question for you to determine is, whe-
ther the boy’s thumb and arm are in their present condition
from want of skill or care of Dr. Pratt 2 To solve this question,
you will consider what were the injuries which required treat-
ment. Were they trifling or were they severe and dangerous?
Were the wounds properly dressed, and were the dislocated
joints and broken bones all properly set, or reduced, and properly
242
dressed, or secured by splints and bandages, and were they
timously looked to from time to time P Did the flesh wounds
kindly heal in about the usual time? If they did, is it possible
that the bandages were too tight, when there was no death or
sloughing of the soft parts. Did the broken bones unite within
the lapse of eight weeks from the time the fractures occurred, and
was the arm then deformed or in natural shape 2 Were the frag-
ments out of place on the third of February, when old man Yeo-
man says they were, and that he helped Dr. Pratt put them
in place If they were out of place, was it the exercise of proper
care and skill to put them in place 2 If these fragments were not
out of place, but Dr. Pratt on that occasion manipulated the part
to see what the actual condition was, was that want of care or
skill P
If the fragments were then somewhat out of place, could they
have become united by the twentieth of the same month 2 We
have proved that this might have been, and no one has deposed
to the contrary, and we have proved that, union was complete on
that day. No one has testified that these fractures were not
properly put up ; and that they were not is the sum total of their
complaint, as developed by the declaration. If you find that
union had taken place on the twentieth of February, then after
that, did the boy re-fracture the arm or rupture the new union, by
playing ball or otherwise; and after this, were the fragments put
in apposition by Dr. Pratt P And did he subsequently watch the
case and find that the fresh fracture had not united, and did he try
to produce union by fiction; and did he try this a second time
upon the recommendation of other surgeons upon consultation ;
and up to this time was there any pretence put forth by the boy
or his parents that Dr. Pratt had not treated the case with proper
care and skill; and did he then and at other times insist that
other means promising success should be resorted to, and
was he allowed the privilege of so doing, or was the case taken
from him without any cause being assigned for doing so 2 In
short, did Dr. Pratt in any particular fail to pursue the mode of
treatment recommended by the very best surgeons, and if so,
wherein P . - , \
Is this arm still curable as we have proved, and has any one
testified that it is not ? Have they proved what it was that caused
this non-union, and are they not bound to prove that the cause
243
was want of care and skill by Dr. Pratt, to maintain this action ?
Clearly this is so.
You are to consider the facts in this case coolly, deliberately
and dispassionately, and apply the law as given you in charge
by the court. You are not to decide this case upon
the score of sympathy, nor should you be led astray by
the eloquent appeals of Mr. Turner, directed rather to the pas-
sions than to the judgment. You should look upon and consider
the facts stoically. If you properly understand the testimony,
you do not need to be out five minutes to find a verdict for the
defendant. ". : -
I trust, gentlemen, that you will so decide this case that in
future life you will have the pleasing reflection that you have
done justice to the parties under the law and the testimony.
I tender to you, gentlemen, my thanks for the attention you
have given, through the lengthy argument, loaded with some
considerable repetition, which I have deemed it my duty to make,
to the end that you might properly appreciate the case in all its
phases. So far as I well could, I have discharged my duty, and
it is now closed. When you shall have heard all the arguments
and the charge of the court, in the silence of the jury-room your
great duty will commence. When there, exercise that common
sense of which Mr. Miller spoke, and that is all we ask. -
COL. TURNER's ARGUMENT.
May it please the Court, Gentlemen of the Jury:-It is very
seldom that I approach the discussion of a case with so much
embarrassment, and with so much hesitancy as I do the present
one. There are several reasons why I feel thus. I remember that
many years ago, after the Bunker Hill monument was finished, I
climbed to the top of that monument, and with a glass took a
survey of the surrounding country—the ocean and hills of New
England, the little cottages which nestled there, the forests and
the rocks. For the time being I felt I was lifted above the world
while looking from that exalted position. That which lay beneath
seemed to have dwindled into comparative insignificance. You
can comprehend my feelings here to-day. We have been soaring
in the fields of science far above the ordinary flights of human
nature. Our minds have been so filled with the sublime truths
244
which lie at the bottom of creation that you will pardon me if, in
coming down to the plain region of matters of fact, I am a
little dizzy now. There is another reason why I feel embarrassed.
I have seen you farmers and mechanics, accustomed to active out-
door life, sit here for seven long days, deprived of that muscular
action and wholesome air which you have been accustomed to
enjoy, and I feel that to do justice to my client, I must occupy at
least half the time occupied by the gentlemen who preceded me.
If I do so, I fear your patience will be wearied. There is
another reason why I approach this case with fear and trembling.
I fear I have not the ability to perform my duty to my client. I
see on my right the court; before me the jury, and the court house
filled with spectators. After the wonderful display of eloquence
and science which has been brought to bear upon this case I feel
I may fail to satisfy the reasonable expectation of this large audi-
ence. On the one hand, I feel I ought to make a full speech; on
the other, that I ought not. When I see the intense anxiety mani-
fested in this case—when I behold men and women sitting here
from day to day, I feel that I ought to follow the gentlemen
through all the intricacies of science which he has brought into
the case. But, when in imagination, that poor boy looms up
before me, he seems to say to me, You have but one object to
attend to and that is, my rights. What is there in this case ? Are
the principles which lie at the foundation of the universe, and the
developments of science, all involved in this case, as the gentleman
claims they are 2 If they are not, why did he occupy your time for
ten long hours in the discussion of these principles. Myinterests are
identified with my client’s. And there is another reason why I
feel embarrassed in this case. I allude to the remark of the gen-
tleman upon taking his seat—the most remarkable one I ever
heard fall from the lips of counsel, and I have practiced some
twenty years. He told you that when the argument of the case
had closed, and the court had given you your instructions, then
no tamperling would be allowed. What, has there been any tam-
pering with you during this trial 2 How did he wish to be under-
stood? Did he mean that up to the time he should give his
instructions, the jury had been tampered with ; that you had been
followed from store to store; from pillar to pillar; and had this
subject discussed before you? Is that it? That, sir, is not the
way we practice law in this country. But, gentlemen, the main
Question which presses upon my mind in entering upon this dis-
245
cussion is, whether the interests of my client require me to go
on the same range of argument which the counsel on the other
side have done. g
The last gentleman who addressed you in a ten hours'
speech of the most ingenious character, tried to lead you away
from the issue, and to blot out from your minds the broken arm
of this boy. In attempting to do so he has indulged in some
things of a comic character. He stood up here with the gravity
of a minister, and told you he was a Homoeopathist, and that his
father had a dog who ate bread and milk, intending by this, I
suppose, to show that his father brought up his dog and his child-
ren very much alike. It was vastly important that you should
know this. I have learned some new things here. Dr. Belding
told us that we had an internal memory, and an external one;
with the internal, he stores up certain things, like a boy with a
cage filled with pigeons; one boy lets them out and the other
shoots them. The external memory is the door through which
the things of the internal memory are let out. Now, this story
of my friend about his father's dog, has opened the trap-door of
my external memory, and suggests a story to me. An old deacon
in Pennsylvania, had a nice orchard and house, and was blessed
with an only son, exceedingly bashful. The ladies called him
awkward. The old man wanted him to marry a little fat plump
Dutch girl, by the name of Stillwagon. Joe went over to see her,
and set down by her side. Joe seemed to be much embarrassed.
After a while, Joe looks up to Betsey and says, “Betsey, does
your cats eat dried apples P’” If they had, I think it would have
been a more wonderful illustration than the judge's, and I tell
this story to the jury and to the people, and I trust it will be
enrolled on the archives of Carroll County. But the judge put a
sort of query to you which had more to do with the case than
either the dog or the cat. .
It was one of those wise things which lawyers sometimes happen
to think of You will remember that the fact was called out by
the other side, that the father refused to give up the brace, but
after talking with his wife, concluded to give it up. How trium-
phantly he appealed to you and asked how can you account for
his refusal, unless he thought that the keeping of the brace would
be important testimony against the boy. He dwells upon this a
full half hour, and says that he would have burnt it up. But if
they had burnt it up it might be called in question and they dare
246 **
not do it. But we may answer this query by saying that the boy
could not sleep without the brace, and the family did not want to
destroy it or to give it up. The poor boy, when he come to have
that splint taken off, his arm dangled there and he could not bear
to sleep without the splint. It was more than the poor boy could
bear, and the father and mother, in the goodness of their hearts,
concluded to indulge him in his request to keep the splint to sleep
in. The gentleman had the audacity to intimate that they wanted
to keep the splint to avoid its testimony. It is perfectly cruel to
do so. There is pathos in this little incident. The boy had worn
the splint so long he did not know how to be deprived of it. But,
gentlemen, I hardly know where to commence the review of this
remarkable speech, the most remarkable one that I or any one in
this house ever listened to. That it was ingenious and that he
dealt hard blows, I will not deny.
But in reviewing it I will commence with aconite. I do not
feel much, however, like going into a full discussion of that
important medicine. Neither its history nor its composition cuts
any figure here. I ask you, gentlemen, what has aconite to do
with this case ? Not a witness has testified that a drop of this
medicine was administered to this boy, and the defendant’s wit-
nesses, who made it the great panacea to allay ſever and inflam-
mation, and to take the place of the lancet, might have saved
themselves that trouble. But what do they prove 2 These Drs.
from Chieago, say it will allay fever, check inflammation, and do
away with the lancet. Now, I will tell how this struck my mind.
If aeonite will do all this, I ask you would it not have been better
practice to have given some of that aconite to keep down inflam-
mation, and given the boy some food They refused to give him
food for days and weeks. Why not control the inflammation
with aeonite, and give him something to eat? But no witness
has testified the Dr. gave the boy aconite. Arnica was applied to
the head, and there was some other medicine; nobody knew what
it was. Why the necessity of this starving process 2 I think the
Drs’. acts contradict their theories. I am not presenting the
plaintiff’s side now ; I am only presenting some of the many
inconsistencies of the defence. I will now take the blood ques-
tion. There has been an immense amount of misrepresentation
in regard to our view of the theory of the blood. I shall have
occasion to refer to this question more extensively hereafter.
There was one remark of Judge Knowlton, to which I wish to
247
call particular attention. He said no author ever'maintained that
the blood contained ossific matter. This was his language. He
did not make that assertion accidentally or carelessly, for I called
his attention to it, and he repeated it. (I never made such a state-
ment, Mr. Turner.—Knowlton.) I was surprised that he should
make such a sweeping assertion, when, the day before, he and his
colleague both read from a work admitted to be a standard work,
and they had read up to the very paragraph which I propose to
read; but Mr. De Wolf, when he reached this point, for some
reason, stopped reading. Now, I propose to read what he omitted,
Wilson's Anatomy, page 48: “Ossification is accomplished by
the formation of very fine and delicate fibres within the intercel-
lular substance: this process commences at the punctum ossifica-
tionis, and extends from that point, throug every part of the bone,
in a longtitudinal direction, in long, and in a radiated manner in
flat bones. Starting from the punctum ossificationis, the fibres
embrace each cluster of cells, and then send branches between
the individual cells of each group. In this manner the net-work,
characteristic of bone, is formed, while the cells by their conjunc-
tion constitute the permanent areolar and Hoversian canals. With
a high modifying power the delicate ossific fibres here alluded to,
are seen themselves to be composed of minute cells, having an
elilptical form and central nuclei. These cells attract into their
interior the calcarious salts of the blood, and these nuclei become
developed, as I believe, into the future corpuscles of Parkinje.”
Is this a standard author P. He says these new cells throw into
other new cells calcarious matter. (Very different from the deposit
of ossific matter. Published). It is impossible. Where is the
science now 2 The underpining is knocked out. Where, then,
is the superstructure which these learned men have erected ?
Both Drs. Beebe and Ludlam swear this is a standard work in their
college—the very book which they teach to the young men. That
book says that this ossific matter is taken from the blood by
these cells and converted into bone. Now, is it not possible
for these professors from Chicago to be mistaken when they say
that the bone does not derive its material from the blood? If
they are mistaken upon that point, may they not be mistaken
upon other things that Drs. Miller and Porter and others have
testified to, and who have been so shamefully abused, may they
not have some little knowledge? If these mighty men from
Chicago possess so much, then there is that great question which ,
248
Mr. Knowlton gave to you and the ladies to solve, and I thought
it was given more to the audience than to the jury. -
I do not know whether the jury will determine whether Moses
or Dr. Porter is correct. Moses has no attorney here; his repu-
tation is to stand upon its own merits. Moses has been dead five
thousand years. Why should he be dragged into court and
pitted against Dr. Porter P He did this with the gravity of a
minister. Now, gentlemen, I have shown you, and the gentleman
knows it, and he cannot get away from it, that these professors
are mistaken when they say that the bone is not derived from the
blood. I have shown you the gentleman’s rhetoric and eloquence
is not logical, where he asserts what he did, and the books say
that this ossific matter is in the blood. We will not undertake
to be witty upon this point. I cannot follow him in that direc-
tion. But it did strike me that in order to get up a little laugh,
he abused Dr. Porter. He said Dr. Porter told you that every
thing was made of blood—that according to that theory way
back in time, he should read in the first chapter of Genesis that
the chaos of the great universe was a vast pool of blood; and the
gentleman seemed to dwell upon it with a great deal of emphasis
—“Blood blood l l blood | | |"—as though Dr. Porter had sworn
to anything of that kind. Dr. Porter swore to no such thing.
He did say that the arterial system carrying the blood supplied
the necessary material for making bone and muscle. That is
what the book shows, and that is all there is of it.
And now, gentlemen, I must be permitted to pursue this a little
further. If I had not a ten hours' speech before me, I would
dare to extend my remarks; but I will do so now. The gentle-
man in his argument, and both witnesses on the stand, speak of
the manufacture of bone and the growth of wheat from the grain.
Did they not have one witness that went so far as to say that the
bone was made of intelligent agents—that every cell was an
agent. Well, now, gentlemen, that struck me as a very singular
proposition—yet I was very much astonished, because they
opened the theology of this case. This case has a theology
attached to it, as presented to your minds. From the testimony
and the argument of counsel, I tell you that these men are dis-
ciples of that old Pantheistic theology, that God is in everything.
These gentlemen declare that the law of Omnipotence pervades
everything, and they are disciples of the old Pantheistic
school, which has now been resuscitated, and it is here claimed
249
that God, the Great Jehovah, is a permeating spirit, and that
everything is permeated by Him. The logical conclusion of this
theory amounts to this, that they believe in an independent crea-
tion—that everything has created itself. One said these little
cells are a living intelligence, creating themselves, and the other
says there is a vitalizing principle, like wheat, which caused them.
to reproduce. I must be pardoned for speaking a little more
upon this subject than I otherwise should, if they had not said so
much about it. - -
I wish to take up Dr. Beebe's testimony. He said these bone
cells occupy the same position that the grains of wheat do—that
these cells did not draw their nutriment from the blood. The
material from which they build up this bone, he told you, was
not derived from the blood. Now, I want you to consider this
matter a little. You are farmers. Take this grain of wheat and
you will find in one end of that wheat; although it is small, a
small delicate point, you cannot see it with the naked eye, but
with the misroscope you will find there is a little delicate point
there which contains the form of the plant; you plant that in the
ground, and the atmosphere, the rain and the ground operating
upon that delicate point, it begins to draw this nutritious food
around it, and causes it to reproduce itself very much in the
same manner that the cells do. Pretty soon the stalk grows up
and produces grain. It is reproduced. It is, in other words, the
living principle which has been stamped upon nature by the
Infinite Giver. It has performed its feat of re-producing itself,
and the grain has returned to its mother earth.
Let us see. There is a covering which we call bran. It is a
nice, delicate substance, thrown around that grain for different
purposes; like the skin of the hand, it has great functions to per-
form. You take that bone and plant it—it will not reproduce
itself—it will not produce bone—it will not produce wheat, or
that out of which wheat will come forth. Let us take that ten
thousand bushels of wheat and plant it which does not contain
this little point, and you cannot raise a stalk.
A few years ago, an American tourist was traveling in Egypt.
On the top of one of the Pyramids he found a kernel of wheat
which had lain upon that Pyramid at the time when Moses was
upon the earth, and still back of that period it had been lying in
the darkest part of this Pyramid for thousands of years. It was
planted, and it germinated and produced wheat. I ask you, if all
250
the bones in the universe had been planted in that Pyramid,
could one ounce of bone have been produced 2 I would like to
carry this farther; but I am now testing these men, gentlemen of
the jury, upon the sublimest principles of logic and science, and I
will show every proposition which they have made to be false.
Gentlemen, how can bone produce itself? Can you extract
from your body a bone, and by any possible process that your
ingenuity can invent, will it make bone P Has it, in other words,
the power of producing itself? Now, gentlemen, you must adopt
the great principle that Nature's God has stamped upon man.
Like the grain of wheat, under the laws which the Omnipotent
has given, can He reproduce, or does He reproduce, Himself?
No ; not one particle of man reproduces man, and when they say
that bone can reproduce itself, they say what science will not
bear them out in, and what philosophy contradicts, and what God
never did say. If these little cells are independent intelligences,
and reproduce themselves, as the judge says they are, you may
set to work here and make feet and hands. Some poor fellow in
the army comes along who has lost hand or foot, and we may go
to work and plant a bone and raise him a foot or hand. That is
a process we have not yet learned ; yet Chicago is a great city,
but I tell you that this war closes before the Chicago surgeons
learn to do that. Now, gentlemen, in regard to that theory, I
have upset it. Where do they stand now 2 I say that logically,
physiologically, morally,–theologically, if you please, the whole
structure has tumbled to the ground. It has not a peg whereupon
it can stand. If this case is turned over to you, I believe there
are twelve minds here who will say that it is so.
Well, now, gentlemen, whatever I have to say about the circu-
lation of the blood, I will say when I open the case. The judge
has labored with wonderful skill and learning, and the gentlemen
from Chicago have testified with a wonderful degree of skill and
learning. And here let me say I will not undertake to denounce
men as fools and ignoramuses, because they do not believe as I
do; because Drs. Ludlam and Beebe do not agree with me, I will
not denounce them as fools. If I ever go to Chicago, I shall try
to cultivate their acquaintance. I never come in contact with
such men without learning something. There was an Old School
Presbyterian preacher, who lived in an adjoining neighborhood,
who preached every Sabbath, and I used attend his church, on
account of the girls. My father did not like it, and used to
251
threaten to whip me if I did not keep away. I liked the doctrines,
but my father did not, and was determined I should hear nothing
which he did not like. Just so with these gentlemen; if they
cannot build up their own side they are determined to break
down all others. They run down all our doctors except one, and
I will tell you why they except him before I get through. I will
drop the blood question now. I do not believe that chaos before
creation was a tub of blood. -
I now come to the subject of false joint, and here again, gentle-
men, there is no misunderstanding of the testimony of the Chi-
cago doctors; both of these professors swear positively, without
a why or a wherefore, that this boy’s arm is not a false joint. I
take issue with the gentlemen, and if I prove it is a false joint,
according to the understanding of false joints, you must conclude
the Chicago gentlemen must be mistaken with all their learning. I
will prove it out of their own books, which they teach the young
gentlemen who go there to study medicine. I have nothing to
say about Drs. Miller and Porter; their heads are as clear as
mine. Drs. Freas and Bulkley are young men. Is it a fact, that
under all the lights of surgery and Homoeopathy, in the Chi-
cago, Cincinnati, Cleveland and St. Louis schools, young men
are permitted to graduate without being taught what con-
stitutes a false joint? If they say they do not teach about false
joints, they are lying, and I will expose them. Some of our men
state it is a false joint. Among the authors they state as reli-
able, I will read one—Miller's Practice of Surgery, 630. Pardon
me for reading more than one. I propose to read under the head
of false joints:
Disunited Fracture.—“The false joint which results from
disunited or from un-united fracture, bears no resemblance to
normal articulation ; there is neither articular cartilage nor
synovial apparatus. The ends of the bone taper Somewhat, and
are rounded off; they are invested by a dense fibrous expansion
and by a similar teacture they are joined together.”
I will say here, that false joints are not always uniform, as that
book says. They use this book in Chicago. Now then, what
does it say * Drs. Beebe and Ludlam told you that this was a
C3 Se of disunited fracture. They said there was no false joint;
but this book says there is. They admit that there is a cartila-
ginous substance, so that the bones will not rub against each
other. This is to the joint what grease is to the Wagon. Just
2
252
exactly the case here. Now, then, that is all there is of it.
When the bone does not unite where it has been refractured, so
that the bones play upon each other, that is a false joint. I do
not care to run this thing further to see whether false joints may
not sometimes have ligatures. I do not remember of ever read-
ing of or of having seen a false joint. This leads me to another
proposition, and one that I was very much struck with. When
the gentleman brought it out in the argument, the counsel said
that instead of prosecuting this man, he ought to feel very thank-
ful this was not a false joint. I think he ought to thank his
Maker first for giving him one good joint, Dr. Pratt for giving him
another. But still I am not sure that you would feel much
like thanking the surgeon for giving your son a second joint at
the elbow. I think that theory of false joints is pretty well an-
swered. .
I now come to review that part of the gentleman’s speech
where he talks about provisional callus and definitive callus. Well,
perhaps, if I were delivering a lecture before a medical class, or
if I were making a speech to a purely literary society, and where
my scientific knowledge would be very closely serutinized, I
would go into it more lengthy. If I were going to educate you
for physicians, I would go into a discussion on this subject—I
would show you, probably, in this connection, what forms the
bridging or scaffolding over which to carry the bone—I would -
first tell you that the first outgrowth or exudation had a less pro-
portion of life in it than that which forms definitive callus, and
that definitive callus has 50 per cent. of phosphate and 10 or 12
of carbonate of lime.
Much fault has been found with Dr. Porter for saying that
nature has wisely provided for this callus; but it is a truth which
will stand, and stand forever—that nature has well provided for
the repair of fractures in the human body—not in the human
body only, but in the animal and vegetable creation, and I main-
tain, the mineral creation also. It does in the vegetable creation.
I will now talk about something of which you know something.
I have been there myself. I have cultivated trees and carried on
farming. I know you know all about it, just as much as the pro-
fessors do—probably more. Go out this time of the year with
your axe and strike into a cherry, a poplar or chesnut, which
grows very rapidly. Where it is cut there is a wound—a great
fracture in that tree. This great law of nature—this wise power
. 253
of Omnipotence—you will see how the energies of nature go
to work to repair that tree. You see how the sap runs in it and
runs out. The bark you see pushing out the woody fibre, and
presently you see a great clump healed over. True, nature has
been injured in that blow of the axe ; but that wise provision of
nature has gone earnestly to work to fill in with cells and to close
up the wound. If you watch this you will see this process going
on, and that provisional callus which is first thrown out becomes
hard, just like the rest of the tree. Just so in the human body.
Well, now, these gentlemen undertook to say that nature does
not put forth any of this energy; that is their theory, in order to
repair these damages. I apprehend some of you are heads of
families; if you are not, if you remember when you cut your fin-
ger, or foot, as I have done many times with the axe, you will see
how earnestly nature goes to work to repair the wound—in three
weeks from that time, if you will closely examine it, you will see
the granulations taking place, and nature working as busily as she
can be—you will see a little degree of redness, and these little
cells pushing out within a week, and in a few weeks nature has
bridged over that gap, and the work is complete. But, here, the
gentlemen ran off with the theory that it healed by what he
called first intention. What of it? They say that none of these
gentlemen have explained it; that if you cut your finger and put
every vessel in place, the circulation goes right on, and you
hardly know you have been injured; it is all healed over; the
instrument, if a sharp one, or if from any other cause there is no
foreign matter taxing nature, the work is soon completed and the
bone will do the same. These gentlemen say they have read the
same books—which prove that bone will do this same thing, and
not one of these gentlemen ever saw bone do that. Our friend
from Chicago, who has had 4000 cases, never saw but two cases
of the humerus fractured, and Dr. Miller, who has practiced sur-
gery, never saw but three. Dr. Ludlam says he never saw the
humerus which would not unite. They say it is in Miller's Prac-
tice of Surgery, and I have referred to it, and you will
find that all the knowledge in the world is not centered in
Chicago, and here again, gentlemen. Imust be permitted to read to
you the treatment of false joint. (Miller’s Practice of Surgery,669).
That is the point they come to. 657, subject, provisional callus,
and here is what it refers to. I will show you that the reference does
not in any manner bear out the conclusion that provisional callus
254 .
is not necessary. They say that the provisional callus is not ne-
cessary to a re-union. I refer to the book and page, and to see
that it is not necessary. We find it is not so laid down. Here is
the reference, and they have failed to make their point here.
Now, gentlemen, this author does not teach that a bone ever
united without provisional callus. It does say it may unite with
but very little, and that is all there is of it: -
“It appears, from the observation of Mr. Paget, that in a well
managed facture, the formation of provisional callus is reduced
to a minimum ; the exudation being thrown out almost entirely
between the fractured ends, and nature’s splint being in a great
part superseded by that of the surgeon.” 2-
Knowlton says, “Read that on page 630.”
“To undo the apparatus of a fractured limb, and to find the
solution of continuity in the bone still unrestored, at the end of four,
five, six, seven or eight weeks, is no demonstration of the expected
union having altogether failed. It may be that the formation of
definitive callus is yet in progress; and, if undisturbed by move-
ment of the limb, this may be completed in no unreasonable time.
The provisional callus has doubtless failed, but in truth this is not
essential to osseous re-union. When it does exist, it is but a fer-
rule, or clasp, tightly embracing the broken part.” : \
I know what I am about. He wants to refer me to the cases
of flat bones where no provisional callus is thrown out, to prove
that their doctrines are right. By the way, gentlemen, I wish to
impress upon you this fact-in calling my attention to the treat-
ment of these bones, it is merely a repetition of what was said
before. In speaking of the treatment of these bones, it does say they
may form without provisional callus, and refers back to the sub-
ject as prima facie proof of that—and when I go back to it—it
says it forms without much provisional callus. -
I would read more if I had the strength and lungs to talk to
you, and you had the time to listen to it. But, take the fracture
of the skull; if it produced provisional callus, it would produce
congestion on the brain and cause death. Nature is always right;
man may err. There is another thing which tells me that if there
is considerable motion, it takes much provisional callus to hold
it in apposition. When the bone on the head is broken, the brain
is pressed against the skull and the little veins are all around it.
If you have never examined, it will astonish you. There is no
different position which the bones can occupy. The little provis-
ional callus which forms there is just sufficient to hold the bone in
{ 255
place. Suppose there was a little provisional callus attached to the
bows of these spectacles; before the definitive callus could form,
nature would throw out a provisional callus to hold the bows in
place. It would be hard to conduct definitive callus without pro-
visional callus. It is more than scaffolding for the definitive to
lean upon. X-
He (Judge K.) undertook to say that the books say there could
be no provisional callus on the femur, which has a head like the
humerus, only more so. This is placed in a very delicate socket,
like a new box skein which fits so nicely that you cannot put the
blade of a small knife between them. It is so with the femur. It
operates in that little socket so that nothing can intervene. It
has a thin, oily substance—if it was not for that it would squeak,
we should go round here with squeaking joints. Suppose, for illus-
tration, that here was the fracture on this bone. That upon some
occasion or another that part was fractured, but not removed out
of the socket; you see the fitting it to the socket so closely would
not permit of callus being formed around it. The idea of a
fracture presupposes a space. Can a fracture have provisional
callus without space. It is like a crack in the delicate china cup
which the housewife cannot discover until she puts it into the hot
water. They say there cannot be any such callus. Hence,
there is no room for it, for there is a fracture without a crack.
If the tea cup does break there is a crack in it, or vacuum in it,
I don’t care how minute; it might go down to the third or thirty-
third attenuation of a hair, like the gentleman’s aconite. It is
there, and by the microscope can be seen. It is the same as
nature has made it—there is evidence of provisional callus here,
they say; but it was so minute they could not discover it. I
remember that when my mother broke a cup, she had to mend it
in the best way she could ; there was some kind of an herb which
she would boil and put the cup into it; the crack would be there,
but something got into the crack and stopped it up. It was milk
and leek. It was not bread and milk, I am sure. She made a
provisional callus of it. . . . .
Well, now, gentlemen, I have disposed of the blood, the aconite
and the provisional callus, and these were their great principles
involved in this case, so far as I remember. There are some
other things which some how or another have worked into this
case. I don’t know how ; that is, I don’t know why they
should, but they have got into it. There was one other sub-
256
ject that there was a little issue upon. The subject of in-
flammation. Now I shall have to read a greatdeal more
than I want to, to dispose of that subject as I should like
to. Drs. Porter, Miller, Bulkley, McPherson, Freas and Haller
all testify that inflammation, to a certain extent, was neces-
sary to union in all fractures, and they told you why it was
necessary. They told you that in most cases inflammation was the
mode that nature adopted to carry off the debris caused by the
fracture. It was not absolutely essential, but they all testified
that it was a system of absorption that would carry it off, without
injury. Nature provided through means of this inflammation, that
the old superstructure which had been broken up, might be
repaired, and that nature also provided by this inflammation, a
greater supply of blood; thereby making a greater supply of
material for repair. I spoke of the tree where inflammation was
going on, where you discovered an unusual degree of activity,
in carrying the sap to the place of injury. Drs. Porter, Miller
and others all agree upon this point; they said inflammation is
necessary to the supply of blood to form the provisional callus.
These Chicago physicians say it is not necessary; it is only a dis-
eased state. If I remember right what I have read, it is this,
that where nature does a certain thing in a certain way, we have
a right to conclude this is the right way. I have a right, then, to
conclude this is the right way. If by planting an apple seed a
hundred thousand or million of times, it will produce a tree,
we have a right to say that nature will not produce anything but
an apple tree from such a seed. They have no right, then, to
conclude that nature ever fails in her modes of operation. She will
never produces apple leaves from oak trees. We have a right to
say this is nature’s mode. r -
And, gentlemen, if any physician or surgeon has testified that
any bone is actually cured, or any fracture was ever restored
without inflammation, I say they are going contrary to nature's
laws. We have had six medical men on our side, and they have
had three or four, and not in one single case have they ever had
a fracture cured without inflammation. They have a theory that
the infinitessimal dose of aconite might cure. If I should go to a
college a year I might get a theory into my mind I could produce
apple trees from acorns—my learning does not teach me so. Here
is a witness who has had 4000 cases; every one had inflammation
and resulted favorably, so far as he knew. Here is that terrible
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Dr. Porter, that awful man, who stands in direct opposition to
Moses, who has practiced twenty years and never had a case
without inflammation. I conclude that inflammation is a univer-
sal and immanent force—that nature has not cut in on this uniform
rule. If Dr. Porter was a disciple of that doctrine which teaches
that God is in every thing, I do not know but I might think nature
might prove false to herself. According to that theory you need
not be at all surprised before I get through that you may see a
young lamb grow right out of that book, because it is covered with
sheep skin. - - - - -
Now, gentlemen, there has been a great many things said, in
these remarkable speeches, that I may go over in reviewing this
case. I want to observe due courtesy to Mr. De Wolf. I must
notice two or three remarks which he made. He said there was
a question of outside pressure in this case, and you must not be
governed by it. Who made it, and where did it come from ? I
do not know there is any outside pressure. I have not felt it.
There has been no outside pressure, but only the pocket pressure,
and which does not apply to me in this case. When I look around
here and see my client, I see a poor crippled boy, not yet sixteen
years of age—a boy who does not know twenty persons in Carroll
county, and without friends; and the proof shows that Mr. Frisby
is a poor man—that it is not three years since he removed to the
county of Carroll,—before he had fairly moved into the county, this
boy's arm was fractured before they had got settled. I may say,
in regard to the father of the boy, that he is an ignorant man—
not a man of position; that he is a good, honest man, I have no
doubt; that he is not a man of intelligence you saw by his appear-
ance on the stand, when they applied their science to him; you
saw he was ignorant of science. This poor boy and this stranger,
his father, who has but just become a voter, has produced no
such an outside pressure ; certainly not. He has no means
of producing an outside pressure, for there is no interest
felt here for him in this trial. It is not because of over-
shadowing talent; but fair, common lawyers, like myself whom
you have heard make speeches before; and you have known
me before Carroll county was born. If I may be allowed the
expression, I used to haul my grub up here from the Mississippi
with an old pair of oxen, driven by myself, so you see there is no
pressure in that direction. Who has done it? I will tell you,
gentlemen, where and how it comes. I stand here presenting to
258
you a poor boy, without friends and without money, against the
wealthiest men in Carroll county, backed up by the best talent in
Chicago, lawyers and surgeons. There is where the outside
pressure comes from. Look around you; surrounding us here
are lawyers whom I have met for many years; men who have
tried cases successfully with me. I find in this ease, the defendant
has not employed these, but has employed counsel of the most
overshadowing ability of any in the Northwest. There he sits,
that Ajax of the Northwest. He has been brought here at an
expense of one thousand dollars; brought here, for what ? Pri-
marily, to sustain Dr. Pratt; secondly, to sustain a system of
medical practice. Further, I look around, and I am not going
out of their own circle of practice. I see a large number of
medical gentlemen who practice the same system, but are not
called in this case. We did not send for Dr. Blaney, nor Dr.
Brainard, and the mighty lights of Chicago. We took up with
Dr. Miller and Dr. Porter, this second Moses. We picked up
Drs. McPherson and Freas and others, as we could gather them.
They did no such thing ; they did not have a single physician
from the country. They go to the city of Chicago and select two
of the mightiest men in that city; keep them here for more than
a week to testify in a case where this poor boy prosecutes for a
ruined arm. That is where the pressure comes from ; there is
where curiosity is excited. I remember of reading in a certain
paper in the city of Chicago, why a certain convention should be
held there ; that Chicago was the great centre of finance, and the
great centre of railroads; the great centre of commerce, and two
or three other reasons why it should be held there. But really,
gentlemen, until this trial took place, and I heard the speech
of my learned friend, I did not know that Chicago was the great
centre of intelligence, before the gentleman informed you that
you would take such a case to Chicago rather than trust it to
Miller and Porter–old Moses, here on the anxious seat. I am
under the conviction, and I may be a convert to Homoeopathy.
The first proposition was, that Homoeopathy was taken from the
Greek, and meant that like cured like. The second was taken
from Latin, and means that like produces like—that bone produces
bone. But I must be permitted to tell a story. -
When I was a bigger fool than I am now, when I was stumping
it for the democratic party, there was a speaker on the other side.
I hit him and he hit me. He said that Chicago was once a great
259
frog pond, and that you might find there all sorts of frogs, from
the great bullfrog down to the little white-bellied, striped-backed
peeping frog, which falls in the spring rain; that when the water
had fallen away it left the frogs upon the ground, and there was a
terrible commotion among them and divers scrambling. When
they found they could not get water, they got into a rampage and
swore “Be Jabers, they were no more frogs; but dimmercrats,” and
ever since that they have had a great antipathy to cold water.
This man says, and I believe there is some truth in it, that Chi-
cago is a great city. The first time I visited Chicago, was imme-
diately after the Black Hawk War. I walked over a thousand
miles to see this great city. It was nothing but a frog pond then.
I saw frogs there, from the big buil frog down to the little white-
bellied peeping frog. Behold Chicago, rising out of the frog
ponds, and look at the varieties of frogs which have been sent out
here, from the great big bull frog down to the small white-bellied
peeping frog. Like produce like. That is why these people are
here. They knew Chicago was going to exert herself. They
have come out here from their abnormal state (excuse me if that
is not a surgical phrase). It is not quite fair that this state of
things should exist. Is it fair, in other words, that we should be
overshadowed in this way ? It seems to me that the talent here
would have been sufficient for this case under ordinary circum-
stances. It is not fair that us country clod-hoppers, that have
tried to get along in this case, should be pushed out by these
learned professors and gentlemen from Chicago. I remember
when a boy, reading the translation of Homer. I would read
along where the mighty armies were pressing down upon the little
handfull of horsemen, that old Homer would paint the great
Gods as descending and entering the hearts of the weaker
party. That was the style that struck my young fancy. When I
saw the feeble army struggling for the right, for God and Lib-
erty, and I saw the Gods descend from Heaven to aid the weaker,
I could not help crying. - -
We present you this case, of a poor boy who has been misused,
and that these mighty gods of Chicago have descended upon us
to carry us away. Perhaps they will succeed. I don’t know what
there is in this case, stripped of all its excitement. What is there
in this case ? On the one side we have a boy who claims he has
not been properly treated by a doctor; on the other side we have
a doctor, and no doubt a very respectable man, so far as I know.
260
I know nothing against Dr. Pratt. I have no reason to speak ill
of him; no reason to say anything but what he is a respectable
man. So far as feeling is concerned, there is not, in the deepest
recesses of my heart, the slightest ill feeling towards Dr. Pratt.
Gentlemen, I am not related to this boy in any way that I
know of, only by the common ties of humanity. I never saw
these parties until they came to this court house. I saw the
plaintiff only once before I took this case, and I have nothing to
do with this case but to see that this boy has his rights—only
so far as it lies in my power to aid him. I was astonished at the
closing remark of the gentleman before he took his seat. I was
greatly astonished when the gentleman told you (if I understood
him right) I was a man of an affectionate nature, and to look
upon me Stoically. I think these were the words; and look upon
me stoically, because I was a man of an affectionate nature. I
claim to be no more affectionate in my nature than falls to the
lot of humanity. You will bear testimony that I am no more
affectionate than common men. When I saw that arm stripped
here before you, I did not turn sick and faint at the sight. I cast
my eyes over the jury and saw there this great distinction which
distinguishes man from the beast, which manifested itself upon
your countenances, and some of you could hardly endure the
sight. Now, gentlemen, if that arm so much affected you, being
entire strangers, how must it affect that mother, whose head has
grown gray under this trouble 2
How must it affect that father, who has looked upon that boy
from day to day as he has grown up before him, and that every
night when he undresses him he has to look upon that arm! How
must that woman’s heart bleed every time when she looks upon
that distressed boy How must that father’s hopes shrink back
into his heart when he beholds his son crippled for life! Then
tell you to look upon me stoically. Shut out from your heart
that which distinguishes you as men and look stoically upon me.
I am asking no favors, gentlemen of the jury. I am not coming
here a beggar at your feet by any manner of means. I am pre-
senting to you the most outrageous case of malpractice, and yet
the attorney asks you to look upon me stoically, or not to look
upon the case with humanity. We find, from the testimony, that
on the 20th day of December, 1862, this boy, with the elder bro-
ther, was coming home with a load of corn from an adjoining coun-
ty. They attempted, on the defence, to prove that they attempt-
261
ed to run their horses—that this boy tried to run past his brother,
or his brother past him. That may or may not be so, but proba-
bly is so. I don’t care anything about it. It cuts no figure in
this case. The boy was thrown out of the wagon and badly hurt
—the right hand badly lacerated; the metacarpal bone was frac-
tured; the head had a contusion which took a little time to cure,
and the left arm was broken—how much, you must find from the
testimony, because that is matter for you to find. -
These people had just come into the precincts of Carroll
county; they were utter strangers in the neighborhood. The
proof shows they knew no doctor, and when the accident hap-
pened kind neighbors called the doctor and had the wounds
dressed. It occurred near the house of Mr. Morris. The elder
brother picked up the boy and tried to take him to the house.
On his way to the house he met Mr. Morris, and said his brother
had been killed—go for a doctor. He did not look stoically upon
it, and goes for Dr. Pratt, and sent for the father. When the
father got there Dr. Pratt was there. They had not commenced
doing up the arm. The chloroform was sent for, the first thing
to be done in the case. The father sees his boy badly wounded;
he finds the doctor there. What would you have done? You
would have done as he did. He says to Dr. Pratt : “Are you
competent to take this case and take care of it?” Dr. Pratt says,
“I am.” Dr. Pratt tells him, “If you wish for any other doctor
you can have him.” Frisby said, “I am a stranger here, and as
lief employ you as any other man, if you can do it right.” Dr.
Pratt assured him he could. What would you have done in simi-
lar circumstances, in a strange country, not acquainted with any
doctors, the boy lying there, with his wounds undressed, and
utterly incompetent to help himself? That reminds me of another
thing, gentlemen of the jury. The question was not asked, what
kind of physician he was. There was no question about “pathies”
at that time. The only questions at all operating upon the mind
of the father were, “Are you capable * “Are you skillful?” “Are
you competent to take charge of this boy " He told him as he
ought to, go on and spare no pains or expense. He felt as you
would feel. If you had found your boy mutilated you would
spend the last dollar you had in the world that the boy might
have proper treatment. Upon that assurance the doctor goes to
work and does up the arm in splints, and sets one of the Mr.
Morris to make splints. Gives him chloroform. This was on
262
Saturday. On Sunday the boy was taken home in a wagon. On
Monday or Tuesday Dr. Pratt visited the house in company with
Dr. Wales. Two or three weeks after this he visited it with Dr.
Wales again. He continued to visit it occasionally afterwards;
and that brings me to the first great discrepancy in the testimony.
There was no discrepancy as to the wounding and dressing; but
in what occurred next there was a great discrepancy. One of the
great things for jurors to do is, to reconcile testimony and discard
that which ought not to be reconciled. -
We come now to the testimony of the splint. There is no wit-
ness that has testified that this is the angular splint which was put
upon the arm. There is no testimony to my mind, or would be if I
was a juror, to show that this might be the splint. Now, it be-
comes a question of the gravest importance, as to when it was
put on the arm. Even old Moses here admits, and no one denies
it, that the splint is a good one. Now then, when was it put
on the arm. Dr. Wales says, on Monday or Tuesday he visited
the patient with Dr. Pratt, and the splint was on the arm at that
time. Dr. Pratt, in presence of the parents and the boy, observed
that the splint was put on at Morris's, as to move him. I state it
fairly and candidly, and as favorably for Dr. Wales as I can. He
swears positively that Dr. Pratt said he put it on to protect the arm,
in bringing him home from Morris's. Then, according to that tes-
timony, it was then on and must have been on at Morris's at that
time. That brings me to the most disagreeable part of the case,
gentlemen of the jury. It is disagreeable for me to have to take
certain possitions to expose the reasons which I have for arriving
at this conclusion. I must refer to the testimony, and I will state
it to you, and they have it taken down in the same way. Mr.
Frisby does not know. He tells us he has no recollection of it,
when it was put on ; it might have been put on the next day or
the next week. Then his testimony does not amount to anything
definite. But Mrs. Frisby’s testimony is direct, that on the Tues-
day of the second week Dr. Pratt came there and she sent her
son to Dr. Pratt's for that splint. She swears positively that it
was never near the boy until the second week. There is no
equivocation about that. - -
Mrs. Moscript swears positively, and sticks to it, that the splint
was not put on until the second week. . * .
Harvey Frisby, the brother, swears positively that he was sent
for this splint to Dr. Pratt's. - -
263
That was two weeks after the injury. I have stated it exactly
as it stood on the cross-examination by one of the most able and
ingenious attornies that ever visited Carroll county. That Dr.
Wales could have been mistaken I cannot believe. I am as char-
itable as most men, and I know it is difficult for me to arrive at
a conclusion which implicates any man. If I have a weakness
that overrides my judgment, and which my friends blame me for,
it is, that I am too charitable to believe any man guilty of perjury,
and I never give it up that it could be so until it is thrust upon
me by evidence I cannot resist. There is but one conclusion as
regards the splints which a logical man can arrive at, and that
is, either Dr. Wales has sworn to what is not true, or else these
two women and Harvey have perjured themselves, and stand
here before Almighty God guilty of the highest crime known to
the law resting upon their consciences. There is no reason for a
mistake by either. The other party will not call it a mistake.
These witnesses, unimpeached, swear that splint was not on the
day Dr. Wales says it was. “False in one thing, false in all,” is
the Latin maxim. If Mrs. Frisby, Mrs. Moscript and Harvey have
sworn falsely in one part of the case, you are to disregard their
entire testimony, and say in your hearts that these three wit-
nesses stand before High Heaven with the crime of perjury rest-
ing on their heads. If Dr. Wales, for the purpose of sustaining
his partner, or of sustaining Homoeopathy, or any other “pathy,”
has falsified the truth, you are to disregard that testimony.
Before the eye of the Omnipotent God, you are bound to disre-
gard that testimony. -
Gentlemen, who has falsified the truth 2 These three witnesses
or that one P What are the probabilities that charity would say,
that one man was guilty rather than two women and one man
Who committed that perjury P Humanity would admit only this
conclusion. - -- .
Now, gentlemen, without delay upon that subject at this time,
let us proceed a little further. Following it up, we find Dr. Pratt
constantly saying that this arm was doing well for some six or
seven weeks. Here, again, we come in conflict with direct testi-
mony. Here we find Dr. Wales testifying that he and Dr Pratt
undressed that arm in the presence of the father and mother;-I
am not certain as to the father. They found that the boy could
raise his arm to his head; that he called the attention of the
mother to the fact, and that she noticed it. There can be no mis-
264
take about it. Mrs. Frisby swears that she never saw that arm
raised—was never in a position it could be done. “False in one
thing, false in everything,” is again echoed back to our minds.
Who would be the most likely to treasure it up in their hearts
forever, the young aspirant for surgical honors and partner of Dr.
Pratt, or that mother? Had I a jury of mothers they would
answer that question very soon.
Gentlemen, you may have the good fortune to have children.
I remember the degree of pride when I went home and my wife
told me that our eldest had taken the first step. Show me
the mother that cannot remember when her child cut
its first tooth or took its first step. There is something there that
is treasured up. These peculiar emotions at the first step or the
cutting of the first tooth are applicable here. Think you that.
mother, who, for several weeks did not take her eyes from that
child, would have forgotten this important fact P When the
important news came that he could raise his arm, would she not
remember it 2 I have known bad women, but I never knew one
so lost to the dignities of womanhood, who would not have treas-
ured up that fact. How much more would the mother be likely to
remember it when she had wasted her own health in taking care
of him—the lifting up of this arm. Look upon me stoically, but
not upon that boy or mother, for God’s sake. The echo comes
back, “False in one thing, false in all.” Did that mother lie
when she told you that that boy’s arm never had been raised
from the time is was fractured Did she lie when she said Dr.
Wales never called her attention to it? She did, or some one
else did.
There are other discrepancies in this testimony, but I shall not
weary you with following it out as particularly as did Judge
Knowlton. I will try this case without any ambition on my
part to show my knowledge of science. On the third of Febru-
ary old Mr. Yeoman was there, and Dr. Pratt was there, and
Mr. Yoeman, at Dr. Pratt's request, took hold of the shoulder,
and Mrs. Yeoman took hold of the arm; and he tells you he
thinks he pulled a hundred weight. There was extension applied,
and Dr. Pratt manipulated the arm at the same time. Mr.
Knowlton ridicules this idea, and undertakes to show he could
not pull that much. . ~.
The injury took place on 20th Dec., and this was the third
of February, and ossific union had not taken place. If this
265
had been properly set, there would ordinarily have been union
by that time. The testimony shows that treatment was not proper.
The Chicago gentlemen claim, if the bones were out of place,
it would have been proper to put them in place. The old gentle-
man who testified to this, has not been contradicted, is a respecta-
ble man, and his countenance shows him to be an honest man.
There he sits, and he has as good a countenance as any of you,
gentlemen, and you are bound to believe him. Dr. Pratt said
pull harder. I know that is the way to make extension, for I
have assisted. It is perfectly natural that Dr. Pratt should have
said so. The probability is that the provisional callus, if any
had formed, was broken up then, when Dr. Pratt reset the arm.
Sometime about the last of February, it is claimed that this
arm was refractured. Upon this point there is some contrariety
of testimony. Mrs. Frisby says that the boy came into the
house and went up stairs; that she discovered there was a slight
split on the side of the splint, but she interrogated Frank, and he
said it did not hurt him. The testimony of the other witnesses
all agree that it was not as much fractured as it is now. Did the boy
refracture the arm on that occasion ? If it was not in apposition
on the third of February, there had not been time for the arm
to unite between that and the last of February, when this took
place. Young Shaffer testifies he caught his arm on the fence
post, but that the boy kept on playing for some time, and did not
complain. Mr. and Mrs. Frisby both swear that when they saw
the splint split, they interrogated the boy thoroughly, and he said
it did not hurt him. The remark that Mrs. Frisby was alleged
to have made was, that she thought it hurt him worse than
he pretended. She denies; and you have a right to bring your
own experience to bear upon this point, to test the probability of
her having said so. We know it could not have been done with-
out being attended with pain, and no one heard him complain of
pain. We find that the Morrises and all the witnesses testify he
was in much pain at the time of the fracture. Mr. Morris did
not mean to be understood that the boy did not complain of pain;
he did complain, then. The testimony of Miller and Porter is
direct upon this point, that there must have been pain, and the
Chicago Drs. say there must have been some pain in case of re-
fracture. Suppose it was refractured the second time. Dr. Pratt
was there the next day following, and the parents did not conceal
what the boy had done, but Dr. Pratt did not even take the
17 --
266
splints off. He said the boy had loosened the parts a little. But
suppose the arm was refractured, which we deny ; what was the
duty of the surgeon It was to reset the fracture. I tell you,
there is a beautiful young lady in this room who broke the bone
of the femur, and had it set, and fell and refractured it, and the
Dr. set it again, and she soon walked around with it as before.
These Drs. from Chicago say it could not be that it could refrac-
ture without pain. You have been really fortunate if you have
not had some instance of this kind. These cases, however, of
delayed union are mostly in the books which are written by pro-
fessors in the medical institution—and occur about cities, being
rarely in the country. - -
In this county of Carroll, which has sent one thousand sol-
diers to the army, there has not been a single case of fracture of
the humerus, I venture to assert, which did not re-unite. If you
have been in the hospitals in the cities, you would have seen men
and women rotten with disease from head to foot. There you
would find the miserable debauchees, and every form of vice; and
there alone you would find the false joints treated of in the
books. In the country like Carroll county, where the young
men and women are healthy, under proper treatment you find no
false joints. There is one of the miserable old fogy doctors who
had never had any these cases of false joint? Where is Dr.
Miller? I do not see him; if he is not here he ought to be. He
has practiced surgery twenty years, and attended the birth of
more than half your children in Carroll and Jo Daviess, for that
period of time, and he has never seen a case of false joint. What
a miserable old fogy. He has stood by the bedside of families of
this county, and assisted in bringing into existence two-thirds of
the children of this county. Poor old fogy What a pity it is
that your people could not have had Chicago Drs. to set the frac-
tures. Will you not take the next son or daughter who has a
fractured limb to Chicago to be treated? ‘. .
Dr. Porter, he has been sometime in the West, and he has
never seen any false joints since he left Baltimore. Dr. Freas has
never seen a case in twelve years’ practice. Dr. Haller has
practiced two years and has never seen a case before. I believe
you are all fogies. George Washington was an old fogy;he never
saw a railroad But I think you will not take your children to
Chicago to be operated upon by these Chicago Drs. I think the
day is far distant when Carroll county will be blessed with that
2’
267
kind of life which will cause false joints like those in the city of
Chicago. There is another bit of collateral testimony that comes
in here in regard to this old fogy practice—which always cures,
There was one thing which struck me as curious; you have not failed
to notice that Judge Knowlton has the most imperturbable counte-
nance you ever saw. Whether things go to please or displease,
it makes no difference with him. I should recommend him for
the next Secretary of State, for he can beat even William H.
Seward in that. When I had old fogy Miller on the stand, he
said he never had seen a false joint. He said he had seen one
which went some five or six months, and by this friction power
he cured it. If one of these big Southern bomb-shells had
exploded under the Judge's chair, he could not have jumped up
quicker than he did when I asked Dr. Miller that question, and
objected to its being answered. He was not permitted to answer
my question; the court overruled it. But why was it that that
question had such remarkable effect on the Judge 2 Was that
one of Dr. Pratt's patients? The witnesses did not say so. I
cannot say so. Shall I tell you what struck me? It was that this
was a case of incipient false joint, and they did not want to have
Dr. Pratt's surgery examined. If it had been good they would
have been proud of it. I leave it to you to judge what the motive
was. Dr. Miller would not have been afraid of having his sur-
gery examined; why should Dr. Pratt? He could have called
up his friends and had them testify in this matter. Miller would
have allowed these witnesses to come up, and so would old Moses.
Then this case and that case are the only cases which Dr. Miller
ever saw, and that one Dr. Miller cured—this is tolerable good
evidence that he might cure this one. Dr. Pratt says you may
take this case to any one around here or in Chicago, but Dr.
Miller, because he would not do justice, because he is so opposed
to Homoeopathy. It struck me that when he touched Dr. Miller
so lightly, and pitched into Dr. McPherson and handled him
without gloves, and skinned Porter up one side and down the
other, it meant something. He says Miller is a pretty good old
fellow ; is all right. But Dr. Pratt said, go to any other living
man but Dr. Miller. Yet Dr. Miller had had a case, and it had
been cured. But to return; Dr. Pratt did not re-adjust that bone
on that occasion, if it was refractured, or ever afterwards. The
testimony of Mrs. and Mr. Frisby, and Mrs. Moscript all concur
in saying, that two weeks after that time, Dr. Pratt did say it.
268
was back to its original place, and thus all concur in saying that
Dr. Pratt did continue to say it was doing well up to the time
when he went down to Dr. Belding's. How did he come to go
there? The testimony shows Frisby had become uneasy, and,
that about the 15th of May they went to Dr Belding's and met
Dr. Belding and Dr. Freas, both of whom have been witnesses
on the stand. Dr. Belding says, that in questioning him, I did
not state his testimony fairly. If I did not, gentlemen, you
undoubtedly know which was correct. Dr. Belding says, by the
way, he felt a little nervous about the shingle nails; he said it
only in a joke, that he only said he would fasten the bones
together with shingle nails. He likes to be witty, and I am
inclined to make due allowance for everything he stated ; he is
seventy-three years old; he said that old head could not think as
fast as he used to. I would not utter a word against him ; per-
haps none of us will reach the age he has attained; the probabil-
ity is, that our minds may not be as well preserved as his. I
have no doubt that what he told you was true, that what passed
thirty or forty years ago he could remember; what two or three
years ago, not so well. He could not remember passing events;
and the old man Dr. Belding has not sworn to anything which
affects this case one way or the other. He told you his opinion
was made up partially of his own examination, and partially from
the examination of Dr. Pratt and Dr. Freas. He says that if I
said that his opinions were made up from what Drs. Freas and
Pratt said, I misrepresented him. I said that it was in the con-
dition as now. -
Dr. Freas says he examined the arm and found no evidence of
provisional callus on the arm. That he, Dr. Pratt, did not claim
that the arm had ever been united. Dr. Belding says that Dr.
Pratt claimed that what we call the principal fracture (which I
did not think existed) had united. Dr. Freas says he did not
claim that the arm ever united. It is strange that at that consul-
tation, when everything was talked over, this was not mentioned.
Freas says they did say something about the splitting of the
splint, but there was no pretence on the part of Dr. Pratt that the
bone had ever been united. Mrs. Belding testifies that on that
occasion Mrs. Frisby told her that the boy had refractured the
arm; that she had made the boy own it up, or words to that effect.
Mrs. Frisby, who was the speaker, swears she never did make
any such statement; that she never had any introduction to Mrs.
- 269 \ .
Belding, and did not talk to her at all. Mrs. Belding said, “I was
at your house, Dr. Pratt, a week or two ago. You told me that the
arm was united, and how is this?” Dr. Pratt said, “It was hit;
Frank was playing ball and fell against the fence and refractured
his arm; is that not so, Frank? if not, how was it * The boy,
she says, said it was the way it was done. If this conversation
occurred, then Mrs. Frisby does not state the truth—you must
reject one or the other of these witnesses. If Dr. Pratt made
any such statement, he was mistaken. Take either horn of the
dilemma. When it comes to conflict of testimony, I have a mem-
ory as impressible as wax, and remember such testimony very
accurately. I cross-examined her upon how long it was before
this time, she was at Dr. Pratt's ; she said it was three, four, or
five weeks; not longer than five weeks. That would carry us back
to the fifth of April. This corroborates the statements of Dr.
Pratt, to the parents of this boy, that the arm was doing well;
he told her he was going to take off the splints soon. You must
do one or other of these two things—if you believe Mrs. Belding,
then Dr Pratt did not tell her the truth. I leave it to your con-
science, which is correct. This was no more than a month after
they claim the arm was refractured. I have given a statement
of what I call the conflicting testimony. We have three unim-
peached witnesses against Dr. Wales. We have the testimony
of the mother—you well recollect it. I have shown you that Mrs.
Belding has stated what is true or not true; you may take either
horn of the dilemma. ?'
Having disposed of the conflicting testimony, I propose to
show the statements of these women, in regard to splints. One
swears that the angular splint went on at the time of the fracture
—and then that it did not go on for two weeks. If I had known
as much about these long splints at first as I do now, I would
have had them brought here. The testimony is not that when
the arm was first fractured, Dr. Pratt was called and dressed the
arm, and made a very bad job of it, as I think. There is a little
conflicting testimony about the thumb; I do not care much about
it. Dr. Wales stated that the arm was done up first, and then
the thumb, and finally he stated that he was positive the arm was
done up first. I pressed him hard upon that point. We call the
two Morrises, and they swear positively that the thumb was done
up first. I want you to remember this. I now go to the band.
ages. One of these Morrises swears—by the way, when one of
270
these women was on the stand, one of them swears that these
splints were used—one of the Morrises says there was certain
shingle splints put on the arm, which I do not doubt. I never
tried to controvert that testimony. If we had had these splints
on the start, we would have gone into the more minute particu-
lars. This young man says these pine splints were longer than
these, when there was nothing put on to the fore-arm to brace it.
Dr. Wales testifies that the roller was applied from the wrist up
to the shoulder. The women say the bandages came just below
the elbow. I am going to show that this testimony is true. We
call your attention to the splints. Dr. Wales positively testifies,
three or four times, that these were not the splints; if they are,
they have been cut off after they were put on. Mrs. Moscript
and Mrs. Frisby both swear these splints were on the arm when
it was undone, and that they were never cut off. Dr. Freas
noticed they were too short, at Dr. Belding's, but did not speak
of it. Dr. Walestestifies they were cut off then. If these have
been cut off, Mrs. Frisby and Mrs Moscript both swear falsely,
and Dr. Freas was mistaken. In conclusion, Dr. Wales, by
swearing that these have been cut off, tacitly admitted they
were too short. Did he tell the truth 2 I think we have
established our position on the subject of splints, and perhaps
these two shingle splints, which the witnesses say were as long as
this one—then measuring by the size, they may be mistaken. I
do not wish to give a false statement of it, that there was no
other support of the fore-arm, only as it was bandaged to the
wrist. If Dr. Wales has so falsified the truth that you cannot
believe him, that the bandage went to the wrist. This testi-
mony shows, after the arm had been done up, by the way, this
bandage should have been kept on all the time. They testify
that the arm and hand swelled, and was black and blue. If that
bandage had been on they could not have seen that the arm was
black and blue. Dr. Pratt told them to rub the arm. It would
do no good to rub the arm when the bandage was on. Dr.
Wales says it was put in a sling. They cannot find any author,
Homoeopathy, Allopathy, Hydropathy, or any other pathy, but
what says the arm must be so confined as to prevent muscular
action. Some say it must commence at the finger, but most of
them contend it must commence at the wrist. These learned
Drs. from Chicago tell you why, and so do our old fogies, too—
that the muscles which affect the hand and fingers are fastened
271
near the elbow; and this pronation and supination are made by
these muscles. They tell you, the old fogies and the new fogies,
Allopathy and Homoeopathy, that if the bandage is not tight
enough to keep these muscles confined, they will draw the bones
out of place. I have shown that these muscles here could not be
kept quiet, if the bandage only extended to the wrist, they were
not tight enough, for there was muscular motion here. Mrs.
Moscript says the arm was uncovered several times. If it was
uncovered so often, you could plainly see whether it had properly
coaptated, for every time it bowed out, the non-union could be
seen if it bowed out. If it bowed out every time, it was not held
in place, it was not properly set. It was six weeks after this that
we find this pulling process was resorted to, as testified by Mr.
Yoeman, and a protrusion of the bone. It was contracted and
moved by these muscles that were not confined. Was this good
surgery; not to confine the muscles of the fore-arm 2 I refer you
to their own books—to Hamilton, this is the best book of any of
them. Here again Mr. Knowlton shows his great ingenuity in
arguing this case. He took a place in Grose and showed you
certain plates where the bandage only extended to the wrist. He
did not tell you this was the proper bandaging used with certain
kinds of splints; their own books concur in stating the fore-arm
must, in all cases, be confined and kept in a quiscent state. (Shows
the bandaging plate which Judge Knowlton exhibited.) From their
argument, we must suppose that the author argued that that was
the kind of splint to be used. The diagram has nothing to do
with the roller coming out to the fore-arm and up to the shoul-
der. If that is useful, that wants to be put on in the first 'place.
There was no bandaging on the fore-arm, and the bone was not
put in apposition, as proved by Mr. Yoeman, and the manipula-
tion of the arm. x
Gentlemen of the jury:-I thought I had said all I could about
keeping that arm in place. I attempted to show that arm had
not been put in place, and never been kept there. The gentlemen
read from several books, the cause which prevent union, and if I
were to undertake to read over again what they read, and pick
out what applies to our side of the case, it would take more time
and more voice than I can expend upon it. I very well see that
you must be tired by this time. • .
These testimonies show there was no constitutional causes
which could operate to procure non-union. We must, therefore,
272
look to local causes. If you will turn to Hamilton you will find
that the practice is upon army surgery, applied to gun-shot
wounds, which are much more likely to fail of union than any
other case, We must conclude, then, that if this arm had been
properly dressed at first, and kept in a proper place afterwards,
the arm would not have failed to unite. (Knowlton.—I wish you
would read the title of the book. That shows it is not a treaties
on army surgery.) I have read it, and it fully sustains what I
stated. : * - -
Now, in regard to the thumb, I have a word to say. There was
a tearing of the soft part of the thumb, to a considerable extent;
it was an ugly wound; the thumb was put out of joint, or more
properly speaking, broken ; at all events, the thumb was not
cured. A Chicago physician said he would have been proud of
it. After the outside wound had healed, he said that he should
have gone to work to repair it. Dr. Pratt said he was ashamed
of it. Why ashamed of it? If it was such a job that the Chi-
cago physician would be proud of it, I should feel grati-
fied. If, after I have closed this case, I feel I have done my duty,
I know my friend Knowlton feels gratified with the effort he has
put forth here. I know that the thumb was put up to suit Dr
Pratt. If he was ashamed of it he did not perform his whole
duty. You must take this into consideration. What was the
fracture on the arm 2 I think the testimony of Dr. Wales has no
weight. The Chicago surgeons testify that provisional callus will
form around a comminuted fracture. I think no surgeon has had
the sagaciousness to say that this bone would unite without pro-
visional callus. It is where the fracture is simple, where the
parts are put in proper apposition, but in cases of bones broken in
many places, I challenge them, all books and physicians, to say
that this has been a comminuted fracture—from the provisiona
callus. * : - - - -
Judge Knowlton read a case of a child having a fracture at its
birth. In a year that callus had gone away. I tell you that was
very natural; there was not a bone in the child’s body you could
not have bent. It hardly passed out of a callus state and there-
fore, when there was a great diffusion of the callus, and flexing
of the parts it was in the uppermost part of the bone formation.
If this had been a comminuted fracture, it would not have thrown
off this provisional callus in five months. Dr. Freas tells you
that he examined the arm at Dr. Belding's in May, and no pro-
273
visional callus had formed there, and the bones had rounded off,
as though absorption had taken place. Was there any callus
there at that time? Dr. Freas failed to see it. Dr. Freas says,
from that examination he was satisfied it was a compound frac-
ture; and there is pretty strong evidence that it was not a com-
minuted fracture. -
Dr. Miller is one of the most skillful surgeons in the North-
West. He says he has practiced surgery here and in Jo Daviess
for twenty-three years, where he has had twelve or fifteen cases
per year, or more. They admit he is good authority, and he states
positively that he examined the arm, and that it was not a com-
minuted fracture; that it would have produced provisional callus and
could not have been destroyed by that time. There were two sur-
geons who examined it within five months, and who say there was
none to be found, and they were as good surgeons as we had. We
are backed up by Dr. Porter, who says there is no provisional
callus, and there was never a comminuted fracture, and with all
the abuse they have heaped upon him, they have failed to pro-
duce a man of more science. --> - .
Dr. Bulkley, of Freeport, has practiced twelve years, and has
about as good practice as any of them. He lives in my town, and
I do not like to praise him too much. We think he is about right.
Dr. Bulkley did not put on any airs—made a critical examination,
stated if a comminuted fracture, there would have been provisional
callus there. - r t
Dr. McPherson, who did not graduate, but who attended a
course of lectures, made an examination of the arm, says there is
no provisional callus—that the callus would have been there if a
comminuted fracture. Four surgeons state it was a compound
fracture. There was no comminution. Have we not any evi-
dence upon this subject 2 Have we not the evidence of that cel-
ebrated man, Dr. Ludlam, who said there was no evidence of
provisional callus there, and could see no trace of compound com-
minuted fracture.
When I come to the testimony of Dr. Beebe I take execptions.
He pressed his arm with great force. I ask you if it would not
hurt you to pinch your arm in that way? He pinched it until the boy
winced. Dr. Beebe took that as evidence there might have been
a fracture there. He did not say there was one; there might be.
There is no one of you who would stand it without flinching. I
think there are as good Drs. in this Court as Dr. Beebe claims to
274
be. Dr. Ludlam appears to be a fine man and exceedingly skill-
ful in his profession; he could detect none. . -
Now, Gentlemen, what are we to infer? Dr. Wales merely
fixed up this testimony to suit the case. If it was a compound
comminuted fracture, after the warning the father gave him, not to
spare any pains or expense, it was his duty to put the bones in
proper place, and to see that they were kept there. If John Doe
hangs out a sign and claims to be a tailor, and I take a coat there
to be cut and made, and he spoils the coat, he is responsible; and
so of every profession or calling. w
They say upon the other side, that the surgeon is not an insurer
that the limb will heal, but he is bound to use due skill and care.
The simplest form of liabiliy in law is that of an attorney in col-
lecting a note. You come along here and see a sign out, “Miller
and Smith, attorneys at law”; you place a note of a thousand
dollars in their hands for collection. That sign is an assurance
that they practice law. They take your note and begin a suit,
file a declaration. The note is dated in 1863, promises to pay A B,
or bearer, one thousand dollars, six months after date. The case
comes on for trial; there is enough in the case to warrant recov-
ery, but when they come to try it, their papers are not right. The
jury is empannelled; there is the note. The declaration is in 1853.
Here is a variance, and the note is ruled out, and the judgment is
against you; your thousand dollars lost. Who is to blame? Their
shingle that attraeted you to the office 2 If I was guilty of such
an act, what would you do with me? You have lost your thous-
and dollars, you would go to some other good lawyer and bring
a suit against me, and recover the amount of note lost and the
cost. The public has a right to be protected against frauds and
malpractice. Suppose I am insolent; your damages is lost; the
thousand dollars you put into my hands has been the means of
turning you upon the world a beggar—and you are crowded as
such. You would not be obliged to put confidence in such a law-
yer. . -
Now, what would you do with the doctor ? I cannot tell wha
is his general skill. Now you notice that we attempted to prove
that the doctor was not a skillful surgeon, but the Court ruled it
out. He might have treatedone thousand cases successfully before
this; and if he failed to give this case the kind of treatment which
resulted in a cure, he would be responsible for the case. If you think
that Dr. Pratt ought to pay damages in this case, that is why I
275
may undertake to prove what is the general skill of Dr. Pratt. I
knew as soon as I put my eye upon the countenance of the Judge
that he would try to direct your minds away from the real issue,
and not try the case upon the merits. You are not to enquire
whether he is the most skillful or unskillful surgeon on the earth, or
whether it is the most careful or negligent. You have nothing
to try but the treatment of this case. The tailor to whom I took
my coat, and who spoiled it, may have before and since made a
thousand good coats; but he spoiled mine, and must pay for it
Dr. Pratt has spoiled this boy’s arm, beyond all question, and
must pay for it. This is probably the last point in the case which
I wish to discuss to any considerable length. Was the treatment
of this case conducted right or wrong? The general hypothesis
of the case was all that was put to the surgeons. What did they
tell you? What did these women swear to ? They said that
the boy was kept for three or four weeks with no diet at all—gave
him gruel, crackers and toast. The father and the women swear
to this. Was that proper treatment, gentlemen. The gentleman
in his argument, said it was not the quantity, but the quality.
They tell you that it was the low diet, and small quantities. They
say he cried for something to eat. A boy fourteen years old cried
for food, because his parents dare not give it to him, because the
doctor forbid them not to do it. They felt sorry for the boy while
weeping for food, still obeying the orders of the doctor. But
love for the boy triumphed over the mother’s better judgment,
and she refused to give him food. Why did not the doctor give
the boy something to eat and control it by aconite ” But they did
not give a particle in this case. .
They said the blood stood in puddles on the floor; and the quilt
was saturated with it, according to their testimony. I show you
from their own books, that in cases of this kind, of severe extrav-
asation of blood, Drs. Miller, Porter and all, tell you that a gen-
erous died was required in each case. But they throw themselves
upon their dignity and say that food has nothing to do with the
manufacture of bone. But this blood goes from the heart down
through the arteries, by which the capillaries in the bone are fed,
and then back again to the heart. Now, I will see if they are
consistent. I tell you they are not consistent. If the ossific
matter is not thus deposited, why attempt to prove that the destruc-
tion of this nutritious foramen would delay the manufacture of
bone. If it did not get any nutrition from the blood, how could
276
the destruction of this artery delay the manufacture of bone 2
Answer it upon your oaths. I should like to talk about that
nutriteous foramen, and this anastomosing process and vindicate
these little men, Dr. Porter and Dr. McPherson. Mr. Knowlton
said a good deal about Dr. McPherson saying “provisionary”
Callus instead of “provisional.” I say there is no more learned
man in Chicago than Judge Knowlton; he has studied law and
medicine, and has explained almost the whole field of science, and
yet he talks about a system of cross section. Cross section is a
term for enquiries in surgery. There is resection, but no cross
section. Shall we say he has no scientific skill because he said
Cross Section instead of resection ? He makes use of another
word, and I will venture the assertion, that he uses “Worcester,”
because he is a Boston man, instead of Webster. He talks to
you about “tenaciousness.” Every school girl knows better;
there is no such word. I wonder if these school girls here are
taught this word at your seminary. “Tenaciousness” is a new
word, and there will have to be a new dictionary got out. Will
it be really fair to try my friend, McPherson, because he said
“provisionary” instead of provisional callus. I have shown their
inconsistency in saying that bone is not derived from blood.
Judge Knowlton has occupied a position on the bench, and is a
lawyer and doctor, and I don’t know but doctor of divinity, too.
But when he presented you the egg and said it was not made of
blood, he had a purpose other than the promulgation of science,
when he turned and appealed to the audience and asked, “Is the egg
all blood, too º' He thought he had a question which could not
be answered. But how is it, school girls in Chemistry? I say
it is the doctrine of Liebig, the most eminent chemist who ever
lived, said the egg was all blood except the coloring material,
which is iron. Chicago men will not deny this. It is taught in
all the text books on chemistry which are used in the schools.
How is it, then, that these Chicago men are at issue upon this
point with “Old Moses.” I don’t read that good book as much
as I ought, but I recollect that when Moses was giving the law
to that wonderful nation, the Israelites, and telling them what
they should not eat, he said that “all these animals you may eat,
but the blood of the animal which is the life thereof thou shalt
not eat.” Where is the issue now, between Dr. Porter and old
Mr. Moses? Dr. Porter is right, or else Moses is not right. He said
the iron in blood is the coloring matter. We have heard a great
277
deal about this reproduction. How is it that this little thing,
called the egg, produces the chicken In this are little mem-
branes laid up, and when you apply a moderate heat these become
quickened, and all the materials for the future chicken are here.
It is in the blood, and the heat developes it, surrounded in this
little world, the shell. Neither dew or rain have anything to do
with producing the chicken. All the materials of the chicken,_the
flesh, the vessels of the blood, the bone the skin and feathers, are in
this blood, and the heat applied to the egg developes; no matter
whether from the hen or from other sources—the heat developes
and arranges the materials in the egg, and a chicken is in due
time brought forth to view. If these materials are not in the
blood of the egg, where do they come from ? Will the gentle-
man deny that the egg is blood 2 If he does I have the author
here, and I will prove to you he dare not deny it. I remember
how I used to do when a boy. I would take ten or a dozen pure
white eggs—not blood—and put that under the hen. I might as
well here state that in the yolk of the egg is blood, except a little
yellow oil which makes up its composition. In about three weeks
you will find a check in the shell and the chicken’s bill sticks out,
and in a few days a full formed chicken. It is all blood. It is
fully supplied with blood. You cut its head off and it will bleed
profusely. It has feathers, but not very well coated.
Where does the muscular tissue—where does the nervous tis-
sue—where does all that beautiful arrangement come from ?
And where the bone It all comes from blood. What then
becomes of the theory of the gentlemen who so triumphantly
asserted before you that the egg was not blood. I tell you fur-
ther, that what I state is proved to be true by every book which
they have furnished here. This chemistry and philosophy
teach; that you can find blood in every substance. This book
teaches it. I can prove it by these school girls in that gallery,
who study chemistry, that blood is in everything which goes to
make up bone. Even in the turnip there is blood, although some
people say it has to draw blood out of a turnip. I challenge that
man, or any other man, to refute that great German philosopher,
who says that the lean meat we eat is mostly blood, only a denser
form from that in the arteries. The fat is a decomposed matter;
it is used for various purposes; for oiling the machinery, and to
supply heat. Blood produces the bone. But how is animal heat
produced 2 I will illustrate it to you. Take a pan of lime from
278
the kiln in the coldest days in winter; lay on to ice, and water
enters into the lime, and the whole substance is slaked; it
becomes quick lime, and a burning heat is produced. Liebig, the
great German chemist, says the blood is absorbed in heat.
The blood passes into a fluid state. In that state it makes ani-
mal heat. I have much respect for these Chicago men, although
they do not appear to have studied these books much ; they do
not appear to understand how the material of bone can be pro-
duced better:from animal than vegetable food. They claim the
ox who is fed from vegetables has large bones; they cannot see
how his flesh can produce more material for bone than the veg-
etables themselves. I answer, by eating the flesh of the animal.
It's not by a tub of blood or a tub of chaos.
Both these gentlemen on the stand question man’s being carni-
verous. Dr. Porter said, from the formation of teeth man was
not calculated to live on either a vegetable or animal diet, but
upon both. This is not Dr. Porter's theory; solely we find it in
books on anatomy and physiology, by men who have written
upon this subject for the last two or three hundred years. They
pitched into Dr. Porter because he taught what these books teach,
—that man is not made to live on either animal or vegetable diet.
You remember that Judge Knowlton tried to get over it by say-
ing his father's dogs ate bread, and milk, and had bones. One of
them thought he had answered me triumphantly, when I asked
him if wolves had bones. He said they cronched up bones and
But the gentleman's testimony was more logical than his argu-
ment. I have been referred to the fact that but very little meat
should be used in the South. But further North they eat fat
pork or something of that kind. But his science was badly
formed. That Great Creator who created everything upon this
earth formed him for all climates. The elephant, the lion, the
tiger, are all formed for Southern climates. But the polar bear,
the seal, and various other animals are formed polar for regions.
They have teeth formed for the mastication of animal food. But
man is in the North, South, East and West, and has constituted
him to subsist on either animal or vegetable food, or both. Tess
animal is needed in hot climates, and more in Northern ones.
The Esquimaux revels while eating the seal and the bear oil;
even a candle he would eat with a gusto. -
* Oh, gentlemen, when they undertake to talk to you about sci-
279
ence and scientific truth, they do not seem to understand what is
taught in the great book to which Judge Knowlton refers, that
the Great Jehovah, who made man of this earth, as Moses tells
you, has dominion over all these things, over the beasts of the
field; over the fowls of the air, and the grass of the field. When
the gentlemen undertakes to talk about science in a case of this
kind, you may understand he is treading on sacred ground. I
wish to read from Hamilton on Diet, but which is moee fully laid
down in Grose. Hamilton says, in order to hasten consolidation,
they should use a generous diet, and may resort to wines, brandy
and other stimulants. Now, when a patient was in a low condi-
tion this is proper treatment. When we see the boy enfeebled by
the loss of blood, they ought to have given him good, healthy
died, and used this panacea, aconite. This is a very curious idea,
that low diet would not injure him.
Gentlemen, I have gone over this case hastily. I debated in
my mind, whether I should go into the examination of this case
in detail, item by item, as the other side did. Judge Knowlton
occupied one nine hours, and Mr. De Wolf two. But I have
tried to present the case plainly and without prejudice. I have no
personal vanity to gratify, nor professional reputation, as a speaker,
to build up. I therefore concluded to confine myself to a few
points in the case, believing as I did, that the condition of the
arm was good evidence that the boy had not been properly treated.
They have failed to show he was properly treated. This man,
Beebe, who has had 4000 cases, not one failed of union. As I
told you before, we did not come here begging. I have tried
many of these cases, as well as Judge Knowlton, and in my whole
practice there has never been so sad a case as the young lad
before you, turned out upon the world without a hand to help
him. The right hand crippled, the left hand destroyed. But, say
they, it can be repaired by an operation—take him to Chicago and
let Drs. Beebe or Ludlam cure him.
Gentlemen, when I look overy these books, I find that this
resection is attended with great danger. Dr. Miller said, when
the weather got cold he might attempt an operation. If this
mother and this father, after nursing that boy for two years, and
seeing the condition he is in, should take him to Chicago to these
doctors to be operated upon, they would take him there as they
would to the tomb. They would take him there with no hope of
recovery. They must take him there with the design to give him
280
up. But because we did not let them try these experiments, they
say we took him out of Dr. Pratt's hands too soon. Dr. Pratt
told these parents, all the time, that this arm was doing well, and
they tell you they never knew otherwise until Dr. Freas told them,
at Dr. Belding’s.
This treatment reminds me of the New England witches. A
man by the name of Wilkes discovered an infallible way to detect
the witch. It was as great a discovery as aconite. When a
woman was suspected of being a witch, she was sewed in a sheet
and thrown into the river; if she sunk to the bottom she was an
honest woman—if she did not sink she was brought out and hung,
and many of the trees and posts at the corners of the streets of
New England witnessed the victims of that man’s discovery.
Ileave that boy with me till I doctor him to death—I will take
him to Chicago and have him operated on. This reminds me of
a case your honor related, of a doctor who presented a bill in the
settlement of the estate of A B to Dr. Jones, Dr., thirty dollars for
curing your wife till she died. Now this would be Dr. Pratt's
account—Chas. Frisby to Dr. Pratt, Dr., to curing the boy till he
died, two hundred dollars. They should have left the boy until
all these experiments had been tried. 1st. Friction. 2d. Puno-
turation. 3d. Resection. 4th. Ivory pegs. I have learned
something new from these Chicago Drs. I thought this driving
pegs was like dowelling; but I find I was mistaken. Saw off the
bones, drill a hole through, and drive some ivory pegs, and wire
the ends together. Is this so P. Their books say so. Was there
anything objectionable to Dr. Belding's driving shingle nails
through 2 There is another way, by running down a hot iron; all
these they must witness before taking that case out of Dr. Pratt's
hands. I have a boy of that age ; I would not leave him in the
hands of such a doctor; no man of sense would do it.
How cruel it was, when they wanted to call in the best surgeon
in Carroll county, Dr. Miller, he would not let them. What are
you going to do with this case ? If you have made up your
minds that you are going to try Dr. Porter instead of Dr. Pratt,
or Homoeopathy or Allopathy, my talk is useless. I have no
prejudice against Homoeopathy—my bestfriends are in that school.
I am not going to say that Homoeopathy is a humbug, when I
see such men as Drs. Beebe and Ludlam and Judge Knowlton
defending it. I do not know that Dr. Pratt is a Homeopathist
by anything which appears here. I am not trying Homoeopathy.
281
I have no prejudices. I am trying a case against a respectable
man who has made a blunder, a terrible blunder, by which a poor,
unfortunate boy is made a cripple for life. I believe if I should
meet Dr. Pratt to-morrow, he would meet me in friendship, as I
certainly would him. I have a feeling of sympathy for him. Dr.
Pratt has no friend, in the world I have the slightest ill feeling
against. I have come to this work, believing this boy should have
damages; I have tried it faithfully. If, in the start, I had had my
present knowledge, I could have tried it wastly better. I have
done my duty. Your duty, in part, is to be performed. How
will you perform it—on your Homoeopathist or Allopathist? Will
you go to your jury rooms and discuss the two systems? I will
say to you, gentlemen of the jury, that these Chicago doctors
admitted to you that they had a deep feeling in this case, because
they said that other doctors were testifying against their system
of medicine. You remember with what gusto Dr. Beebe explained
the Homoeopathy. He said, “I wish to remove from your minds
the prejudice here exhibited toward Homoeopathy.” I must say,
gentlemen of the jury, that these witnesses, throughout their testi-
mony, have maintained their theory. Our doctors had a different
theory than theirs; but really, surgery means the same in both
systems. Upon this ground Judge Knowlton has abused Dr.
Porter, to a certain extent. He has been actively engaged in his
profession since he graduated in Baltimore, some twenty years
ago, and what has induced him to misuse Dr. Porter 2
You see that Dr. Porter was a good witness; he understood more
of this technicality of the science of man than he had the words
upon his lips, and those men who came from Chicago came
directly from the professional chair they had been occupying in
teaching their system. As soon as I began to question their posi-
tion, they would turn to you and speak of it. I think both sides
enlarged upon their theories too much. They drew them out, and,
as Knowlton says, you have been betrayed by it. - .
Dr. Porter has not taken a position he did not sustain, and that
I could not find in the books. I never saw these men before they
came here, and so far from abusing them, they have commanded my
respect by the knowledge they have displayed of their system.
If I ever meet them I will use them well. -
And I do not think the Judge should come out here and abuse
Dr. Porter, and other physicians who have testified here. You
will find them just as good men as Drs. Ludlam and Beebe. Dr.
- - 18 -
282
Beebe has treated two cases of fracture of the humerus, but qual-
ified it by saying, he had the care of but one of the cases. Dr.
Ludlam says he has treated one. Drs. Porter and Miller have
treated several. Tetit be understood, when I speak of Dr. Beebe's
cases, I mean those in his civil practice. Would you not trust a
fracture in the hands of Dr. Porter or Miller as soon as in care
of Dr. Beebe or Ludlam? I would. You would.
Now, gentlemen, what is to be your verdict? The oath which
you took when you took your seats in that jury box, that you had
no prejudice against any system, or either of these parties, you
answered under the solemnity of an oath, that you had not
expressed or formed any opinion as to the merits of this case.
We then took you upon trust. After that was done, with your
hands uplifted towards high Heaven, you said you would try this
case and render a true verdict, according to the testimony. That
oath rests upon you to-night, and rests down upon you until your
verdict is rendered to the Court. You did not swear that you
would try Dr. Porter, or any one else—Homoeopathy or Allopathy.
I think we have made out a clear case. It is a matter that I can-
not determine for you; you must determine it for yourselves.
You must sift it for the great object it embraces. If you find the
defendant guilty, the next thing will be, what amount of damages
will you give this boy 2 Upon that point there may be diversity of
opinion among you. My client's son has failed to have a good
arm, in the hands of Dr. Pratt. We have no doubt, gentlemen
of the jury, that by your verdict you will not do wrong to Dr.
Pratt, and bring damages upon him which he is unable to sustain ;
we have no vindictive damages to ask. We simply ask that Dr.
Pratt shall stand the damages he has caused. We have no right
to call witnesses to show the damages; you may give one or ten
thousand dollars. His arm and right hand are injured. If this
be your opinion, you cannot fail to find him guilty. If guilty, you
fix the amount. In estimating these damages, you have many
things to take into consideration. They have argued that this
may be repaired. How much is this going to cost to send this
boy to Chicago to be treated How much must you pay him for
this suffering 2 These are the principal questions. And when
you have discharged your duty, you will have the honor of say-
ing that you have sat for eight long days in this court house, and
that no counsel on this side has attempted to persecute any one.
We have been called upon to do our duty, and we have done it.
283
You have listened with a great deal of patience, for which you
have my hearty thanks. I leave this case—I leave it feeling that
I have not, in my weakness, done my client the justice I ought to
have done. I feel, in parting with this case, and in trusting it to
your hands, that there is much that I should have done that I
have not done, and I give it into your hands—and I believe I
leave it in the hands of twelve honest men, that will decide and
meet the great argument in this case, and do justice.
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